Effects of Focal Muscle Vibration on Gait and Balance in Parkinson Patients: Preliminary Results

Round 1

Reviewer 1 Report

General comments:

Overall, this is a well performed study and well-written manuscript. It provides important clinical findings that potentially add to the literature and would be of interest to clinicians and researchers in this area. Some minor typos and editorial corrections are needed. Some more detail regarding reasoning for the choice of muscles for vibration might also be of interest to readers. The statistical methods and reporting of results need some further clarification but overall are appropriate for this study. Some more discussion about why the authors believe they observed statistical differences in some variables and not others might also be interesting, but not critical. The biggest limitation of the study, being the lack of a control group, is addressed in the limitations section. However, this probably needs to be discussed more thoroughly and certainly acknowledged more in major statements of findings. For instance, in the abstract and in the conclusions section, it should be reiterated that it was a combination of treatments that have resulted in positive outcomes. The way it is written in these sections implies that the improvements are only due to focal vibration. Readers might also have more confidence in the effects being, in part, due to the focal vibration, if similar findings from similar studies were discussed more in the introduction and discussion sections.

 

Specific comments:

Abstract

Line 19: Capitalise ‘t’ at start of the sentence…. “Results: there…”

Lines 19-20: Remove ‘and’ from “…in the and Romberg area….”

Line 21: Capitalise ‘f’ at start of the sentence…. “Conclusions: focal…”

 

Materials and Methods

Line 68: The mean age reported in text here doesn’t match the mean age reported in Table 1. Please clarify or correct.

Lines 94-96: Readers might be interested in a brief statement about why you chose these muscles, specifically. In the introduction you state that …  “focal vibration applied over the cervical and soleus muscles and on quadriceps and paraspinal muscles has shown positive effects”. Considering the important postural role of soleus, readers might wonder why this was not included in your study.

Line 128: Remove ‘the’ from…. “…Tinetti scale was used to assess the gait…”

Line 139: Remove ‘by the’ from…. “…approved by the by the Ethics Committee…”

Lines 145-147: Rewrite sentence… “Subsequently, these were compared through mean and standard deviation (SD) if normally distributed, or median and opposite interquartile range (IQR), where normally distributed, or median and opposite interquartile range (IQR)”. There appear to be typos. Also, considering you had 3 testing times, perhaps a one-way ANOVA should have been performed before paired t-tests. If this was done, please clarify. If not, perhaps justify why only paired t-tests were performed.

 

Results

Lines 158-161: The reporting of P values is confusing. I’m assuming this is for the significant difference between T0 and T1, not at T2, where the P value appears. Please rewrite and clarify.

Table 2: Consider reporting the numerical results only once. Either in text, or in this table, but not both. Wherever reported, it needs to be clearer where the paired differences were. This isn’t apparent in the table. Please clarify.

 

Discussion

Lines 186-187: Please be careful with statements regarding findings that aren’t strongly supported by statistics. “Moreover, a progressive improvement of the Tinetti scores was observed throughout the protocol.” While a slight trend may be present from T1 to T2, the difference is very small. The only significant difference was between T0 & T1. Best to temper statements like these throughout.

 

Conclusions

Lines 231-234: These statements should acknowledge the efficacy of the joint treatments, and not imply that your findings are only due to the focal vibration treatment.

Author Response

Dear revisor, we wish to thank you for your useful comments and suggestion. Below, we provided a list of comments in response to your inquiries.

• We have corrected typing errors
• We have clarified the statistical analysis of our preliminary data
• We have underlined that EVM treatment is associated with conventional rehabilitation
• We have modified the discussion and the conclusion according with your suggestions

Reviewer 2 Report

This article deals with rehabilitation issues of people with Parkinson's disease. The research aim of the article is quite demonstrable and publishable. Unfortunately, its conception within the professional treatment is insufficient. Although the authors demonstrate appropriate erudition in the subject matter, the expertise of the article is very weak. 

 

1. Introduction: in the introduction, the authors rely on a number of publications which, although reflecting the topic, do not bring anything special to the table. From my point of view, they are rather focused on a very general description. The introduction does not highlight any research problem, research objective, etc. I recommend to expand the introduction with a number of scientific studies, to go more into the depth of the given issue. It is therefore advisable to divide the introduction into chapter 1. Introduction and chapter 1.1. theoretical background. The introduction should serve to clearly define the theoretical definition of the issue. I do not find such a connection here. 

2. Materials and Methods: what I am missing here is a flow diagram that will describe the research procedure and a subsequent verbal description of this procedure, as requested in professional sources. I recommend to complete it! I also recommend describing the instruments used and citing them appropriately; the authors present the results of descriptive statistics, i.e. they present MEAN and standard deviation. Then we meet the presentation of p-values. However, this lacks a description of the statistical method, a specific graph expressing the relationship and also the contrasts that were compared. Again, I recommend that this be added.

4. Discussion: this part of the paper gives reasonably good feedback and no major modifications are needed here.

5. Conclusion: again an insufficient chapter. This should be a summary of the findings and the formulation of clear objectives and recommendations for practice. Here there is only some brief mention, which seems very unprofessional. I would also recommend expanding the discussion in the conclusion regarding comprehensive approaches to the diagnosis and the possibility of a number of multidisciplinary collaborations. Suggest to consider the following resources in the conclusion: https://www.webofscience.com/wos/woscc/full-record/WOS:000618092500006 and https://www.webofscience.com/wos/woscc/full-record/WOS:000801505500001

Robotic therapy and holistic rehabilitation are exemplified in the articles. I think this will elevate the conclusion and better articulate the generalized results of your work. 

If the given comments are incorporated, I am subsequently inclined to publish your paper.

 

Author Response

Dear revisor, we wish to thank you for your useful comments and suggestion. Below, we provided a list of comments in response to your inquiries.

• As we mentioned in the introduction section, there are only few studies regarding the use of vibratory energy in Parkinson disease. To the best of our knowledge, we have reported all relevant studies in the literature regarding different types of vibration used in this field.
• We did not provide a flow diagram, because this paper is an observational study that reports only preliminary results of 23 patients affected by Parkinson disease without missing data or “drop out” patients.
• As you suggested we clarified the description of the statistical analysis.
• In the conclusions section, unfortunately at this stage we cannot provide clear “practice recommendations” as these are just a series of preliminary data for which we describe the trend. Specifically, we reported an improvement of dynamic and static balance of 23 patients treated with EVM and conventional physiotherapy. Further and better conclusions will follow after completion of the study when the whole sample of patients will be screened a comparison with a control group will be performed.
• Regarding robotic therapy and holistic rehabilitation, we believe that they are very interesting topics with regard to Parkinson disease however, we would consider them for a different paper or a review as there is little relationship with focal vibration treatment.

Round 2

Reviewer 2 Report

I still find the conclusion insufficient. The authors present the results obtained, which is fine. The paper is rather very basic in its value. I recommend to extend the conclusions.

Author Response

As suggested, we extend the conclusion, in order to specify the integrated and multidisciplinary approach useful in the rehabilitation treatment of patients with Parkinson disease, in which the focal vibration could  be a useful therapeutic tool 

Author Response File: Author Response.docx