Effects of an Intensive 6-Week Rehabilitation Program with the HUBER Platform in the Treatment of Non-Specific Chronic Low Back Pain: A Pilot Study

Round 1

Reviewer 1 Report

The manuscript is well written and provides sufficient information about the application of the HUBER system. 

Due to the poor sample, I'd suggest including the term "pilot study" in the title.

The introduction should consider the background of the NSCLBP rather than focusing mainly on the HUBER.

Author Response

Reviewer #1

-The manuscript is well written and provides sufficient information about the application of the HUBER system. 

-Due to the poor sample, I'd suggest including the term "pilot study" in the title.

-The introduction should consider the background of the NSCLBP rather than focusing mainly on the HUBER.

We thank the reviewer for his careful reading of the manuscript and his suggestions. We added directly in the title that this is a pilot study. We also have added some materials and references in the introduction and in the discussion section (underlined in yellow).

Reviewer 2 Report

I think that this paper corresponds to the requirements regarding the elaboration of a research paper, all the stages passed by the authors in the scientific approach are clear.

Author Response

I think that this paper corresponds to the requirements regarding the elaboration of a research paper, all the stages passed by the authors in the scientific approach are clear.

We thank the reviewer for his careful reading of the manuscript and its positive evaluation.

Reviewer 3 Report

Dear authors, 

Manuscript shows a Huber platform effectiveness for low back pain. Here are my considerations.

Line 88: follow the same format: space or no space before º.

Figures must be named after the figure (change figure 1 and figure 2).

Line 188 "degrees": always write º, follow the same format

Do all RHB sessions follow the same order?

No results related to Oswestry or fear-avoidance beliefs questionnaire in the results section.

Cost-benefit in favour of HUBER? It seems contradictory that a machine is less costly than exercise alone.

Correct reference 22, please.

I understand that there is a few literature, about Huber platform, but it is not the case for the treatment of low back pain, more literature should be added at discussion session to support your results.

Maybe a graphic or schedule about procedure help readers.

Table 1: there is no information about Oswestry and the other Questionnaire, please add this data.

Author Response

Reviewer #3

Line 88: follow the same format: space or no space before º.

Figures must be named after the figure (change figure 1 and figure 2).

Line 188 "degrees": always write º, follow the same format

We thank the reviewer for his careful reading of the manuscript and his suggestions. We have modified line 88 and 188 and the figures in the text.

Do all RHB sessions follow the same order?

Yes, in order to standardize the rehabilitation sessions we proceeded with the same order each time. We added a brief explanation in the manuscript line 144.

No results related to Oswestry or fear-avoidance beliefs questionnaire in the results section.

We added a brief description in the result section line 206 and 207.

Cost-benefit in favour of HUBER? It seems contradictory that a machine is less costly than exercise alone.

We thank the reviewer for this remark. Medico-economic studies are needed to compare the cost of different exercises programs. In order not to mislead the reader, we have deleted this sentence.

Correct reference 22, please.

Thank you for your careful reading. We corrected the ref 22 and added the full name.

I understand that there is a few literature, about Huber platform, but it is not the case for the treatment of low back pain, more literature should be added at discussion session to support your results.

Thank you for your suggestion. We completed the discussion section with a short paragraph and references (two Cochrane reviews studying the effects of the Pilates and Motor Control Exercise and one systematic review and meta-analysis comparing stabilization exercises vs manual therapy) (lines 288-299).

Maybe a graphic or schedule about procedure help readers.

We think that is a good idea. We added a short section called ‘Research plan/design’ before the ‘statistical analysis section’ (line 178-183).

Table 1: there is no information about Oswestry and the other Questionnaire, please add this data.

In the table 1, the results of the questionnaires before/after rehabilitation are already presented according to the overall score for Oswestry Disability Index and FABQ-work and physical activity (we underlined in yellow the corresponding lines).

To clarify, does the reviewer suggest adding the details of each question/answer?

Round 2

Reviewer 3 Report

Dear authors,

Thank you very much for considering my suggestions.

Related to your question, no, there is no need to add a specific question about Oswestry questionnaire, just to mention your results and compare them to other authors.

God job.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

From my point of view, the paper is superficially approached and presented. The introductory part is far too concise, it does not provide the full substantiation note to support the actual research that has been conducted. Also, the HUBER 360 platform is not described in detail to indicate to readers the parameters it measures, under what conditions and with what significance.

The Discussion Part is also very concise, the information that properly highlights the research undertaken, its limits, etc. are not indicated.

Bibliographic sources are also too few.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

The manuscript titled “Effects of an Intensive 6-Week Rehabilitation Program With HUBER Platform in the Treatment of Non-Specific Chronic Low Back Pain” investigates a non-pharmacological method, i.e., the HUBER system, in treating chronic LBP. The authors provided a rehabilitation program with the HUBER to twelve participants. The results highlighted promising results for the hamstring, quadriceps and trunk.

The manuscript is an interesting brief report about the results of the HUBER; some issues have to be solved for its publication.

There is a crucial issue to solve because it may affect the publication of this work. The authors say that the measurements were accomplished before and after the treatment, why is no follow-up present? It seems obvious that researchers could expect changes after a 6 week of treatment (whatever the treatment is). Since authors are talking about chronic LPB, it’s mandatory to understand if this method produces long-term effects.

Abstract

According to the journals’ guidelines, the abstract must be written without headings (objective, methods ecc).

Introduction

L30 Non specific low back pain deserves a deep explanation because there are many factors involved in the non specific, so authors should explain better that situation. I suggest reading the following papers to include further information about the NSCLBP.
Non-specific low back pain, The Lancet, PMID: 27745712
Kinesiological Treatment of Early Spine Osteoarthritis in a Motorcyclist, IJERPH, PMID: 35055784
Kinesio taping in treatment of chronic non-specific low back pain: a systematic review and meta-analysis, Journal of Rehabilitation Medicine, PMID: 31544952

L49-51 Authors claim the absence of a gold standard method, however, with the word “this study”, is not clear if they talk about the previous study (cit 8) or the present one. They have to clarify this issue. Furthermore, I disagree with this assumption, sEMG is a gold standard method to evaluate the spine trunk flexors/extensors muscles.
“Main force directions of trunk muscles: A pilot study in healthy male subjects” (PMID: 29960185).

L53-55 This is not a gold standard, and therefore, not even a common method used to evaluate the LPB alterations. The authors have to change this sentence. Furthermore, this method of the “60-120°” has not been described enough; if readers are not familiar with it, they may not understand the whole manuscript.

L56 This assumption is not supported by a reference.

Material and methods

The number of participants is not present in this section.

L66 which clinical assessment was provided? How can the participants be classified as NSCLBP is readers do not know how they were classified?

L75-76 specify this method better.

L77-84 Even if the authors explained these methods in the supplementary, I’d suggest briefly explaining these methods (maybe the readers won't check the secondary file for the deep explanation).

L92-94 Who followed the correct execution of aerobic exercises? Was a trainer present? Furthermore, the authors have to include these exercises in the manuscript.

L105 “Histogram” is not a statistical test to check the normality.

Results

Table 1: I suggest highlighting the statistically significant parameters because among all these numbers, the important ones may not be considered (both for p-value and cohen’s d).

Discussion

This section is too poor. The authors have to add some more information and compare this new method, HUBER, with existing methods (classic physical therapy, exercise therapy, mezieres, etc) to treat NSCLBP.

Conclusion

The clinical relevance of the manuscript has to be better highlighted, and how this manuscript can increase the knowledge in the field of NSCLBP.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

Dear authors,

The manuscript exposes a Hubert platform to treat the low back pain. I have some considerations.

- More literature on the evidence on platforms should be included in the introduction.

- Considering your inclusion criteria: I understand that patients in the acute phase were not included in the study. But couldn't this platform be considered as a complement to the initial treatment of this pathology once the physical condition of the patient allows it?

- I was struck by this exclusion criteria: Does treatment with corticosteroids influence the results?

- Were the exercises the same for all patients or were they adapted to each patient?

- Were the exercises performed before or after the balneotherapy and the platform?

- Did you have home exercises in addition to the 4 sessions/week?

- What does the treatment with the platform consist of, in the photograph I see a woman and a screen on the platform, but I don't know what exercises she has done.... Coordination? Proprioception? Balance?

- In relation to table 1, I understand that there are 3 women, and the rest are men, can this imbalance affect the results? Since the literature reflects that the perception of pain is different in men than in women.

- The absence of a control group as well as the limited sample size are weaknesses of the study.

- Improved quality of life is presented as one of the benefits demonstrated by this platform, however the study only refers to improvements in flexion and extension ratios, even after performing the Oswestry questionnaire?

- I understand that there are few or only 1 study on this platform, but it is not the case for this pathology... a comparison on the superiority or not of this platform against conventional treatment is necessary in the discussion.

- More references are needed to support the results obtained.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Thank you for addressing my comments. There are still some points to solve.

 I do not really understand why authors continue excusing the presence of poor information (such as poor knowledge in the introduction or literature about the platform) by saying “this is a Brief Report”. Brief report aims to briefly present new results or methods, not to summarize the knowledge with little exhaustive information briefly.

The authors now included the Shapiro-Wilk test for normality. However, I have a doubt. The authors are studying the effects of HUBER in a sample of 12 individuals. Usually, low sample sizes may encounter non-normal distribution but it does not happen in your data; that’s curious. Furthermore, I wonder why the “data availability statement” is reported as “not applicable”; why?

Second, 3 females and 9 males represent a too heterogeneous sample to include everyone in one group.

Third, no control group was present.

These conditions may bias the data.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

Dear authors, 

Evaluation process is much clearer now and discussion has  improved.

Good job!

Author Response

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Author Response File: Author Response.docx