The Correlation between Core Muscular Endurance, Body Composition, and Back Pain in Firefighters: An Observational Study
Round 1
Reviewer 1 Report
The problem addressed in the manuscript is interesting and may apply not only to the firefighter population but to other military, police and security service formations. The research presented in the manuscript was evaluated in the review as "Communication" so a comprehensive solution to the problem was not expected. In this regard, the analysis of the presented research is sufficient. One may have reservations about the structure of the work. It is not clear why a strict division into introduction-material and methods-results-discussion-conclussion was not applied. The material of the study is described inadequately. This part of the work needs to be supplemented. It is possible to read some demographics of the study group from the graphics. However, this is not the best way to describe the study group. The methods of the study are not described sufficiently. The description of the methods needs to be completed and organized. A necessary part for this type of research which is Study designe is missing. The cited definitions of physical activity and physical fitness from 30-40 years ago are not current with the current state of knowledge. Today's understanding is much more specified, and the quotes cited are not accurate. Missing from the discussion is the marking of the problem of the psychological aspect of experiencing pain. This also needs to be supplemented. The work as a communication is interesting, research based on simple methods that allow further development of the marked problem. Expects to respond to the comments of the authors of the work and make corrections, supplement the text and make significant editorial additions.
Author Response
Dear Reviewer,
Thank you for your comments. Please see our responses to your comments below.
Comment 1: One may have reservations about the structure of the work. It is not clear why a strict division into introduction-material and methods-results-discussion-conclusion was not applied. The material of the study is described inadequately. This part of the work needs to be supplemented.
Response: I understand your reservation. I believe the Materials and Methods section was overlooked as it is located below the Discussion as Section 4. It is outlined with the headings: 1. Introduction, 2. Results, 3. Discussion, and 4. Materials and Methods.
Comment 2: It is possible to read some demographics of the study group from the graphics. However, this is not the best way to describe the study group.
Response: We have updated Table 1 to include more demographic information including age, height, weight, BMI, and years of service as a firefighter. We have also included descriptive statistics for the other predictor variables that were measured and for back pain itself, since these variables technically describe the study sample. Additionally, we have specified the mean and standard deviation values for (a) the entire sample, (b) the subjects with back pain, and (c) the subjects with no back pain, in order to more clearly display the characteristics of this group of firefighters and the subgroups included in the post hoc analyses. This table is referenced in section 4.2 –Participants.
Comment 3: The methods of the study are not described sufficiently. The description of the methods needs to be completed and organized. A necessary part for this type of research which is Study designe is missing.
Response: I believe these were overlooked from the Materials and Methods section. The Materials and Methods section includes the following subsections: 4.1 Experimental Design, 4.2 Participants, 4.3 Protocol, and 4.4 Statistical Analysis.
Comment 4: The cited definitions of physical activity and physical fitness from 30-40 years ago are not current with the current state of knowledge. Today's understanding is much more specified, and the quotes cited are not accurate.
Response: Thank you. The definition has been updated to ACSM’s most current definition.
Lines 44-48: “Physical fitness is defined as a “set of attributes or characteristics individuals have or achieve that relate to their ability to perform physical activity and activities of daily living”. There are five health-related components of physical fitness which include muscular strength, muscular endurance, cardiorespiratory endurance, body composition, and musculoskeletal flexibility.”
Comment 5: Missing from the discussion is the marking of the problem of the psychological aspect of experiencing pain. This also needs to be supplemented.
Response: The following was supplemented to the end of the Discussion section regarding the psychological aspect of pain as it fits with our manuscript:
Lines 182-185: “Developing research-based physical fitness and educational programs to reduce backpain is essential to reduce the fear and anxiety in those experiencing back pain, as these psychological factors have been shown to intensify and continue feelings of pain.”
Reviewer 2 Report
Introduction
At the end of the introduction (lines 74-76), the authors use the following phrase "however, it is still uncertain how muscular strength and endurance affect back pain development and/or progression and the period and intensity of low back pain may not be correlated to decreases in muscular strength and endurance”. However, this sentence is not in accordance with what is actually done in the study.
When reading this sentence, the reader thinks that the study is of a longitudinal observational type, because it speaks of the relationship of the muscular component with the progression and development of pain, when the results only present a bivariate correlation analysis in a cross-sectional study. Authors should correct or delete this sentence.
Materials and Methods/Results
Why did they only perform analyzes between muscular endurance and fat mass? Why not the other bioimpedance components, such as trunk lean mass, muscle quality, etc...?
From my point of view, including other body composition variables would improve the quality of the manuscript. In addition, some relevant variables, such as previous pain and years of service as a firefighter, were not taken into account and limit the results presented.
The authors should reconsider the analyzes, including other variables of body composition. They must, additionally, collect information on the years of service of the 25 subjects included in the analysis of the group with low back pain.
Author Response
Dear Reviewer,
Thank you for your comments. Please see our responses to your comments below.
Comment 1: At the end of the introduction (lines 74-76), the authors use the following phrase "however, it is still uncertain how muscular strength and endurance affect back pain development and/or progression and the period and intensity of low back pain may not be correlated to decreases in muscular strength and endurance”. However, this sentence is not in accordance with what is actually done in the study. When reading this sentence, the reader thinks that the study is of a longitudinal observational type, because it speaks of the relationship of the muscular component with the progression and development of pain, when the results only present a bivariate correlation analysis in a cross-sectional study. Authors should correct or delete this sentence.
Response: Thank you for this revision and we agree. That sentenced was replaced with the following sentence to better reflect our study’s aim and scope:
Lines 72-75: “In addition, it has been shown that individuals with low back pain have deficits in com-ponents of physical fitness; however, the role that muscular strength and endurance plays on the severity of low back pain is still uncertain.”
Comment 2: Why did they only perform analyzes between muscular endurance and fat mass? Why not the other bioimpedance components, such as trunk lean mass, muscle quality, etc...? From my point of view, including other body composition variables would improve the quality of the manuscript. In addition, some relevant variables, such as previous pain and years of service as a firefighter, were not taken into account and limit the results presented.
Response: Thank you for the thoughtful feedback. We originally sought to use predictor variables that could be measured on-site at fire stations with limited cost and time burden, so that these assessments could be completed at regular intervals by fire station staff, if indeed they were correlated with back pain. This is why we originally focused solely on analyzing measures such as body fat percentage (easily measurable with an affordable handheld BIA device), plank time, etc.
It makes more sense to present other indices of body composition, as you noted, because even if a fire station is unable to assess these variables, the reported finding could help build a compelling case for the need to assess body composition in firefighters and other first responders more thoroughly using a more sophisticated and expensive device like the Inbody 570 used here.
As such, we have performed the same analyses as in the original submission for lean mass, fat mass, trunk fat mass, trunk fat percentage, and total body water. The findings, along with graphs representing the findings, are featured in Figure 1.
Comment 3: The authors should reconsider the analyzes, including other variables of body composition. They must, additionally, collect information on the years of service of the 25 subjects included in the analysis of the group with low back pain.
Response: In addition to the body composition variables mentioned in response to the prior comment, we have collected the years of service of each participant and analyzed it as a predictor variable. Results are presented in the text and in Figure 1.
Reviewer 3 Report
I consider that the manuscript titled "The correlation between core muscular endurance and back pain in firefighters" is of no interest to the scientific community. Although at first glance, due to the title, it could be interesting, the methodology used and the results obtained do not yield any relevant results, neither from a scientific nor a clinical point of view.Author Response
Dear Reviewer,
Thank you for your comments. Please see our responses to your comments below.
Comment: I consider that the manuscript titled "The correlation between core muscular endurance and back pain in firefighters" is of no interest to the scientific community. Although at first glance, due to the title, it could be interesting, the methodology used and the results obtained do not yield any relevant results, neither from a scientific nor a clinical point of view.
Response: Thank you, we have updated the manuscript to include correlations of back pain with other body composition variables including lean mass, fat mass, trunk fat mass, trunk fat percentage, and total body water. Interestingly, back pain score demonstrated a significant relationship with trunk fat mass in those with back pain. In addition to the body composition variables mentioned in response to the prior comment, we have collected the years of service of each participant and analyzed it as a predictor variable. Results are presented in the text and in Figure 1.
We should also emphasize that this study is novel in that it investigates the relationships of these physiological and demographic variables with low back pain in a unique population (firefighters) exposed to considerable physical stress. The findings presented may therefore guide future investigations into experimental research in this topic, such as physical activity and nutritional interventions in firefighters. The results are also meaningful to practitioners in tactical training who benefit from an understanding of how different physiological variables may influence the health of first responders.
Round 2
Reviewer 1 Report
The work has an incorrect structure. The Material and methods chapter should be the second part of the paper. Other comments have been taken into account and the paper can be accepted for publication
Author Response
Thank you, we have moved the Methods section to the second section after the Introduction.
Reviewer 2 Report
Dear authors,
I congratulate you on the work of revising and rewriting the manuscript. I only suggest two more corrections:
* They must add the type of study in the title. It is a recomendation from international guides.
* There is an error in the citation on line 47 of page 2.
Greetings
Author Response
Thank you!
Comment 1: They must add the type of study in the title. It is a recommendation from international guides.
Response: This has been updated to include “an observational study”. The updated full title is: “The correlation between core muscular endurance, body composition, and back pain in firefighters: an observational study”,
Comment 2: There is an error in the citation on line 47 of page 2
Response: The period between the reference numbers has been changed to a comma.
Reviewer 3 Report
Although the authors have made an effort to improve the manuscript, I do not believe that the work brings important contributions to the scientific comunity.
Author Response
Thank you for your time you spent reviewing our paper. We are glad you found it much improved.
