The Thermo-Pressure Concept: A New Model in Diabetic Foot Risk Stratification
, Nachiappan Chockalingam 2,3,* and Alfred Gatt 1,2Round 1
Reviewer 1 Report
Dear Editors,
This is an interesting study regarding the use of thermo-pressure concept . The followings are my comments
1. Page 7 , "A number of statistical tests were performed to determine ", please detail the methods of stastistical tests and the version of the software.2. Table 1, please show the case number and whether there is difference of the baseline parameters of the 4 groups.
3. Table 3, please explain the lack of correlation in the healthy group
4. Page 7 , Line 208 , Please illustrated the data of "significant difference" in the table or context.
5. Page 9 , Line 258 , please cite "Falzon et al"
6. Line 274 , it should be demonstrated by the experiment not statistical methods.
7. Line 189 , how many measurements performed to get the mean value ?
Author Response
We would like to thank the reviewers for their important comments regarding our paper. Kindly note that we have gone over the paper again, firstly to address the reviewers’ comments and to improve the readability of our paper.
- Page 7 , "A number of statistical tests were performed to determine ", please detail the methods of stastistical tests and the version of the software.
This sentence has been changed to: Pearson correlation tests were performed in IBM SPSS version 27 on the various areas of interest to determine whether a correlation between pressure and temperature exist.
Table 1, please show the case number and whether there is difference of the baseline parameters of the 4 groups.
Kindly note that as per suggested correction by Reviewer 2, this Table has been converted into a figure for more clarity. The number of cases has been included in the caption for the figure: Figure 1: inclusion criteria for each group. 12 participants per group were recruited
This figure describes the inclusion/exclusion criteria with the required baseline parameters required in each group.
- Table 3, please explain the lack of correlation in the healthy group
(Table 3 is now numbered as Table 2 due to deletion of Table 1). The text in this related paragraph has been altered as follows to clarify the lack of/ or corelation found:
The results in Table 2 indicate that the Pearson Correlation test exhibited a positive relationship between the two variables in the areas marked with an asterisk (i.e. p<0.05). For Group A and B combined, only the 5th MPJ accepts the alternative hypothesis as its p- value is smaller the 0.05 level of significance. Thus there is a lack of correlation in all the other areas in these groups. On the other hand, for Groups C and D combined, the Hallux, 2nd to 4th MPJ, 5th MPJ and Heel accept the alternative hypothesis as their p- value is small than the 0.05 criterion, thus demonstrating a positive correlation between temperature and pressure in these specific areas.
Page 7 , Line 208 , Please illustrated the data of "significant difference" in the table or context.
This data is previously published by Gatt et al and referenced no 15 in this article. The reader is thus directed to read this paper in order to get better understanding of the findings and thus justification as to why the groups in this study were categorized as such. However, this sentence was altered for more clarity as follows: “as per Gatt et al, who had identified no significant differences between healthy and healthy diabetic groups (p>0.05), and a significant difference between the ‘healthy’ groups (healthy + DM without complications) and the complications groups (PAD + neuroischaemia) (p<0.05) [15].”
Page 9 , Line 258 , please cite "Falzon et al"
Paper cited
Line 274 , it should be demonstrated by the experiment not statistical methods.
‘statistical tests’ have been changed to ‘this study’
Line 189 , how many measurements performed to get the mean value ?
‘mean temperatures’ refer to the mean value of all the temperatures of each pixel within the region of interest. This is done automatically by the thermographic software used. A sentence has been added as follows: “These mean temperatures were automatically calculated by the thermographic analysis software by dividing the temperature at each pixel in the region of interest by the number of pixels.”
Reviewer 2 Report
I read with interest Sarah Perren article entitled The Thermo-Pressure Concept: a new model in diabetic foot risk stratification.
The authors, on the basis that there is currently very limited evidence supporting the use of single clinical parameters in predicting the risk of DFU, in this article present and propose a novel “Thermo-Pressure model” combining, temperature and pressure, in order to develop a risk categorization model for diabetes patients at risk for ulceration. This subject is extremely topical and really interesting. The study is well conducted, detailed and well written.
I have few comments to make to the authors:
Comments:
line 4: and should be inserted at the end for only the last authors and numbers for affiliation should be progressive
line 17: not really clear for the abstract better rephrase different groups in a schematic manner A: B: C: D:
Table 1: too many information try to synthetize or make more schematic and readable
Line 199: I imagine that this distribution doesn't reflect any statistical difference but please provide pscore
Line 236: Since the great difference in the results by region I ask the author to add a new graphic comparing the mean temperature and pressure measurement in healthy group (A) vs diseased group (B-C-D) and make the same comparison between groups A vs D to enhance and show the differences in results
Author Response
We would like to thank the reviewers for their important comments regarding our paper. Kindly note that we have gone over the paper again, firstly to address the reviewers’ comments and to improve the readability of our paper.
line 4: and should be inserted at the end for only the last authors and numbers for affiliation should be progressive
In the original manuscript, there are no “and” inserted. Perhaps these have been inserted by the submission system? We have changed the affiliation numbers.
line 17: not really clear for the abstract better rephrase different groups in a schematic manner A: B: C: D:
Abstract has been updated as requested
Table 1: too many information try to synthetize or make more schematic and readable
Table 1 has been converted into a figure (now designated as Figure 1) and text reduced to make it more readable. Other figure numbers have been altered to reflect this change.
Line 199: I imagine that this distribution doesn't reflect any statistical difference but please provide pscore
p-score provided. P=0.069, showing no statistical differences between the two groups
Line 236: Since the great difference in the results by region I ask the author to add a new graphic comparing the mean temperature and pressure measurement in healthy group (A) vs diseased group (B-C-D) and make the same comparison between groups A vs D to enhance and show the differences in results
Round 2
Reviewer 1 Report
Dear Editor
The authors respond to the questions raised. I have no further questions.
Reviewer 2 Report
no more comments
