Title: A cross-sectional investigation on the function of the female pelvic floor in the Sichuan
province, China
Version: 1 Date: 09 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This study investigates the relationship between pelvic floor
dysfunction (PFD) and changes in pelvic organ position and electrophysiological indices among
different female cohorts, offering valuable insights into early PFD detection and prevention.
However, the discussion primarily reiterates findings without sufficient analysis of their clinical
implications or connections to prior research. Key terms and statistical results, such as "Aa, Ap,
C, and D values," are inadequately explained, limiting accessibility for readers. The lack of in-
depth comparative analysis, missing citations for general claims, and omission of limitations
weaken the study’s rigor. While the adherence to cross-sectional standards and strict quality
controls is commendable, the discussion fails to highlight the study's unique contributions or
propose specific clinical interventions. Addressing these gaps, along with providing clearer
terminology and actionable recommendations, would enhance the study’s clarity, relevance, and
impact on the field of obstetrics and gynecology.
REQUESTED REVISIONS:
I recommend to take into account the following suggestions:
- Introduction: While the section cites general references ([1-3], [4, 5], etc.), it lacks specific
examples or more recent studies to substantiate claims about the prevalence, impact, or low
consultation rates. Include concrete data or statistics, such as prevalence rates in similar
populations, to better contextualize the issue.
- Introduction: The objective is broadly stated and could benefit from more specificity, such as
the key parameters or outcomes being studied. Detail what aspects of "fundamental pelvic floor
status" the study investigates (e.g., prevalence of specific conditions, anatomical or functional
assessments).
- Introduction: The statement about insufficient public awareness is important but lacks detail.
Expand on why awareness is low, including cultural, systemic, or educational barriers specific
to the population.
- Introduction: While the Leshan area in Sichuan is mentioned, the rationale for selecting this
region is missing. Explain why this region was chosen and how findings from this area may
contribute to broader insights into PFD.
- Introduction: The statement about insufficient public awareness is important but lacks detail.
Expand on why awareness is low, including cultural, systemic, or educational barriers specific
to the population.
- Introduction: The emphasis on married women is introduced but not justified. Clarify whether
marital status is relevant to PFD prevalence or if it is an artifact of the study design.
- Methods: The rationale for dividing participants into three specific groups (married women
without children, premenopausal women with children, and postmenopausal women) is missing.
Include an explanation of how these groupings align with the study objectives, particularly
regarding pelvic floor dysfunction.
- Methods: The study does not mention how the sample size of 368 participants was determined.
Conduct and report a power analysis to ensure the sample size is adequate for detecting
statistically significant differences.
- Methods: Some inclusion criteria, such as "intention to reside locally for an extended period,"
are unclear in their relevance to the study aims. Streamline the inclusion criteria and explain
why each condition is necessary for participation.
- Methods: There is no indication if the two doctors collecting data were blinded to group
assignments to minimize bias. Clarify whether blinding was implemented or assess inter-rater
reliability to ensure consistency.
- Methods: The description of the PHENIX U4 instrument lacks details about calibration,
testing protocols, or standardization across participants. Provide detailed information on how
measurements were standardized and calibrated to ensure reliability.
- Methods: The section does not specify if data were checked for normality or if adjustments
were made for multiple comparisons. Include details about normality tests and how violations
of statistical assumptions were addressed.
- Methods: There is no mention of how potential confounders (e.g., BMI, parity, or
comorbidities) were accounted for in the analysis. Incorporate strategies to control for
confounders, such as stratification or multivariate analysis.
- Methods: The measures to ensure participant privacy and data security are not discussed.
Elaborate on protocols for maintaining confidentiality and securing participant data.
- Results: The repeated statements of "no significant difference" across groups without providing
specific values make the section cumbersome. Use concise phrasing, such as combining results
with similar outcomes (e.g., "No significant differences were found between groups B and C
for Aa, Ap, and D values").
- Results: Some results indicate statistical significance (e.g., p<0.05), but actual p-values or
effect sizes are not provided. Include specific p-values or effect sizes where possible to provide
more granularity and transparency.
- Results: Phrasing like "in presented in Table 1" or "in presented in Table 3" is grammatically
incorrect. Replace with "as presented in Table 1" for better readability. Ensure table references
are consistent and clearly labeled.
- Discussion: The discussion primarily reiterates results without adequately analyzing their
implications or connecting them to broader clinical or research contexts. Expand on the
significance of findings, such as the decline in pelvic floor muscle strength with age and
menopause, and how these align with current understanding or present novel insights.
- Discussion: Statements like "effective education, early diagnosis, and appropriate treatment
are crucial responsibilities" are overly general. Provide specific examples or actionable
recommendations for education, diagnosis, and treatment based on study findings.
- Discussion: While the study claims alignment with other domestic and international research,
it does not critically compare its findings to specific prior studies. Discuss how these results
confirm, contradict, or add nuance to previous research, citing concrete examples.
- Discussion: The discussion does not adequately address the study's limitations. Acknowledge
potential issues such as the small sample size, reliance on specific measurement techniques, or
potential bias in self-reported data, and suggest how these could be mitigated in future research.
- Discussion: While the discussion mentions statistically significant differences (e.g., for Aa,
Ap, C, and D values), it does not consistently report the exact p-values or effect sizes. Include
these details to enhance transparency and allow readers to assess the strength of the findings.
- Discussion: The concluding remarks are vague, emphasizing general prevention and awareness
without proposing concrete next steps for research or clinical practice. Suggest specific
interventions or areas for further investigation to provide actionable insights.
- Discussion: The study's unique contributions are not well-highlighted. Emphasize what
differentiates this study from others, such as the cross-sectional design or focus on pelvic floor
function prior to symptom onset, to underscore its value to the field.