Comparative Effects of Telerehabilitation Versus In-Person Core Stability Training in Postpartum Women

This randomized controlled trial aims to compare the effectiveness of tele rehabilitation-based versus in-person supervised core stability exercises in postpartum women diagnosed with diastasis recti abdominis. Fifty-four participants will be randomly allocated to either a tele rehabilitation group or an in-person supervised exercise group. Both groups will receive the same standardized 8-week core stability exercise program consisting of three supervised sessions per week. Outcomes will be assessed at baseline and after completion of the intervention. Primary outcome will be inter-recti distance measured using a digital nylon caliper. Secondary outcome will be body image measured using the Body Image State Scale (BISS). The findings will help determine whether tele rehabilitation provides comparable clinical outcomes to conventional supervised physiotherapy for postpartum rehabilitation.

• Telerehabilitation (Other): Participants were assessed at baseline by a physiotherapist and attended supervised in-clinic follow-up sessions every two weeks to monitor progress and ensure correct exercise performance. Individualized exercise demonstrations were recorded on participants' mobile devices to facilitate home-based practice. The intervention consisted of an 8-week progressive postpartum exercise program beginning at 6 weeks postpartum, including pelvic floor muscle (Kegel) exercises, abdominal bracing, trtransversus abdominis (TrA) activation, and pelvic tilts. Exercise dosage (sets, repetitions, hold time, and fast contractions) was progressively increased each week according to the study protocol to improve pelvic floor muscle strength, core stability, and lumbopelvic control.
• In-Person (Other): Participants were assessed at baseline by a physiotherapist and participated in supervised in-person group exercise sessions for 8 weeks, beginning at 6 weeks postpartum. The intervention followed the same progressive exercise protocol as the telerehabilitation group and included pelvic floor muscle (Kegel) exercises, abdominal bracing, transversus abdominis (TrA) activation, and pelvic tilts, with weekly progression in sets, repetitions, hold duration, and fast contractions. The physiotherapist provided real-time supervision, exercise correction, and progression throughout the intervention.

Primary outcomes

• Digital Nylon Caliper [Baseline (pre-Intervention) Post-Intervention (after 8 weeks)]: Digital nylon calipers are recognized as both reliable and valid for measuring inter-recti distance (IRD), Measurements of inter recti distance will be taken at the umbilicus and at standardized points 4.5 cm above and 4.5cm below umbilicus.
• Body Image Scale (BISS) [Baseline Post-Intervention (after 8 weeks)]: The Body Image State Scale (15) is a validated, self-reported tool for assessing body image, satisfaction, and emotional responses. BISS scoring uses the mean of the six items (each scored 1-9) with certain items reverse-scored (items 2, 4, and 6), and higher totals signal higher body satisfaction. The scale is tested for reliability and validity in various populations, including postpartum women, with Cronbach's alpha generally reported around 0.82-0.83 for internal consistency.

Sex: Female, ages: 18 Years to 40 Years

Inclusion Criteria: Participants falling in this category would be recruited into the study.

* 6 weeks to 6 months postpartum
* Multiparous or primiparous
* Diagnosis of diastasis recti (IRD ≥ 2cm)/
* Able to use or operate digital/electronic devices
* With internet access and the ability to participate in remote group sessions.

Exclusion Criteria: Participants fall in this category would be excluded of the study.

* Significant musculoskeletal or systemic comorbidities i.e. diabetes mellitus, cardiovascular disease, Severe psychiatric disorders, Active malignancy.
* Prior major abdominal or pelvic surgery (except cesarean)
* Any Contraindications to exercise.
* Recent/Current pregnancy.

• Rida Ijaz, MSPT(WH), Principal investigator, Riphah International University