User Evaluation of Technology-Based Interventions Developed to Address Falls in an Inpatient Ward

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript evaluated a technology-based inpatient fall prevention system integrated AI cameras, communication devices and autonomous commode. Due to the following issues, they are not satisfactory.

1. The scope of the manuscript is confusing. Although the manuscript evaluated the feasibility of the IFPS in some aspects, its content is related to technology, method or science. Such as, as the words “Human-Centered (HCD) approach, defined as" an iterative, collaborative, and people-centered approach for designing products, services, and systems”, it seems more like a guideline rather than a technical matter. I'm wondering if these contents fall within the scope of the journal.
2. The manuscript presents the process of the system, such as the content in 2.1. Study phases, rather than the specific technologies and mthods of the system. Although the manuscript claims that a feasibility assessment has been conducted for the system, it is difficult to carry out a technical evaluation for content of the manuscript because there are no specific technical details, such as the AI algorithms, video processing methods, etc.
3. The advancement of the manuscript is a concern. One is, as the words “This multiphase study was conducted at an acute public hospital in Singapore from May 2019 to September 2022.” This research was completed over three years ago. The advanced nature of the results and the technology are both cause for concern. The other is, according to the references, there are few references in the past three years.
4. The evaluation indicators are cause for concern. Just as the evaluation in the section "Post- phase user feedback survey" indicates, it mainly involves survey and statistics. As a manuscript of the technical type, objective evaluation indicators should be provided.
5. The lack of comparison in the technical aspects of this manuscript also contributed to its unacceptability. In the results section, there is a lack of comparison with new or classical methods or techniques.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The presentation of the results can be expanded by including some reflections on the increase in cognitive requirements for personnel in crisis situations or emergencies, it is also worth examining what it means to resolve simultaneous requests from patients in an area of care, it is possible to examine how to categorize the signals and information that the person in charge will receive, it is advisable to examine how the tasks of monitoring and control of the different sources of information work increase. This should also be included in the system design requirements analysis

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you very much for the authors’ contribution to this important area of research. As someone who has elderly family members in need of care, I personally find this study particularly meaningful and relevant.

1. Figure 1: It might be better to arrange the panels in two rows and enlarge each subfigure to improve readability and comprehension for the readers.

2. Figure 2: Would it be possible to include a short demonstration video or supplementary material showing how the service operates and how it benefits older adults? This would make the study’s application more intuitive and accessible.

3. Regarding the nurses’ feedback, could the authors provide a more detailed analysis of the reasons behind the “disagree” responses? It is somewhat surprising that such a promising service received opposition from some nurses, and understanding their concerns could be very insightful.

4. Does the device or service developed in this project have comparable products or competing brands available on the market? If so, a brief comparison of their features and performance would help highlight the advantages and uniqueness of the proposed system.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank the author for the revisions made to the manuscript. Although the issues raised in the previous round have been responded to, it is still difficult to remove the concerns about this manuscript. As mentioned in the response "our paper was scoped with the primary goals of describing the developmental process of IFPS and feasibility results of the IFPS. ", In fact, many technologies, including vision and wireless, have already proven their feasibility in the field of healthcare. If the focus of manuscript is merely on demonstrating feasibility, then many relevant technical literature have already provided such explanations. However, this manuscript clearly fails to demonstrate the advancement of the proposed content, which is a great pity. Similarly, due to the lack of supplementary comparison of technical indicators, the persuasiveness of the manuscript is insufficient.

It is suggested that the authors could provide some comparisons of technologies and also make comparisons of relevant literature. At the same time, the discussion should not focus on a specific technical issue or requirement, but rather on the gap between the overall system requirements and the technical application. Furthermore, how the manuscript addresses this problem and resolves it.

 

Author Response

Comment 1: [Thank the author for the revisions made to the manuscript. Although the issues raised in the previous round have been responded to, it is still difficult to remove the concerns about this manuscript. As mentioned in the response "our paper was scoped with the primary goals of describing the developmental process of IFPS and feasibility results of the IFPS. ", In fact, many technologies, including vision and wireless, have already proven their feasibility in the field of healthcare. If the focus of manuscript is merely on demonstrating feasibility, then many relevant technical literature have already provided such explanations. However, this manuscript clearly fails to demonstrate the advancement of the proposed content, which is a great pity. Similarly, due to the lack of supplementary comparison of technical indicators, the persuasiveness of the manuscript is insufficient.It is suggested that the authors could provide some comparisons of technologies and also make comparisons of relevant literature. At the same time, the discussion should not focus on a specific technical issue or requirement, but rather on the gap between the overall system requirements and the technical application. Furthermore, how the manuscript addresses this problem and resolves it.]

Response 1: Thank you for pointing this out. We agree with the reviewer that "many technologies, including vision and wireless, have already proven their feasibility in the field of healthcare". Such technologies include those developed for fall detection which are widely studied in existing literature. To the best of our knowledge, there is limited or no feasibility study which looks into an integrated system (network of multiple technologies working together, not standalone individual technologies) which is primary designed to prevent falls in a hospital setting. In our effort to address this gap, our paper describes the development process of the proposed integrated fall prevention system (IFPS) components and reports on user evaluation of the IFPS to assess its safety, appropriateness, and acceptability in component and system level. In our discussion session, we have purposefully described the benefits and gaps (not limited to technical issues) of our proposed IFPS. As such, findings from our feasibility study will enable hospital providers to refine and improve their IFPS further prior to real-world implementation and effectiveness trials. We have reviewed and revised the manuscript and this change could be found at page 2 line 83, page 14 line 401, page 15 line 430 and page 16, line 477.

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript has been revised and responses have been provided to the questions raised in the previous round. However, it is still recommended to consider the novelty rather than merely discussing the feasibility of the integrated system. After all, this is an academic article, not a feasibility report for system development.

Author Response

Comments 1: The manuscript has been revised and responses have been provided to the questions raised in the previous round. However, it is still recommended to consider the novelty rather than merely discussing the feasibility of the integrated system. After all, this is an academic article, not a feasibility report for system development.

Response 1: We would like to thank the reviewer for the comment. In consideration of the comment, we have added a table S3 under the supplementary document to describe how different the IFPS as a system when compared with recent reported fall detection approaches. Additionally, we have also added a paragraph under Discussion [page 15, line 422 to 434] to further elaborate on this, hopefully, it addresses reviewer's comment.