A comparison of overall function between postpartum women with and without diastasis rectus abdominis (DRA)

Purpose: The primary purpose of this study was to examine whether the Inventory of Functional Status after Childbirth (IFSAC) questionnaire could identify deficiencies in overall function of postpartum women with diastasis rectus abdominis (DRA). Specifically, the IFSAC scores were compared between postpartum women with and without DRA. The secondary purpose of the study was to determine the reliability and construct validity of a self-palpation assessment of inter-rectus distance (IRD) via telehealth instruction for diagnosing DRA. Methods: Twenty-one women, 610 weeks after vaginal delivery, completed the study. All participants completed the IFSAC questionnaire before a telehealth visit and an in-person visit for DRA diagnosis. To determine the within-session intrarater reliability of the telehealth-instructed self-palpation assessment of IRD for DRA diagnosis, each participant completed the self-palpation assessment twice during the telehealth visit. To determine the between-day intrarater reliability of the self-palpation method for DRA diagnosis, each participant completed another self-palpation assessment during the in-person visit. During the in-person visit, DRA diagnoses made by ultrasonographic assessment of IRD were used to determine the construct validity of the self-palpation method. Each participant was assigned to the DRA group or no DRA group using the DRA diagnosis made by ultrasonography.
Results: Although participants with DRA (n = 10) reported a slightly lower total IFSCA score (median = 3.28) than those without DRA (n = 6; median = 3.46), there were no statistically significant differences in scores between the two groups (p = 0.635). The reliability analysis showed a moderate-to-substantial agreement of DRA diagnosis for both the within-session intrarater reliability and between-day intrarater reliability with k = 0.76 and k = 0.50, respectively. For construct validity, there was no or poor (k = -0.290.36) agreement between the self-palpation assessment via telehealth and ultrasound assessments for DRA diagnosis. Conclusion: The results indicates that the IFSAC questionnaire may not be an adequate outcome measure to determine functional levels for postpartum women with DRA. Although telehealth-instructed self-palpation assessment for DRA diagnosis is reliable, this method does not appear to be valid. This suggests that DRA diagnosis for postpartum women should be assessed in-person by qualified clinicians.