The Effects of Insole-Based Visual Feedback on Weight-Bearing in Patients Undergoing Total Hip Replacement

Round 1

Reviewer 1 Report

The paper presented a method to investigate the visual biofeedback effect on weight-bearing with force insoles, for patients with hip replacement. The study is interesting, and more information is needed to fully reveal the details and results of the work.

1. Please provide a picture to demonstrate the experiment scenario.
2. Please provide a picture to illustrate the workflow of the system.
3. Four the outcome measures, some are given in Table 2, some in Figure 2 and 3, and some in text, making it hard to follow and compare.
4. For keywords, there should be one or more about weight-bearing assessment/outcome measure.
5. Grammar and typos, for example, page 2, line 48, 'trough verbal instructions'

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

The main scientific question is investigate the visual biofeedback effect of a sensorized system for plantar pressure dynamic evaluation of in patients with a total hip replacement, and it is relevant and interesting for rehabilitation science and people who practice it. The topic is original, and paper is well written. Conclusion corresponding to the performed study and with the evidence.

In the presented manuscript authors proved that a visual biofeedback, based on the use of sensorized insoles, can act as a support for the rehabilitation process to regain correct weight – bearing in patients after total hip replacement  in order to regain the correct weight-bearing.

In materials and methods : Authors must add exclusion criteria for this study ( did any patients have gonarthrosis or other orthopedic problems or not)

Line 113 : EG instead of EC

Author Response

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Reviewer 3 Report

This is a manuscript on the effectiveness of a sensorized insole (FlexInFit) for uniform distribution of pressure. When the sensor was used, the patients showed more evenly distributed pressure on both feet. This is an interesting topic, however, the data was not convincing enough because the manuscript lack demographic data and proper statistical analyses. The recovery speed depends on age, duration of symptom, function score before surgery, etc. It seemed that at least there was a large difference in body weight between EG and CG. Authors need to show background data to show how those two groups were different before surgery.

Other points:

How the randomization was performed? For example, using envelopes or other tools?

Please clarify “heterometry of lower limbs ≤ 0.5 mm” was correct.

Authors should show the images of visual Biofeedbacks (BF).

Difference in WBAH between CG and EG was large. It was probably because there was a large difference in the body weight between CG and EG. They need to exhibit detailed demographic table and discuss this happened even after randomization. In this circumstance, statistical comparison in the difference between WBPS would be better.

Authors need to place a Table to show demographics for each group.

What were Sway Healthy limb and Sway Surgical limb? They were seen in only abstract, not in the main text.

Please explain briefly about 6 minutes walking test.

Author Response

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Author Response File: Author Response.docx

Reviewer 4 Report

Thank you for letting me review the manuscript entitle “The effects of insole-based visual feedback on weight-bearing in patients undergoing total hip replacement”.

I would like to congratulate the authors for the effort for the effort made in this work. However, I have few concerns that, in my opinion, should be addressed before further considerations.

Introduction:

Line 39-40. “the most important daily living activity: gait pattern”. I understood the meaning of the sentence, but the gait pattern is not a daily living activity, this word should be changed for “walking” and the sentence should be re-writing.

A sentence/paragraph about the treatment therapy should be necessary in the introduction to justify the intervention used in the study.

Methods:

Line-78-79. There is no exclusion criteria. Please provide the exclusion criteria below the inclusion criteria. I have few questions about this point: Where the patients excluded if presented OA in other lower limb joints? if they had previous surgeries?; if they were taking other pharmacological or non-pharmacological therapies during the study intervention?; if they presented other pathologies that could limit the exercise protocol? Or there was a specific time since surgery?

Line 107. I couldn’t find anywhere the protocol and would be completely necessary to replicate de study. Please add the supplementary section or add some information in the manuscript.

Line 122. Please provide the exact number of sessions performed by each group, the duration of each session, the type of exercise, intensity of the exercises, the advices given in both groups and if the use of crutches or other devices were allowed.

Results

Line 179. Please provide the data about the age, operation side, dominant side, gender, mean time since surgery and other clinical and sociodemographic data necessary to correctly interpret the results of the study.

Tables. Please add the 95% Ci.

Line 224-228. I recommend the authors to add all data in the Table 2 to make easier the readability of the study. Also, the results are not well-explained. The results are presented in a different order than the rest of the manuscript. The explanation should be following the same order than the rest of the manuscript.

Discussion

Lhe discussion parti is missing some key points.

Explain in detail and its mechanism how the outcome variables are helpful

Short rationale and clinical implication may be stated for good understanding

Conclusion.

Line 280-281. Please delete the sentence.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Please improve the format and language. There is even a typo in the keyword.

Reviewer 3 Report

All issues I raised have been addressed appropriately.

Reviewer 4 Report

THe authors have taken into consideration all my suggestions. Good luck