Billis Evdokia, Skoura Anastasia, Papakonstantinou Tatiana-Elena, Papanikolaou Dimitra Tania, Tsekoura Maria, Andriopoulou Maria, Matzaroglou Charalampos, Lampropoulou Sofia, Koumoundourou Dimitra, Trachani Eftichia, Bania Theofani, Drakonaki Elena
Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece.
General Hospital Asklipieio Voulas, Athens, Greece.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251361999. doi: 10.1177/17455057251361999. Epub 2025 Aug 12.
Ultrasound imaging has become popular among physiotherapists for monitoring diastasis rectus abdominis postpartum, but its reliability requires further exploration.
To investigate physiotherapists' intra-tester, inter-tester, and test-retest reliability of inter-recti distance measurement utilizing real-time ultrasound across a mixed women sample.
Reliability study.
Volunteers comprising nulliparous and parous women of different ages and body mass index participated. Five physiotherapists performed ultrasound measurements, following sonographic training. Four conditions were tested in supine; rest, curl-up, transversus abdominus activation, and transversus abdominus with curl-up. Three locations were randomly measured: umbilicus, 3 cm above the umbilicus, and halfway between the umbilicus and xiphoid process. For intra-tester reliability, each therapist undertook three repeated measurements. For inter-tester reliability, mean inter-recti distance measurements were explored across any two tester combinations within and across sessions. Test-retest reliability explored repeated measurements 5-8 days later. Data were analyzed with intraclass correlation coefficients.
54 women (33.2 ± 15.2 years old, body mass index: 24.2 ± 3.7), 19 (35.2%) being parous participated. Intra-tester reliability across each physiotherapist was very good (intraclass correlation coefficients = 0.677-0.989). Intra-session reliability across any two testers yielded very good results (intraclass correlation coefficients = 0.76-0.92), whereas across-session yielded good reliability (intraclass correlation coefficients >0.76) except for one condition (3 cm above umbilicus in combined transversus abdominus and curl-up). Test-retest reliability was also very good (intraclass correlation coefficients = 0.78-0.96). Significant differences in inter-recti distance were found, with parous women showing consistently larger values (p < 0.05).
Physiotherapists, following sonographic training, can reliably measure inter-recti distances in both nulliparous and parous women across active and resting tasks. Thus, ultrasound measurement of inter-recti distance is recommended in physiotherapy practice for monitoring diastasis rectus abdominis and assessing rehabilitation progress. However, sub-umbilical inter-recti distance measurements and the impact of co-contraction on reliability require further research.
超声成像在物理治疗师中已广泛用于监测产后腹直肌分离情况，但其可靠性仍需进一步探究。
通过实时超声检查，研究物理治疗师在不同女性样本中测量腹直肌间距时的测试者内、测试者间及重测信度。
信度研究。
招募不同年龄和体重指数的未生育及已生育女性志愿者。五名物理治疗师在接受超声检查培训后进行测量。受试者仰卧位测试四种状态：休息、卷腹、腹横肌激活、腹横肌激活同时卷腹。随机测量三个位置：脐部、脐上3厘米处、脐与剑突中点。测试者内信度方面，每位治疗师进行三次重复测量。测试者间信度方面，在不同时间段内，探索任意两名测试者组合测量的腹直肌平均间距。重测信度在5至8天后进行重复测量。采用组内相关系数分析数据。
54名女性（年龄33.2±15.2岁，体重指数24.2±3.7）参与，其中19名（35.2%）为已生育女性。每位物理治疗师的测试者内信度非常好（组内相关系数=0.677 - 0.989）。任意两名测试者在同一时间段内的信度结果非常好（组内相关系数=0.76 - 0.92），不同时间段的信度除一种情况（腹横肌激活同时卷腹时脐上3厘米处）外良好（组内相关系数>0.76）。重测信度也非常好（组内相关系数=0.78 - 0.96）。腹直肌间距存在显著差异，已生育女性的值始终较大（p<0.05）。
经过超声检查培训的物理治疗师能够可靠地测量未生育及已生育女性在活动和休息状态下的腹直肌间距。因此，在物理治疗实践中，推荐使用超声测量腹直肌间距来监测腹直肌分离及评估康复进展。然而，脐下腹直肌间距测量以及协同收缩对信度的影响仍需进一步研究。
