We were glad to read that Stenberg et al. agree that the “what” specific bias within RoB determined the score of LoE could be expressed more clearly, and we believe this is a valuable first step toward increased research quality, which is also addressed by Stenberg et al. in this letter to the editor. Because it is impossible to always have a low LoE (on simple methodological grounds that all the five topics within RoB would all have a low RoB is a utopia), it can help to know what the specific element within RoB was and what made RoB high, so that new studies can be designed to over come this.