Clinical Pilates Diagnostic Bullseye Concept for Neck and Shoulder Musculoskeletal Patients: Case Studies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1) Clarify what is new and what is adapted

• Please state explicitly (end of Introduction) the novel contribution: e.g., “(i) proposed neck bullseye mapping, (ii) proposed shoulder bullseye mapping, (iii) integration rule for lower-quadrant preference influencing upper-quadrant prescription, (iv) worked examples via 2 cases.”

• Consider adding a short box (“How to use the bullseye in practice”) summarizing the steps already described across sections, but in a concise, replicable sequence.

2) Strengthen case-report transparency (CARE elements) without expanding too much
Both cases are understandable, but readers will benefit from a small amount of additional detail that improves reproducibility:

• Add a compact Table summarizing each case: age/sex/occupation/sport, symptom duration, key exam findings, directional preference (lower quadrant, neck, shoulder), intervention(s) prescribed (dose, frequency, progression), number of sessions, follow-up interval, and outcomes.

• Please report whether outcomes were collected at every visit, and specify exact timing (e.g., “baseline, visit 2, visit 3, and discharge at n days”).

• Add a sentence acknowledging natural history/regression-to-the-mean as an alternative explanation (even if unlikely), since these are uncontrolled cases.

3) Tone down or rebalance a few discussion statements (avoid overgeneralization)
In the Discussion, some statements about biopsychosocial approaches risk sounding like a dismissal and may be seen as a “strawman.” A minor edit can keep your intended point (directional-specific exercise matters) while staying balanced:

• Replace absolute phrasing such as “patients may be misled…” with more neutral language.

• Consider adding one sentence recognizing that biopsychosocial and movement-specific approaches can be complementary, not mutually exclusive, and that screening for red flags and directional preference can sit alongside psychosocial-informed care.

4) Define/justify key classifications and constructs

• When you classify “Grade II/III neck pain,” please briefly specify the classification source/criteria in Methods or within the Case description (1–2 lines is enough), so non-specialist readers understand what Grade II vs III means.

• “Bullseye Clinical Pilates” is introduced to avoid confusion—good idea—but please keep terminology consistent throughout (Clinical Pilates method and DMA Clinical Pilates and Bullseye Clinical Pilates). A short glossary line may help.

5) Improve intervention description (dose + progression)
You provide some dose information (e.g., sets/reps, daily frequency), but please standardize it for both cases:

• Include: sets/reps, frequency per day/week, approximate time per session, and clear rules for progression (load, tempo, ROM, symptom response).

• For RPE, specify whether it was targeted or simply recorded (and clarify Borg scale version used).

6) Figures: small clarity adjustments
The figures are central to the concept. Minor enhancements:

• Ensure each bullseye figure caption explicitly defines green (treatment direction) and red (trauma/provocation) consistently (some captions already do; standardize across all).

• If feasible, add a small legend to the bullseye images themselves so readers don’t need to hunt the caption.

• Cite the software used to create the Pilates exercise in the method section.

 

In the Abstract/Conclusion, avoid implying effectiveness beyond the case context. Suggest phrasing like “feasibility illustrated in two cases” rather than “shown to be feasible” without qualification.

Please proof for small grammar/consistency items (e.g., hyphenation and repeated phrasing). A light copyedit will improve flow.

Given the stated conflict (authors in a private practice delivering the method), please add a one-sentence statement on how bias was mitigated (e.g., routine outcome collection, consecutive cases, standardized measures, or independent verification of scoring if applicable).

 

 

Comments on the Quality of English Language

Needs improvement. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

The study objective is established and understandable. However, the study design, and in particular the methodology, which uses two clinical cases, does not allow us to reach the formulated conclusions. In view of the above and considering the methods adopted, it will be challenging to demonstrate the authors' thesis, "present a conceptual framework in the management of neck and shoulder musculoskeletal conditions from the perspectives of the Clinical Pilates method". Without wanting to interfere with the authors' autonomy, it would be more logical to follow a case study design.

Kind regards

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The review comments for each area are as follows:

1. Abstract
- While structured as a "Methods/Results/Conclusions" study, it is actually closer to a report format, presenting a conceptual framework and reporting two case studies. Therefore, it would be appropriate to clearly state from the first sentence of the abstract that this report is a "technical report/case series" demonstrating concept proposal and case application, and to lower the conclusion to "applicability/hypothesis generation" rather than "proving effectiveness."

2. Introduction
Please revise or delete any theoretical assumptions that have not yet been scientifically proven. For example, "muscle damage occurs in a prolonged state" or "treatment should be directed toward shortening."

3. Method
Considering this, conceptual frameworks like those in sections 4-6 are not reproducible treatment protocols. Therefore, standard procedures such as assessment, interpretation, and prescription algorithms should be indicated.

4. Results
While the description of nearly complete recovery after three sessions in two cases is impressive, it is likely due to rater bias (therapist-asserted results).

5. Discussion
The statement asserting the validity (effect) of the conceptual framework based on two cases is considered an overgeneralization. Therefore, future research is needed to verify the reliability and validity of this model.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors

There were some improvements; however, there are some recommendations that should be addressed: 

The scientific gap is clearly identified and appropriately justifies the study. However, the introduction is relatively extensive and, at times, approaches a narrative review, which could be condensed to improve clarity and focus.

The study is correctly classified as a technical report with case studies, focusing on feasibility rather than clinical efficacy. The design is appropriate for the proposed exploratory aims.

The assessment is methodologically appropriate at an exploratory level but has significant structural limitations.

The results are consistent with the study design, but insufficient for causal inference.

In the discussion, some statements regarding gaps in physiotherapy practice would benefit from stronger empirical support, although this does not substantially undermine the overall quality of the discussion.

The conclusions are proportionate to the results presented and appropriately cautious. The authors limit their claims to the model's conceptual feasibility, without asserting clinical efficacy.

In conclusion:

Greater conciseness in the introduction;

Clearer distinction between theoretical plausibility and empirical evidence;

Stronger emphasis on the need for future studies addressing reliability, validity, and clinical effectiveness.

Regards

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The revisions reflecting the reviewer's comments have been successful.
Thank you for your hard work.

Author Response

Comments: The revisions reflecting the reviewer's comments have been successful. Thank you for your hard work.

Response: We thank the reviewer for the time in reviewing our work and prior suggestions to improve our manuscript.