Aspects of Clinical Utility of the Distress Thermometer and Problem List after Burns
Round 1
Reviewer 1 Report
The paper deals with an overlooked issue: physical and psychosocial problems following the burn event, that generally receive little attention despite its large and long-term impact on health-related quality of life.
It is not well clear to me how the authors selected some items in addition to the standardized questionnaire used.
I found the results section a little bit unclear. I suggest to improve the lienarity of presentation in that section.
Introduction
Line 56-57: “However, the instrument does not comprise a distress measure rating scale which has 56 shown to offer additional insight in the burden of the complaints” Please provide a reference for this
Method
Line 69-70: “Exclusion criteria were psychiatric problems that interfere with the comprehension of questionnaires (e.g., psychosis, cognitive problems).” How did the authors evaluate the presence of psychiatric problems? If they didn’t use some questionnaire, may be it is better not to indicate this sentence.
Line 88-90: “For the purpose of 88 this study, three items were added to the PL that were deemed relevant to burn care. 89 Those include guilt, loss of muscle strength and condition.” On which basis did the authors selected these items? Did they draw them from the literature? They should provide adequate references to motivate this choice.
Results
Line 106: “19 had low Dutch proficiency”. This is an aspect that the authors could put as an inclusion/exclusion criteria in the Method section
It is not clear to me what the figures 1 and 2 indicate, compared to the tables. I found the figures not clearly understandable.
Discussion
Well written
Author Response
The paper deals with an overlooked issue: physical and psychosocial problems following the burn event, that generally receive little attention despite its large and long-term impact on health-related quality of life. It is not well clear to me how the authors selected some items in addition to the standardized questionnaire used.
Authors’ response: We would like to thank the reviewer for the time and efforts to review our manuscript and for the valuable recommendations. Regarding the items that were added, those items were deemed relevant by clinicians because they frequently encountered this kind of problems, particularly in children or their parents. Because the PL was developed for adults, those items were added. We have provided references to motivate the addition of the items.
I found the results section a little bit unclear. I suggest to improve the lienarity of presentation in that section.
Authors’ response: We have reorganized some parts of the results and hope this adds to the clarity of the results.
Introduction
Line 56-57: “However, the instrument does not comprise a distress measure rating scale which has shown to offer additional insight in the burden of the complaints” Please provide a reference for this
Authors’ response: we have added the reference.
Method
Line 69-70: “Exclusion criteria were psychiatric problems that interfere with the comprehension of questionnaires (e.g., psychosis, cognitive problems).” How did the authors evaluate the presence of psychiatric problems? If they didn’t use some questionnaire, may be it is better not to indicate this sentence.
Authors’ response: We have removed this sentence, it was indeed not structurally measured.
Line 88-90: “For the purpose of this study, three items were added to the PL that were deemed relevant to burn care. Those include guilt, loss of muscle strength and condition.” On which basis did the authors selected these items? Did they draw them from the literature? They should provide adequate references to motivate this choice.
Authors’ response: see first comment
Results
Line 106: “19 had low Dutch proficiency”. This is an aspect that the authors could put as an inclusion/exclusion criteria in the Method section
Authors’ response: We now have included this in the exclusion criteria.
It is not clear to me what the figures 1 and 2 indicate, compared to the tables. I found the figures not clearly understandable.
Authors’ response: we agree with the reviewer that the figures may not add much to the table and because the items in the subgroups differ, it may not be clear. Therefore, we have replaced the figures and we now present the total number of problems reported in every domain. In this way, we can demonstrate that the DT is indicative for the number of complaints. We hope that these figures are more illustrative and easier to understand.
Discussion
Well written
Reviewer 2 Report
I really apprecciate this manuscript.
In my opinion, authors have develop a very interesting work and relatively new within this field.
I only suggest to check percentages and numbers in table 1. Also check in section 3.3 if pediatric sample is 47 or 48 children.
Another little concerns is about conclusion section. I suggest to expand the reflection.
After this few revisions, in my opinion the manuscript is suitable for publication.
Author Response
Reviewer 2
I really apprecciate this manuscript.
In my opinion, authors have develop a very interesting work and relatively new within this field.
I only suggest to check percentages and numbers in table 1. Also check in section 3.3 if pediatric sample is 47 or 48 children.
Authors’ response: We would like to thank the reviewer for the time and efforts to review our manuscript and for the detailed suggestions. The pediatric sample is 48, but some items are completed by 47 respondents (for example items in the emotional domain).
Another little concerns is about conclusion section. I suggest to expand the reflection.
Authors’ response: We have expanded the conclusion section.
After this few revisions, in my opinion the manuscript is suitable for publication.
Reviewer 3 Report
Manuscript Number: EBJ-1617388
Title: Aspects of clinical utility of the Distress Thermometer and Problem List after burns
Thank you for your interesting report. This report presented “Aspects of clinical utility of the Distress Thermometer and Problem List after burns.” I have some suggestions for revision.
<Major revision>
- I wonder if the language in which the distress thermometer and problem list (DT & PL) survey questionnaire was first developed was English or Dutch. If the original text was standardized in Dutch, please describe in which study the standardization was performed and whether validation was performed. Otherwise, the quality of the survey can be highly questionable.
- This is a study using the DT & PL questionnaire used in other fields in the field of burn. Whether similar studies had conducted in other languages, and what limitations have led to the use of DT & PL in the field of burn should be presented in the introduction section. Please describe, for example, the limitations of the tools used in the Gibson et al and Kool et al studies.
- I was wondering if it was possible to perform a sub-analysis based on the severity of the burn (eg. Total body surface area (TBSA)). Also, I wonder if there was a difference between first-degree burns, second-degree burns, and third-degree burns, for example.
Author Response
I wonder if the language in which the distress thermometer and problem list (DT & PL) survey questionnaire was first developed was English or Dutch. If the original text was standardized in Dutch, please describe in which study the standardization was performed and whether validation was performed. Otherwise, the quality of the survey can be highly questionable.
Authors’ response: We would like to thank the reviewer for the time and effort to review our paper and for raising critical comments.
Regarding the validation question, the DT & PL is validated in Dutch. We have provided the reference (Tuinman et al 2008).
This is a study using the DT & PL questionnaire used in other fields in the field of burn. Whether similar studies had conducted in other languages, and what limitations have led to the use of DT & PL in the field of burn should be presented in the introduction section. Please describe, for example, the limitations of the tools used in the Gibson et al and Kool et al studies.
Authors’ response: To our knowledge, there is only one instrument which is the instrument developed by Gibson. The paper reports on how the instrument was developed and does not report limitations. Kool et al is a qualitative study that provides information about domains of functioning that were hampered. We adjusted the text as this may not been formulated clearly.
I was wondering if it was possible to perform a sub-analysis based on the severity of the burn (eg. Total body surface area (TBSA)). Also, I wonder if there was a difference between first-degree burns, second-degree burns, and third-degree burns, for example.
Authors’ response: Thank you for this question. We have run a correlation with the DT and TBSA burned but this was not statistically significant. We mention this now in addition to the correlation coefficients already reported. In figure 3, we present the mean TBSA burned in relation to the wish to discuss the problems with a professional and also this is not statistically significant. We cannot distinguish between burn depth because we did not register that.
Author Response File: 
Author Response.docx
Round 2
Reviewer 1 Report
The paper is now adequate for publication.
Congratulations to the authors
Reviewer 3 Report
Thank you for your effort.
