Shoulder Pain Biomechanics, Rehabilitation and Prevention in Wheelchair Basketball Players: A Narrative Review

Round 1

Reviewer 1 Report

while an overview of the state of the art in shoulder pain biomechanics research and treatment related to wheelchair basketball is certainly warranted, I do not feel that this MS does what it intends to do. Especially chapter 2 suffers from imprecise, if not incorrect referencing and unjustified conclusions. In its current form I do strongly feel that this paper should not be published; for two reasons:

- it is the wrong example of how references should be used;

- it suggests that we know far more than we actually do.

To give a few examples:

line 77- 79: Ladd [13] did not study wheelchair propulsion, athletes or sports, does not say anything about transfers or even mobility, so where does this statement come from? "Moreover, the continuous use of the wheelchair, that depends on individual weightbearing, creates unnatural biomechanical efforts on the upper limbs that are primarily designed for transfers and mobility [13]."

line 104: reference [25] is a comparison on the prevalence of RC tears between paraplegic patients and controls. Nothing is reported on sports or wheelchair use (part from dependency). So how could this conclusion be drawn from that reference: "Secondly, repetitive and overhead movements, such as reaching, propulsion, throwing and passing, sudden changes of direction with wheelchair, 105 game tackles and falls can cause injuries responsible for SP [24-25]."?

line 157: this was the actual conclusion of [40] : "Changing posture while sitting did not directly affect pain provocation and pain levels during performance of 3 clinical shoulder tests in participants with shoulder pain and RCDTs.". How do the authors come to the conclusion that this is a relevant reference for the statement "in the long period, there is a high risk of developing degenerative tendons tears and SP"??

line 171-172: how do the authors come to the conclusion that the reference to Bayley [38] is justified for this statement: "

As described above, rotator cuff tendons, especially supraspinatus, are extremely exposed to biomechanical stress both for the reduction of subacromial space and for the excessive efforts due to under load rotational movements during sports practice [38].

Bayley did not study sports practice, did they?

Overall I consider the quality of this analysis and the extremely inaccurate use of references an unacceptable flaw.

no comments

Author Response

Please, see the attached file

Author Response File: Author Response.pdf

Reviewer 2 Report

I am extremely honoured to be able to review the paper entitled: Shoulder Pain Biomechanics, Rehabilitation, and Prevention in Wheelchair Basketball Players: A Narrative Review.

In the Introduction, the importance of further physical activity for people with certain physical disabilities, as well as the popularity of wheelchair basketball, is presented in a detailed and systematic way. Furthermore, the risks of doing the same from the perspective of sports injuries are explained, which also indicates the importance of such an overview scientific paper.

In this paper, the authors analysed in a highly systematic way the biomechanics of movement during wheelchair basketball as the fundamental cause to sports injuries of the shoulder joint, as well as an overview of previous research from the aspect of rehabilitation and prevention of the aforementioned injuries of WB athletes, using 106 literary references.

What I would suggest to the authors is perhaps to put the chapter on prevention before rehabilitation, because I believe that prevention of the sports injury itself is key, and only after the injury occurs does the importance of good rehabilitation follow.

In addition, the authors gave a systematic overview of the aforementioned shoulder joint injury and the importance of prevention and rehabilitation, but perhaps in the paper itself they would have highlighted some of the programme proposals for the same prevention and not just give a systematic overview of all programmes analysed from the literature.

Author Response

Please, see the attached file

Author Response File: Author Response.pdf

Reviewer 3 Report

I read with attention the present review examining the prevention and rehabilitation strategies to counteract shoulder pain in wheelchair basketball players . Overall, the rationale for performing this study is well explained, the search methodology and the results are well presented. I believe that present article has merit but I have some comments that should be addressed.

Paragraph 1, introduction:

Please include a brief description about search strategy and methodology (i.e. eligibility criteria, study selection, information source)

Paragraph 4, shoulder Pain in Wheelchair Basketball Players: prevention strategies: please consider to expand the role of customized training program in Para sport, as well as the importance of training monitor to check improvements overtime.

Here some references to consider:

Cavaggioni L, Trecroci A, Tosin M, Iaia FM, Alberti G. Individualized dry-land intervention program for an elite Paralympic swimmer. J Sports Med Phys Fitness. 2019 Jan;59(1):82-86.

Paulson TA, Mason B, Rhodes J, Goosey-Tolfrey VL. Individualized Internal and External Training Load Relationships in Elite Wheelchair Rugby Players. Front Physiol. 2015 Dec 21;6:388.

Paragraph 5, conclusions: please insert the main limitations of the current study

Author Response

Please, see the attached file

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

While the authors did improve part 4 extensively, I am somewhat surprised that they did not do a thorough check on their referencing throughout the MS.

I did a few checks and ran into the following:

line 49, reference 1!!: This statement by Chenier is not based on their work, but is a statement supported by, by themselves, irrelevant references. Please check the basic rules for referencing! General knowledge, or belief does not need referencing. This reference suggests that Chenier maybe did a review, questionnaire or whatever research on which they drew the mentioned conclusion, but they did not.

lines 114-118: this was not the conclusion of [20]. Kulig et al conclude:

The increased joint loads documented during fast and inclined propulsion could lead to compression of subacromial structures against the overlying acromion. They did not quantify upward translation (impossible with their model), but conclude that there certainly is a risk for UT happening .....

lines 156-157:  I am quite certain that [38] does not contain WUSPI data or does it?

line 218: [53] is not  a publcation on prevention programs. They conclude that their results can be used. Their own interpretation:

These predictors may provide insight into how to improve rehabilitation

And these were certainly not the result of a thorough check of all references, but based on a quick  sample.

Please do a proper, complete, check on referencing!

Author Response

Please, see the file attached

Author Response File: Author Response.pdf