Adherence to Compression Garments in Lymphedema Patients: A Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In this article Rodríguez et al. investigated the role of compression garments in link to lymphedema patients. The authors concluded that adherence to compression garments is essential to prevent the disease progression. In the material section the authors can provide the questionnaire they used to select patients. The sample size is low to have a proper conclusion. The authors can emphasize on the future direction of this study. 

 

 

 

Author Response

We would like to express our sincere gratitude to the reviewer for their insightful comments and constructive suggestions, which have been instrumental in enhancing the clarity and depth of our manuscript.

We are in agreement with the reviewer on the importance of adherence to compression garments in preventing the progression of lymphedema. Our findings and the research carried out by others appear to support the same conclusion. We have taken care to present this message clearly and provide ample support for it throughout the Results and Discussion sections.

1.- Reviewer's comment: "In the material section the authors can provide the questionnaire they used to select patients."

Authors' response: In response to the suggestion regarding the methods section, we have included the questionnaire used for patient selection and data collection as supplementary material (Annex I). Additionally, we have referenced this inclusion in the Materials and Methods section of the main text (p. 3; l. 89-90).

2.- Reviewer's comment: "The sample size is low to have a proper conclusion."

Authors' response: Concerning limitations, it has been recognised that the sample size may pose a challenge; this issue has been mentioned in the revised Discussion section (page 7; lines 243-247) and further discussed there. With a total of 92 patients, the relatively small sample limits the generalisability of our conclusions and prevents us from performing more robust subgroup analyses, particularly for patients with primary lymphedema and those with lower limb involvement, who were underrepresented.

Nevertheless, we believe the study offers valuable preliminary insights into adherence behaviours among patients with lymphedema in our hospital setting, and it provides a foundation for future studies involving more extensive and diverse populations.

3.- Reviewer's comment: "The authors can emphasize on the future direction of this study."

Authors' response: Finally, we have expanded the Discussion to include a more detailed reflection on future research directions (page 7, lines 254-263). We emphasize the need for larger, more heterogeneous samples, the development of objective tools to measure adherence, and the exploration of psychosocial and economic factors that may influence long-term adherence.

We sincerely believe that these additions will provide a clearer outlook for future studies in this field. We would like to express our sincere gratitude to the reviewer for their helpful comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study aims to improve adherence to compression garments in patients with

lymphedema.

The study indicates the importance of the etiology and localization of lymphadenoma in patients' acceptance of wearing compression garments.

Future work should focus on secondary lymphedema and upper extremities.

The study also has a social aspect: financial support from health systems is vital (due to the higher price of personalized aids) and to stock up on new garments often enough.

The study lacks objectivity because most of the data (wearing time, clothing fit, and severity of edema) are based on patients' subjective perceptions.

Adopting the findings of this study could increase the percentage of patients who wear clothing for the recommended number of hours.

 

Author Response

We thank the reviewer for their insightful comments and thoughtful suggestions, which have significantly contributed to improving the quality and depth of our manuscript.

Comment 1: "The study indicates the importance of the etiology and localization of lymphadenoma in patients' acceptance of wearing compression garments. Future work should focus on secondary lymphedema and upper extremities."

Authors´ response: 

Regarding the recommendation to focus future work on secondary lymphedema and upper extremities, we agree that these areas are clinically relevant, particularly in the context of post-breast cancer care. However, given that this topic has been extensively explored in the literature, our study focused on a less represented but equally important population: patients with primary lymphedema and/or lower limb involvement. These subgroups often face different challenges regarding adherence to compression therapy. Nevertheless, we recognize the need for future studies with larger and more diverse samples to allow for stratified analyses based on etiology and anatomical location, as these factors may influence adherence. This point has been incorporated into the revised Discussion section (page 7, line 243-247;254-256).

Comment 2: "The study also has a social aspect: financial support from health systems is vital (due to the higher price of personalized aids) and to stock up on new garments often enough."

Authors´ response:

We also appreciate the reviewer’s observation about the social and economic dimensions of compression therapy. In the revised manuscript, we have expanded the Discussion to highlight how financial limitations can impact patients’ ability to acquire and replace compression garments according to clinical recommendations. We emphasize the importance of public health system support and reimbursement programs to improve long-term adherence and promote equitable access to effective treatment (page 7, line 232-234).

Comment 3: "The study lacks objectivity because most of the data (wearing time, clothing fit, and severity of edema) are based on patients' subjective perceptions."

 Authors´response: 

We are in agreement that there is a possibility of bias when relying on patient self-report, especially for variables such as garment wearing time, perceived fit, and severity of edema. We have taken care to address this potential limitation in the revised Discussion section, and we invite you to refer to the specific comments we have added on pages 7, lines 240-243 and 258-261.

Comment 4: "Adopting the findings of this study could increase the percentage of patients who wear clothing for the recommended number of hours."

         Author's response:

Finally, we thank the reviewer for highlighting the practical value of our findings. In response, we have added a statement in the Discussion section underscoring how a better understanding of the barriers to adherence—such as those identified in our study—can inform the design of educational and support interventions. These efforts may help increase the proportion of patients who comply with the recommended use of compression garments, thereby improving treatment outcomes (page 7, line 248-253).

 

Author Response File: Author Response.docx