Title: PELVIC FLOOR MUSCLE TRAINING WITH BIOFEEDBACK OR FEEDBACK
FROM A PHYSIOTHERAPIST FOR URINARY AND ANAL INCONTINENCE AFTER
CHILDBIRTH - A SYSTEMATIC REVIEW
Version: 1 Date: 05 Jun 2023
Reviewer's report:
The manuscript „THE EFFECT OF PELVIC FLOOR MUSCLE TRAINING WITH
BIOFEEDBACK OR FEEDBACK FROM A PHYSIOTHERAPIST FOR INCONTINENCE
AFTER CHILDBIRTH - A SYSTEMATIC REVIEW“ is a systematic review to evaluate the
outcome of PFM training with feedback by a physiotherapist vs. biofeedback by a device in a
specific population.
First of all: Thanks to the authors for this study! This study question is up-to-date and important
for the believes of young women after delivery with UI or/ and AI.
However there are some points that have to be clarified:
1. The overall question is: what is your intention for this review? Please add one sentence for
this study question.
In Line 24 – 26: „The purpose of this systematic review was to investigate the scientific basis
for the effect of PFMT with feedback from a physiotherapist or biofeedback on incontinence in
women within the first six months after vaginal delivery.“
Please clarify and specify this: „the scientific basis for the effect of PFMT“ -
For my understanding – the question is: are outcomes in and/ or symptoms of UI and/ or
AI different when physiotherapists give feedback compared with feedback that is given by a
„machine“ or a device (biofeedback)?
Please clarify the term „feedback“ – do you mean „supervised pt“ in contrast to control with
biofeedback given by a device?
2. The first question is: better outcomes/ differences in symptoms (number/ frequency/ etc.)
…. How measured? Questionnaires – self-reported (ok) but are questionnaires validated? Yes/
no….. (see guidelines/ recommendations/ etc.)
3. The second question is:
What is „feedback by a physiotherapist“? – for me, it is „check a correct PF contraction by
vaginal palpation“ and let the women know if it´s correct or not.
Please clarify…
4. Furthermore, it is recommended amongst specialized physiotherapist in the field of female
LUTS that a vaginal palpation is performed to be sure that only women with a correct PFM
contraction are enrolled in studies. Please clarify if this is an inclusion criteria of the „selected“
studies…
5. Please clarify the term „tactile instruction“ in the studies (e.g. Table 5). This is unclear for
readers
6. What is the difference between a verbal instruction of a therapist and a written instruction by
a sheet? Please add information, literature and discuss this in discussion….
7. Inclusion of studies in this review:
- used validated questionnaires for first and follow-up measuring time point?
- Evaluation of correct PFM contration tested by vaginal palpation?
8. I miss information in discussion that to date, there is no study that directly compares outcomes
on UI and/ or AI with both forms of feedback (physio vs. device)…. As I can see in the included
studies, this is not done – please provide insight in this – maybe missing – study field. Please
discuss….
9. Line 6: Definition of feedback/ biofeedback… please search for the first mention (not
secundary literature) – literature no 25 is a 2020 review. Please clarify…