The TOR concept (training, operation, and rehabilitation) applied to a cohort of postpartum women with training-resistant symptomatic rectus diastasis: evaluation 1 year after surgery.

BACKGROUND: Rectus diastasis is a common sequela of pregnancy and is associated with functional disabilities such as back pain, abdominal core instability, abdominal muscle weakness, urinary incontinence, and psychological issues such as a negative body image. The aim of this study was to evaluate the effect of the TOR concept (training, operation, and rehabilitation), a novel concept for treating abdominal wall insufficiency combined with rectus diastasis, after pregnancy. TOR consists of preoperative evaluation of symptoms and custom-designed abdominal core training, tailored rectus diastasis repair, and individual progressive postoperative rehabilitation. METHODS: A consecutive series of women diagnosed with rectus diastasis and core dysfunction resistant to training, underwent plication of the linea alba between 2018 and 2020. After surgery, all patients participated in an individually designed rehabilitation programme over a 4-month interval. Physical function was recorded before surgery and 1 year after surgery using the disability rating index questionnaire. Symptoms associated with core instability were recorded before and 1 year after surgery. Quality of life was assessed using the SF-36. The abdominal wall anatomy was assessed with ultrasound before and 1 year after surgery. RESULTS: Seventy-one women were included and all attended 1-year follow-up. Response rate was 81.7 per cent (58) for the disability rating index, and 59.2 per cent (42) for SF-36. Self-reported physical function (disability rating index) improved in 54 of 58 patients (93.1 per cent), with a median score reduction of 91.3 per cent. Core instability symptoms decreased significantly. All SF-36 subscales improved significantly compared with preoperative scores, reaching levels similar to or higher than the normative Swedish female population. No recurrence of rectus diastasis was seen at the 1-year follow-up. CONCLUSIONS: Surgical reconstruction within the TOR concept resulted in significant improvements in physical function and quality of life as well as a significant decrease in symptoms of core instability.

Evaluation of functional outcomes following rectus diastasis repair-an up-to-date literature review.

INTRODUCTION: Over the last decade rectus diastasis has gained attention as a condition that may benefit from surgery. Numerous surgical techniques have been presented but scientifically proper studies reporting functional outcome are few and evidence is incomplete. The aim of this up-to-date review is to analyse the outcomes of rectus diastasis repair in recently published papers, focusing on functional changes following surgery. METHOD: A comprehensive search in PubMed and Web of Science was performed. Suitable papers were selected using titles and abstracts with terms suggesting surgical treatment of rectus diastasis. All abstracts were scrutinised, and irrelevant studies excluded in four stages. Reports providing original data, including outcome assessment following surgery, were included. RESULT: Ten papers with a total of 780 patients were found to fulfil the search criteria. Study design, surgical procedure, follow-up time, functional outcome and assessment instruments were compiled. All included studies reported improvements in a variety of functional aspects regardless of surgical method. The outcomes assessed include core stability, back pain, abdominal pain, posture, urinary incontinence, abdominal muscle strength and quality of life. CONCLUSION: The results of this review show that surgical repair of rectus diastasis is a safe and effective treatment that improves functional disability. However, the absence of standardized instruments for assessing outcome makes it impossible to compare studies. Since indications for surgery are relative and related to core function, valid instruments for assessing indication and outcome are needed to ensure benefit of the procedure.

Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life.

Background: During pregnancy, women are at risk of developing persistent symptomatic diastasis recti abdominis (DRA), which may have a detrimental effect on their physical function and quality of life (QoL). The aim of this prospective cohort study was to determine the effect of surgical repair of DRA on abdominal trunk function, urinary incontinence and QoL in postpartum women with trunk instability symptoms resistant to training. Methods: Postpartum women with diagnosed DRA and training-resistant symptoms underwent double-row plication of the linea alba. Abdominal trunk function was evaluated as the primary endpoint using a multimodal examination tool, the Abdominal Trunk Function Protocol. Recurrence was assessed by CT, urinary incontinence was evaluated using the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and QoL was assessed with the Short Form 36 (SF-36®) questionnaire. All subjects were examined before and 1 year after surgery. Results: Sixty women were recruited. There was no DRA recurrence at the 1-year follow-up. Self-reported abdominal trunk function had improved in 98 per cent of patients, with a mean score improvement of 79·1 per cent. In the physiological tests monitored by a physiotherapist, 76 per cent performed better and endured exercise tests longer than before surgery. All SF-36® subscales improved significantly compared with preoperative scores and reached levels similar to, or higher than, the normative Swedish female population. For the UDI-6 and IIQ-7, 47 and 37 per cent respectively reported fewer symptoms at follow-up than before surgery, and 13 and 8 per cent respectively reported more symptoms. Conclusion: In this series of postpartum women presenting with DRA and symptoms of trunk instability resistant to training, surgical reconstruction resulted in a significant improvement in abdominal trunk function, urinary incontinence and QoL.

Antecedentes: Durante el embarazo, las mujeres tienen el riesgo de desarrollar una diástasis rectoabdominal persistente y sintomática (diastasis rectoabdominis, DRA) que puede tener un efecto perjudicial en su función física y en la calidad de vida (quality of life, QoL). El objetivo de este estudio de cohortes prospectivo fue determinar el efecto de reparación quirúrgica de la DRA en la función de la musculatura de la pared abdominal, la incontinencia urinaria y la QoL en mujeres con síntomas postparto de inestabilidad de la musculatura abdominal resistentes al entrenamiento. Métodos: Sesenta mujeres diagnosticadas en el postparto de DRA y con síntomas resistentes al entrenamiento se sometieron a una plicatura de doble capa de la línea alba. El objetivo primario fue evaluar la función de la musculatura de la pared abdominal mediante una herramienta de examen multimodal, el protocolo de la función de la pared abdominal (abdominal trunk function protocol, ATFP). La recidiva se evaluó mediante tomografía computarizada, la incontinencia urinaria utilizando los cuestionarios UDI­6 y IIQ­7 y la calidad de vida con el cuestionario SF­36. Todas las participantes fueron examinadas antes de la cirugía y un año después de la misma. Resultados: Tras un año de seguimiento, no hubo recidiva de la DRA. Según informaron las pacientes, la función de la musculatura abdominal había mejorado en el 98,2% de los casos, con una mejoría en la puntuación media del 79,1%. En las pruebas fisiológicas controladas por un fisioterapeuta, el 76,0% presentó mejoría y aumentó la duración en las pruebas de resistencia en comparación con antes de la cirugía. Todas las subescalas del SF­36 mejoraron significativamente en comparación con las puntuaciones preoperatorias y alcanzaron niveles similares o superiores a los de la población femenina sueca normal. Para el UDI­6 y el IIQ­7, el 46,7% y el 36,7% respectivamente, manifestaron menos síntomas en el seguimiento que antes de la cirugía, mientras que el 13,3% y el 8,3% respectivamente, reportaron más síntomas. Conclusión: En esta serie de mujeres que presentan DRA en el posparto y síntomas de inestabilidad de la musculatura abdominal resistente al entrenamiento, la reconstrucción quirúrgica produjo una mejora significativa en la función de la musculatura abdominal, la incontinencia urinaria y la calidad de vida.

Functional outcome is impaired following traumatic brain injury in aging Nogo-A/B-deficient mice.

Increasing age is associated with a poor prognosis following traumatic brain injury (TBI). CNS axons may recover poorly following TBI due to expression of myelin-derived inhibitors to axonal outgrowth such as Nogo-A. To study the role of Nogo-A/B in the pathophysiological response of the elderly to TBI, 1-year-old mice deficient in Nogo-A/B (Nogo-A/B homozygous(-/-) mice), Nogo-A/B heterozygous(-/+) mice, and age-matched wild-type (WT) littermate controls were subjected to a controlled cortical impact (CCI) TBI. Sham-injured WT mice (7 months old) and 12 month old naïve Nogo-A/B(-/-) and Nogo-A/B(-/+) served as controls. Neurological motor function was evaluated up to 3 weeks, and cognitive function, hemispheric tissue loss, myelin staining and hippocampal beta-amyloid (A beta) immunohistochemistry were evaluated at 4 weeks post-injury. In WT littermates, TBI significantly impaired learning ability at 4 weeks and neurological motor function up to 2 weeks post-injury and caused a significant loss of hemispheric tissue. Following TBI, Nogo-A/B(-/-) mice showed significantly less recovery from neurological motor and cognitive deficits compared to brain-injured WT mice. Naïve Nogo-A/B(-/-) and Nogo-A/B(-/+) mice quickly learned the MWM task in contrast to brain-injured Nogo-A/B(-/-) mice who failed to learn the MWM task at 4 weeks post-injury. Hemispheric tissue loss and cortical lesion volume were similar among the brain-injured genotypes. Neither TBI nor the absence of NogoA/B caused an increased A beta expression. Myelin staining showed a reduced area and density in the corpus callosum in brain-injured Nogo-A/B(-/-) animals compared to their littermate controls. These novel and unexpected behavioral results demonstrate that the absence of Nogo-A/B may negatively influence outcome, possibly related to hypomyelination, following TBI in mice and suggest a complex role for this myelin-associated axonal growth inhibitor following TBI.