Characterization of Flexor Digitorum Superficialis Muscle Stiffness Using Ultrasound Shear Wave Elastography and MyotonPRO: A Cross-Sectional Study Investigating the Correlation between Different Approaches

Round 1

Reviewer 1 Report

The current work assessed the the capability and effectiveness of sheer wave elastography and MyotonPro in characterization of hand muscle stiffness. The research topic of this work is interesting, however, the language and style of the manuscript should be improved to be suitable for publication. 

1. I wonder how were the references ordered. The references should be ordered numerically (1, 2, 3, 4, ...................) according to the order of their citation in the text.

2. The data in table 1 should be statistically compared (i.e. between males and females) using independent t test.

The language of the manuscript is very poor and should be extensively revised.

Author Response

Dear Reviewer,

Thank you for your comments and suggestions. Please kindly see the attachment.

Best regards,

Phongpan

Author Response File: Author Response.docx

Reviewer 2 Report

Reviewer Comments

Thank you very much for the opportunity to review the manuscript submission entitled: Characterization of flexor digitorum superficialis muscle stiffness using ultrasound shear wave elastography and MyotonPro: a correlation between different approaches.

The purpose of this study is to assess the capability and effectiveness of MyotonPro and SWE for hand muscle stiffness characterization. The study is interesting, and it has a relevant rationale. However, some limitations and constructive comments are pointed out below:

Specific comments

The manuscript requires English editing by native English speakers.

Title and Abstract

·      Include study design in the title

·      Include the mean age along with the SD of the participants.

·      Use MeSH terms as keywords.

Introduction

·      Clearly Explain the scientific background and rationale for the investigation being reported. Research gap?

·      There are a number of sentences without references. For example, you say “Indirect measurements associated with muscle stiffness have been reported.” There is no reference. Similarly, “Manual muscle test is used for 44 functional examinations whereas handheld or isokinetic dynamometer and surface electromyography are applied for 45 measuring muscle force and muscle activity, respectively.” – This sentence has no reference.

·      Ultrasound shear wave elastography (SWE) has been developed for direct measurement of muscle mechanical 52 properties – provide the reference.

·      Recently, MyotonPro (Myoton AS, Estonia) has been purposed as a portable, non-invasive, painless and reliable 62 tool for measuring the mechanical properties of the muscle. It is a hand-held digital palpation device equipped with muscle 63 stiffness measurement function – provide a reference.

·      You say “However, only a few studies reported using MyotonPro to evaluate upper limbs muscles” Why are few studies, not enough? Why do you want to do more studies? Provide what is lacking in their studies and why you are carrying out this study.

·      What is the use or goal of the correlation between the muscle stiffness achieved from two different approaches was investigated. Need to mention this clearly in the introduction.

·      State prespecified hypotheses.

Methods

·      Present key elements of study design early in the paper.

·      Describe the setting, locations, and relevant dates, including periods of recruitment, follow-up, and data collection.

·      Mention the diagnostic criteria clearly.

·      Why were the Participants were excluded from the study if they have BMI greater than 30 kg/m2?

·      Mention the reliability and validity of the MyotonPro measurement and Ultrasound shear wave elastography (SWE) measurements.

·      In 2.3 Study design: except the design you mentioned other things.

·      Describe any efforts to address potential sources of bias.

·      Did not discuss blinding?

·      Is the data normally distributed? You should say data is normally distributed so I am using parametric statistics or data is not normally distributed so I am using non-parametric statistics.

Discussion

·      Discuss the limitations of the study, taking into account sources of potential bias or imprecision.

·      Give a cautious overall interpretation of results considering objectives, limitations, the multiplicity of analyses, results from similar studies, and other relevant evidence.

·      Discuss the generalisability of the study results.

·      Mention the clinical significance of this study.

 

References

·      More than 50 % of your references are older than 5 years. Please update with the recent literature.

 

The manuscript requires professional English editing. 

Author Response

Dear Reviewer,

Thank you for your comments and suggestions. Please kindly see the attachment.

Best regards,

Phongpan

Author Response File: Author Response.docx

Reviewer 3 Report

Thank you for giving me the time to review your manuscript. This manuscript is interesting and scientifically meaningful for considering the Characterization of flexor digitorum superficialis muscle stiffness using ultrasound shear wave elastography and MyotonPro. Regarding the contents, the following revision should be considered.

 

The title should include the study design.

 

The introduction has too many paragraphs and few information regarding research contexts. The author should focus on theory building, the problems, and research question paragraphs. The first to third paragraphs contain mixed contents. The first paragraph should focus on the general information regarding flexor digitorum superficialis muscle stiffness using ultrasound shear wave elastography in international contexts. Moreover, the second and third paragraphs should introduce the flexor digitorum superficialis muscle stiffness issues and the research topic as the theoretical and conceptual framework, including research questions.

 

The introduction should include the research question of this study.

 

There are no descriptions regarding sample calculation in the sample section of the method.

 

The discussion part should be based on paragraph writing. There are too long paragraphs, and they are not friendly for readers.

 

Tables and Figures contain many abbreviations. They should be spelled out under each table and figure.

 

Tables and figures are vague in quality. The authors should replace all of the contents with clearer ones. 

 

This study should describe the limitation of sampling bias, the results' applicability to other settings, and the future investigation in the limitation part.

 

In the conclusion or discussion, the study’s strengths should be focused on international readers.

 

The conclusion should be modest. This study has many limitations and should describe just a possibility.

Author Response

Dear Reviewer,

Thank you for your comments and suggestions. Please kindly see the attachment.

Best regards,

Phongpan

Author Response File: Author Response.docx

Reviewer 4 Report

The manuscript by Tantipoon et al, describes the application of MyotonPro in comparision to Shear wave elastography (SWE), and show the usefulness of MyotonPro in detecting stiffness values of Flexor digitorum superficialis (FDS) during muscle contraction and at rest. 

 

1. The name MyotonPro should be consistently represented throughout the manuscript, eg: Page 4, line 117 and Page 6, line 192. 

2. The resolution of the Figure 3 can be improved. 

NA

Author Response

Dear Reviewer,

Thank you for your comments and suggestions. Please kindly see the attachment.

Best regards,

Phongpan

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors have diligently and comprehensively addressed all of my comments, making this manuscript suitable for publication.

 

NIL

 

Reviewer 3 Report

The manuscript has been considerably improved. I think that this paper is suited for inclusion in our journal.