Reviewer's report 
 The effectiveness of pelvic floor muscle training alone and with other physical therapies for the Title: 
treatment of stress urinary incontinence in women: a systematic review 
 3  2 March 2006 Version: Date: 
 Peter Herbison Reviewer: 
Reviewer's report: 
General 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
Many of the replies to my previous comments are of the nature people do it so why shouldn't we. This is not a good enough argument. I feel particularly strongly about quality scores. I think that the assessment of quality of studies is essential in systematic reviews, but adding up the elements of 
quality and assigning meaning to it is not appropriate. I realise that there are still many 
recomendation for quality scores around, but there is a general feeling now that these are inappropriate. For example, the section on quality in the Cochrane Handbook is currently being revamped completely and is looking at a new way of assessing quality and how it may affect the 
review. 
I still find it very strange to read about a level II study or whatever. From the definition the authors 
provide as supplementary material, level II is defined as "Evidence obtained from at least one 
properly-designed randomised controlled trial". Thus it applies to the evidence, not the trial. It would 
be simpler and more correct to refer to the study as a properly designed RCT. 
Thank you to the authors for pointing out that I hadn't read the inclusion/exclusion criteria clearly 
enough. I agree that the Glazener et al paper did not exclude women with mixed incontinence, and I 
am sure that a small proportion of the women would have had this. 
I am concerned that the authors do not seem to know the literature about selective reporting of 
outcomes, a phenomenon that clearly occurs, but they are correct that there is no evidence one way 
or the other that this has happened in the studies in this review. 
There seems to still be a misunderstanding about efficacy and effectiveness. RCTs can measure 
effectiveness - see Roland M, Torgerson DJ. Understanding controlled trials. What are pragmatic 
trials? BMJ 1998;316(24 January):285. 
There is also good evidence that study counting can be misleading, although the apperance of this 
is hard to avoid in a narrative review. 
I think the changes that have been made improved the paper. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct) 
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Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests