Lori Maria Walton
University of Scranton,
USA
Abstract Title: Diastasis Recti Abdominis (DRA) and Pelvic Floor Dysfunction (PFD) Outcome by Birth Mode During Postpartum: A Systematic Review
Biography:
Dr. L Maria Walton, PhD, DPT, MS, MPH(s) is a Professor at the University of Scranton in Pennsylvania, USA, and Honorary Professor at the Bangladeshi Health Professions Institute in Dhaka, Bangladesh. Dr. Walton is a graduate of Creighton University’s DPT Program and graduated with a PhD from NSU. Dr. Walton specializes in women’s health and neurologic physical therapy as it pertains to trauma and vulnerable populations of women and children. She has published over forty peer reviewed journal articles in top quartile journals and has presented, both nationally and internationally, on trauma, toxic stress, refugee health, and women’s health issues. She is a member of Phi Beta Delta, Honor Society for International Scholars, since 2010, and has developed long term community driven programs and teaching/research collaborations in several international locations, including MENA countries and South Asia (Pakistan, India, Bangladesh). She is a strong advocate, scholar, and volunteer for multimodal rehabilitation programs for vulnerable populations across the world, particularly in the MENA and SAARC Nations.
Research Interest:
Purpose/Hypothesis: To determine differences in pelvic floor outcomes for women with and without diastasis recti abdominis during the postpartum period. Number of Subjects: N=8132, reviewed across 11 articles that met the criteria. Materials and Methods: A literature search was conducted of PubMed, CINAHL, ProQuest, and Wiley using "pelvic floor dysfunction (PFD)" AND “diastasis recti abdominis (DRA)” OR “inter-recti distance (IRD)”. Search limits: 2015-2025,peerreviewed,human,English. Selection criteria: Postpartum women, age 18+ with PFD and measured Inter-Recti Distance (IRD). Primary Outcomes: PFD outcomes, including one or more of the following: incontinence, prolapse, weakness, or pelvic pain. Three women's health physical therapist expert reviewers independently assessed each study for methodological quality and came to consensus using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the NIH Quality Assessment Tool for Case Control Studies. Results: 17 articles were assessed and eleven (N=11) articles met selection criteria. Levels of evidence ranged from FAIR (59.8-72.8% scores) to GOOD (75.5-82.8% scores). Samples ranged from 36-6302 (N=8132) with a mean age of 43.7. Studies assessed DRA using ultrasound(N=6), finger-width palpation (N=3), combination of both(N=1), or combination of palpation and calipers (N=1). Six (N=6) GOOD EVIDENCE studies found significant PFD in women with DRA compared to without DRA. The FAIR EVIDENCE category yielded five (N=5) studies showing no significant differences. Conclusions: There is good evidence in the literature to support significantly greater PFD for women with DRA when compared to women without DRA. Limitations included: Variation in the methods of DRA measurement, lack of RCTs. Clinical Relevance: DRA may have negative pelvic floor dysfunction outcomes, particularly in women post caesarean delivery and greater parity. This information informs physical therapists regarding the importance of screening for DRA and PFD and the need for valid and reliable instrumentation.