Title: The effectiveness of pelvic floor muscle training on lumbar function and muscle
performance in sedentary women with lower back pain: A randomized controlled trial
Version: 0 Date: 22 Sep 2024
Reviewer's report:
GENERAL COMMENTS:
- The title and purpose of the study should be compatible. The title should be considered as
“The effectiveness of combined pelvic floor and core training on lumbar function in sedentary
women with low back pain”.
ABSTRACT:
- Revise the study groups as control group, core training group and combined PFM and core
training group. Because the group names are confusing.
- How were trunk muscle endurance, deep lumbar stabilizing muscle activity and LBP severity
assessed? Explain your outcome measures here.
- Do not present data that are not statistically significant in the Results section.
- Clearly state p-values for significant findings.
- Add “core training” to the keywords.
INTRODUCTION:
- Why did you think that combined PFM and core training might be superior to core training
alone? This question should be explained in more detail.
- Literature showing the level of evidence for core training in LBP should be added.
- The synergy between core muscles (diaphragm, abdominal muscles, multifidus, PFM) should
be well emphasized.
- Literature examining the efficacy of PFM-only training in individuals with LBP should be
mentioned.
MATERIAL AND METHODS:
- Please specify the type of research.
- It is not clear how the sample was reached, it should be more descriptive.
- How did you assess women's physical activity level? Did you use any scales?
- You stated that you used VAS for LBP. It describes that you included women with >3 moderate
to severe LBP according to VAS. Please confirm if this is correct.
- Who determined the exclusion criteria? For example, how was pelvic floor dysfunction
questioned? Did you use any questionnaires or assessment methods? Women between the ages
of 18-40 were specifically selected. However, these women may or may not have given birth.
PFM strength is affected in women who have given birth. This may have had a negative effect
on lumbar stabilization. Were the obstetric factors of the women analyzed? Were all groups
similar in this respect at baseline?
- Provide detailed information about the women's working status, working hours, etc. For
example, were they office workers who worked in a certain position for a long time?
- I understand that you assessed the thickness of the deep lumbar stabilizing muscle (TrA,
multifidus, PFM) with USG. Did you use EMG to assess muscle activation? If not, the term
activation should be revised in the whole text. Because muscle thickness can be evaluated with
USG.
- Who performed the USG evaluations? Was the evaluation performed by the same investigator?
Provide more detailed information with USG device and protocol.
- Trunk muscle endurance tests should be explained in detail.
- Were the training programs administered by the same therapist? Was blinding performed?
- Was any training given to the control group?
- The progression of the training programs should be more descriptive with their aims.
RESULTS:
- The p-values and confidence intervals of your statistically significant findings should be clearly
stated.
- Consider presenting your findings regarding the demographic data of the participants.
- Were the muscle thickness and muscle endurance values of the groups similar at baseline?
- Was there a difference between the groups after treatment? If so, which group was favored?
DISCUSSION:
- In this section you should first present the main findings of your study.
- Avoid mentioning group names in the discussion section. For example, group P.
- You found that combined PFM and core training is more effective on muscle endurance.
Consider supporting this conclusion with literature showing synergy between PFM and other
core muscles. Also, the contribution of this result to the clinic should be addressed.
- It is not correct to discuss muscle thickness results as activation. Please revise the discussion
section to take this into account.
- You say that only core training negatively affects PFM thickness. This is not understandable.
Why PFM thickness increased even in the control group and decreased in the core training group
should be more clearly stated.
- I think paragraph 4.4 should be removed.
- Was the improvement in VAS clinically significant?
CONCLUSION:
- You state that both core training alone and combined PFM and core training improved lumbar
function.  Did they both provide similar benefit? This is not clear in the results and discussion
section. If so, how would you interpret this from a clinical point of view and what advice would
you give to the clinic? Elaborate on this.
TABLES:
- The difference between groups before treatment should be shown in Table 1.
- You may consider presenting Table 2 with exercise figures as an appendix.
- Table 3 should present p-values, confidence intervals, within-group change (post-treatment vs.
pre-treatment) and between-group difference values, and analysis methods should be indicated
in the table description.