Effect of Digital Therapeutics on Range of Motion, Flexibility, Dynamic Balance, Satisfaction, and Adherence: A Randomized Controlled Trial
, Jin-Seop Kim 1, Seong-Gil Kim 1 and Yeon-Gyo Nam 1,*
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsRevisions of “Effect of Digital Therapeutic on Exercise Effects and Psychological Factors: A Randomized Controlled Trial”
I would like to thank to the editor to let me revise this interesting work. I believe the work is interesting and well structured.
Introduction section
· Please, give a definition of the Digital therapeutics.
· Line 57-57 It is not clear what is exercise effects, authors include this statement also in the abstract but for me it is not clear which type of effect they are looking for.
· The study hypothesis is clear but a clear statement related to the aim is missing.
Methods section
· Lines 82-84, why authors did not use a questionnaire to asses the physical activity levels of participants?
· Lines 96-97 Outcome assessor was blind to group allocation?
· Figure 3: Maybe if possible can be easily to see a translation in English of the images.
· Lines 138-139 Please provide references for this tests
Results section
· Table 3 should be revised adding a new column in the right part of the table instead of in a single pre-post results like authors did in table 4.
Discussion
· Lines 276-278 should be move at the beginning of the introduction
· I suggest authors to try to discuss more about the main findings in the discussion. Try to compare it with similar literature.
Comments on the Quality of English LanguageMinor revisions are needed
Author Response
Please see the attachment. Thank you.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThis manuscript aims to examine the effect of digital therapeutic on exercise effect, satisfaction, and participation. I do have some concerns about the manuscript in its current form and I have summarized in the section below. These comments are intended in the light of constructive feedback.
Comments for author File: Comments.pdf
Author Response
Please see the attachment. Thank you.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors1) Title: did the author mean digital therapeutic devices? Also I see this was a stretching program so probably want to include that in the title.
2) Title: consider removing the second "effects" from the title.
3) Abstract: How long was the program, may want to state that here.
4) English language and typo review is needed. For example, Abstract line 14-15, Digital Therapeutic Group is capitalized but "Non-digital therapeutic Group is partially?
5) Abstract line 17-18: I don't understand this sentence, what was assessed?
6) I appreciate the authors stating the significant differences between groups in the Abstract but they don't say which group was better or worse.
7) Intro line 42: Wasn't sure what the red line was indicating?
8) Intro line 57: Refrain from using "in this study" in subsequent sentences.
9) Table 1 continue to see red lines and text.
10) Appreciate the application screenshots but it needs to be translated to English.
11) Did the patients perform warm-up prior to assessments/intervention sessions?
12) Appreciate homogeneity of variance was assessed in data analyses but what about other parametric testing assumptions (e.g., normality)? If any data were found to be non-normal appropriate transformations (log) would need to be performed and analyses repeated.
13) Were there significant differences at baseline between the intervention and control groups? This needs to be tested and if there are, ANCOVA needs to be conducted potentially to account for these baseline differences.
14) Results section: appreciate the p values but some data needs to be included in-text for the tests discussed. It is not possible to determine what the "difference" is without including numbers that are higher/lower compared to pre-intervention.
15) It's always a little surprising when there are no patient drop outs. Granted this was a minimal intervention over a short period of time but if the authors can confirm there was no attrition, that would be helpful.
16) I didn't see any results for adherence rates.
17) There are far too many tables in this paper. Some of the results should be reported in-text instead of just stating the numbers in tables. An alternative would be to refer some of these things to an online supplement.
18) Discussion line 289: The 2.75, was that a positive or negative direction? This and many other places throughout the paper don't clearly tell readership this. Also the number really should be in the Results not in the Discussion.
19) The discussion is pretty good but far too lengthy. Consider cutting some of it to only the most important points relevant to the study.
20) Conclusions: The authors should temper their results and say that applications may increase flexibility. This is a small study which is a limitation and larger trials evaluating the role of digital health applications for stretching are needed.
Comments on the Quality of English LanguageSee my comments in Author suggestions.
Author Response
Please see the attachment. Thank you.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsPlease see attachment. Thank you
Comments for author File: Comments.pdf
Author Response
Please see the attachment. Thank you.
Author Response File: 
Author Response.docx
Reviewer 3 Report
Comments and Suggestions for Authors1. Thank you for addressing my comments. The manuscript is very much improved and I only have a few comments primarily on methods that need to be addressed.
2. Abstract line 20: To clarify, state the independent t-tests were used to compare the change scores between groups.
3. Delete the the last sentence of the Abstract. You can't definitively say that based on your results. Would need to conduct further longitudinal studies in patient populations to be able to make the statement.
4. Intro 3rd paragraph: Delete this paragraph as it starts to frame the study to look at musculoskeletal events and how stretching prevents that. I understand the rationale for it, so could possibly add a condensed version of it to the Discussion.
5. Intro hypothesis sentence: exhibit better dynamic balance
6. I see outcomes were assessed at baseline before randomization occurred, well done. Were outcome assessors blinded to study arm allocation of patients for post-outcome assessments? If not this is a limitation as significant bias could have been introduced (either intentional or implicit) which would have influenced the outcome of the study results.
7. Delete the "Figure 1. Experimental procedures" repeated text within the figure.
8. There is potential of poor diary entry practices when asking patients to report exercise (control group in the current study). Failure to record sessions, falsified data, poor memory leading to inaccurate data, etc could occur so list this as a limitation in the Discussion section.
Author Response
Please see the attachment. Thank you.
Author Response File: Author Response.docx
Round 3
Reviewer 2 Report
Comments and Suggestions for AuthorsThe authors have made major changes to the paper and I appreciate their work. The manuscript presentation and content has been significantly enhanced. Thank you fro their cooperation!
Author Response
Please see the attachment. Thank you
Author Response File: Author Response.docx
