Stepping Forward: A Scoping Systematic Literature Review on the Health Outcomes of Smart Sensor Technologies for Diabetic Foot Ulcers

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

- The paper adds to the subject area by highlighting the benefits of smart technologies in DFU management, such as facilitating care management, improving monitoring, prevention, prognosis, healing rate, and patient adherence. It suggests that these technologies can potentially redefine DFU management by emphasizing accessibility, efficacy, and patient-centricity.

 

- Regarding methodology, the authors could consider providing more details about the search strategy and selection criteria used to identify studies. It could also consider conducting a meta-analysis to quantitatively analyze the outcomes of the studies. Further controls that could be considered include comparing the effectiveness of different types of smart insoles or off-loading devices and evaluating the cost-effectiveness of these technologies. Overall, the paper provides a valuable contribution to the field of DFU management and smart technology use in healthcare.

Additional questions
1. please provide a detailed description: why were specific years of analysis selected?

2. In identification you have 2103 records, minus 51, you have 280 records screened-provide a detailed in Prisma flowchart; add a level?

End comments

Author Response

Manuscript ID: sensors-2799847

 

Type of manuscript: Review

Title: Stepping Forward: A Scoping Systematic Literature Review on the Health Outcomes of Smart Sensor Technologies for Diabetic Foot Ulcers

 

Authors: Ioulietta Lazarou, Vasiliki Fiska, Lampros Mpaltadoros, Dimitris Tsaopoulos, Thanos G. Stavropoulos, Spiros Nikolopoulos, George E. Dafoulas, Zoe Dailiana, Alexandra Bargiota, Ioannis Kompatsiaris

Thank you for the opportunity to revise our manuscript 2799847 entitled: “A Semantic Framework to detect problems in Activities of Daily Living monitored through Smart Home Sensors”. 

 

We greatly appreciate all the constructive comments provided by the Reviewer 1. All have been taken into account in order to strengthen our work. In summary, the revision incorporates changes to address missing information and present in a more clear way the novelty of the study. 

 

It is our belief that the manuscript is substantially improved after making the suggested edits. More specifically, in the following pages, we have included the individual comments made by the reviewers (marked in bold), along with our detailed answers. In addition, for each comment we specifically refer to the parts of the manuscript that have been revised to address the related concerns as suggested. We hope that the reviewers will find our responses (and resulting improvements) satisfying and we would like to express our willingness to incorporate any further suggestions that may derive from this revision

 

Reviewer 1

Comment 1: The paper adds to the subject area by highlighting the benefits of smart technologies in DFU management, such as facilitating care management, improving monitoring, prevention, prognosis, healing rate, and patient adherence. It suggests that these technologies can potentially redefine DFU management by emphasizing accessibility, efficacy, and patient-centricity.

Answer 1: We appreciate the reviewer's recognition of the value our paper adds to the field of diabetic foot ulcer (DFU) management by emphasizing the benefits of smart sensor technologies. We aimed to underline the potential of the suggested technologies in enhancing various aspects of DFU management, including care coordination, monitoring, prevention, prognosis, healing rates, and patient adherence. By emphasizing accessibility, efficacy, and patient-centricity, smart technologies have the potential to redefine the current standards of DFU management. We are encouraged by the reviewer's acknowledgment of this important contribution to the field

Comment 2: Regarding methodology, the authors could consider providing more details about the search strategy and selection criteria used to identify studies. It could also consider conducting a meta-analysis to quantitatively analyze the outcomes of the studies. Further controls that could be considered include comparing the effectiveness of different types of smart insoles or off-loading devices and evaluating the cost-effectiveness of these technologies. Overall, the paper provides a valuable contribution to the field of DFU management and smart technology use in healthcare.

Answer 2: We thank the Reviewer for the comment. While we appreciate the suggestion to conduct a meta-analysis, we have carefully evaluated the feasibility of this approach given the nature of the included studies. Due to significant heterogeneity in study designs, interventions, and outcome measures among the included studies, conducting a meaningful meta-analysis may not be feasible or appropriate at this point. Meta-analyses are typically most effective when the studies included in the analysis are sufficiently homogenous to allow for meaningful comparisons and pooling of data. However, in our systematic review, the diverse nature of the studies and the variability in methodologies may limit the interpretability and reliability of results. Instead, we have opted to provide a narrative synthesis of the findings, which allows us to qualitatively summarize and contextualize the evidence from the included studies. This approach enables us to highlight key trends, common themes, and areas of consensus or divergence among the studies, providing valuable insights into the benefits and challenges of smart technologies in DFU management. We believe that this narrative synthesis approach is more suitable for our review given the diverse range of technologies and outcomes examined across the included studies. By adopting this approach, we aim to provide a comprehensive overview of the current state of the literature while acknowledging the inherent limitations and heterogeneity of the available evidence. Future reviews could consider conducting a meta-analysis for a better interpretation of the study findings and thus we have updated the conclusion section.

{Changes: Conclusion section }

Comment 3: Additional questions
1. please provide a detailed description: why were specific years of analysis selected?

2. In identification you have 2103 records, minus 51, you have 280 records screened-provide a detailed in Prisma flowchart; add a level?

Answer 3: 

1. The specific years of analysis were selected based on the availability of literature relevant to the topic of interest. We aimed to capture the most recent and comprehensive evidence about the use of smart technologies in the management of diabetic foot ulcers (DFUs), particularly considering that smart technologies are relatively recent developments in healthcare, with significant advancements occurring after 2013. By focusing on studies published within a defined timeframe, typically from 2013 onwards, we aimed to ensure that our review reflects the latest developments and advancements in this rapidly evolving field. Additionally, restricting the search to a specific timeframe helps to manage the scope of the review and ensures that the included studies are contemporary and relevant to current clinical practice. We have updated the M&M  section accordingly.
2. We have provided a more detailed Prisma flowchart, including additional information about the screening process as suggested by the Reviewer. Thus, we have revised the flowchart to provide a clearer depiction of the screening process, including the number of records screened at each stage and any exclusions made based on predefined eligibility criteria. Additionally, we have added a level to the flowchart to further delineate the screening process and improve transparency in reporting. Thank you for highlighting this, and we will ensure that the revised flowchart provides a more comprehensive overview of the study selection process.

{Changes: Lines 144-154, Figure 3}

Reviewer 2 Report

Comments and Suggestions for Authors

Please address the following comments:

1- The introduction section is too long. Please summarize this section into three short paragraphs. 

2- Please add more details regarding the literature search strategies used in this study. 

3- Please add DOI identifiers to all cited records and make sure that problematic papers such as retracted records were not cited within the paper. 

4- Please use VOSViewer to analyze your literature search results and add the obtained results in the supplementary files. 

5- In the search strategies section: Instead of the given text, you can use a flowchart to summarize this section. In this way, you can help the academic readers to understand your paper well. 

6- There are some minor typographical errors within the text. Please carefully revise your manuscript text and improve its quality.

7- Please also discuss the challenges of modern technologies for monitoring and diagnosis of diabetes mellitus at the end of your discussion. 

8- There are two concluding sections in this paper. Please rewrite the concluding remarks in a unified paragraph and highlight the major findings of your literature search analyses. 

9- Some of the articles whose findings were summarized in Table 2 have statistical data. Please carefully recheck all selected papers and summarize more details from their contents to add to your Table 2 data. 

10- Optional comment: If it is possible conduct a metanalysis on the gathered data to reach a unified conclusion about the discussed terms

 

Author Response

Manuscript ID: sensors-2799847

 

Type of manuscript: Review

Title: Stepping Forward: A Scoping Systematic Literature Review on the Health Outcomes of Smart Sensor Technologies for Diabetic Foot Ulcers

 

Authors: Ioulietta Lazarou, Vasiliki Fiska, Lampros Mpaltadoros, Dimitris Tsaopoulos, Thanos G. Stavropoulos, Spiros Nikolopoulos, George E. Dafoulas, Zoe Dailiana, Alexandra Bargiota, Ioannis Kompatsiaris

Thank you for the opportunity to revise our manuscript 2799847 entitled: “A Semantic Framework to detect problems in Activities of Daily Living monitored through Smart Home Sensors”. 

 

We greatly appreciate all the constructive comments provided by the Reviewer. All have been taken into account to strengthen our work. In summary, the revision incorporates changes to address missing information and present more clearly the novelty of the study. 

 

We believe that the manuscript is substantially improved after making the suggested edits. More specifically, in the following pages, we have included the individual comments made by the reviewers (marked in bold), along with our detailed answers. In addition, for each comment, we specifically refer to the parts of the manuscript that have been revised to address the related concerns as suggested. We hope that the reviewers will find our responses (and resulting improvements) satisfying and we would like to express our willingness to incorporate any further suggestions that may derive from this revision.

 

Reviewer 2

Comment 1- The introduction section is too long. Please summarize this section into three short paragraphs. 

Answer 1:We appreciate the feedback regarding the length of the introduction section. While we acknowledge the importance of conciseness, we believe that the comprehensive nature of the introduction is essential for providing readers with a thorough understanding of the background, significance, and context of our systematic review. However, we understand the importance of ensuring that the introduction is focused on maintaining reader engagement and clarity.

While we agree that condensing the introduction into three short paragraphs may not capture the depth of the information adequately, we will endeavor to streamline the introduction without compromising the clarity and comprehensiveness of the content. We will carefully revise the introduction section to eliminate any redundant or extraneous details while retaining the essential information necessary to contextualize the study and its objectives effectively.

{Changes: Introduction}

Comment 2- Please add more details regarding the literature search strategies used in this study. 

Answer 2:We thank the Reviewer for the valuable feedback regarding the literature search strategies. We understand the importance of transparency and reproducibility in systematic reviews and meta-analyses. In response to your suggestion, we will provide additional details regarding the literature search strategies employed in our study.

Specifically, we have expanded upon the following aspects of our literature search methodology:

Search terms and keywords: We have provided a comprehensive list of search terms and keywords used to identify relevant studies related to diabetic foot ulcers and smart technologies.

Databases searched: We have specified the databases searched, including PubMed, MEDLINE, Embase, and any other relevant electronic databases.

Inclusion and exclusion criteria: We have carefully clarified the criteria used to select studies for inclusion in our review, including criteria related to study design, population characteristics, intervention types, and outcome measures.

Search dates and time frame: We have provided details regarding the time frame of the literature search, including the start and end dates of the search period.

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Comment 3- Please add DOI identifiers to all cited records and make sure that problematic papers such as retracted records were not cited within the paper. 

Answer 3: We thank the reviewer for the valuable feedback. All citations were individually checked and cited again in the manuscript using Mendeley Reference Manager and Mendeley Cite add-in for Microsoft Word. DOI identifiers were included, the citation format was fixed and wrong citations were corrected. No retracted records or problematic papers in general were identified during this cross-check.

Comment 4- Please use VOSViewer to analyze your literature search results and add the obtained results in the supplementary files. 

Answer: The insightful comment regarding the utilization of VOSviewer in our scoping review is greatly appreciated. We are pleased to inform you that your suggestion has been carefully considered, and our manuscript has been adjusted based on the feedback provided. The integration of VOSviewer for network visualization has indeed enhanced the depth of our analysis, allowing thematic similarities to be discerned, key contributors to be identified, and emerging trends within the literature landscape of smart sensor technologies for diabetic foot ulcers to be illuminated. The adjustments made based on this comment have strengthened the scholarly contribution of our manuscript. Once again, our sincere gratitude is extended for your thoughtful input, which has undoubtedly enriched the quality of our research.

{Changes: Lines:212-244}

Comment 5- In the search strategies section: Instead of the given text, you can use a flowchart to summarize this section. In this way, you can help the academic readers to understand your paper well. 

Answer 5: We thank the Reviewer for the suggestion regarding the search strategies section. While we appreciate the idea of using a flowchart to summarize the search process, we believe that the text-based description provided offers a comprehensive overview of our search methodology. However, to enhance clarity and transparency, we have incorporated a simplified flowchart alongside the textual description to help readers understand our search strategy more effectively. 

Comment 6- There are some minor typographical errors within the text. Please carefully revise your manuscript text and improve its quality.

Answer 6:We thank the Reviewer for the comment. We have thoroughly reviewed the manuscript to identify and correct any typographical errors to ensure its overall quality. 

Comment 7- Please also discuss the challenges of modern technologies for monitoring and diagnosis of diabetes mellitus at the end of your discussion.

Answer 7: We thank the Reviewer for the valuable suggestion. We have included a discussion on the challenges associated with modern technologies for monitoring and diagnosing diabetes mellitus in the concluding part of our discussion section. A comprehensive overview of both the benefits and limitations of utilizing smart technologies in the management of diabetes mellitus has been added in the Discussion section. 

{Changes: Lines 542-566}

Comment 8- There are two concluding sections in this paper. Please rewrite the concluding remarks in a unified paragraph and highlight the major findings of your literature search analyses.

Answer 8: We thank the Reviewer for the constructive comment. We acknowledge the need for a unified conclusion that highlights the major findings of our literature search analyses. In the revised manuscript, we have merged the two concluding sections into a single paragraph to provide a cohesive summary of our key findings. We will aim to emphasize the significance of smart technologies in the management of DFUs. As such, the revised conclusion effectively summarizes the main insights gained from our systematic review and highlights their implications for clinical practice and future research.

Comment 9- Some of the articles whose findings were summarized in Table 2 have statistical data. Please carefully recheck all selected papers and summarize more details from their contents to add to your Table 2 data. 

Answer 9: We thank the Reviewer for the constructive comment regarding Table 2. We have carefully reviewed the selected papers again to extract more detailed statistical data and incorporate it into Table 2. This will enhance the comprehensiveness of our summary and provide readers with a clearer understanding of the findings presented in the selected articles. 

{Changes: Table 2}

Comment 10- Optional comment: If it is possible conduct a metanalysis on the gathered data to reach a unified conclusion about the discussed terms

Answer 10: We thank the Reviewer for the suggestion regarding the possibility of conducting a meta-analysis of the gathered data. While we acknowledge the potential benefits of meta-analysis in synthesizing findings from multiple studies and reaching a unified conclusion, we would like to clarify our approach in this regard. As Reviewer 1 also suggested, due to the heterogeneity of the included studies in terms of study designs, interventions, outcome measures, and patient populations, conducting a meta-analysis may not be feasible or appropriate. Additionally, the primary focus of our systematic review was to provide a comprehensive overview of the current literature on smart technologies in the management of diabetic foot ulcers and to identify trends, gaps, and areas for future research. We have updated the conclusion section accordingly.

{Changes: Lines: 606-617}

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I have no further comments on this paper and it is ready for publication.