Reviewer ’s report  
 
Title: Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a 
mixed methods pilot for a randomised controlled trial  
 
Version: 1 Date: 20 Apr 2017  
 
Reviewer: Stephanie Madill  
 
Reviewer's report:  
 
First I wish to thank t he authors for their thorough responses to my earlier comments. Overall I 
think that the manuscript is in very good shape. I do still have a few comments.  
1. The PFMT provided in the study does not qualify as "intense" PFMT. The guidelines quoted 
were deve loped from studies that provided at least weekly supervised PFMT for a minimum 
of 12 weeks. While the provided therapy meets those qualifications for duration, it does not 
for frequency. Please clarify this in the manuscript.  
2. I do not understand how MP is more "holistic" than PFMT. Both are forms of physical 
exercise. I would suggest that the authors refer to the assessment as holistic, and not the 
intervention.  
3. I still disagree with the authors about not including a dire ct measure of urine leakage. I 
absolutely agree that symptom severity does not directly correlate to quality of life; however, 
this study compared the effectiveness of two interventions for reducing urine leakage. 
Therefore, it should have been included in  the outcome measures. I still don't buy the burden 
or not recommended as part of routine clinical assessment arguments. I accept the comments 
from the advisory group; however, part of participating in a study is understanding that there 
is likely to be mo re required of the individual than would be in routine clinical care. This 
needs to be included in calculations of sample size, including the time required to recruit an 
adequate sample. This is an RTC, not a routine clinical assessment and it is inappropr iate to 
apply guidelines for one to the other. If part of your eventual aim is to explain why adding 
MP to PFMT provides more benefit, you must have direct measures of the physiology you 
are trying to improve. This needs to be addressed more thoroughly in the limitations section 
and a measure of leakage and/or of pelvic floor muscle function must be included if a large 
RTC is undertaken.  
4. As you used non -parametric statistics, aggregate results should be presented as median and 
range or interquartile ran ge, not as mean and standard deviation.  
5. Another area that must be addressed more thoroughly in the limitations section is the 
inequality of the two interventions in terms of contact time. If a primary concern is the cost 
of the intervention to the NHS, Chantale Dumoulin has demonstrated the group PFMT is as 
effective as individual therapy, in diverse groups of women. She has also demonstrated that 
participating in group PFMT provides the same sorts of group benefits as were reported by 
the MP group. If a  full RTC is undertaken, the amount and type of contact time must be 
equivalent between groups.  
6. Page 14, Line 21, should read "pelvic floor muscle strength".  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in th e manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in a ny way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding , or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you  can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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