Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample

Background: Ultrasound imaging has become popular among physiotherapists for monitoring diastasis rectus abdominis postpartum, but its reliability requires further exploration. Objectives: To investigate physiotherapists’ intra-tester, inter-tester, and test-retest reliability of inter-recti distanc...

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Main Authors: Evdokia Billis, Anastasia Skoura, Tatiana-Elena Papakonstantinou, Dimitra Tania Papanikolaou, Maria Tsekoura, Maria Andriopoulou, Charalampos Matzaroglou, Sofia Lampropoulou, Dimitra Koumoundourou, Eftichia Trachani, Theofani Bania, Elena Drakonaki
Format: Article
Language:English
Published: SAGE Publishing 2025-08-01
Series:Women's Health
Online Access:https://doi.org/10.1177/17455057251361999
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author Evdokia Billis
Anastasia Skoura
Tatiana-Elena Papakonstantinou
Dimitra Tania Papanikolaou
Maria Tsekoura
Maria Andriopoulou
Charalampos Matzaroglou
Sofia Lampropoulou
Dimitra Koumoundourou
Eftichia Trachani
Theofani Bania
Elena Drakonaki
author_facet Evdokia Billis
Anastasia Skoura
Tatiana-Elena Papakonstantinou
Dimitra Tania Papanikolaou
Maria Tsekoura
Maria Andriopoulou
Charalampos Matzaroglou
Sofia Lampropoulou
Dimitra Koumoundourou
Eftichia Trachani
Theofani Bania
Elena Drakonaki
author_sort Evdokia Billis
collection DOAJ
description Background: Ultrasound imaging has become popular among physiotherapists for monitoring diastasis rectus abdominis postpartum, but its reliability requires further exploration. Objectives: 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. Design: Reliability study. Methods: 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 2,1 . Results: 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). Conclusion: 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.
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spelling doaj-art-43963aac461047d387fc78cfced77b2e2025-08-20T04:02:41ZengSAGE PublishingWomen's Health1745-50652025-08-012110.1177/17455057251361999Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sampleEvdokia Billis0Anastasia Skoura1Tatiana-Elena Papakonstantinou2Dimitra Tania Papanikolaou3Maria Tsekoura4Maria Andriopoulou5Charalampos Matzaroglou6Sofia Lampropoulou7Dimitra Koumoundourou8Eftichia Trachani9Theofani Bania10Elena Drakonaki11Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceGeneral Hospital Asklipieio Voulas, Athens, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceDepartment of Pathology, University Hospital of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceLaboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, GreeceAnatomy Department, Medical School, University of Crete, Heraklion, GreeceBackground: Ultrasound imaging has become popular among physiotherapists for monitoring diastasis rectus abdominis postpartum, but its reliability requires further exploration. Objectives: 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. Design: Reliability study. Methods: 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 2,1 . Results: 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). Conclusion: 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.https://doi.org/10.1177/17455057251361999
spellingShingle Evdokia Billis
Anastasia Skoura
Tatiana-Elena Papakonstantinou
Dimitra Tania Papanikolaou
Maria Tsekoura
Maria Andriopoulou
Charalampos Matzaroglou
Sofia Lampropoulou
Dimitra Koumoundourou
Eftichia Trachani
Theofani Bania
Elena Drakonaki
Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
Women's Health
title Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
title_full Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
title_fullStr Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
title_full_unstemmed Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
title_short Physiotherapists’ reliability of inter-recti distance measurement with real-time ultrasound across a mixed women population sample
title_sort physiotherapists reliability of inter recti distance measurement with real time ultrasound across a mixed women population sample
url https://doi.org/10.1177/17455057251361999
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