Title: Examining the risk factors of chronic pelvic pain and its effect on the quality of life in
refugee and non-refugee women
Version: 2 Date: 13 Jul 2024
Reviewer's report:
I would like to begin by expressing my gratitude to the authors for allowing me the privilege of
reviewing this article. The topic is both interesting and understudied, which makes it a valuable
reference point for future research. Pelvic floor dysfunctions, in particular chronic pelvic pain,
are a prevalent problem, especially among women. However, there is still insufficient knowledge
on this topic in refugee women.
I would be grateful if the authors could provide some clarification on the following point:
1. Introduction:
- The Royal College of Obstetricians & Gynaecologists defines chronic pain as "intermittent or
constant pain in the lower abdomen or pelvis of at least 6 months duration, which does not occur
exclusively with menstruation or sexual intercourse and is not associated with pregnancy". It
would be beneficial to include menopause as a factor in the study, particularly given the age
range of the participants, which extends up to 49 years.
-  It would be beneficial to provide further detail on the negative impact of this condition. While
the authors have outlined the impact on various areas, it would be valuable to gain insight into
how this condition affects the lives of women who experience it. For instance, does it lead to
feelings of embarrassment or social isolation?
2. References and Complementary Studies:
- It would be beneficial to supplement Reference No. 7 with more recent studies. Further
studies have examined the prevalence of this pelvic floor problem, including: Peinado-
Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-
Galiano JM. The prevalence and associated factors of pelvic floor dysfunction. BMC
Public Health. 2023 Oct 14;23(1):2005. doi: 10.1186/s12889-023-16901-3. The following
references are provided for further information:  Peinado-Molina RA, Hernández-Martínez A,
Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction:
prevalence and associated factors. BMC Public Health. 2023 Oct 14;23(1):2005. doi: 10.1186/
s12889-023-16901-3
3. Recruitment:
- Is the selection of women up to the age of 49 years due to a specific reason, or is it because no
women of an older age group attended the aforementioned health centres?
4. Results
5. The results section presents the minimum sample size and provides an estimate of the number
of women. Has this calculation been informed by any previous studies? If this is the case, kindly
provide a reference.
6. Methodology:
- With regard to the instruments employed for data collection, the WHOQOL-BREF and the
DASS-21 are previously validated tools. Nevertheless, with regard to the assessment of chronic
pelvic pain, it is unclear how the question: "Please indicate whether you have experienced
persistent or intermittent pain in the lower abdomen or groin area over the past six months, which
is not associated with menstruation, pregnancy, or sexual intercourse." Please indicate whether
the answer is 'No' or 'Yes'. In other countries, questionnaires are employed to evaluate the
presence and impact of pelvic floor dysfunction, such as the PFDI-20, particularly its subscale
CRADI-8. In the questionnaire used, was the assessment limited to the presence of chronic pelvic
pain, or was its impact also considered?
7. Presentation of results:
- In regard to the results, it is recommended that the text include the format aOR: 95% CI XXX;
XXX-XXX. To illustrate, in the second paragraph: "1.68 times (OR: 1.68)", following Table 1.
- It would be beneficial to highlight statistically significant values in bold within Table 1
and Table 2, accompanied by an explanation in the table footnote. Furthermore, it would be
beneficial to define the terms # and SE. Furthermore, the confounding variables for which the
multivariate analysis is adjusted should be specified in the table footnote.
- In addition, it would be beneficial to reflect all the categories of each variable, rather than only
those who have responded in the affirmative, in Table 2.
8. Discussion:
It would be beneficial for the authors to acknowledge their limitations and strengths during the
discussion. It would also be valuable for them to address any potential biases they may have
had. It is unclear whether they evaluated the subject clinically or only by questionnaire.
9. Bibliography:
It is recommended that the bibliography be updated, as some of the sources are outdated.
Overall, the manuscript addresses a significant and innovative topic, but certain aspects require
further clarification and justification before it can be accepted and published. Thank you for
allowing me to review this work and please let me know if you need any further clarification.