Reviewer ’s report  
 
Title: Physiotherapists' and midwives' views of increased inter  recti abdominis distance and its 
management in women after childbirth  
 
Version: 0 Date: 01 Nov 2019  
 
Reviewer: Philip Teg -Nefaah Tabong  
 
Reviewer's report:  
 
Reviewer Repo rt: How do physiotherapists and midwives in primary healthcare perceive the 
phenomenon of increased inter recti abdominis distance and its management in women after 
childbirth? A focus group study  
 
 
General comment  
 
I wish to thank the authors for undertaking  this study. The subject area is interesting and 
potentially useful. However, there is the need for the authors to thoroughly review the 
manuscript in some areas to improve on flow and scientific soundness. Below are suggestion to 
improve the article:  
 
1. Title: The title is too long and convoluted. It should be reviewed to "Physiotherapists and 
midwives views on increased inter recti abdominis distance and management"  
 
There is no need to add the data collection strategy "focus group discussion. The tone in the 
above suggested topic "views" clearly show it is a qualitative study.  
 
2. Abstract  
 
Methods: The methods should be revised. There is no need to ask research questi on when writing 
an abstract. The authors should rather add the sampling strategy.  
 
Result: the first theme identified is vague. The themes should be written as results clearly 
indicating the findings.  
 
Conclusion: The conclusion has been written as a discus sion. The first two sentences are more 
useful in the results section but not conclusion. The conclusion should be based on perception 
and management.  
 
3. Keyword: The key words should include perception, management.  
 
4. Main manuscript  
 
 * Background  
The fir st sentence here is the exactly the same as introduction in the background. The authors 
should vary the writing style.  
 
It will be important for the authors to add some statistics about the prevalence and proportion 
that seek for health care.  
 
 * Material a nd methods  
 
Design: the authors should indicate the qualitative study design. Phenomenology, narrative, 
grounded theory, case study, historical study, ethnography etc. Although content analysis may 
suffice as qualitative study design in some instance, the use of "content analysis" in the 
manuscript is related to "data analysis". The study is not a content analysis. The authors may 
have adopted content analysis strategy to summarize the data. Focus group discussion is also not 
a qualitative study design, it is data collection strategy. It is important these distinctions are 
clearly emphasized in a qualitative study to improve rigour.  
 
 * Participants  
 
The participants have been clearly described. My main challenge with this section is the use of 
focus group dis cussion when the participants were just sixteen. Individual interviews would have 
been better. No good justification has been given for the use of FGDs. The authors put them into 
four in a group when ideally you need at least 6 members to make it a proper FGD.  
 
In the last sentence in this section, the "focus groups" should be changed "prior to the discussion 
or data collection"  
  
 * Procedure for data collection  
 
Well written  
 
5. Data analysis  
 
Well written  
 
6. Results  
 
The themes identified by the author sho uld be revised to make the manuscript clear. For example 
what does the theme "Ambivalent attitudes towards the phenomenon of increased IRD and its 
significance as a causal factor for functional problems" mean?  
 
In the opening sentence under this theme the authors draws a rather vague conclusion and 
presented it as results. The statement "The participants expressed ambivalence in their views" 
The participant definitely did not expressed ambivalence in their view. This is inference from the 
authors which should be reserved for discussion.  
 
If there were no consensus on whether IRD should be perceived as a condition that require 
medical attention, it should be clearly stated. From my reading of the write -up and illu strated 
quotes, some participants felt IRD does not have psychosocial effects on women whilst others 
feel otherwise. Views may differ across participants in FGD but a good moderator should be able 
to probe to arrive at the norm or consensus which become th e overarching theme. So the authors 
report this as the theme and can also indicate the outliers.  
 
 * Perceived insufficient professional knowledge base for the management of 
increased IRD 
 
Well written  
 
* Lack of inter -professional collaboration and teamwork  in the management of 
patients with increased IRD  
 
Well written  
 
7. Discussion  
 
The discussion is balance. I noticed on page 15 starting from line 29, the authors discussed some 
limitations of the study. It will be important for the authors to introduce a sub -heading 
"limitations".  
 
8. Conclusion  
 
This is repetition of discussion. The authors should conclude based on the findings. The authors 
have challenges because of the way the results have been presented. The strategy they adopted 
makes it difficult to diff erentiate between results and findings of the study. The suggested 
findings of the study are participants were unware and lacked knowledge on IRD and 
management; perceived IRD are not included in training curriculum and the need for 
collaboration in the ma nagement of IRD.  The authors should conclude based on the findings and 
not repeat results in this section.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript 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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing intere sts 
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or l ose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any 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 you r reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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