Title: Clinical outcomes of a digital musculoskeletal women’s pelvic health program: an
observational, longitudinal study with comparison group
Version: 1 Date: 06 Sep 2024
Reviewer:  Maria Jesus Mena-Iturriaga
Reviewer's report:
General appraisal:
Congratulations to the authors for this relevant research in CPP, as this is a highly prevalent
and relevant dysfunction in patients, affecting their quality of life. The study of digital health
benefits is remarkable, due to the high reach of these types of strategies.
The background, related to CPP's health and economic burden, both in the patients´ sphere and
society's impacts, is well explained. This is allowing to recognize the study topic's relevance.
The methods section needs more specifications in the “Exposures”, and detailing the
measurement times in the follow-up process (see below).
In the results shown in the supplementary material, some table's naming should be clarified.
In the discussion, I highlight the strength of the analysis of study limitations. It clarifies the
elements that authors or other researchers in the field have to consider related to, for example,
study design and sample selection in future studies.
General suggestions, comments, and clarifying requests:
Introduction
- Line 55: I suggest adding the keyword “telerehabilitation”
Methods
- Line 101: In the explanations of the Women’s Pelvic Health Program please provide
information regarding the program duration (from day zero until the discharge; the number of
exercise sessions each patient had to develop in the app).
- Line 115 – 117: Here is the information explaining that the program contained exercise sessions
and reviewing educational articles, but there is no information on how many exercise sessions or
weeks of exercise sessions they had to complete, and no information about the number of papers
need to be read in the education part. It is well explained that participants choose to progress at
their one pace, but is not showing which is the goal to finish.
Methods (Data Sources)
- Line 166-167: To clarify if the 4 and 12 weeks measurements were taken from the beginning
of the digital program, or from the moment they finished the digital women’s pelvic health
program. Again, here appears the need to explain the duration of the program.
Results
- Line 234 – 237: These results are not allowed to confirm which percentage of the sessions
and reading required was developed by the intervention group subjects. (see recommendation
in Lines 115 – 117). To clarify, it is suggested to show the relative and the absolute frequency,
not just the absolute numbers, and to give more details in the methods part.
Supplementary files
- Line 9 – 11: Figure S1. “Unadjusted NPRS scores over time. Results adjusted for age, general
health, employment status, duration of pain, baseline pain, baseline anxiety, baseline depression,
healthcare service use, and time as fixed effects.”
Please review the “Figure 1” name. More precise information is needed in naming the figure. It
represents the unadjusted scores for both groups over time?  Or the figure represent the adjusted
scores?
- Line 19 – 21: Same recommendation
- Line 26 – 28: Same recommendation
- Line 36; Table 4: In the first column to the left, the third row says “intervention” and the fifth
row says “weeks”. In the same column, in row number 9, it says again “intervention”, but with
“*weeks”. Please clarify, because the asterisk meaning is not clarified.
- Line 39: Same commentary for Table 5 as for Table 4 (read Line 36 comments).
- Line 43: Same commentary for Table 6 as for Tables 4 and 5 (read Line 36 comments).