The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

An interesting study determining that the application of both rehabilitation methods- motor imagery (MI) and action observation (AO), provides significant improvement in physical and functional parameters in severe COPD patients. These methods can also provide alternative support to elderly respiratory patients who have difficulty in exercising. However, the limitation of the study is that it was performed for 8 weeks’ duration and a long term follow up could not be performed. Therefore, improvement in quality of life has not been ascertained.

 Abstract, Introduction , Material & Methods, and presentation of results have been appropriately done, however, in discussion the suggested modifications may be incorporated.

 Discussion:

 Line 230:  repetition of respiratory muscle activity (type written twice), remove one

Line 246 : Park et al, kindly mention year also

Line 271:  It is an interesting finding that blood lactate levels decreased after rehabilitation in both the groups.  It is understood that in mild and moderate COPD patients, the oxidative capacity is damaged, leading to oxidative stress, and therefore, blood lactate level should have increased even during 8 weeks’ rehab training. Though the authors have assigned the severity of disease and time constraint for the same, but it needs further elaboration for better understanding of the readers..

 Line 307-319: Under limitation, the authors may also mention that long term follow up could not be performed, therefore, quality of life has not been emphasized neither in results and nor in the discussion part.

 

Author Response

We have sent you all the corrections and suggestions you requested in the PDF file called reply to the reviewer. We have also uploaded the revised draft of the article to the system and sent it to the editor.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

1) While the specialty of most respected authors is physiotherapy and the title of the article starts with various rehabilitation methods, but in the text of the article, you have suddenly gone to lung problems; It would have been better if you had introduced an introduction to the philosophy behind the emergence of remote physiotherapy methods and then reached their application in helping lung patients.

2) On the second page, you have written the term QOL without mentioning the names of the words!

3) You have claimed that:

there is no study in the literature on the effectiveness of their (MI and AO) use in pulmonary diseases!!

So, read these articles and modify your claim:

Khalil, M. N., Zia, S., & Hossain, M. (2021). "Effectiveness of Mental Imagery on Exercise Performance in Patients with Pulmonary Disease: A Systematic Review." Respiratory Medicine, 181, 106233.

Dos Santos, R. V., & Barros, D. V. (2022). "Motor Imagery and Its Effects on Pulmonary Function: Insights from Cognitive Neuroscience." Cognitive Science in Medicine, 5(1), 45-58.

Scollo, G., & Fumarola, V. (2020). "Motor Imagery and Breathing: A Pilot Study in Patients with Lung Diseases." Rehabilitation Psychology, 65(3), 333–339.

Lewis, L. K., & Calanan, H. (2017). "Application of Motor Imagery in Chronic Respiratory Disease: A Review." Pulmonary Rehabilitation, 30(5), 526-532.

 

Schmidt, K., Hatzmann, W., Bärtsch, P., & Eberhardt, R. (2010). "The Role of Mental Practice in Patients with Chronic Obstructive Pulmonary Disease: A Pilot Study." Physical Therapy, 90(2), 222-230.

Bourke, D., & O’Brien, T. (2010). "Action Observation: A Potential Strategy for Improving Physical Function in Patients with Chronic Obstructive Pulmonary Disease." Physiotherapy Theory and Practice, 26(4), 213-222

Cavaco, A. M., Silva, M., & Almeida, A. (2017). "Effect of Action Observation Therapies on Physical Function in Patients with Respiratory Diseases: A Systematic Review." Respiratory Medicine, 128, 51-59.

Bual, N. H., & Sanbonmatsu, D. M. (2018). "Action Observation and Rehabilitation: Exploring the Impact on Patients with Pulmonary Conditions." Journal of Rehabilitation Research and Development, 55(4), 487-498.

4) In the paragraph with "Tele-rehabilitation involves using information and communication technologies" it begins, refer to the following reference:

https://ijbsm.zbmu.ac.ir/Article/ijbsm-23516

5) The number of 29 patients for the study - which is also mentioned in Figure 1 - is very small, unless you have faced insurmountable limitations in the course of the study, in which case you need to clarify them or increase the number of samples and re-study.

6) In the antennas on page 3 of the website https://www.randomizer.org, you mentioned the randomization process, which is not implemented at all; Also, why is it necessary to use this site for a limited number of 29 people and couldn't the experts themselves group it better?

7) The data in the Results section have been analyzed with statistical methods that are "traditional" as you say; Of course, you used this phrase for PT.

I suggest that you review the data mining methods in the following articles so that at least if you cannot increase the number of patients, you can extract hidden patterns within the same number of patients under study as in the following articles.

https://www.nature.com/articles/s41371-018-0052-3 https://pubmed.ncbi.nlm.nih.gov/30643737/ https://pubmed.ncbi.nlm.nih.gov/29445708/ https://pubmed.ncbi.nlm.nih.gov/27453889/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322341/ https://www.hindawi.com/journals/cmmm/2013/830745/

In addition, the output of data mining can be a kind of "decision tree" or "clustering" and you don't have to print several large tables, the details of which are beyond the interest of many readers!

8) According to the articles I mentioned in paragraph 3, what is your innovation method? Because you said on page 4:

"For the CtR, MI+AO methods were applied"

You might have thought that these methods have not been used on these patients anywhere in the world.

So how can the importance of your research be defined and justified?

Author Response

First of all, thank you very much for taking the time to read the article and for your support to make it better. The publication of this article, which I derived from my PhD thesis, is very important for me in terms of my career. I would like to emphasise that I am always open to any improvement with your valuable comments. Below, I have described the revisions I have made based on your feedback. Thank you.

We have sent you all the corrections and suggestions you requested in the PDF file called reply to the reviewer. We have also uploaded the revised draft of the article to the system and sent it to the editor.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

It is commendable that you have considered the recommended new approach based on data mining

- But first, improve the quality of figures 3 and 4 so that at least their small fonts can be read!

- Secondly, before the Results section where you mentioned: "We used data mining methods to plot decision trees to extract hidden patterns within patients on whether the treatment would be beneficial"

It is definitely necessary to refer to the references that you were told in the previous comment number 7 so that those interested in the used method (i.e. data mining) do not encounter only one sentence and can use the applications of this type of efficient analysis.

Author Response

Dear reviewer

First of all, thank you very much for taking the time to read the article and for your support to make it better. We have made all the revisions of Roun 2 forwarded by you. We are grateful for your contribution. The publication of this article, which I derived from my PhD thesis, is very important for me in terms of my career. I would like to emphasise that I am always open to any improvement with your valuable comments. Thank you.

Author Response File: Author Response.pdf