Zhu Jiahui, Dong BaoJin, Liu Shuang
School of Special Education and Rehabilitation, Binzhou Medical University, Yantai, China.
Int J Gynaecol Obstet. 2025 Jul 25. doi: 10.1002/ijgo.70413.
There are currently many rehabilitation therapies for diastasis recti abdominis (DRA) and no unified treatment recommendations in clinical practice.
A network meta-analysis (NMA) was conducted to explore which rehabilitation therapy has the best treatment effect.
PubMed, WOS, EMBASE, and Cochrane Library were searched separately, involving relevant randomized controlled trials published from database establishment to April 24, 2024. This NMA compared 11 rehabilitation therapies, including Pilates, suspension training, electro-acupuncture, core stability exercises, abdominal supports, abdominal and pelvic floor muscle exercise, isometric-isotonic exercises, and neuromuscular electrical stimulation. Following the predefined inclusion and exclusion criteria, literature screening and data extraction were performed. Quality assessment was conducted using Risk of Bias 2 (RoB 2), and data analysis was performed using R (V4.4.1) and STATA (v16) software.
A total of 17 articles involving 783 patients were included. The probability rankings for each outcome measure were calculated using the Surface Under the Cumulative Ranking Curve (SUCRA). A higher SUCRA value indicates better overall performance across all studies and a greater likelihood of the treatment being the optimal therapeutic option. Measurement of the inter-rectus distance (IRD) above the umbilicus showed that the suspension training system (STS) had the most significant therapeutic effect (SUCRA = 84.7%), while measurement at umbilicus showed that Pilates had a significant therapeutic effect (SUCRA = 93.5%). Measurement below the umbilicus revealed that the abdominal support plus core stability exercise (ABD_support_cse) had a significant therapeutic effect (SUCRA = 82.9%). In terms of reducing the IRD below the umbilicus, ABD_support_cse was more effective than abdominal support (ABD_support) (standard mean difference [SMD]: 1.45; 95% credible intervals (95% CrI): [0.16, 2.74]). According to Cohen's guidelines for effect size, the SMD can be used to measure the effect size between interventions or variables. An SMD of 1.45 implies that abdominal support plus core stability exercise (ABD_support_cse) has a more profound effect on the rehabilitation of patients with DRA, warranting further research and promotion.
Our findings have shown that STS, Pilates, and ABD_support_cse might have the best effect on reducing IRD above, at, and below the umbilicus, respectively. These methods potentially hold the most promise or are the optimal interventions for improving IRD above, at, and below the umbilicus. However, considering the limitations of the research, future research should employ standardized and objective measurement techniques, utilize blinded assessments, incorporate longer follow-up periods, design standardized intervention protocols, and include diverse populations. Further analysis and exploration based on high-quality evidence are warranted to refine the understanding and exploration of this area.
目前针对腹直肌分离（DRA）有多种康复治疗方法，临床实践中尚无统一的治疗建议。
进行网状Meta分析（NMA）以探究哪种康复治疗效果最佳。
分别检索PubMed、WOS、EMBASE和Cochrane图书馆，纳入从数据库建立至2024年4月24日发表的相关随机对照试验。该NMA比较了11种康复治疗方法，包括普拉提、悬吊训练、电针、核心稳定性训练、腹部支撑、腹部及盆底肌锻炼、等长 - 等张运动以及神经肌肉电刺激。按照预先设定的纳入和排除标准进行文献筛选和数据提取。使用偏倚风险2（RoB 2）进行质量评估，并使用R（V4.4.1）和STATA（v16）软件进行数据分析。
共纳入17篇文章，涉及783例患者。使用累积排序曲线下面积（SUCRA）计算每个结局指标的概率排名。SUCRA值越高表明在所有研究中的总体表现越好，该治疗成为最佳治疗选择的可能性越大。脐上腹直肌间距（IRD）测量显示，悬吊训练系统（STS）治疗效果最显著（SUCRA = 84.7%），而脐部测量显示普拉提有显著治疗效果（SUCRA = 93.5%）。脐下测量显示，腹部支撑加核心稳定性训练（ABD_support_cse）有显著治疗效果（SUCRA = 82.9%）。在减少脐下腹直肌间距方面，ABD_support_cse比腹部支撑（ABD_support）更有效（标准化均差[SMD]：1.45；95%可信区间（95% CrI）：[0.16, 2.74]）。根据Cohen效应量指南，SMD可用于测量干预措施或变量之间的效应量。SMD为1.45表明腹部支撑加核心稳定性训练（ABD_support_cse）对DRA患者的康复有更显著效果，值得进一步研究和推广。
我们的研究结果表明，STS、普拉提和ABD_support_cse可能分别对减少脐上、脐部和脐下腹直肌间距效果最佳。这些方法可能最有前景或为改善脐上、脐部和脐下腹直肌间距的最佳干预措施。然而，考虑到研究的局限性，未来研究应采用标准化和客观的测量技术，采用盲法评估，并纳入更长的随访期，设计标准化的干预方案，并纳入不同人群。有必要基于高质量证据进行进一步分析和探索，以完善对该领域的理解和探索。
