The Influence of Emotional and Cognitive Factors on Limb Laterality Discrimination in Women with Fibromyalgia Syndrome: A Cross-Sectional Study Secondary Analysis

Round 1

Reviewer 1 Report

>> The language usage throughout this paper need to be improved, the author should do some proofreading on it. Give the article a mild language revision to get rid of few complex sentences that hinder readability and eradicate typo errors.

>> Your abstract does not highlight the specifics of your research or findings. Rewrite the Abstract section to be more meaningful. I suggest to be Problem, Aim, Methods, Results, and Conclusion.

>> Introduction section can be extended to add the issues in the context of the existing work and how proposed algorithms/approach can be used to overcome this.

>> The problems of this work are not clearly stated. There is ambiguity in statement understanding.

>> Add main contributions list as points in the Introduction section.

>> Add the rest organization section at the end of the Introduction section.

>> More clarifications and highlighted about the research gabs in the related works section.

>> identified research gaps and contribution of the proposed study should be elaborated.

>> I feel that more explanation would be need on how the proposed method is performed.

>> If no one has proposed before a method like the proposed algorithm, this claim should be highlighted much more. Else, it should be indicated who has done this, and it should be indicated what the innovations of the current paper are.

>> Authors should add the parameters of the algorithms.

>> A comparison with state of art in the form of table should be added

>> Results need more explanations. Additional analysis is required at each experiment to show the its main purpose.

>> The Limitations of the proposed study need to be discussed before conclusion.

 

Author Response

REVIEWER 1

Comments and Suggestions for Authors

>> The language usage throughout this paper need to be improved, the author should do some proofreading on it. Give the article a mild language revision to get rid of few complex sentences that hinder readability and eradicate typo errors.

RESPONSE: We have carried out a revision of the English language to improve the understanding of this work

>> Your abstract does not highlight the specifics of your research or findings. Rewrite the Abstract section to be more meaningful. I suggest to be Problem, Aim, Methods, Results, and Conclusion.

RESPONSE: We have reorganized the abstract section as indicated.

 

>> Introduction section can be extended to add the issues in the context of the existing work and how proposed algorithms/approach can be used to overcome this.

RESPONSE:
Thank you very much for this appreciation. Reviewer 3 has told us that he found the introduction section a bit long and we do not want to add more information to this section that might make this article difficult to read.

 

>> The problems of this work are not clearly stated. There is ambiguity in statement understanding.

RESPONSE: In the last paragraph of the introduction it is stated that there is a lack of current knowledge about how psychosocial factors can influence the laterality recognition task. This work is pioneering in this regard.

 

>> Add main contributions list as points in the Introduction section.

RESPONSE: we have clarified the introduction, but we do not understand the points you indicate to include in this section. since all introductions end with the objectives, we believe that everything has been previously clarified in the introduction.

 

>> Add the rest organization section at the end of the Introduction section.

RESPONSE: We have not included it because we understand that in the introduction of an article it is not necessary to include an organisational section at the end, but rather to determine the objectives of the study.

 

 

>> More clarifications and highlighted about the research gabs in the related works section.

RESPONSE: We believe that the salient points of the rationale for the study are included in the introduction.

 

>> identified research gaps and contribution of the proposed study should be elaborated.

RESPONSE: In the discussion section, previous gaps in the scientific literature regarding the relationship between psychological variables and the laterality recognition task are mentioned. It can be found from lines 487 to 502.

>> I feel that more explanation would be need on how the proposed method is performed.

RESPONSE:  We have added how the data on the number of hits and reaction time were collected.

>> If no one has proposed before a method like the proposed algorithm, this claim should be highlighted much more. Else, it should be indicated who has done this, and it should be indicated what the innovations of the current paper are.

RESPONSE: This is discussed in the last paragraph of section 4.1 of the discussion. To highlight our results, we have added that our study is the first to delve into the study of these variables by performing a statistical correlation analysis.

 

>> Authors should add the parameters of the algorithms.

RESPONSE: We don´t undertad what do you mean with parameters of the algorithms

 

>> A comparison with state of art in the form of table should be added

RESPONSE: we believe that rationale justified explanation has been included

 

>> Results need more explanations. Additional analysis is required at each experiment to show the its main purpose.

RESPONSE:In results sections is only to report the main outcomes, we don´t  understand what do you ask we for.

 

>> The Limitations of the proposed study need to be discussed before conclusion.

RESPONSE: limitations are stated in discussion section 4.3 and conclusions appear later in discussion section 4.5

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

You have presented a great topic. Patients with fibromyalgia often see a rheumatologist, and are often treated as rheumatological patients. However, there is no correlation in laboratory findings with rheumatic diseases. Considering the seriousness of the clinical picture and the evidence that emotional and cognitive factors are still the main cause of complaints (sometimes very pronounced), the cause should be sought in a disorder of neuromuscular transmission. This disorder seems to be very mysterious so far and neurophysiologists should pay more attention to it. Although there is a statistically good representation of how patients with fibromyalgia have significantly disturbed emotional and cognitive functions, the question remains whether they are the cause of the subsequent disease or the consequence of a primary disorder that has not been clarified. Perhaps a little more attention should be paid to this in the discussion. Perhaps then it would be possible to answer why lateral discrimination is not correlated with psychological variables. 

 

Author Response

Comments and Suggestions for Authors

You have presented a great topic. Patients with fibromyalgia often see a rheumatologist, and are often treated as rheumatological patients. However, there is no correlation in laboratory findings with rheumatic diseases. Considering the seriousness of the clinical picture and the evidence that emotional and cognitive factors are still the main cause of complaints (sometimes very pronounced), the cause should be sought in a disorder of neuromuscular transmission. This disorder seems to be very mysterious so far and neurophysiologists should pay more attention to it. Although there is a statistically good representation of how patients with fibromyalgia have significantly disturbed emotional and cognitive functions, the question remains whether they are the cause of the subsequent disease or the consequence of a primary disorder that has not been clarified. Perhaps a little more attention should be paid to this in the discussion. Perhaps then it would be possible to answer why lateral discrimination is not correlated with psychological variables. 

RESPONSE: Thank you for this comment and and for accepting our work in this form.

Author Response File: Author Response.docx

Reviewer 3 Report

More specific comments are as follows:

1. The introduction section is too lengthy and could be benefited from shrinking.

2. Because the study only included female patients, this should be reflected in title and aim.

3. Was numeric pain rating scale validated for Spanish language?

4. Line 231. Use another sample for nominal variable. In your study all patients were females.

5. Line 211. Correct "wich"

6. Line 232. Please, explain how you tested for the normality of data distribution.

7. In the methods section it is mentioned that each image was demonstrated for 10 seconds. Yet, it is not clear how the speed of reaction was measured. Please, clarify this.

8. The study has small sample size. There is a need for more detailed description of how healthy controls were recruited as this may significantly impact the differences observed.

 

Author Response

Comments and Suggestions for Authors. More specific comments are as follows:

1. The introduction section is too lengthy and could be benefited from shrinking.

RESPONSE:

In order for the reading of this article to be more fluid, we have decided to eliminate the definitions of the psychological variables from the introduction section. We think that future readers already know what these basic concepts consist of. The bibliography has also been updated. We have maintained in the introduction how the psychological variables studied in the present work influence patients with fibromyalgia.

2. Because the study only included female patients, this should be reflected in title and aim.

RESPONSE:

We have specified in the title and in the aim that the study population are women with fibromyalgia.

3. Was numeric pain rating scale validated for Spanish language?

RESPONSE: According to our knowledge of the current literature, there are no studies that have validated the NPRS in the Spanish population. However, this scale is widely used on a daily basis in clinical and research settings. Participants only have to say an ordinal number from 0 to 10 to describe their current perception of pain intensity. Perhaps, due to how simple it is to use this instrument, no research has been done to validate it in the Spanish population.

4. Line 231. Use another sample for nominal variable. In your study all patients were females.

RESPONSE: We have given the profession or marital status as an example of a nominal variable.

5. Line 211. Correct "wich"

RESPONSE: we have corrected this error

6. Line 232. Please, explain how you tested for the normality of data distribution.

RESPONSE: The Shapiro-Wilks and Kolmogorov-Smirnov tests were used

7. In the methods section it is mentioned that each image was demonstrated for 10 seconds. Yet, it is not clear how the speed of reaction was measured. Please, clarify this.

RESPONSE: We have explained that the application software collects the data of the reaction time and the percentage of hits

8. The study has small sample size. There is a need for more detailed description of how healthy controls were recruited as this may significantly impact the differences observed.

RESPONSE: We have added the origin of the control group participants. They were recruited through advertisements at the Rey Juan Carlos University to ensure that they did not have any type of personal relationship that could bias the results with the patients recruited in the fibromyalgia association.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The manuscript lacks a thorough literature review on the topic, which makes it difficult to understand the significance and relevance of the study. The methodology used in the study is not clearly explain d and it is not clear how the data was collected and analyzed. The results of the study are not clearly presented and it is difficult to understand the conclusions drawn from the data. The authors did not address the limitations and weaknesses of their study, which may make it difficult to trust the conclusions. The authors did not provide a clear explanation of the impact of their findings on the field or how their research contributes to the existing literature. 

The authors did not follow the corrections that were pointed out in the previous decision. The manuscript has a low quality of English, this make difficult to understand the content. The study is not well-designed, the design is weak and the used tools are not validated.

Author Response

RESPONSE TO REVIEWERS

REVIEWER 2

Thanks for your time and comments.

Comments and Suggestions for Authors:

The manuscript lacks a thorough literature review on the topic, which makes it difficult to understand the significance and relevance of the study. The methodology used in the study is not clearly explain d and it is not clear how the data was collected and analyzed. The results of the study are not clearly presented and it is difficult to understand the conclusions drawn from the data. The authors did not address the limitations and weaknesses of their study, which may make it difficult to trust the conclusions. The authors did not provide a clear explanation of the impact of their findings on the field or how their research contributes to the existing literature.

 

RESPONSE: The present study includes in the introduction 55 references to the previous scientific literature, which from our point of view is sufficient to introduce the state of the art on this subject. Regarding the recognition of laterality and fibromyalgia, there are only two previous studies (references 54 and 55). The methodology of this work is explained in detail in the section on materials and methods. It explains what the measurement variable consists of, as well as the laterality recognition task procedure so that other researchers can carry out this study exactly like our research group. We performed the data analysis with the Statistics Package for Social Science (SPSS 25.00, IBM Chicago, IL, USA), employing a 95% (95% CI) confidence interval and considering all values ​​with a p-value lower than 0.05 to be statistically significant. The results of this work are presented in detail as follows. First, the results of the sociodemographic variables and the clinical status of the participants are described (Table 1). The differences between groups in performing the laterality recognition task are described below (Table 2). Then the results and differences between groups in the psychological aspects of the participants are shown (Table 3). Finally, the results of the correlation analysis between the study variables are shown (Table 4). The limitations of the present work are exposed in section 4.3 of the discussion. To highlight the main findings of this study, we have added the following to lines 556 and 577: "The findings of this study suggest that the psychological variables presented by patients with FMS do not influence the results obtained in the laterality discrimination task".

 

 

The authors did not follow the corrections that were pointed out in the previous decision. The manuscript has a low quality of English, this make difficult to understand the content. The study is not well-designed, the design is weak and the used tools are not validated.

 

RESPONSE: The English language has been carefully checked to ensure an understandable reading of this original article. The present study follows the STROBE recommendations for observational studies. All measurement variables have been previously validated and widely used in previous scientific literature.

 

 

 

 

 

 

 

 

 

 

 

Author Response File: Author Response.docx