运动干预对产后腹直肌分离患者自我效能、腹围及腹直肌分离间距的影响

赵容; 王换换; 梁婉婉; 张利; 王红雨; 岳建兴

doi:10.16766/j.cnki.issn.1674-4152.003219

运动干预对产后腹直肌分离患者自我效能、腹围及腹直肌分离间距的影响

doi: 10.16766/j.cnki.issn.1674-4152.003219

1.
蚌埠医学院护理学院，安徽蚌埠 233030
2.
蚌埠医学院健康体适能研究中心，安徽蚌埠 233030
3.
蚌埠医学院第二附属医院康复医学科，安徽蚌埠 233040

基金项目:

安徽高校人文社会科学研究项目 SK2020ZD32

蚌埠医学院研究生科研创新计划资助项目 Byycxz22044

详细信息

通讯作者:
岳建兴，E-mail：yuejx1981@163.com

中图分类号: R715.3
计量
- 文章访问数: 100
- HTML全文浏览量: 45
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2023-05-05
- 网络出版日期: 2023-11-23

Effect of exercise intervention on self-efficacy, abdominal circumference and spacing of rectus abdominis separation in patients with postpartum rectus abdominis separation

1.
School of Nursing, Bengbu Medical College, Bengbu, Anhui 233030, China

摘要

摘要: 目的探索运动干预改善产后腹直肌分离患者自我效能、腹围及腹直肌分离间距的效果，为临床运动干预提供参考依据。方法选取2022年8月—2023年3月就诊于蚌埠医学院第二附属医院康复科的产后腹直肌分离患者86例，按照就诊时间分为对照组(43例)和干预组(43例)。2组均进行常规的康复训练，干预组在此基础上进行运动干预。干预前后采用自我效能感量表(GSES)评估患者的自我效能，并测量患者的腹围及腹直肌分离间距。结果 2组患者干预前比较，各项指标差异均无统计学意义(均P>0.05)。干预后，2组患者的腹围均减少，且干预组腹围[(81.67±7.09)cm]小于对照组[(84.42±6.72)cm]，差异有统计学意义(t=2.071, P=0.045)；2组患者的三处腹直肌分离间距均有所减小(均P < 0.05)，且干预后干预组腹直肌分离间距脐上2 cm处[(1.37±0.50)cm]、平脐处[(1.74±0.50)cm]、脐下2 cm处[(1.24±0.53)cm]均小于对照组的间距[(1.60±0.42)cm、(1.95±0.38)cm、(1.44±0.37)cm]，差异有统计学意义(均P < 0.05)；2组患者自我效能均提高(均P < 0.05)，且干预组自我效能感更好(P < 0.05)；比较2组患者干预前后腹围、腹直肌分离间距及自我效能感评分的差值，干预组患者的改善情况优于对照组(均P < 0.05)。结论运动干预可以减小产后腹直肌分离患者的腹围及腹直肌分离间距，提高产妇的自我效能感，能够有效促进产后恢复，具有较高的临床推广价值。
- 产后 /
- 腹直肌分离 /
- 运动康复 /
- 自我效能
Abstract: Objective To explore the effect of exercise intervention on improving self-efficacy, abdominal circumference and separation distance of rectus abdominis in postpartum patients with separation of rectus abdominis, and to provide reference for clinical exercise intervention. Methods Eighty-six patients with postpartum rectus abdominis separation who attended the rehabilitation department of the Second Affiliated Hospital of Bengbu Medical College from August 2022 to March 2023 were selected and divided into a control group (n=43) and an intervention group (n=43) according to the time of consultation; both groups underwent conventional rehabilitation training, and the intervention group underwent exercise intervention on this basis. Patients ' self-efficacy was assessed using the general self-efficacy scale (GSES) before and after the intervention, and abdominal circumference and the separation distance between the rectus abdominis muscles were measured. Results Comparing the two groups of patients before intervention, there was no significant difference in the indicators (all P>0.05). After intervention, the abdominal circumference of patients in both groups was reduced, and the abdominal circumference of the intervention group [(81.67±7.09) cm] was smaller than that of the control group [(84.42±6.72) cm], with statistically significant differences (t=2.071, P=0.045). The separation distance of the three rectus abdominis muscles in both groups decreased (all P < 0.05), and the separation distance of the rectus abdominis muscles 2 cm above the umbilicus [(1.37±0.50) cm], at the flat umbilicus [(1.74±0.50) cm] and below the umbilicus [(1.24±0.53) cm] in the intervention group were smaller than those of the control group [(1.60±0.42), (1.95±0.38) and (1.44±0.37) cm], and the differences were statistically significant (all P < 0.05). The self-efficacy of patients in both groups increased (all P < 0.05), and was better in the intervention group (P < 0.05). Compared the differences in abdominal circumference, rectus abdominis separation distance and self-efficacy score between the two groups before and after intervention, the improvement of the intervention group was better than that of the control group (all P < 0.05). Conclusion Exercise intervention can reduce the abdominal circumference and distance between diastasis recti abdominis in patients with postpartum diastasis and improve maternal self-efficacy, which can effectively promote postpartum recovery and has high clinical promotion value.
- Postpartum /
- Rectus abdominis separation /
- Exercise rehabilitation /
- Self-efficacy

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表 1 2组产后腹直肌分离患者一般资料比较

Table 1. Comparison of general data between 2 groups of patients with diastasis recti postpartu

组别	例数	年龄(x±s，岁)	生产方式[例(%)]		胎次[例(%)]		产后时间(x±s，d)
组别	例数	年龄(x±s，岁)	顺产	剖宫产	一胎	二胎	产后时间(x±s，d)
对照组	43	30.81±2.74	30(69.77)	13(30.23)	25(58.14)	18(41.86)	61.86±15.59
干预组	43	30.04±3.20	26(60.47)	17(39.53)	24(55.81)	19(44.19)	57.14±14.72
统计量		1.257^a	0.819^b		0.047^b		1.268^a
P值		0.216	0.365		0.828		0.212
注：^a为t值，^b为χ²值。

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表 2 2组产后腹直肌分离患者腹围比较(x±s，cm)

Table 2. Comparison of abdominal circumference between two groups of patients with diastasis recti postpartum (x±s, cm)

组别	例数	干预前	干预后
对照组	43	88.47±8.36	84.42±6.72^a
干预组	43	87.80±6.58	81.67±7.09^a
t值		0.441	2.071
P值		0.662	0.045
注：与同组干预前比较，^aP＜0.05。

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表 3 2组产后腹直肌分离患者腹直肌分离间距比较(x±s，cm)

Table 3. Comparison of rectus abdominis separation distance between 2 groups of patients with diastasis recti postpartum (x±s, cm)

组别	例数	脐上2 cm		平脐		脐下2 cm
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	43	2.27±0.57	1.60±0.42^a	3.16±0.40	1.95±0.38^a	2.12±0.52	1.44±0.37^a
干预组	43	2.56±0.72	1.37±0.50^a	3.37±0.54	1.74±0.50^a	2.33±0.82	1.24±0.53^a
t值		1.963	2.075	1.983	2.216	1.263	2.129
P值		0.056	0.044	0.054	0.032	0.214	0.039
注：与同组干预前比较，^aP＜0.05。

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表 4 2组产后腹直肌分离患者自我效能感量表评分比较(x±s，分)

Table 4. Comparison of self-efficacy scale scores between two groups of patients with diastasis recti postpartum (x±s, points)

组别	例数	干预前	干预后
对照组	43	25.74±1.40	27.02±2.28^a
干预组	43	26.51±2.20	29.28±2.43^a
t值		1.943	4.412
P值		0.059	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 5 2组产后腹直肌分离患者腹围、腹直肌分离间距及自我效能感评分干预前后差值比较

Table 5. Comparison of abdominal circumference, separation distance, and self-efficacy scale scores between two groups of patients with diastasis recti postpartum

组别	例数	腹围的差值(x±s，cm)	腹直肌间距的差值(x±s，cm)			自我效能差值[M(P₂₅, P₇₅)，分]
组别	例数	腹围的差值(x±s，cm)	脐上2 cm	平脐	脐下2 cm	自我效能差值[M(P₂₅, P₇₅)，分]
对照组	43	-3.31±1.45	-0.76±0.33	-1.17±0.31	-0.77±0.44	0.98(0.72，1.23)
干预组	43	-5.27±1.46	-1.17±0.58	-1.63±0.35	-1.08±0.56	2.77(2.43，3.10)
统计量		6.295^a	4.257^a	6.854^a	2.695^a	-6.524^b
P值		＜0.001	＜0.001	＜0.001	0.010	＜0.001
注：^a为t值，^b为Z值。

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参考文献(21)

[1]	LIU Y, ZHU Y, JIANG L Y, et al. Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: a randomized controlled clinical trial[J]. Front Public Health, 2022, 10: 1003361. DOI: 10.3389/fpubh.2022.1003361.
[2]	BARBOSA M V, DIAS A, BAUTI I, et al. The normal width of the linea alba in cadavers: a parameter to define rectus diastasis[J]. Anatomy, 2021, 15: 132-136. doi: 10.2399/ana.21.922706
[3]	HU J, GU J F, YU Z Y, et al. Efficacy of standardized rehabilitation in the treatment of diastasis rectus abdominis in postpartum women[J]. Int J Gen Med, 2021, 14: 10373-10383. DOI: 10.2147/IJGM.S348135.
[4]	CAVALLI M, AIOLFI A, BRUNI P G, et al. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation[J]. Hernia, 2021, 25(4): 883-890. doi: 10.1007/s10029-021-02468-8
[5]	叶秀琴, 潘群艳. 产后腹直肌分离高频超声特征及其与分娩方式的相关性研究[J]. 中华全科医学, 2023, 21(3): 469-472. doi: 10.16766/j.cnki.issn.1674-4152.002909 YE X Q, PAN Q Y. High frequency ultrasound characteristics of postpartum rectus abdominis separation after delivery and its correlation with delivery mode[J]. Chinese Journal of General Practice, 2023, 21(3): 469-472. doi: 10.16766/j.cnki.issn.1674-4152.002909
[6]	KESHWANI N, MATHUR S, MCLEAN L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial[J]. Physiother Theory Pract, 2021, 37(9): 1018-1033. doi: 10.1080/09593985.2019.1675207
[7]	KIM S, YI D, YIM J. The effect of core exercise using online videoconferencing platform and offline-based intervention in postpartum woman with diastasis recti rbdominis[J]. Int J Environ Res Public Health, 2022, 19(12): 7031. doi: 10.3390/ijerph19127031
[8]	李群凤, 张新玲, 李思敏. 超声评估瑜伽对产后女性早期腹直肌分离间距的效果研究[C]//第十二届全国体育科学大会论文摘要汇编: 墙报交流(运动医学分会). 日照: [出版社不详], 2022: 50-52. LI Q F, ZHANG X L, LI S M. A study of the effect of ultrasound assessment of yoga on the separation spacing of the rectus abdominis muscle in early postpartum women[C]//Chinese Society of Sports Science. A compilation of abstracts from the 12th National Sports Science Congress - Poster Exchange (Sports Medicine Section). [publisher unknown], 2022: 50-52.
[9]	LEE R, THAIN S, TAN L K, et al. IPRAMHO exercise in pregnancy committee. Asia-Pacific consensus on physical activity and exercise in pregnancy and the postpartum period[J]. BMJ Open Sport Exerc Med, 2021, 7(2): e000967. DOI: 10.1136/bmjsem-2020-000967.
[10]	KUMARI A, RANJAN P, VIKRAM N K, et al. Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: an AⅡMS-DST initiative[J]. Diabetes Metab Syndr, 2022, 16(3): 102425. DOI: 10.1016/j.dsx.2022.102425.
[11]	HERNÁNDEZ-GRANADOS P, HENRIKSEN N A, BERREVOET F, et al. European Hernia Society guidelines on management of rectus diastasis[J]. Br J Surg, 2021, 108(10): 1189-1191. doi: 10.1093/bjs/znab128
[12]	BROWN W J, HAYMAN M, HAAKSTAD L A H, et al. Australian guidelines for physical activity in pregnancy and postpartum[J]. J Sci Med Sport, 2022, 25(6): 511-519. doi: 10.1016/j.jsams.2022.03.008
[13]	史海燕, 王兆蒙, 张超, 等. 神经肌肉电刺激联合凯格尔运动治疗产后腹直肌分离及便秘的疗效观察[J]. 中国妇幼保健, 2021, 36(21): 4924-4927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202121013.htm SHI H Y, WANG Z M, ZHANG C, et al. Efficacy of neuromuscular electrical stimulation combined with Kegel exercises in the treatment of postpartum rectus abdominis muscle separation and constipation[J]. Maternal and Child Health Care of China, 2021, 36(21): 4924-4927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202121013.htm
[14]	FEI H, LIU Y, LI M X, et al. The relationship of severity in diastasis recti abdominis and pelvic floor dysfunction: a retrospective cohort study[J]. BMC Womens Health, 2021, 21(1): 68. doi: 10.1186/s12905-021-01194-8
[15]	YUAN S, WANG H H, ZHOU J. Prevalence and risk factors of hernia in patients with rectus abdominis diastasis: a 10-year multicenter retrospective study[J]. Front Surg, 2021, 8: 730875. DOI: 10.3389/fsurg.2021.730875.
[16]	GLUPPE S, ENGH M E, BO K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis[J]. Braz J Phys Ther, 2021, 25(6): 664-675. doi: 10.1016/j.bjpt.2021.06.006
[17]	KESHWANI N, MATHUR S, MCLEAN L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomized controlled trial[J]. Physiother Theory Pract, 2021, 37(9): 1018-1033. doi: 10.1080/09593985.2019.1675207
[18]	LAFRAMBOISE F C, SCHLAFF R A, BARUTH M. Postpartum exercise intervention targeting diastasis recti abdominis[J]. Int J Exerc Sci, 2021, 14(3): 400-409. http://www.xueshufan.com/publication/3152314065
[19]	THABET A A, ALSHEHRI M A. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial[J]. J Musculoskelet Neuronal Interact, 2019, 19(1): 62-68.
[20]	LIANG P Q, LIANG M, SHI S, et al. Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial[J]. Physiotherapy, 2022, 117: 16-21. doi: 10.1016/j.physio.2022.05.001
[21]	SALEEM Z, KHAN A A, FAROOQUI S I, et al. Effect of exercise on inter-recti distance and associated low back pain among post-partum females: a randomized controlled trial[J]. J Family Reprod Health, 2021, 15(3): 202-209.