Vojta Therapy and Conservative Physical Therapy versus Physical Therapy Only for Lumbar Disc Protrusion: A Comparative Cohort Study from Romania

Round 1

Reviewer 1 Report

This article is of interest to therapists and patients who may be considering the efficacy of Vojta therapy, for which there is not currently conclusive evidence. Thank you for describing the therapy in detail in your methods (and providing references).

Comments for your consideration:

1. Page 1, lines 41-44: The labels "high" and "low" referring to prevalence of LDH are arbitrary, and the data does not seem to support the claim that there is "wide variation." Suggest reframing this sentence.

2. Page 2, line 59: Suggest omitting "conventional" as Vojta is not, to my knowledge, considered conventional therapy at this point. Reference #21 (a Łozińska et al.) states that "Vojta therapy is still not very popular in adult patients."

3. Page 2, lines 59-62: Please provide a reference for the use of Vojta therapy in neuropediatrics/cerebral palsy.

4. Page 2, lines 73-75: I was unable to access reference #19; however, the end of this statement ("...an optimal trunk stabilization and postural control") does not seem to be supported by your other two references (#20-21). Please provide additional support for this statement or omit it.

5. Page 2, lines 82-86: These two sentences seem to conflict with each other. I agree that literature on the benefits of Vojta for LDH is sparse. Therefore, how do we know that it is successfully used to decrease pain and disability? Please provide a reference for this statement or revise.

6. Page 3, line 101: Sciatica is listed as an exclusion for your study, however, LDH is a common cause of sciatica, and "sciatica" is frequently used interchangeably with "lumbar radiculopathy." Since you report the incidence of radiculopathy in your subjects, I assume this was not an exclusion criteria. Please further clarify or omit.

7. Page 3, lines 113-115: Please provide more information about the therapists performing the conventional physical therapy program. How many were there? What were their qualifications?

8. Page 4, line 172: Please provide a citation for the online sample size calculator.

9. Page 7, line 271: Suggest revising "only marginally" to "this was not significant" for clarity.

Author Response

Dear Madame/Sir,

Please find the answers to your comments in the attached document.

Sincerely,

Dorina Ianc, PhD

Author Response File: Author Response.docx

Reviewer 2 Report

-        The work presented for evaluation is based on the nature of research in the field of practical applications, and more specifically, the methodology of rehabilitation exercises.

-        It is to be expected that many physiotherapists in their practice must decide what type of therapy to use in the case of patients with LDH. An attempt to answer this question was made in the described experiment.

-        A total of 77 patients divided into two subgroups participated in the observations. The division was intentionally made so that in terms of demographic characteristics they were homogeneous to the group.

-        In my opinion, the work is distinguished by careful and well-chosen statistics. A small note: instead of the Kolmogorov-Smirnov test to analyze the data distribution, it was better to use the Shapiro-Wilk test, which has greater statistical power.

-        Line 159 describes the methodology of measuring the muscle strength of patients. A reference to a 1987 item is not the best form of information about how strength was measured. A brief description of the measurement would be useful.

-        There are no units in the entire table 2. For example, what is the force MSTFF=3.63 [N, N*m, points, %]? The SI unit of force is [N].

-        Personally, I am not surprised by the lack of differences between the effects of rehabilitation, regardless of the type of rehabilitation method; Vojt and conservative physical therapy. None of these methods have the effect of removing the cause of disc herniation. Both methods only help to alleviate the symptoms of functional disability.

-        For practice, this is important information because it does not matter which method the physiotherapist chooses for a patient with LDH.

Author Response

Dear Madame/Sir,

Please find the answers to your comments in the attached document.

Sincerely,

Dorina Ianc, PhD

Author Response File: Author Response.docx