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Introduction: Palpatory methods such as caliper and fingerbreadths are clinically viable techniques to determine the rectus abdominis diastasis. Objective: To evaluate the reliability and agreement of the fingerbreadths and caliper methods on measuring the rectus abdominis diastasis in the immediate postpartum. Methods: A descriptive crosssectional study with immediate postpartum women. The measurements were performed at different times by two evaluators. The reference points for measurement were: three fingers (4.5 cm) above and below the umbilicus region and at the umbilicus. The diastasis was scored by the caliper and by the number of fingers between the medial edges of the rectus abdominal muscles. A value of 1.5 cm was estimated for each finger. The diastasis was considered present when a distance greater than 3 cm occurred between the medial edges of the rectus abdominal. Statistical analysis was performed using weighted Kappa coefficient, to assess the agreement between the techniques, and intra-class correlation coefficient to assess reliability. In all analyses, a significance level of p<0.05 was adopted. Results: A total of 261 postpartum women were evaluated, with mean age of 23.74±6.42 years. Of these, 143 (54.8%) were primiparous and 118 (45.2%) were multiparous. Excellent values of reliability were verified in the fingerbreadths technique and moderated ones were observed with the use of caliper. The agreement between the two techniques demonstrated to be excellent. Conclusion: Both techniques, fingerbreadths and caliper, have proven to be reliable instruments with agreement in measuring the rectus abdominis diastasis.
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2. Bursch SG. Interrater reliability of diastasis recti abdominis measurement. Phys Ther. 1987;67(7):1077-9.
3. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082-6.
4. Hsia M, Jones S. Natural resolution of rectus abdominis diastasis. Two single case studies. Aust J Physiother. 2000;46(4):301-7.
5. Hickey F, Finch JG, Khanna A. A systematic review on the outcomes of correction of diastasis of the recti. Hernia. 2011;15(6):607-14. http://dx.doi.org/10.1007/s10029-011-0839-4
6. Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011;41(6):435-43. http://dx.doi.org/10.2519/jospt.2011.3507
7. Chiarello CM, McAuley JA. Concurrent validity of calipers and ultrasound imaging to measure interrecti distance. J Orthop Sports Phys Ther. 2013;43(7):495-503. http://dx.doi.org/10.2519/jospt.2013.4449
8. Rett MT, Araújo FR, Rocha I, Silva RA. Diástase dos músculos retoabdominais no puerpério imediato de primíparas e multíparas após o parto vaginal. Fisioter Pesq. 2012;19(3):236-41. http://dx.doi.org/10.1590/S1809-29502012000300008
9. Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008;13(2):112-21. http://dx.doi.org/10.1016/j.math.2006.10.001
10. Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8. http://dx.doi.org/10.1016/j.physio.2013.08.005
11. Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750-62.
12. Boxer S, Jones S. Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. Aust J Physiother. 1997;43(2):109-14.
13. Baracho E, Baracho SM, Felissíssimo M. Atuação do fisioterapeuta no puerpério imediato e tardio. In: Baracho E. Fisioterapia aplicada à obstetrícia, uroginecologia e aspectos de mastologia. 4th ed. Rio de Janeiro: Guanabara Koogan;2007; p. 241-50.
14. Noble E. Essential exercises for the childbearing year: a guide to health and comfort before and after your baby is born. 2nd ed. Boston: Houghton Mifflin; 1982; p. 117-23.
15. Mendes DA, Nahas FX, Veiga DF, Mendes FV, Figueiras RG, Gomes HC, et al. Ultrasonography for measuring rectus abdominis muscles diastasis. Acta Cir Bras. 2007;22(3):182-6. http://dx.doi.org/10.1590/S0102-86502007000300005
16. Mesquita LA, Machado AV, Andrade AV. Fisioterapia para redução da diástase dos músculos retos abdominais no pós-parto. Rev Bras Ginecol Obstet. 1999;21(5):267-72. http://dx.doi.org/10.1590/S0100-72031999000500004
17. Barbosa S, de Sá RA, Coca Velarde LG. Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination. Arch Gynecol Obstet. 2013;288(2):299-303. http://dx.doi.org/10.1007/s00404-013-2725-z
18. Mota P, Pascoal AG, Sancho F, Carita AI, Bø K. Reliability of the interrectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther. 2013;18(4):294-8. http://dx.doi.org/10.1016/j.math.2012.10.013
19. Rett MT, Almeida TV, Mendonça ACR, De Santana JM, Ferreira APL, Araújo KCGM. Fatores materno-infantis associados à diástase dos músculos retos do abdome no puerpério imediato. Rev Bras Saúde Mater Infant. 2014;14(1):73-80. http://dx.doi.org/10.1590/S1519-38292014000100007
20. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231-40. http://dx.doi.org/10.1519/15184.1
21. Fleiss JL. Design and analysis of clinical experiments. 2nd ed. New York: John Wiley & Sons; 1999.
22. Rett MT, Braga MD, Bernardes NO, Andrade SC. Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Rev Bras Fisioter. 2009;13(4):275-80. http://dx.doi.org/10.1590/S1413-35552009005000037
23. Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol. 2011;82(11):817-21.
24. van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41-53. http://dx.doi.org/10.1016/j.math.2015.09.013
25. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321-8. http://dx.doi.org/10.1007/s00192-006-0143-5
26. Sheppard S. The role of transversus abdominus in post partum correction of gross divarication recti. Man Ther. 1996;1(4):214-6. http://dx.doi.org/10.1054/math.1996.0272
27. Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case-control study. Physiotherapy. 2014;100(4):344-8. http://dx.doi.org/10.1016/j.physio.2013.11.006