Introduction

Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 44 in 2025, we had International Course in Spain, A Coruna, in the Faculty of Physiotherapy at University of Coruña about EBP. The program was opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields. More than 30 physiotherapy students and 9 teachers from six universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Czech Republic, CERRFF and École D´Assas, France, and Escola de Santa María de O Porto, Portugal), actively participated this week and shared experiential group dynamics and social activities. The students collaborated and wrote articles on a range of topics, including evidence-based neurology, respiratory and musculoskeletal disorders, geriatric and pediatric care, as well as sports injuries and related issues. This blog article explores the effectiveness of supervised versus online pelvic floor and core rehabilitation for postpartum women with diastasis recti.

Background

Many new mothers experience unexpected changes in their abdominal wall after pregnancy — a condition known as diastasis recti abdominis (DRA), which affects up to 60% of postpartum women. It may cause reduced core stability, pelvic floor weakness, and urinary incontinence, impacting daily activities and quality of life. Recent years have seen an increasing use of supervised, clinic-based rehabilitation programs and online/home-based interventions, but robust evidence directly comparing their effectiveness remains limited. The need to optimize recovery for postpartum women motivates research on which modality (supervised vs online/home-based) delivers better outcomes.

Methods

This evidence review focused on postpartum women with diastasis recti (below the bellybutton, >2 cm). Interventions compared were supervised, clinic-based pelvic floor/core rehabilitation delivered in person by a physiotherapist, and online or home-based programs, which included either unsupervised home exercise routines or home training with remote follow-up through online platforms, depending on the study. Primary outcomes included pelvic floor muscle strength, urinary incontinence symptoms, core stability, and quality of life. Only randomized controlled trials (RCTs) were considered. Database searches (mainly PubMed) used keywords and MeSH terms such as “postpartum,” “pelvic floor,” “core training,” “diastasis recti,” “supervised,” “online,” “telerehabilitation.” The search was restricted to English-language articles published between 2015 and 2025. Selected articles had to report at least one primary outcome.

The literature was screened for methodology, population, interventions, and results; studies were quality-rated using the PEDro scale: Kim et al. (2022) with 5/10, Tim & Mazur-Bialy (2024) with 6/10, and Zhang et al. (2025) with 6/1011. Consequently, three relevant RCTs were included in the final review. Conversely, two articles were excluded as they did not fully meet the PICO criteria for this review. Ozdincler et al. (2025) compared telerehabilitation-based pelvic floor muscle training with supervised sessions but did not specifically target postpartum women with diastasis recti ≥2 cm defined in our PICO. Similarly, Dufour et al. (2019) explored the feasibility and acceptability of a mobile health intervention for pelvic floor muscle training; however, the study involved a small sample size and lacked a direct comparison to supervised rehabilitation programs.

Results

The review of the included studies indicates that while both modalities offer benefits, supervised training generally yields superior results. Kim et al. (2022) found that while both supervised and online groups improved inter-recti distance, muscle thickness, trunk endurance, and maternal quality of life, the gains were stronger in the supervised group. These findings were supported by Tim & Mazur-Bialy (2024), who reported that the supervised group showed the best outcomes with lower DRA prevalence, better exercise accuracy, and fewer urinary symptoms. Although their online sessions improved outcomes over the control group, supervised training remained superior for diastasis reduction. Furthermore, Zhang et al. (2025) observed

that the remote intervention group had greater reductions in inter-recti distance and improvements in knowledge/self-efficacy compared to standard care, but found no significant difference in pelvic floor muscle strength. Across studies, interventions varied in delivery, duration, and assessment methods, but supervised programs consistently offered greater clinical improvements, particularly in core and pelvic floor function. Online/home-based programs were beneficial for accessibility but were impacted by issues of exercise execution and adherence.

Conclusion

Both supervised and online/home-based exercise interventions can support postpartum recovery and reduction of diastasis recti abdominis, but supervised training tends to yield superior outcomes for core function, pelvic floor strength, and urinary symptom relief. The overall methodological quality was moderate, with limitations related to sample size, short-term follow-up, and frequent use of self-reported outcomes. Future research should prioritize larger, multi-site trials, standardized outcome measures, and longer follow-up to provide clearer guidance for clinical practice. Integrating accessible yet well-supervised physiotherapy approaches may help bridge the gap between evidence and postpartum care worldwide.

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Authors:

Vanessa Porubčanská, physiotherapy student, Charles University

Pauline Andujar, physiotherapy student, Assas University

Fanny Cardon, physiotherapy student, CEERRF physiotherapy school

Carlota Cabrera Cao, physiotherapy student, Universidade da Coruña

Dagmar Pavlu, PT. Assoc. Prof. Charles University, Czech Republic.

Ivana Vláčilová, PhD., PT. Charles University, Czech Republic.

Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland.

Veronica Robles García, PhD. PT. OT. Associate Professor, University of A Coruña, A Coruña, Spain.

Zeltia Naia Entonado, PhD. PT. University of A Coruña, A Coruña, Spain.

María Vilanova Pereira, PhD., PT. University of A Coruña, A Coruña, Spain.

Adrien Pallot, PT, MSc, Lecturer at École D´Assas, France.

Aurel Bellaïche, PT, Lecturer at CEERRF, France.

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References:

Kim, S., Yi, D., & Yim, J. (2022). The Effect of Core Exercise Using Online

Videoconferencing Platform and Offline-Based Intervention in Postpartum Woman

with Diastasis Recti Abdominis. International journal of environmental research and

public health, 19(12), 7031. https://doi.org/10.3390/ijerph19127031

Tim, S., & Mazur-Bialy, A. (2024). Online vs. Supervised Training in Relieving Urinary

Incontinence and Diastasis Recti Abdominis in Early Postpartum. Journal of clinical

medicine, 13(24), 7730. https://doi.org/10.3390/jcm13247730

Zhang, R., Guo, Y., Zhang, J., Zhang, J., Zhuang, R., Liao, C., & Bo, H. (2025).

Effectiveness of telehealth pelvic-abdominal mechanics training rehabilitation

program for pelvic floor rehabilitation in puerperal women: a randomized controlled

study. European journal of physical and rehabilitation medicine, 61(4), 679–688.

https://doi.org/10.23736/S1973-9087.25.08971-3

Ozdincler, A. R., Dayican, D. K., & Ozyurek, B. (2025). The Effects of Pelvic Floor

Muscle Training Applied via Telerehabilitation During the Postpartum Period: A

Randomized Controlled Study. Telemedicine Journal And e-Health, 31(7), 902-913.

https://doi.org/10.1089/tmj.2024.0540

Dufour, S., Fedorkow, D., Kun, J., Deng, S. X., & Fang, Q. (2019). Exploring the Impact

of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot

Randomized Controlled Feasibility Study. JMIR Mhealth And Uhealth, 7(7), e12587.

https://doi.org/10.2196/12587

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