Reviewer's report
Title:Baropodometry on Women Suffering From Chronic Pelvic Pain - a
cross-sectional study
Version: 1Date:1 August 2011
Reviewer: Max Brenner
Reviewer's report:
Reviewer's report
The authors pose the following question: do women with chronic pelvic pain
(CPP) have increased prevalence of antalgic postural patterns? This is a relevant
question, because an antalgic postural pattern could contribute to perpetuation of
the chronic pain syndrome and require specific corrective measures. To answer
this question, the authors designed a cross-sectional case-control study. Controls
were selected from the same population as the CPP patients and were slightly
younger and leaner. Sample size was calculated. The main diagnostic method
used was baropodometric analysis, which identifies abnormalities in step
orientation and support distribution based on how plantar pressures are
distributed. The authors also evaluated patients for postural changes and
collected data to control for confounding variables. Baropodometric patterns of
patients with CPP were similar to those of healthy controls. The authors
concluded that no differences in posture were observed, and raised the
possibility that the tests may have not been sensitive enough to detect slight
postural abnormalities.
- Major Compulsory Revisions
1. The abstract’s conclusion assumes the existence of postural abnormalities in
CPP and prompts to question the sensitivity of baropodometric analysis in
detecting such changes. Has the sensitivity of baropodometry been studied?
Increased emphasis should be given to other postural tests that were done,
especially because they appear to have corroborated the baropodometric results.
2. The discrepancy between the negative findings and the reports in the literature
is clearly noted, but not properly discussed. Was CPP in the studies reporting
postural abnormalities associated with basal conditions other than
endometriosis? Did patients in this manuscript’s cohort have had less severe
CPP than other cohorts in which postural abnormalities have been detected? Did
these patients have less pain or decreased duration of disease? Level of pain
was assessed but not presented in the Results. Was there a correlation between
baropodometric abnormalities and increased CPP severity? Also, were the
patients in pain at the time of the baropodometric study?
3. For the sample size calculation, how were the outcome, prevalence and
expected difference between groups selected/estimated? Was there a pilot
study?
4. The authors state in the Discussion that the control group was meticulously
chosen, but no mention to how these controls were selected is presented in
Methods. It would be interesting to know if the controls were selected based on
sequential patients or any matching criteria. The study group was older and more
obese, making CPP patients more likely to present baropodometric
abnormalities. It would be in the interest of the authors to acknowledge that in the
light of negative results these were actually conservative biases.
5. It is hard to compare prevalence of lumbar pain in both groups. Paragraph 2
describes chronic lumbar pain for the CPP group and bilateral lumbar pain for the
control group, and Table 1 does not include the control group at all.
- Minor Essential Revisions
6. Important elements have been left out of the abstract and should be included
therein: the relevance of the study question, the sample size calculation, and the
evaluation for confounders. The abstracts conclusion should be rewritten to
reflect the manuscripts’ conclusion.
7. Discussion paragraphs 2 and 3 repeat observations made in the introduction.
The authors should try to explain why their findings contrast with previous reports
8. Discussion paragraph 4 is not clearly related to the hypothesis or results.
9. Method’s description of the baropodometric analysis suggests it was
conducted in both static and dynamic positions, but that appears to have not
been the case.
- Discretionary Revisions
10. Readers not familiar with baropodometry may have a hard time
understanding the measurements that were taken to control for confounding
variables. I would be useful to have a few words explaining them in the methods
or the discussion.
- Minor issues not for publication
11. Background paragraph 1: “Therefore” does not make sense; it might be
replaced for “Additionally”.
12. Background paragraph 2: the actual problem (is CPP associated with
postural abnormalities?) should be introduced preferentially in the first paragraph.
“express themselves the normal function of body language” is cryptic (and of
unclear relevance to the papers question) . If an “association was demonstrated”,
it should be referenced; if not, it should read “suggested”. The same goes for
“there is evidence…”
13. Background paragraph 4: skeletical-> skeletal
14. Protocol and Evaluation, paragraph 2: FRS and A/D - unusual abbreviations
not explained. Molar wedge test for asymmetric scapula?
15. Results last paragraph: “evaluation postural” -> “postural evaluation”
16. Discussion paragraph 1: “huge” is an overstatement and should be toned
down
17. Discussion, paragraph 5: “captors” (twice) -> “factors”?
18. Conclusion: the first sentence is inaccurate and should be rewritten. And the
next two sentences reveal the authors’ ambivalence regarding their findings.
These should also be reworded into a more coherent statement.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests