The Impact of Acupuncture on Health-Related Quality of Life in Veterans with Combat Post-Traumatic Stress Disorder: A Secondary Analysis of a Randomized Control Trial

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

• The abstract doesn't include sufficient information on type of RCT and its details.
• The number of patients is not mentioned.
• All reported findings are descriptive with no inferential statistics.
• The introduction section is scattered to multiple small paragraphs.
• Highlight in the study title that this study is based on secondary analysis for previously published RCT.
• Mention the p-value in Table 1 to show whether there is a statistically significant difference in the demographic characteristics between the two arms of the trial.
• The discussion is very brief, and we want to see the clinical interpretation and justification for the study findings

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a secondary analysis of the previously published study (1). The current study aimed to evaluate the effect of acupuncture on health-related quality of life measured by Veterans RAND 12-health survey (VR-12).

Assuming that this questionnaire was introduced before and after acupuncture treatment, it is surprising that it was not mentioned in the original study (1).

Introduction

Fig. 1 is identical to the one published in the previous study (1).

Table 1 is huge, and has been published in the previous study as well (1). Furthermore, as the authors mention that there were no meaningful group differences on any variable in Table 1 (p.7, L. 117), perhaps the data relevant to the current study, can be presented as a text.

Results

Table 2 is not mentioned in the text.

The correlation between the data presented in Table 3 and the text is not clear. Please consider re-editing the Result section.

3.3. Secondary Analysis

p.9, L.197: please define in the Methods, what are the clinically relevant changes on MCS and PCS scores.

P.9, L. 201-204: the authors mention that neither MCS, nor PCS changes between the groups achieved statistical significance, which quite contradicts the Conclusions (p.11).

 

 

1. Hollifield M, Hsiao AF, Smith T, Calloway T, Jovanovic T, Smith B, Carrick K, Norrholm SD, Munoz A, Alpert R, Caicedo B, Frousakis N, Cocozza K. Acupuncture for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2024 Jun 1;81(6):545-554. doi: 10.1001/jamapsychiatry.2023.5651. PMID: 38381417; PMCID: PMC10882512.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This Reviewer commends the Authors for a well-written manuscript. Please review the following recommendations for your consideration:

Abstract:  This Reviewer found the abstract to be very well-written as it provides an enticing summary of the manuscript. No recommended modifications to the abstract in its current form.

 Page 3, Lines 89-90: When referring to “Veterans” up until this point in the paper, the word “Veteran” is capitalized.  However, beginning at this line in the manuscript, the word “veteran” is not capitalized. Recommend the Authors consider capitalizing the word “Veteran” throughout the paper as it is a proper title of the main subject of this manuscript.

Page 8, Line 154: The Authors state “. . . also with up to 3 additional . .”  Recommend numbers less than 10 be spelled out for proper format. The recommended new sentence fragment should read as follows: “ . . . also with up to three additional . . .”

Page 9, Table 2: The table displays fascinating information. However, the sham line is very faint and not easily depicted. Recommend the Authors strengthen the weight of this line or somehow make it more visible to the Reader.

Page 10, Table 3: The table displays fascinating information. However, the sham line is very faint and not easily depicted. Recommend the Authors strengthen the weight of this line or somehow make it more visible to the Reader.

Concluding comments: This Reviewer commends the Authors for a fascinating and quite informative and relevant manuscript. The background information provided the  Reader with the importance of seeking ‘non-traditional’ treatments such as acupuncture for a very deserving population: the Veteran. The study methodology was detailed and was effective in describing the study format how both groups were compared. This Reviewer very much liked how the study group was open to analyzing all aspects of their findings, resulting in their discovery of some unexpected, but positive results. This Reviewer also applauds the study group for highlighting the study limitation such as a study population that was predominantly male in gender.  Regardless, the study findings are fascinating and offer reinforcement of the value of acupuncture to the Clinician treating the Veteran population.  This Reviewer commends the study group for a phenomenal study and looks forward to continued manuscripts from this group advancing the knowledge to treat our deserving Veteran population. No additional recommended modifications identified. Thank you.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The introduction should not have these subheadings.

The discussion should be expanded.

Author Response

thank you, please see attached cover sheet. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for conveying me the revised manuscript, which has been improved, but there are still some additional comments:

Please rephrase the text at lines 112-4, 128-9, 152-3, 250 to cite the references to support your statement, rather than a direction to read another study. This is as a stand-alone manuscript and thus has contain all essential data and the methods.

Methods, lines 162 &168: the full name of the scores should be mentioned prior to their abbreviations.

Table 1.

Thank you for adding the p values, which supposedly address the differences between the groups. It is suggested therefore to incorporate them next to the values that were compared (as an in additional column).

Tables 2&3 (within groups differences).

When exact p values are indicated in the table, please consider omitting *p<0.05, **p<0.01 from the legends.

Table 4. Since no significant between-groups differences were detected, perhaps this information could be presented as a text.

The Discussion should address the limitations of the findings. some of them were mentioned indeed. However, a major limitation of this study that should be indicated and addressed, is a lack of significant between-groups differences.  

 

Author Response

Thank you, please see attached cover sheet.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I applaud the Authors for the improvements throughout the manuscript. I have no further recommended modifications and I look forward to seeing this manuscript published. Thank you.

Author Response

Thank you, please see cover sheet.

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

The authors addressed all of my comments.

Author Response

As mentioned in the reviewer comments all comments have been addressed. We thank this reviewer for their time and energy to improve this paper.

Reviewer 2 Report

Comments and Suggestions for Authors

Though the manuscript has been improved, there are still referrals to other studies for additional information (p7., lines 127-128; p.8, lines151-152). A stand-alone manuscript should contain all essential data and methods.
A lack of statistical difference between the verum an sham group does not necessarily mean that any kind of acupuncture provided an improvement (p11, lines 232-235), but rather may indicate that in this particular study, no specific acupuncture effect has been demonstrated on the parameters evaluated.
Please amend the legend of Tables 2&3 according to the previous review: most readers are quite familiar with the significance of p values.
Finally, the paper would benefit from a proper scientific editing. 

Comments on the Quality of English Language

please consider a scientific editing of your paper

Author Response

Thank you for your comments, we have replied to them and significantly restructured the paper. See attached cover sheet for details. 

Author Response File: Author Response.pdf