Reviewer’s report
Title: 
Attitudes and Barriers to Pelvic Floor Muscle Exercises of Women with
Stress Urinary Incontinence
Version: 
1 
Date: 
13 Feb 2022
Reviewer's report:
Review: 
Attitudes and Barries to Pelvic floor Muscle Exercises of women with
stress urinary incontinence - BMWH-D-21-00469
Thank you for the opportunity to review this manuscript. 
I would like to
commend the authors for undertaking this research. It is important for our
understanding of the topic to hear the voices of those affected by conditions such
as stress urinary incontinence, particularly from different cultural perspectives. 
Having said that, there are some major areas of concern. 
1. The method of data analysis is not well articulated. 
It appears that a purposive
sampling is used (i.e. the researchers purposively selected participants that could
answer the questions) - which is common when using a Grounded theory
framework, but this is not articulated. 
If this is the case, it is also not clear how
the categories and codes were created, and how the process of iteration was
done, if any particular software was used and if there was a constant comparative
analysis of the data. 
2. There is no detail on the PFMT that was offered to the participants. 
How long
was the training for, what was the dosage of the training, and were the women
examined prior to exercises, able to illicit a correct contraction? 
3. How much contact did the participants have with a health care professional
during their PFMT?
4. At what point after the training were the women invited to participate in the
interview process? 
Although adherence is a major issue for resolution of symptoms of UI, it is
widely acknowledged that dosage of PFMT, how it is delivered, and how
adherence is tracked are key components of success. 
Can the authors please
include some detail in the paper on that. 
While the authors acknowledge that there are some limitations and bias in the
population sampled, it is also a very narrow age range. 
How translatable do the
authors consider these findings to a more general population of women? 
i.e. SUI
is prevalent in younger women particularly post childbirth - this article would be
enhanced by some commentary on that. 
Minor comments:
There is no information on the demographic (other than age) for the participants.
It would be helpful to include a table on POP stage, or other conditions that may
have prompted the initial consultation. 
Although qualitative research papers are typically longer, the discussion could do
with some editing, and perhaps limiting the number of quotes from the
participants. 
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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?
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