Reviewer’s report
Title: 
Reliability and Validity of Pelvic Floor Muscle Strength Assessment
Using the MizCure Perineometer
Version: 
1 
Date: 
11 Sep 2020
Reviewer's report:
The paper presented for the review concerns the validation study of MizCure
perineometer. The study is interesting and worth reading. However, there are
some issues that have to be addressed before the publication of the study.
Major remarks.
1. In the abstract please underline that the examine instrument is compared with
a validated tool (Peritron).
2. Conclusions do not reflect the results and should be change e.g. MizCure
perineometer is a validated tool to measure PFN strength in both supine and
standing position in healthy nulliparous women. 
3. The authors should add information on clinical implications of the study
(when and by whom the instrument may be used in the future). That could make
the article more valuable for the readers. 
4. 20 subjects seem rather a small study group. For that reason, the results should
be interpreted with caution. Please add that information to the limitation of the
study. 
5. Line 32 - vaginal examination is a screening method to assess PFM. The
perineometry and ultrasound (but performed be trained sonographer) are the
diagnostic tools. Please deliberate on that in the Introduction noting that there are
different instruments used for perineometry. 
6. Methods - were all women sexually active in the last week/day before the test?
The frequency of sexual activity could influence the results. 
7. Line 172 - Validity - why different test (Pearson and Spearman) were used? I
assume that because non-normality or lack of homogeneity. Please explain that
in the methods section. 
8. Discussion - in first 3 paragraphs are the repetition of the results. Especially
lines 194-205 should be deleted. 
9. Lines 233-234 and 244-245 should be moved to results section. Furthermore
recent publication suggest different cut-off for ICC "Based on the 95% confident
interval of the ICC estimate, values less than 0.5, between 0.5 and 0.75, between
0.75 and 0.9, and greater than 0.90 are indicative of poor, moderate, good, and
excellent reliability, respectively" - see J Chiropr Med. 2016 Jun; 15(2): 155-163
for details. Please use the current recommendation and change the interpretation
of the data in the Discussion section. 
10. Limitation - there are some other limitations: all women had normal BMI and
all were nulliparous. That information should also be added to the limitation
section. 
Minor remarks.
1. Line 141 - please provide the web link for R software.
2. Line 206 - "ICC (1, 1)" - what are the number in brackets?
3. Line 246 - the correlation is "strong" not "high" - please change. 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes