LAUSR

We thank Talasz et al for their interest in the IUGA/ICS joint report on terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. We are unsure however, how the authors’ criticisms relate to the terms cited in this report. Talasz et al comment that the report “lacks some relevant and well-established scientific findings pertaining to pelvic floor muscle (PFM) physiology and function, which have accumulated during the past 15 years,” citing the work of Hodges et al, Laycock et al, Rock, and Talasz et al. The authors do not explain how these references would fit into the report and further change the terminology. This Terminology Report was inherently and appropriately a definitional document, collating the definitions of those terms, that is, words used to express a defined concept in a particular branch of study, here terms used in relation to the conservative and nonpharmacological management of female pelvic floor dysfunctions. Emphasis was on comprehensively including those terms in current use in the relevant peer-reviewed literature. The aim was not to explore PFM physiology, nor to make recommendations regarding the level of evidence for any of the terms cited in the document. Terms related to the observation of PFM activity in response to respiration or postural adjustments may be included in the “signs” section, where our report refers to: “Co-ordination: property of movement characterized by the smooth and harmonious action of groups of muscles working together to produce a desiredmotion” and in the “treatment” section: “Coordination training: the ability to use different parts of the body together smoothly and efficiently. Related to PFM training, coordination training means PFM contraction with other muscles or other muscle groups, for example, respiratory muscles,” and similarly for “motor control” and “co-contraction.” Terms related to PFM interventions which appear in contemporary literature were not filtered according to evidence to support their effectiveness, for example, “meditation” and “mindfulness.”A future document may apply a rating system to inform recommendations of evidence-based observations and interventions, which would be based on the hierarchy of levels of evidence. For example, the suggestion from Talasz et al: “Thus, in order to increase PFM strength, expiration is more appropriate, whereas inspiration facilitates PFM relaxation” as a recommendation for a PFM training program, would be evaluated according to the strength of evidence supporting this technique. At this stage, the theory of respiration, posture and the pelvic floor is at the first phase (clinical observation and laboratory studies) of research. To be recommended as an evidence-based intervention, findings from a randomized controlled trial would be required. Hence, at present there is no evidence to change clinical practice based on the findings from these phase one studies. As with other standardization of terminology documents, the working party for this IUGA/ICS joint report group—which becomes the author group—was based initially on application from an open invitation to the membership of both societies, followed by an election of members with appropriate expertise representing different countries, disciplines, and clinical practices. The process of selecting and defining terms involved nine rounds of intense review, discussion, and agreement by consensus. Five experts from different disciplines provided comments (neurology, urology, urogynecology, physiotherapy, and nursing), following which a draft was posted on the ICS website inviting comments from members, and subsequently published. Talasz et al refer to the Messelink et al paper from 2005. Some of the authors of our report were also authors of Messelink et al, and therefore, were familiar with the discussions behind the terms cited in that report. Messelink et al has been cited several times in our manuscript. We agree that the Clinical Assessment paper has been important. However, it also had its limitations. Some of the terms defined at that time were widely discussed and consensus was difficult to reach, for Institution at which the work was performed: Norwegian School of Sport Sciences, Oslo, Norway.