Comparison between Short, Medium, and Long Fields of View in Estimating Bicep Femoris Fascicle Length

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Suggestions for authors

Positive aspects: The comprehensive approach to comparing the field of view's impacts on fascicle length estimation and the detailed methodological description are strengths of this paper.

For improvement: This study would benefit from a deeper exploration of how these findings might influence clinical and sports performance practices. Additionally, addressing potential limitations more critically, such as the generalizability of the findings beyond the specific athletic cohort studied, and further exploring the technical and practical challenges of implementing the recommended ultrasound field of view and equations in varied settings, would provide a more rounded discussion.

 

For the methodology section and results of your manuscript, here are specific suggestions for improvement and clarification.

Methodology section:

Clarification on participant selection: Elaborate the rationale behind selecting male team sport athletes exclusively and its pertinence to the study's objectives. If the findings are to be extended to a broader population, potential limitations or future research directions should be discussed to encompass a more diverse participant pool.

Ultrasound image acquisition details: Although the methods for obtaining ultrasound images are outlined, providing a more detailed justification for the selected fields of view (FOV) and how they compare to common clinical or research settings would enhance comprehension. Additionally, explaining any preparatory steps taken to standardize the positioning of the participants and the ultrasound device could bolster reproducibility.

Statistical analysis: The statistical techniques are well detailed, but including information about the selection of non-parametric tests, especially in light of the data distribution, would be beneficial. Furthermore, discussing the implications of using these tests instead of others could reinforce the rationale behind the analytical approach.

 

Results section

Thorough presentation of findings: The current presentation of the findings clearly and effectively highlights the significant differences between the fields of view (FOVs). However, there is room for improvement in terms of providing more context for the clinical and practical implications of these differences. For instance, discussing how variations in FOV might influence diagnostic or therapeutic decisions in the context of sports medicine could be informative for readers.

Graphical representation of data: It is recommended to include additional graphical representations of the key findings, such as scatter plots illustrating the associations between different FOVs and estimation equations. These visual aids can help summarize the data and make the results more accessible to readers.

Discussion of reliability and error estimates: This section on reliability assessments and error estimates is currently included, which is crucial. Enhancing this section by comparing your reliability and error metrics with those from similar studies or accepted clinical standards could provide a valuable context for your findings.

Interpretation of effect sizes: While significant differences are mentioned, delving deeper into the interpretation of effect sizes and their practical relevance would be beneficial. Discussing how these effect sizes translate into real-world differences in fascicle length estimation, and potentially injury risk assessment or performance prediction, would be insightful.

Limitations within results: A more comprehensive discussion of the limitations encountered specifically in the Results section, such as potential biases in FOV selection or the impact of measurement errors, would be informative. Acknowledging these limitations and suggesting ways to mitigate them in future research would enhance the credibility and utility of this study.

 

Implementing these suggestions can significantly improve the methodology and results sections of your manuscript, making it a more robust and valuable contribution to the field.

Comments for author File: Comments.pdf

Author Response

The authors appreciate the time and effort taken in the review process and hope all changes meet the minimum standards as required by the reviewer.

 

Positive aspects: The comprehensive approach to comparing the field of view's impacts on fascicle length estimation and the detailed methodological description are strengths of this paper.

 

The feedback here is appreciated.

 

For improvement: This study would benefit from a deeper exploration of how these findings might influence clinical and sports performance practices. Additionally, addressing potential limitations more critically, such as the generalizability of the findings beyond the specific athletic cohort studied, and further exploring the technical and practical challenges of implementing the recommended ultrasound field of view and equations in varied settings, would provide a more rounded discussion.

 

I hope all changes made are sufficient. 

 

For the methodology section and results of your manuscript, here are specific suggestions for improvement and clarification.

Methodology section:

Clarification on participant selection: Elaborate the rationale behind selecting male team sport athletes exclusively and its pertinence to the study's objectives. If the findings are to be extended to a broader population, potential limitations or future research directions should be discussed to encompass a more diverse participant pool.

 

Participant selection has now been clarified to identify male team sport athletes as convenience sampling.

 

Ultrasound image acquisition details: Although the methods for obtaining ultrasound images are outlined, providing a more detailed justification for the selected fields of view (FOV) and how they compare to common clinical or research settings would enhance comprehension. Additionally, explaining any preparatory steps taken to standardize the positioning of the participants and the ultrasound device could bolster reproducibility.

 

The justification of the FOV has been explained in more detail. Moreover, the detail on participant position was identified.

 

Statistical analysis: The statistical techniques are well detailed, but including information about the selection of non-parametric tests, especially in light of the data distribution, would be beneficial. Furthermore, discussing the implications of using these tests instead of others could reinforce the rationale behind the analytical approach.

 

It has now been highlighted within the statistical analysis the data were found to be non-normally distributed hence the description of non-parametric statistical approach.

 

Results section

Thorough presentation of findings: The current presentation of the findings clearly and effectively highlights the significant differences between the fields of view (FOVs). However, there is room for improvement in terms of providing more context for the clinical and practical implications of these differences. For instance, discussing how variations in FOV might influence diagnostic or therapeutic decisions in the context of sports medicine could be informative for readers.

 

The authors suggestion here is crucial and is discussed within the discussion section of the manuscript in great detail. The results section should only include a description of the results and not any discussion of influence to practise.

 

Graphical representation of data: It is recommended to include additional graphical representations of the key findings, such as scatter plots illustrating the associations between different FOVs and estimation equations. These visual aids can help summarize the data and make the results more accessible to readers.

 

I have included additional figures (scatter plots) within the appendix B due to the number of plots and tables already in the manuscript.

 

Discussion of reliability and error estimates: This section on reliability assessments and error estimates is currently included, which is crucial. Enhancing this section by comparing your reliability and error metrics with those from similar studies or accepted clinical standards could provide a valuable context for your findings.

 

We have attempted to add more detail here and comparing to previous literature.

 

Interpretation of effect sizes: While significant differences are mentioned, delving deeper into the interpretation of effect sizes and their practical relevance would be beneficial. Discussing how these effect sizes translate into real-world differences in fascicle length estimation, and potentially injury risk assessment or performance prediction, would be insightful.

 

I completely agree with the sentiment here, interpreting differences on magnitudes is crucial. We have attempted to add more detail here.

 

Limitations within results: A more comprehensive discussion of the limitations encountered specifically in the Results section, such as potential biases in FOV selection or the impact of measurement errors, would be informative. Acknowledging these limitations and suggesting ways to mitigate them in future research would enhance the credibility and utility of this study.

 

 

We have added a more robust limitations section, with more detail around the population and the methods used within the present study.

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript is well written. It contains all parts according to the editorial guidelines. The literature cited is well matched to the content discussed, although not the most recent (last 5 years) literature. It does not contain an excessive number of self-citations. As noted earlier, the study group is not very large. Despite this, it is sufficient to confirm the research hypothesis.  The reviewer recommends increasing the group in subsequent studies. The authors developed the results well and presented them in tables. The discussion correctly analyses the results in relation to the literature and in relation to all hypotheses set.

 

The main hypothesis was that there would be significant and meaningful differences in single image estimates between FOVs. It was also hypothesised that there would be significant correlations between FOVs, due to the identification of similar tangible measures. The authors should consider improving the methodology by increasing the number of respondents. They conducted the study on a fairly small group. Consideration should be given to increasing the number of respondents.  The conclusions are consistent with the results presented. All the main questions posed were addressed. References are appropriate but not recent. There are no comments on the tables, they are well prepared. Easy to interpret and analyse the data.

Author Response

The manuscript is well written. It contains all parts according to the editorial guidelines. The literature cited is well matched to the content discussed, although not the most recent (last 5 years) literature. It does not contain an excessive number of self-citations. As noted earlier, the study group is not very large. Despite this, it is sufficient to confirm the research hypothesis. 

The authors appreciate the feedback, it is worth noting that there has been little advancement in the ultrasound assessment of bicep femoris long head in the last 5 years.

The reviewer recommends increasing the group in subsequent studies. The authors developed the results well and presented them in tables. The discussion correctly analyses the results in relation to the literature and in relation to all hypotheses set.

The authors are not sure by what you mean by “the group” whether you are referring to the investigators or the number of participants. It is worth noting that the results are sufficiently powered for the investigation based on the large sample size. Additionally, the number of investigators is related to the study being completed as PhD study by a primary investigator and co-investigators being PhD supervisors.

The main hypothesis was that there would be significant and meaningful differences in single image estimates between FOVs. It was also hypothesised that there would be significant correlations between FOVs, due to the identification of similar tangible measures. The authors should consider improving the methodology by increasing the number of respondents. They conducted the study on a fairly small group. Consideration should be given to increasing the number of respondents.  The conclusions are consistent with the results presented. All the main questions posed were addressed. References are appropriate but not recent. There are no comments on the tables, they are well prepared. Easy to interpret and analyse the data.

The authors appreciate the honest review, obviously the 36 participants are still considerably more than in comparison to other studies. Additionally, the results are achieved statistical power.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors

This was an interesting article about test accuracy for biceps ultrasound imaging. Study design was adequate,and statistic methods robust. below my suggestions:

1. Lower plagiarism, since you've a high percentage of the work identical to previous studies

2. Correct all abbreviation (i.e. HSI is not explained at first appearance in the text)

3.  Better describe inclusion criteria

4. Enrich discussion with reference to limits due to BF muscle structure 

Author Response

This was an interesting article about test accuracy for biceps ultrasound imaging. Study design was adequate,and statistic methods robust. below my suggestions:

1. Lower plagiarism, since you've a high percentage of the work identical to previous studies

As the study was originally completed as part of a PhD thesis which is publically available online but is not published literature, so it is difficult to reduce the similarity, the authors have attempted to change this score by adapting the text where necessary. It is worth noting that the majority of similar text is related to the methods.

2. Correct all abbreviation (i.e. HSI is not explained at first appearance in the text)

This has been amended.

3. Better describe inclusion criteria

Further information on the inclusion criteria has been added, specifically it is convenience sampling.

4. Enrich discussion with reference to limits due to BF muscle structure 

The authors are completely sure what you mean by this, a limitations section has been included. But the comments around BF structure are discussed within the methods when relating to work via Freitas and Franchi, respectively.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

The authors thank the review for the time and effort in reviewing once again.

 

The authors have now provided further technical information regarding the ultrasound machine set up 

L104-106 - 2D, B-mode ultrasound (MyLab 70 XVision, Esaote, Genoa, Italy) with a 7.5 MHz, 10 cm linear array probe with a depth resolution of 67 mm, an XView of 3 and a density of 48%."

 

The authors have also provided a sentence on directions for future research.

L332-334 - "Therefore, future research should look to include female athletes and non-athletic populations to determine if there any differences in the accuracy of assessments."

We hope this meets all expectations.

Reviewer 3 Report

Comments and Suggestions for Authors

None

Author Response

The authors thank the reviewer for the previous review and we are glad all changes are of the required standard.