Title: The effectiveness of pelvic floor muscle training on lumbar function and muscle
performance in sedentary women with lower back pain: A randomized controlled trial
Version: 0 Date: 14 Sep 2024
Reviewer's report:
Reviewer(s)' Comments to Author:
General comment:
It is well written in a format that is entirely appropriate. It would be better to write by dividing
paragraphs by keywords in section of Introduction and Discussion. Also, accurate references
would be cited to explain the results of this study, I think it would be a better article.
Detailed comment:
The author seems to have suggested muscle endurance, muscle activation, etc. as lumbar
function. However, these factors are difficult to consider as functions. Therefore, it is
recommended to list each factor in the title or revise it to refer to muscle performance as a
general term.
<Abstract>
Page 2 line 23 to 24: The training group should be specifically expressed as core training group,
and the PFM training group should be specifically named as core training combined with PFM
muscle activation group.
<Introduction>
General comment: Although the necessary content is mentioned overall, the content is continued
without paragraph division, which reduces readability. I recommend rewriting it so that the
main keywords (e.g., LBP, Core muscle training for individuals with sedentary lifestyle, PFM
training) are separated in order and each paragraph is arranged.
In addition, please emphasize the explanation of why PFM exercise is more necessary for
NSLBP patients with sedentary lifestyle in the last paragraph.
Page 4 line 76: Please list lumbar function in more specific items such as muscle endurance,
muscle activation, etc.
Page 4 line 77: Please delete the sentence below.
The conclusions provide fresh insights into core training methods.
<Data and methods>
Page 5 line 85: Is the LBP point a score measured by VAS? If so, please write that it is a score
measured by VAS or pain score.
Page 5 line 90: What criteria do you use to define pelvic floor dysfunction? Please provide
specific details.
Page 5 line 92: The contents of the three groups are described in Table 1. Please describe whether
homogeneity was secured. Also, please write that there was no significant difference in each
item among the three groups in Table 1.
Page 6 line 97: The description of the muscle endurance test method is missing in the evaluation
methods section. Please add more details.
Page 6 line 103~Page 7 line 133: The author confirmed the change in muscle thickness using
ultrasound. The measurement method should be expressed as muscle thickness change ratio or
muscle thickness change rather than muscle activation. Please revise the expressions in the text
and table.
Page 8 line 140-142: In the case of exercise program intervention, it is important how faithfully
the subjects performed the total number of repetitions. Please mention information about the
subjects’ adherence.
Page 8 line 150-152: Was stretching exercise also continuously included in the exercise
program? If so, please also write the contents in Table 2.
Page 9 line 153: How did you confirm and control the contraction of the PFM during the
exercise? Also, please mention the method of educating the patient to perform the PFM
contraction in the manuscript.
<Discussion>
General comment: The author investigated muscle endurance, muscle thickness change, and
pain point. It is recommended that the subheadings be organized accordingly to improve the
readability of the authors.
Page 11 line 208: The author lists the purposes of activation training, dynamic core stability, and
static core stability training included in the exercise program. Please provide evidence for the
stated purpose. For example, in the case of static core stability training, author should be able
to provide evidence that it enhances global muscle performance.
Page 12 line 220: There is evidence that deep muscles can be mobilized through PFM activation,
and that endurance performance can be enhanced by activating deep muscles, which are type 1
muscles. In addition, the design of this study is that Group P added PFM muscle activation to
the exercise program of Group T, so the exercise effects of Group T can be expected in Group P
as well. Therefore, since PFM was not used alone in Group P, I think the author's interpretation
is somewhat unreasonable. Please revise it to interpret it in a different direction.
Page 14 lines 255-257: The author needs evidence (citations) for the interpretation he thinks.
Please suggest an interpretation based on this.
Page 15 line 281: As mentioned earlier, you should accurately confirm the definition of lumbar
function and provide specific variables such as muscle thickness change and pain.
<Table>
Table 1: Please indicate that there is no significant difference in data between groups in the basic
information.
Table 2: Please also indicate in the table that stretching movements are commonly included.
Table 3: Please change the muscle activation section to muscle thickness change. Please also
change the LBP score to pain score.