# Effectiveness of Supervised versus Online Pelvic Floor and Core Rehabilitation in Postpartum Women with Diastasis Recti

> Impact of Supervised vs. Online Pelvic Floor and Core Training in Postpartum Diastasis Recti Recovery.

## Background
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, an International Course was held in A Coruña, Spain, at the Faculty of Physiotherapy at the University of Coruña. The program was opened with welcome words from 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 in different Physical Therapy fields. 

More than 30 physiotherapy students and 9 teachers from six universities participated:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Czech Republic
* CERRFF, France
* École D´Assas, France
* Escola de Santa María de O Porto, Portugal

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. This article explores the effectiveness of supervised versus online pelvic floor and core rehabilitation for postpartum women with diastasis recti.

## Introduction
Diastasis recti abdominis (DRA) affects up to 60% of postpartum women, causing unexpected changes in the abdominal wall. It may lead to reduced core stability, pelvic floor weakness, and urinary incontinence, impacting daily activities and quality of life. While supervised, clinic-based rehabilitation and online/home-based interventions are increasingly used, robust evidence directly comparing their effectiveness remains limited.

## Methodology
This evidence review focused on postpartum women with diastasis recti (below the bellybutton, >2 cm). The review compared supervised, clinic-based pelvic floor/core rehabilitation delivered in person by a physiotherapist against online or home-based programs (unsupervised home exercise or remote follow-up). 

Primary outcomes included pelvic floor muscle strength, urinary incontinence symptoms, core stability, and quality of life. The search was restricted to English-language randomized controlled trials (RCTs) published between 2015 and 2025. Three relevant RCTs were included in the final review after quality assessment using the PEDro scale.

## Findings
The review indicates that while both modalities offer benefits, supervised training generally yields superior results:
* **Kim et al. (2022):** Both groups improved inter-recti distance, muscle thickness, trunk endurance, and quality of life, but gains were stronger in the supervised group.
* **Tim & Mazur-Bialy (2024):** The supervised group showed the best outcomes with lower DRA prevalence, better exercise accuracy, and fewer urinary symptoms.
* **Zhang et al. (2025):** The remote intervention group showed 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, supervised programs consistently offered greater clinical improvements 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 support postpartum recovery, but supervised training tends to yield superior outcomes. Future research should prioritize larger, multi-site trials, standardized outcome measures, and longer follow-up to provide clearer guidance for clinical practice.

## 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

## 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