Title: PELVIC FLOOR MUSCLE TRAINING WITH BIOFEEDBACK OR FEEDBACK
FROM A PHYSIOTHERAPIST FOR URINARY AND ANAL INCONTINENCE AFTER
CHILDBIRTH - A SYSTEMATIC REVIEW
Version: 3 Date: 03 Oct 2023
Reviewer's report:
Thank you for the opportunity to read and review the new version of the manuscript. The
researchers addressed most of my previous comments. I have on my first notes that the literature
search was conducted in January 2023 but on this version of the manuscript it was conducted
in September 2022 (Line 119). I am not sure which one is correct as I don’t have access to the
previous version of the paper. If search was conducted in September 2022, an update would be
important.
I maintain my suggestion of following a pattern regarding the use of the terms feedback and
biofeedback. Some information is presented in multiple ways (main text versus objective versus
table 5).
Background – The changes were satisfactory. Lines 84/5 would be better as “Feedback from
a physiotherapist, in PFMT consist of verbal instructions based on vaginal and anal digital
palpation, to ensure a correct contraction (28).”
The objective is better presented in abstract. I would keep the same writing of abstract in here
and I would also add the timeframe to make sure that it is easy for readers to understand that
it is not an review of the published scientific evidence “The objective of this systematic review
was to examine the scientific evidence from 2012 to 2022 regarding the impact of pelvic floor
muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and
anal incontinence in women during the first six months following vaginal delivery, compared
to treatment without feedback.
Methods - The changes made this section easier to read.
Literature search – The authors mention on their point-to-point response that “terms were used in
both American and British English.” However the strategy presented have terms only in British
(e.g. physiotherapy) or in American English (e.g. randomized), not in both.
Line 119/20 would be better as “The systematic literature search was conducted independently
by AH and JS on 30 September 2022 in the databases PubMed, Cochrane, and CINAHL.”
Results – This section need to be more clearly written. The authors replied “the different
biofeedback devices differ in the manufacture but have the same reading of muscle contraction
and give the same feedback according to the manuals. This is clarified at page 11. “The different
biofeedback devices differ in manufacture but not in function.” If they all presented the same
reading of muscle function, which one are being used? EMG? Make this clear through the text.
Or is function referring to the reasoning for using the device?
Please, make sure each measurement and variability are mentioned (table 5)! The column says
that should be “Median (interquartile range)” however that is not what have been presented. The
manner in which data is being presented and without a clear statement on which measurements
and variability are being presented, it seems that it could be possible to pool data as SMD for
UI (44, 46, 48) and AI (43,44,46).
Lines 250/1 not accurate according to table 5. It would be better as “Of the eight studies
included, two studies reported using biofeedback devices only (42,43), two studies reported
using a combination of biofeedback devices and feedback from a physiotherapist (44, 46) while
four reported participants receiving feedback from a physiotherapist (39-41,45).”
Lines 258/9 – was the device used only at home or both (home and clinical settings)?
Line 278 – Significant
Discussion
Line 473 – increase
Line 474 - published