Effects of AHEs on DrA in Postpartum Women

Study Overview
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Brief Summary
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This study is aimed to determine the effects of Abdominal Hypopressive exercises on IRD, Lumbopelvic pain, Body Image and abdominal muscle function in postpartum women.

Detailed Description
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Postnatal women wish to resume abdominal exercises shortly after delivery to improve trunk function and restore the pre-pregnant state of the body. Diastasis recti is a common occurrence in the postpartum period which is associated with both physical impairments and body image concerns. Despite the high prevalence, treatment options are still being explored to identify the best approach to resolve it. Exercise is a conservative method to reduce IRD and improve the associated symptoms and quality of life of postpartum females. Most of the previous studies have used either digital nylon calipers or digital palpation methods for the outcome assessment of DrA which has important implications. Fewer studies have used the gold standard US diagnosis. Despite various studies being conducted on the effect of exercise on DrA, the results are still nonconclusive with a deficiency of a standardized protocol. Multifaceted and clinically meaningful assessments have been proposed to be investigated by the previous literature.

Official Title
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Effects of Abdominal Hypopressive Exercises on Diastasis Recti in Postpartum Women

Conditions
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Diastasis Recti

Intervention / Treatment
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* Other: Abdominal Hypopressive Training
* Other: Conventional Physical therapy for DrA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 12 weeks to 36 weeks postpartum Both vaginal delivery and C-section Lumbopelvic pain (NPRS >4) Diagnosis of DrA by calliper: 3 cm below the umbilicus: >22 mm, at the umbilicus: >20 mm, 3 cm above the umbilicus: >14 mm Primiparous females Exclusion Criteria: Any conditions affecting the ability to perform exercise or activity of daily living. Previous spinal or abdominal surgery, and neuromuscular diseases. Severe DrA >5cm with the herniation or requiring surgical repair. LBP associated with disc herniation, spondylolysis, and degenerative changes of the spine

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Abdominal Hypopressive Training<br>The Abdominal hypopressive Exercises along with home plan based on conventional exercises. | Other: Abdominal Hypopressive Training<br>* Week 1 and 2 - Patient education , Hypopressive Maneuvers in Standing, Sitting and Supine 5-7 repetitions x 5 sets, with a 10-second hold each time, rest for 30 seconds between each set, 2 days/week. Week 3 and 4, Hypopressive breathing in with varying arm movements along with Week 1 and 2 protocols. Week 5 to 8 - Hypopressive breathing in kneeling, Four-point kneeling and sitting, and supine positions with varying arm movements 5-7 repetitions x 5 sets, with a 10-second hold each time, rest for 30 seconds between each set, 2 days/week.<br>|
| Active Comparator: Conventional Physical therapy for DrA<br>Draw-in maneuver in supine, quarduped, prone lying, bent leg fall outs, curl ups, and front and side planks. | Other: Conventional Physical therapy for DrA<br>* Week 1 to 4, Draw-in maneuver in supine, Quadruped and Prone lying, Bent knee Fallouts and Curl ups. (8 to 12 repetitions x 3 sets, 2 days/week) Week 5 to 8, Front and side planks added to week 1 to 4 exercises. (12 to 20 repetitions x e sets, 2 days/week)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inter Recti Distance | Changes from baseline Ultrasound imaging (US) is the gold standard for IRD assessment. USI is an accurate and valid method of measuring IRD size and location. Patient will be graded as having an IRD of > 22 mm, 3 cm below the umbilicus OR > 20 mm at the umbilicus OR >14 mm, 3 cm above the umbilicus. | 8th Week | 
| Lumbopelvic Pain | Changes from baseline The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. Zero usually represents 'no pain at all' whereas the upper limit of 10 represents 'the worst pain ever possible'. | 8th Week | 
| The Oswestry Disability Index | Changes from baseline The Oswestry Disability Index (ODI) is a validated, 10-point patient-reported outcome questionnaire. The final score/index ranges from 0-100. A score of 0-20 reflects minimal disability, 21-40 moderate disability, 41-60 severe disability, 61-80 crippled, and 81-100 bed-bound. | 8th Week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Shape Questionnaire | Changes from baseline the Body shape questionnaire is a self-reported measurement of body shape concerns designed for women to measure concerns about body image problems. The questionnaire has 34 items scored from 1 to 6 points. The overall total score range is between 34 to 204. | 8th Week | 
| Double Leg lowering test | Changes from baseline Double leg lowering test is used to assess abdominal muscles and the ability of muscles to maintain the posterior pelvic tilting position against the load. In this test Both legs are raised to a 90-degree angle (vertically) while keeping the upper body flat on the floor. The score is the angle of the legs in degrees from the floor. Total score ranges from 0 to 90 degrees, where 0 degree corresponds to excellent and 90 degrees is for very poor. | 8th Week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diastasis Recti, Diastasis Recti and weakness of Linea alba, Low back pain