Injuries in French High-Level and National-Level Women Artistic Gymnastics: One-Year Prevalence and Associated Factors
, Joris Chapon 1, Jeanne Tondut 1,7 and Pascal Edouard 1,2,3,*
Round 1
Reviewer 1 Report
Comments to authors: Manuscript ID: applsci-2528132
Title: Injuries in Women Artistic Gymnastics in France: prevalence and associated factors
_____________________________________________________________________________
General
This manuscript has several purposes: 1) to determine the one-year prevalence of injuries and their characteristics, 2) to analyze potential injury risk factors, and 3) to explore the mental health in gymnastics, in a cohort of elite women artistic gymnasts. This is a relatively large study with a solid sample, but with the disadvantage of a retrospective design. The study is conducted both as an investigation and analyzation study of injury prevalence and risk factors but also as an exploratory study. In my opinion there are too many variables conducted. For example, what is the reason for investigating COVID vaccination, disgust or type of residence? It seems like the authors have gone data dredging and misused data analysis to find patterns in data that can be presented as statistically significant, thus dramatically increasing and understating the risk of false positives. It is not valid research to conduct a study, collect lots of data about lots of variables, and then claim significance because some of the variables seem to be associated.
I suggests a major revision and with removal of the all data not related to the first and second aim of the study.
In addition, there are some other issues that are problematic. First, there are no clear rationale, provided in the Introduction section. Second, the Method section lacks information regarding the Mental health instrument and some new information are provided that is not related to the aim (such as questions regarding COVID and life style). Lastly, the manuscript suffers from not being well written and should be reviewed by an expert in the English language. It has several language mistakes, including grammatical and aiming errors, in addition to incoherently and confusing sentences. Past and present tense are also mixed.Due to the mentioned shortage of the content of this manuscript, just a few specific and general comments are given. Needless to say, this manuscript needs a major re-work.
Specific comments
Abstract
General comments
This section has to be re-written after the whole manuscript is revised. Please be sure that methods are described and results are given for every aim.
Introduction
General comments
Please provide a clear rationale to why this study was made at the end of the Introduction.
The Introduction sections is not well written and are sometimes written in spoken language. In addition, there are some strong statements that only have one or a few references.
For example, on page 4, second paragraph, the authors states: “Whatever the levels and structures of activity, WAG leads to injury risk.” Please add references to this statement.
Another example, next sentence: “Indeed, Gymnastics is known as one of the most injury-provider sport [2].” Please add more references and from prospective studies as well.
Methods
General comments
In the Method section, new information are given that are not related to the aim such as health status and social life. Also, information regarding data collection of injury characteristics, including type of characteristics, is lacking. In addition, the section lacks information regarding the Mental health instrument. The authors have given a reference to the instrument but the instrument (SMHAT-1) used needs to be stated in the Method section. Yet, the instrument used in the present study are not exactly the same as the SMHAT-1 that are referred to. For example, there are no questions regarding “low morale” and “feeling empty following a prevention program”. Why were these questions asked? What is the rationale for these questions? Also, the Likert scale is not according to SMHAT-1 for some items and the instruments’ questions are valid to athletes’ feelings over the past 30 days and not over 12 months. Another concern, was the instrument translate to native language? Obviously, the authors need to clearly provide the reader with information regarding the instrument used. However, I suggest that all of the data regarding mental health, some health status variables and life style questions are removed.
Specific comments
Page 7, “participants”. Please provide the exclusion criteria.
Page 9, last paragraph: “we only included as independent variables those being significant”. Which were? Is there more independent variables besides injury?
Results
General comments
This section includes repetitions of data. Text and table must complement, and not repeat, each other. Another concern refers to the question regarding regular periods. The youngest gymnasts were 9 years old. Thus, most likely had not entered the pubertal stage and had not had the onset of menstruation. How did the authors deal with this issue? Further, what injuries were classified as “joint injury” in addition to ligament and/or bone injury? In addition, what is the definition of a “growth injury”?Discussion
General comments
In general, a more detailed discussion must be provided for the results, all the results (health status, nutrition, all injury characteristics etc) and discussed in relation to previous investigation to enhance the interpretation of data. In addition, the limitations of the study must also be discussed more thorough and any steps taken to minimize the risk of recall bias etc.
Comments for author File: 
Comments.pdf
in the English language. It has several language mistakes, including grammatical and
aiming errors, in addition to incoherently and confusing sentences. Past and present tense
are also mixed.
Author Response
REVIEWER #1
Ms. Ref. No.: applsci-2528132
Title: "Injuries in Women Artistic Gymnastics in France: prevalence and associated factors"
Applied Sciences
Revised Manuscript: Revision #1
Comments to authors:
General
REVIEWER #1: This manuscript has several purposes: 1) to determine the one-year prevalence of injuries and their characteristics, 2) to analyze potential injury risk factors, and 3) to explore the mental health in gymnastics, in a cohort of elite women artistic gymnasts. This is a relatively large study with a solid sample, but with the disadvantage of a retrospective design. The study is conducted both as an investigation and analyzation study of injury prevalence and risk factors but also as an exploratory study.
AUTHORS’ RESPONSE: We would like to thank the reviewer for taking his/her time to review our manuscript and provide these comments, which help to improve our present manuscript, and to see some interest in our manuscript for Sports Medicine Research community.
REVIEWER #1: In my opinion there are too many variables conducted. For example, what is the reason for investigating COVID vaccination, disgust or type of residence? It seems like the authors have gone data dredging and misused data analysis to find patterns in data that can be presented as statistically significant, thus dramatically increasing and understating the risk of false positives. It is not valid research to conduct a study, collect lots of data about lots of variables, and then claim significance because some of the variables seem to be associated.
AUTHORS’ RESPONSE: We do agree that there are lot of data collected, as it was in the study from Jederstrom et al. 2021. Our study aimed to explored injury risk factors in a more exhaustive way that it has been previously done. However, we want to reassure the reviewer about our aim with the data analysis. Given the numerous variables, we did not include all the variables in the multivariable analysis, which could have been relevant clinically given the potential interactions between these variables in the real life, but would have clearly lead to a statistical analytical bias given the ratio between participants and variables. Therefore, we first performed an univariate analysis. In addition, given the number of analyses, we took caution in the interpretation, and we did not go too deep into interpretation and practical implications, as we are aware about the limit of this study.
REVIEWER #1: I suggests a major revision and with removal of the all data not related to the first and second aim of the study.
AUTHORS’ RESPONSE: According to the reviewer comment, we only kept in the study aim the first and second aim. However, as mental health represents an important topic in Sports and Exercise medicine, and could play a role in the injury risk, we do prefer to keep the presentation of these data.
REVIEWER #1: In addition, there are some other issues that are problematic. First, there are no clear rationale, provided in the Introduction section. Second, the Method section lacks information regarding the Mental health instrument and some new information are provided that is not related to the aim (such as questions regarding COVID and life style). Lastly, the manuscript suffers from not being well written and should be reviewed by an expert in the English language. It has several language mistakes, including grammatical and aiming errors, in addition to incoherently and confusing sentences. Past and present tense are also mixed. Due to the mentioned shortage of the content of this manuscript, just a few specific and general comments are given. Needless to say, this manuscript needs a major re-work.
AUTHORS’ RESPONSE: We would like to thank the reviewer for highlighting these issues, we rewrote the introduction, we improved and provided link to the questionnaire to help better understand the methods, and the manuscript has been corrected by a native English speaker.
Specific comments
Abstract
General comments
REVIEWER #1: This section has to be re-written after the whole manuscript is revised. Please be sure that methods are described and results are given for every aim.
AUTHORS’ RESPONSE: This has been done.
Introduction
General comments
REVIEWER #1: Please provide a clear rationale to why this study was made at the end of the Introduction. The Introduction sections is not well written and are sometimes written in spoken language. In addition, there are some strong statements that only have one or a few references. For example, on page 4, second paragraph, the authors states: “Whatever the levels and structures of activity, WAG leads to injury risk.” Please add references to this statement. Another example, next sentence: “Indeed, Gymnastics is known as one of the most injury-provider sport [2].” Please add more references and from prospective studies as well.
AUTHORS’ RESPONSE: The introduction has been rewritten to better support the study rational and aim.
Methods
General comments
REVIEWER #1: In the Method section, new information are given that are not related to the aim such as health status and social life. Also, information regarding data collection of injury characteristics, including type of characteristics, is lacking. In addition, the section lacks information regarding the Mental health instrument. The authors have given a reference to the instrument but the instrument (SMHAT-1) used needs to be stated in the Method section. Yet, the instrument used in the present study are not exactly the same as the SMHAT-1 that are referred to. For example, there are no questions regarding “low morale” and “feeling empty following a prevention program”. Why were these questions asked? What is the rationale for these questions? Also, the Likert scale is not according to SMHAT-1 for some items and the instruments’ questions are valid to athletes’ feelings over the past 30 days and not over 12 months. Another concern, was the instrument translate to native language? Obviously, the authors need to clearly provide the reader with information regarding the instrument used. However, I suggest that all of the data regarding mental health, some health status variables and life style questions are removed.
AUTHORS’ RESPONSE: This was an exploratory analysis, therefore we only chose some parameters and questions for each domain, and we do not use valid but more complex questionnaires to explore/analyse each domain. As mental health represents an important topic, we think that this is important to keep such information to promote future studies.
Specific comments
REVIEWER #1: Page 7, “participants”. Please provide the exclusion criteria.
AUTHORS’ RESPONSE: There were no exclusion criteria, this has been added in the manuscript.
REVIEWER #1: Page 9, last paragraph: “we only included as independent variables those being significant”. Which were? Is there more independent variables besides injury?
AUTHORS’ RESPONSE: These variables are known after analyses and are thus presented in the Table 1. These are the variables with significant association with injury after the univariate analysis.
Results
General comments
REVIEWER #1: This section includes repetitions of data. Text and table must complement, and not repeat, each other. Another concern refers to the question regarding regular periods. The youngest gymnasts were 9 years old. Thus, most likely had not entered the pubertal stage and had not had the onset of menstruation. How did the authors deal with this issue? Further, what injuries were classified as “joint injury” in addition to ligament and/or bone injury? In addition, what is the definition of a “growth injury”?
AUTHORS’ RESPONSE: We do agree with the reviewer that there are some repetitions in the results part. However, since the Table 1 is long, we chose to present a summary of the main findings in the text. The Table 1 is very long. However, it provides the main results of the present study, it helps to understand the methods by presenting the different parameters collected by the questionnaire. We think that this is better to keep it in the main manuscript. However, we let the Editor in Chief decide.
Regarding menstruation, this was an explorative study. The variable can be correlated with the age, but none of these two variables were included in the multivariable analysis.
The injuries were self-reported by the gymnasts, based on their souvenirs, they could have been helped by their parents, or looked at their medical files. There is indeed a risk of recall bias which has been acknowledge in the limitations section.
Discussion
General comments
REVIEWER #1: In general, a more detailed discussion must be provided for the results, all the results (health status, nutrition, all injury characteristics etc) and discussed in relation to previous investigation to enhance the interpretation of data. In addition, the limitations of the study must also be discussed more thorough and any steps taken to minimize the risk of recall bias etc.
AUTHORS’ RESPONSE: We do agree with the reviewer about the interest of a deeper interpretation and discussion. However, given the methodological limitations mentioned by the reviewers and in our manuscript, we do prefer not to go deeper into interpretation.
Author Response File: Author Response.pdf
Reviewer 2 Report
Injuries in Women Artistic Gymnastics in France: prevalence and associated factors
The aims of this study were:
1) to determine the one-year prevalence of injuries and their characteristics,
2) to analyze potential injury risk factors, and
3) to explore the mental health in gymnastics, in a cohort of purportedly elite France’s women artistic gymnasts (WAG).
Major concerns:
- Firstly, when submitting a manuscript for review with intention of a publication, the format of the manuscript should be optimal and done for the ease of the reviewer. For example, there should page numbers and continuous line numbers throughout the manuscript. With line numbers, it allows the reviewer to point-out exactly where are the changes required with ease. With the current manuscript format where there are no page number and no line numbers – the reviewer will have difficulty highlighting to the authors the changes are required, especially if there are many like this one! This means a very laborious cumbersome process to inform the authors where exactly the changes required – and a very time-consuming and not really productive effort. Please include the page and line numbers in your revised version of the manuscript!
- The overall English sentences throughout the manuscript need to be improved substantially. I will highlight some of them – but please get someone suitable to read-proof the written English in the present manuscript!
- I have issue on the use of the term “elite” in this paper. I don’t it is appropriate here. I doubt all of the 88 gymnasts are really elite. I would think “high-performing“, or “national-level” and/or “well-trained” are a much more appropriate terms in this paper. Please refer to the recent published paper that provides a more accurate term of “elite” and other classifications.
- McKay AKA, et al. Defining training and performance caliber: A participant classification framework. International Journal of Sports Physiology and Performance 2022; 17(2), pp317-331. https://doi.org/10.1123/ijspp.2021-0451.
- “The gymnasts filled the questionnaire themselves. We didn’t ask parents supervision even for young gymnasts for answering the questionnaire.” Is this ethical acceptable that minors (children below the age of 18 y) are allowed to do this? And are researchers allowed to collect data from minors with the parents’ consent? In my country, researchers need to seek permission from parents to collect data from their children. Please provide evidence or justification that your ethics board has indeed approved this manner of data collection in minors.
- As mentioned by the authors, how do you ensure that minors understand the questions that were asked of them and they were able to provide accurate information. For example, the question on “puberty” – how do the child know what stage of puberty is he or she is in??
- Table 1 should be placed as Appendix or supplementary data – too long to be put in the paper as main text.
- “Therefore, better understanding of what is currently done and co-construction of improved injury prevention program and approach is clearly needed.
Finally, mental health of elite women artistic gymnasts must be better explored, and elite women artistic gymnasts must be cared appropriately.”
These are what I called “fatherhood” statements. They are pretty obvious and not difficult to comprehend and it nothing new and really stating the obvious and not adding value to your research findings. To me, at least, and after reading your manuscript, the more important one is what can you gleaned from the results of your study that are novel and new. As an example, suppose you hypothetically observed that younger gymnasts had more injury that older ones – okay this is good – what is the implications here. Another example, what is the ‘threshold of training hours’ that seem to link closer to higher injury risk – can your study able to tease out this information? And many more. Please have a think about what are mentioned here. It will make your study ‘richer’ in useful info and invaluable to training and competing in WAG.
-
Minor issues:
- Throughout the manuscript. Do not use numbers at the start of a sentence. If required, then write the numbers out.
- “participants of the research” change to “co-investigators of the research”.
- “august” change to August”
- “divide” change to “dividing”
- “included gymnast” to “participating gymnasts”
- What is “laterality”?
- What is “level before season 2020-2021”? please clarify
- Same for “school adaptation” – what exactly are you asking of the participants.
- What is “time spent sit or lay”? Very awkward term, please change.
- These terms are obvious not clear in their meaning “feeling empty” and “disgust”.
- “having COVID” change to “infected with Covid”.
- “asking to gain or lose weight” to “forced or compelled to gain or lose weight”
- What is “Departemental”?
- “no study” – no such English term!
- “injury type was the ligament” – what is happening to the ligament – is it tearing, broken or what?
- What is “MODY diabete”? Have not seen this word ever before.
- Who is this “someone of the staff”? I know what you trying to say but be specific. Something like “a staff member supporting the athlete training, for example could be the coach, sport scientist or medical team”.
- “This could be explained ….” What is “This”?
- This sentence is really unclear – and I don’t understand what you are trying to say. “But we had chosen to collect and analyse injuries that were responsible of substantial time-loss, because a lot of gymnasts had to train with pain or injury (83% according to Marini et al. [23]) and we would like to collect ‘relevant’ injuries” Please get someone to help you write better.
- Should be “locations”
- This sentence is like “hanging” in mid-air without any clear meaning - “These percentages were 14.6% and 31.8%, respectively, according to Kolt et al. [8], and 10.3% and 17.9%, respectively for Kerr et al. [4].”
- “we did not report” is better if you say “we did not observe”.
- “syndrome” should be spelled “syndrome”.
- “our result reported” is better written as “our result showed”.
- Change “.. or not well-performed” to “not performed according to the prescribed instructions due to the lack of close supervision”.
- This sentence, “The gymnasts who followed a prevention program were in majority in the national training centers (97.4% of national training center gymnasts followed a prevention program) and had a higher number of hours of training.” change to “The majority of gymnasts who followed a prevention program were in the national training centers (97.4% of national training center gymnasts followed a prevention program) and/or they have had a higher number of hours of training.”
- Change “We thus suggest interpreting these results with caution, and better paying attention to the current injury prevention program, improving them, and carefully managing each injury” to something like “Readers should interpret these results with caution, and we recommend that coaches and athletes to focus their attention on the current injury prevention program by managing their injury closely and putting in effort to improve the rehabilitation programme”.
- Change “Mental health disorders could have a negative impact during and after the career [16] to “Mental health disorders could have a negative impact during and even after the end of their sporting career [16]”.
- Change “surfer” to “suffer”. Delete the “a”.
- Delete this sentence “We did not had access to the medical files for precise diagnosis.” because no one can have access to these files except the athletes themselves and their medical doctors!
- Change “Younger gymnasts had 9 years old, and we cannot omit that there would have been some difficulties to understand the questions” to “Some of the participants are 9 y old or younger and it is admitted that they might encountered some difficulties in understanding the questions of the survey”.
- Change “The evaluation of mental health with a score could have been useful in order to quantify and compare the status between the gymnasts and the prevalence of gymnasts suffering with mental health symptoms” to “The evaluation of mental health with an objective score could have been useful in order to quantify and compare the status between gymnasts suffering with mental symptoms and those who are not”.
- What is “code of points”? please clarify when you use new terms – you cannot expect all readers to gymnastic-trained!
- “in training” rather than “on training”.
- Change “In that way” to “Thus,”
- What is this “…on bars…”? Please do your due diligence to check every sentence.
- ASPC and IOC. Both need to written out in full before using the acronyms.
- Change “large amount of questions” to “high number of questions” or ‘numerous questions”.
- Reference 15 is incomplete. Please re-write.
- “17 times their bodyweight during”
- Change “A majority of gymnasts had to deal with injury and miss training or competition in relation with injury (70.5%) when the competition and performance are the main goal of elite gymnasts” to “Within a year, majority (70.5%) of French WAGs would have suffered an injury and had to miss training or competition.” The conclusion statements are very vague and seems too generic and did not really make use of the obtained results of the survey, please re-write.
Please see the amendments required under Minor issues.
Author Response
REVIEWER #2
Ms. Ref. No.: applsci-2528132
Title: "Injuries in Women Artistic Gymnastics in France: prevalence and associated factors"
Applied Sciences
Revised Manuscript: Revision #1
Comments to authors:
AUTHORS’ RESPONSE: We would like to sincerely thank the reviewer for taking his/her time to review our manuscript and to provide these helpful and constructive comments, which helped us to improve our present manuscript, as well as to see some interest in our manuscript for Sports Medicine Research community.
Major concerns:
- REVIEWER #2: Firstly, when submitting a manuscript for review with intention of a publication, the format of the manuscript should be optimal and done for the ease of the reviewer. For example, there should page numbers and continuous line numbers throughout the manuscript. With line numbers, it allows the reviewer to point-out exactly where are the changes required with ease. With the current manuscript format where there are no page number and no line numbers – the reviewer will have difficulty highlighting to the authors the changes are required, especially if there are many like this one! This means a very laborious cumbersome process to inform the authors where exactly the changes required – and a very time-consuming and not really productive effort. Please include the page and line numbers in your revised version of the manuscript!
AUTHORS’ RESPONSE: We are totally sorry, we do not know why there are some important trouble in the word format (some words were attached together and the number of pages disappeared). We did our best to correct that. Regarding the line numbers, this was not required by the journal, but we totally agree with the reviewer that this is of interest and we included it. Again, we would like to sincerely thank the reviewer for taking his/her time to review our manuscript and to provide these helpful and constructive comments, although the document was not easy to read.
- REVIEWER #2: The overall English sentences throughout the manuscript need to be improved substantially. I will highlight some of them – but please get someone suitable to read-proof the written English in the present manuscript!
AUTHORS’ RESPONSE: The manuscript has been read and corrected by a native English speaker.
- REVIEWER #2: I have issue on the use of the term “elite” in this paper. I don’t it is appropriate here. I doubt all of the 88 gymnasts are really elite. I would think “high-performing“, or “national-level” and/or “well-trained” are a much more appropriate terms in this paper. Please refer to the recent published paper that provides a more accurate term of “elite” and other classifications. McKay AKA, et al. Defining training and performance caliber: A participant classification framework. International Journal of Sports Physiology and Performance 2022; 17(2), pp317-331. https://doi.org/10.1123/ijspp.2021-0451.
AUTHORS’ RESPONSE: In order to avoid any misunderstanding we removed the term elite and we used the term “high-level” for gymnasts from national centers and the term “national-level” for gymnasts from TOP 12 clubs.
- REVIEWER #2: “The gymnasts filled the questionnaire themselves. We didn’t ask parents supervision even for young gymnasts for answering the questionnaire.” Is this ethical acceptable that minors (children below the age of 18 y) are allowed to do this? And are researchers allowed to collect data from minors with the parents’ consent? In my country, researchers need to seek permission from parents to collect data from their children. Please provide evidence or justification that your ethics board has indeed approved this manner of data collection in minors.
AUTHORS’ RESPONSE: For such type of study in France, the participants, and their parents (or authority) if participants are lower than 18 years old, must be informed about the study. There is no need of consent from participants or their parents. Accordingly, we informed the participants and their parents: “A written information letter about the study objective and modality was included at the beginning of the questionnaire for the gymnasts and theirparents (especially for the under 18 years old gymnasts).”.
- REVIEWER #2: As mentioned by the authors, how do you ensure that minors understand the questions that were asked of them and they were able to provide accurate information. For example, the question on “puberty” – how do the child know what stage of puberty is he or she is in??
AUTHORS’ RESPONSE: We do agree with the reviewer. Parents could have helped to complete the questionnaire: “The gymnasts had to fill the questionnaire themselves, no supervision was asked but parents were allowed to help, especially for young gymnastics.”. But this indeed represents a limit that we mentioned in the limitations section: “Some of the participants are young and it is admitted that they might encountered some difficulties in understanding the questions of the survey”.
- REVIEWER #2: Table 1 should be placed as Appendix or supplementary data – too long to be put in the paper as main text.
AUTHORS’ RESPONSE: We do agree with the reviewer that the Table 1 is very long. However, it provides the main results of the present study, it helps to understand the methods by presenting the different parameters collected by the questionnaire. We think that this is better to keep it in the main manuscript. However, we let the Editor in Chief decide.
- REVIEWER #2: “Therefore, better understanding of what is currently done and co-construction of improved injury prevention program and approach is clearly needed.
Finally, mental health of elite women artistic gymnasts must be better explored, and elite women artistic gymnasts must be cared appropriately.” These are what I called “fatherhood” statements. They are pretty obvious and not difficult to comprehend and it nothing new and really stating the obvious and not adding value to your research findings. To me, at least, and after reading your manuscript, the more important one is what can you gleaned from the results of your study that are novel and new. As an example, suppose you hypothetically observed that younger gymnasts had more injury that older ones – okay this is good – what is the implications here. Another example, what is the ‘threshold of training hours’ that seem to link closer to higher injury risk – can your study able to tease out this information? And many more. Please have a think about what are mentioned here. It will make your study ‘richer’ in useful info and invaluable to training and competing in WAG.
AUTHORS’ RESPONSE: We would like to thank the reviewer for this relevant comment. The conclusion has thus been rewritten and simplified. We do agree that our study can provide lot of information. However, given the methodological limitations mentioned in our manuscript, we do prefer not to go deeper into interpretation.
Minor issues:
- REVIEWER #2: Throughout the manuscript. Do not use numbers at the start of a sentence. If required, then write the numbers out.
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: “participants of the research” change to “co-investigators of the research”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: “august” change to August”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: “divide” change to “dividing”
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: “included gymnast” to “participating gymnasts”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: What is “laterality”?
AUTHORS’ RESPONSE: Laterality corresponded to the preferred side for writing. As it has not been analysed in the present study, this has been removed from the methods and table 1.
- REVIEWER #2: What is “level before season 2020-2021”? please clarify
AUTHORS’ RESPONSE: This was the level of performance during the 2019-20 season, this has been changed in the manuscript
- REVIEWER #2: Same for “school adaptation” – what exactly are you asking of the participants.
AUTHORS’ RESPONSE: It corresponds to the potential flexibility of the school organisation. This has been explained in the manuscript.
- REVIEWER #2: What is “time spent sit or lay”? Very awkward term, please change.
AUTHORS’ RESPONSE: This has been changed by “sedentary time”.
- REVIEWER #2: These terms are obvious not clear in their meaning “feeling empty” and “disgust”.
AUTHORS’ RESPONSE: We are sorry that the terms were not clear enough, however these corresponds to what we what to deal with: emotion/feeling of disgust and emptiness, and it was validated by the native English speaker.
- REVIEWER #2: “having COVID” change to “infected with Covid”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: “asking to gain or lose weight” to “forced or compelled to gain or lose weight”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: What is “Departemental”?
AUTHORS’ RESPONSE: This corresponds to the local level. This has been changed throughout the manuscript.
- REVIEWER #2: “no study” – no such English term!
AUTHORS’ RESPONSE: The term has been removed.
- REVIEWER #2: “injury type was the ligament” – what is happening to the ligament – is it tearing, broken or what?
AUTHORS’ RESPONSE: Unfortunately we do not have this level of information. We only know that the injured tissue was the ligament.
- REVIEWER #2: What is “MODY diabete”? Have not seen this word ever before.
AUTHORS’ RESPONSE: The term has been removed.
- REVIEWER #2: Who is this “someone of the staff”? I know what you trying to say but be specific. Something like “a staff member supporting the athlete training, for example could be the coach, sport scientist or medical team”.
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: “This could be explained ….” What is “This”?
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: This sentence is really unclear – and I don’t understand what you are trying to say. “But we had chosen to collect and analyse injuries that were responsible of substantial time-loss, because a lot of gymnasts had to train with pain or injury (83% according to Marini et al. [23]) and we would like to collect ‘relevant’ injuries” Please get someone to help you write better.
AUTHORS’ RESPONSE: This has been rewritten: “However, high proportion of gymnasts are training with pain or injury (83% according to Marini et al. [23]). Consequently, a time-loss injury definition could underestimate the extend of the injury problem in WAG. Therefore, we collected injuries leading to limitation or interruption of the gymnastics activity [18], in order to try to collect the most ‘relevant’ injuries.”.
- REVIEWER #2: Should be “locations”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: This sentence is like “hanging” in mid-air without any clear meaning - “These percentages were 14.6% and 31.8%, respectively, according to Kolt et al. [8], and 10.3% and 17.9%, respectively for Kerr et al. [4].”
AUTHORS’ RESPONSE: This has been rewritten: “Caine et al. [5] found that the knee corresponds to 10.9% of all injuries and 12.0% for the ankle. Kolt et al. [8] reported that the knee injuries represented 14.6% of all injuries and ankle 31.8%. And Kerr et al. [4] reported that the knee injuries represented 10.3% of all injuries and ankle 17.9%.”.
- REVIEWER #2: “we did not report” is better if you say “we did not observe”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: “syndrome” should be spelled “syndrome”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: “our result reported” is better written as “our result showed”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “.. or not well-performed” to “not performed according to the prescribed instructions due to the lack of close supervision”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: This sentence, “The gymnasts who followed a prevention program were in majority in the national training centers (97.4% of national training center gymnasts followed a prevention program) and had a higher number of hours of training.” change to “The majority of gymnasts who followed a prevention program were in the national training centers (97.4% of national training center gymnasts followed a prevention program) and/or they have had a higher number of hours of training.”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “We thus suggest interpreting these results with caution, and better paying attention to the current injury prevention program, improving them, and carefully managing each injury” to something like “Readers should interpret these results with caution, and we recommend that coaches and athletes to focus their attention on the current injury prevention program by managing their injury closely and putting in effort to improve the rehabilitation programme”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “Mental health disorders could have a negative impact during and after the career [16] to “Mental health disorders could have a negative impact during and even after the end of their sporting career [16]”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “surfer” to “suffer”. Delete the “a”.
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: Delete this sentence “We did not had access to the medical files for precise diagnosis.” because no one can have access to these files except the athletes themselves and their medical doctors!
AUTHORS’ RESPONSE: This has been removed
- REVIEWER #2: Change “Younger gymnasts had 9 years old, and we cannot omit that there would have been some difficulties to understand the questions” to “Some of the participants are 9 y old or younger and it is admitted that they might encountered some difficulties in understanding the questions of the survey”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “The evaluation of mental health with a score could have been useful in order to quantify and compare the status between the gymnasts and the prevalence of gymnasts suffering with mental health symptoms” to “The evaluation of mental health with an objective score could have been useful in order to quantify and compare the status between gymnasts suffering with mental symptoms and those who are not”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: What is “code of points”? please clarify when you use new terms – you cannot expect all readers to gymnastic-trained!
AUTHORS’ RESPONSE: This has been clarified: “The scoring system in gymnastics also encourage the gymnasts to take more and more risks and pushing human bounds”. We totally agree with the reviewer that we cannot expect all readers to be fully aware with the gymnastics world, this manuscript should be understandable by all readers from any sports.
- REVIEWER #2: “in training” rather than “on training”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Change “In that way” to “Thus,”
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: What is this “…on bars…”? Please do your due diligence to check every sentence.
AUTHORS’ RESPONSE: This has been detailed: “use of handguards on the uneven bars apparatus”.
- REVIEWER #2: ASPC and IOC. Both need to written out in full before using the acronyms.
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: Change “large amount of questions” to “high number of questions” or ‘numerous questions”.
AUTHORS’ RESPONSE: This has been done.
- REVIEWER #2: Reference 15 is incomplete. Please re-write.
AUTHORS’ RESPONSE: With the correction in the manuscript, the reference 15 was removed.
- REVIEWER #2: “17 times their bodyweight during”
AUTHORS’ RESPONSE: This has been corrected.
- REVIEWER #2: Change “A majority of gymnasts had to deal with injury and miss training or competition in relation with injury (70.5%) when the competition and performance are the main goal of elite gymnasts” to “Within a year, majority (70.5%) of French WAGs would have suffered an injury and had to miss training or competition.” The conclusion statements are very vague and seems too generic and did not really make use of the obtained results of the survey, please re-write.
AUTHORS’ RESPONSE: The conclusion has been rewritten and simplified.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Major concerns:
- Abstract. Conclusion. The current study’s metanalysis found that “using a prevention program was associated with a higher risk of injury” clearly does not tally with your conclusion that “improving injury prevention strategies appears fundamental to counter this high injury risks and its potential consequences”. Authors need to ‘entangle” these 2 opposing statements.
- Authors claimed that the manuscript has been vetted by an Engslih-spekaing person – but I still found many awkward sentences and wrong use of terms. For example, the term “in average” was used numerous times throughout the manuscript – it should be “on average”. Please change accordingly.
- For Table 1. What is the difference between “often” and “always”? and between “sleep disturbances” and “nocturnal awakenings”?
Minor issues:
- Line 78. Add “for’ before “about”.
- Line 82 to 85. Awkward sentence.
- Line 442. Should be “a better understanding”.
- Line 757 to 763. Error in using the proposition of “in” and “on”.
- Line 761. Should “…. live with a hosting family …..”
- Line 769. I am able to understand why there is a need to ask the participants about whether they are having “nightmares” in their sleep. What is the relevance here since you already have similar related questions such as “sleep disturbances” and “nocturnal awakening”. In addition, what are the differences between these 2 terms.
- Line 792. Use the term “menstrual cycle” rather than “period”.
- Line 796. Change “during” with “for”.
- Line 840. “…. the type was missing for 14 injuries …” is awkward. Please rephrase.
- Line 847. Use “other” rather than “another”.
- Line 866. …eating disorders concerned 20 gymnasts ….” Is another funny worded sentence. Pease rephrase.
- Line 871. Change the term “change” to “increase or decrease”.
- Line 955. This sentence is awkward. Please rephase. Also, you will need to explain or elaborate on the term “relevant” here.
- Line 977. Add “also” after “we”.
- Line 1021. Use the term “prevalent” rather than “spreading”,
- Line 1023 – 1024. Another clearly awkward and incomplete sentence.
- Line 1027. Should be “This is the first study to evaluate …..”.
- Line 1077. Add “of” after “topics”.
- Line 1079 to 1081. Use the “all of the” rather than “the total of the target”. And replace “can” with “could”.
- You need to elaborate “some I jury types were missing, or some answers were imprecise”.
- “since knowledge are lower than in NCAAA” This sentence is not clear.
- Line 1093. “materials changes” of what exactly? Is it equipment or the apparatus or something. Please clarify.
- _ Line 1093 to 1158. This paragraph is poorly written. Please rephase and re-write. For example, use the term “performance level” or “performance difficulty”. When u use the term risk you should add the term “increase” or “decrease” before the word risk, Change “better known” to better understating”. Change “according” to “relative”. And what do mean by the term “real need”?
As mentioned in notes to authors
Author Response
REVIEWER #2
Ms. Ref. No.: applsci-2528132
Title: "Injuries in Women Artistic Gymnastics in France: prevalence and associated factors"
Applied Sciences
Revised Manuscript: Revision #2
Comments to authors:
AUTHORS’ RESPONSE: We would like to again sincerely thank the reviewer for taking his/her time to review our manuscript and to provide these helpful and constructive comments, which helped us to improve our present manuscript, as well as to see some interest in our manuscript for Sports Medicine Research community.
Major concerns:
- REVIEWER #2: Abstract. Conclusion. The current study’s metanalysis found that “using a prevention program was associated with a higher risk of injury” clearly does not tally with your conclusion that “improving injury prevention strategies appears fundamental to counter this high injury risks and its potential consequences”. Authors need to ‘entangle” these 2 opposing statements.
AUTHORS’ RESPONSE: We would like to thank the reviewer for highlighting this confusing conclusion. Given the high injury rate, it seems logical that injury prevention measures are needed. And indeed, our analyses reported that using injury prevention programs was associated with higher injury rates. So, we think that the current approach should be improved. This has been clarified in the revised version: “Conclusions: More than 70% of French high-level/national-level gymnasts had at least one injury during the 2020/2021 season. This high injury rate supports the need of promoting injury prevention. However, in the present study using a prevention program was associated with a higher risk of injury. There is thus a need to improve the injury prevention strategies to counter the high injury risk and their potential consequences.”.
- REVIEWER #2: Authors claimed that the manuscript has been vetted by an Engslih-spekaing person – but I still found many awkward sentences and wrong use of terms. For example, the term “in average” was used numerous times throughout the manuscript – it should be “on average”. Please change accordingly.
AUTHORS’ RESPONSE: We are sorry that there are still mistakes. We sent our manuscript to a native English speaker, who read and corrected the manuscript. We have not the knowledge to correct it our-self, so we trusted in her corrections. We are sorry that this was not accomplished. We took into consideration all comments from the reviewer and we hope that this version is more accomplished.
- REVIEWER #2: For Table 1. What is the difference between “often” and “always”? and between “sleep disturbances” and “nocturnal awakenings”?
AUTHORS’ RESPONSE: For sleep quality we asked the gymnasts to “score” their potential sleep problems as “never”, “sometimes”, “often” and “always”. There were no more details in the questionnaire than this information. “always” should mean every night, and “often” regularly but not always. But since no information was provided, this is just our interpretation. This limitation has been added in the limitation section of the discussion section: “For some questions (e.g., about sleep quality), the responses could have varied according to the interpretation of the participants.”.
The term “sleep disturbances” was changed as we asked about “difficulty falling asleep”, this has been changed in the manuscript.
Minor issues:
- Line 78. Add “for’ before “about”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 82 to 85. Awkward sentence.
AUTHORS’ RESPONSE: This has been corrected: “Other gymnasts not involved in national training centers can also have this intensive training and a national level by training within TOP 12 clubs, representing the first division of the team French championship.”.
- Line 442. Should be “a better understanding”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 757 to 763. Error in using the proposition of “in” and “on”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 761. Should “…. live with a hosting family …..”
AUTHORS’ RESPONSE: This has been corrected.
- Line 769. I am able to understand why there is a need to ask the participants about whether they are having “nightmares” in their sleep. What is the relevance here since you already have similar related questions such as “sleep disturbances” and “nocturnal awakening”. In addition, what are the differences between these 2 terms.
AUTHORS’ RESPONSE: We aimed to better understand different aspects of the sleep: start, during the night and morning. The term “sleep disturbances” was changed as we asked about “difficulty falling asleep”, this has been changed in the manuscript.
- Line 792. Use the term “menstrual cycle” rather than “period”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 796. Change “during” with “for”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 840. “…. the type was missing for 14 injuries …” is awkward. Please rephrase.
AUTHORS’ RESPONSE: This has been corrected.
- Line 847. Use “other” rather than “another”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 866. …eating disorders concerned 20 gymnasts ….” Is another funny worded sentence. Pease rephrase.
AUTHORS’ RESPONSE: This has been corrected: “20 gymnasts (22.7%) reported being concerned by eatingdisorders”.
- Line 871. Change the term “change” to “increase or decrease”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 955. This sentence is awkward. Please rephase. Also, you will need to explain or elaborate on the term “relevant” here.
AUTHORS’ RESPONSE: This has been corrected: “Therefore, we collected injuries that lead to adaptation of gymnastics in addition to interruption of the gymnastics activity [21].”, and we removed the term “relevant” to avoid any misunderstanding.
- Line 977. Add “also” after “we”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 1021. Use the term “prevalent” rather than “spreading”,
AUTHORS’ RESPONSE: This has been corrected.
- Line 1023 – 1024. Another clearly awkward and incomplete sentence.
AUTHORS’ RESPONSE: This has been changed: “Consequently, it is essential to screen gymnasts for mental health and manage them appropriately, and also to prevent mental health problems in WAG [16,18,19].”.
- Line 1027. Should be “This is the first study to evaluate …..”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 1077. Add “of” after “topics”.
AUTHORS’ RESPONSE: This has been corrected.
- Line 1079 to 1081. Use the “all of the” rather than “the total of the target”. And replace “can” with “could”.
AUTHORS’ RESPONSE: This has been corrected.
- You need to elaborate “some I jury types were missing, or some answers were imprecise”.
AUTHORS’ RESPONSE: This has been corrected.
- “since knowledge are lower than in NCAAA” This sentence is not clear.
AUTHORS’ RESPONSE: This has been clarified: “This is even more important in high-level and national-level WAG, since the epidemiological knowledge in these population are lower than in the population of NCAA gymnasts.”.
- Line 1093. “materials changes” of what exactly? Is it equipment or the apparatus or something. Please clarify.
AUTHORS’ RESPONSE: This has been clarified: “In addition, there were changes in the apparatus in the last decades to protect the gymnasts (e.g., softer and thicker mats, enlarging the horse for the vault, vault board protection forYurchenkos's vault, use of handguards on the uneven bars apparatus).”.
- _ Line 1093 to 1158. This paragraph is poorly written. Please rephase and re-write. For example, use the term “performance level” or “performance difficulty”. When u use the term risk you should add the term “increase” or “decrease” before the word risk, Change “better known” to better understating”. Change “according” to “relative”. And what do mean by the term “real need”?
AUTHORS’ RESPONSE: This has been corrected: “In addition, there were changes in the apparatus in the last decades to protect the gymnasts (e.g., softer and thicker mats, enlarging the horse for the vault, vault board protection forYurchenkos's vault, use of handguards on the uneven bars apparatus). However, these changes also allowed to increase thegymnasts’ performance level and consequently to increase their injury risks. The gymnastics scoring system also encourages the gymnasts to take more and more risks and pushing human bounds. Floor apparatus seems to be the apparatus with higher injury risk, follow by uneven bars apparatus [4,6], since during take-offs and landings gymnasts endure up to 17times their bodyweight [1,4,6]. A cumulative exposure to these massive impacts could be responsible of overuse and acute injuries. Therefore, it would be of interest to better understanding the injury epidemiology relative to apparatus in order to orient injury prevention approach.
Despite the association found between the use of prevention program and the higher injury risk, there is a need to include injury prevention approach in WAG. Therefore, a better understanding of what is currently done, and then to co-construct injury prevention program, seems a relevant, if not fundamental, perspective.”.
Author Response File: Author Response.pdf
Round 3
Reviewer 2 Report
nothing else to add
Author Response
We would like to again sincerely thank the reviewer for all the time and energy invested to review and improve our manuscript.
