Acute Effects of Whole-Body Vibration Exercise on Pain Level, Functionality, and Rating of Exertion of Elderly Obese Knee Osteoarthritis Individuals: A Randomized Study

Round 1

Reviewer 1 Report

This is a double blinded trial to define the effect of whole-body vibration exercise on pain and function of subjects who contract knee arthritis. The concept was relatively new and interesting, and also the manuscript demonstrated attractive results, however, the study design had critical issues that seemed very difficult to address.

The design of the study was unclear. At least radiographic evaluation of each subject, including femoro-tibial angle and the KL grade, should be mentioned. Also, authors stated they had unilateral case and bilateral cases. The factor might affect the pain and functional results. They stated that was a double blinded trial. However, it would be extremely difficult to blind participants who had “control” therapy since it would be very obvious they had no physical vibrations. Authors should make all the efforts to convince they blinded participants. No readers could believe participants were blinded just by the mimicking sound. For knee arthritis even a placebo has an effect to reduce pain. As no pain reduction was seen in the control group implies that participants in CG realized they were allocated to the control group.

 

Other issues:

The mechanism of the WBV exercise should be discussed more.

TUG test results were much worse in WBVEG. The reasons for the difference should be discussed.

Please explain ATF and Borg Scale. I am afraid they are not familiar to all clinicians.

 

2.2.

What is the inclusion criterion for BMI?

 

2.14.3

Sample size was determined for only TUG test?

 

2.14.4

What was the randomization step like? Explain more in detail, like when the participant had an odd number, he/she was allocated to WBVEG.

 

2.14.5.

Who was blinded other than participants?

 

 

Author Response

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Reviewer 2 Report

Moura-Fernandes et al. in their manuscript "Acute effects of whole-body vibration exercise on pain, functionality, and rating of perceived exertion
of elder obese individuals with knee osteoarthritis: a randomized, double-blind, controlled study" identify that one whole-body vibration exercise session with a frequency of 5 Hz, peak-to-peak displacement of 2.5, 5.0 and 7.5 mm, peak acceleration of 0.12, 0.25 and 0.37 g performed for 3 bouts (3 min working time and 1 min-rest time), in a side-alternating vibrating platform reduces the level of pain and improves functionality, without changing the perception of the effort of individuals with KOA. However, the study has some major limitations as follows:

1. The subjects were distributed evenly between the control and treatment groups for several parameters, however, some key characteristics such as age and body mass were considerably skewed towards the control group.
2.  Lequesne’s Functional Index (LFI) was used to assess the activity of lower limbs. However, the authors did not describe the scoring system anywhere in their manuscript. They need to incorporate the grades for each parameter that derives into the ultimate LFI score. Additionally, the LFI score for right and left limbs should be individually assessed in order to provide a precise assessment report.
3. The authors state that the evaluation of pain intensity was done using VAS. However, no detailed information on this procedure is found anywhere in the manuscript. Did this procedure involve questionnaires with information to assess the pain and clinical symptoms? (OR) Provide the details on how the scores have arrived? What were the questionnaires based upon?
4. In the same way, the authors need to provide more information on TUG test and ATF.
5. The authors need to provide the timepoints at which the therapeutic effects were achieved. However, this reviewer finds that there are data only for the baseline and one time-point after treatment. Why did the authors fail to record information at various times (at least 2 time-points) after training? How did the authors choose to arrive at one effective time-point unique to all patients? 

Author Response

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Reviewer 3 Report

The authors suggested a study on whole-body vibration (WBV) exercise could decreases pain level and favors the functionality of knee-osteoarthritis (KOA) individuals. Some comments that could be considered:

1) There was no MRI analysis conducted on bone structure before and after treatment to show the method used did improved KOA patients.

2) Was the vibration given to each patient are the same level for every age and weight? and how long does it takes for each treatment? Would that be considered bias for patients with higher weight received the same vibration level with lower weight? 

3)Since you concluded that your protocol could reduce the pain level and improve functionality, without changing the perception of effort of individuals with KOA, would you specify other studies planned in mind to confirm the  persistence of these effects in the long term?

Author Response

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Reviewer 4 Report

Needs a good English rewrite. Much is "lost in Translation" - frustrating to read as each sentence has grammatical errors.

Introduction - COPD not CPOD.

M and M - Independent observers running all of the tests for both the WBV and controls? Were they present for all of the testing?

            - please place randomization technique earlier in the M and M near the beginning as a reader wonders about how the randomization took place.

Discussion - the third paragraph is a repeat of the Results and should be removed.

                - somewhere in the Discussion there should be a careful description of the relationship between the intervention timing and the testing timing. In other words, how long is it thought that the intervention would still make a difference in the outcome? Is it lost with time? Daily? hourly? or does the effect wear of in minutes?

Conclusion - the authors should mention about the estimated effect time for the intervention (as above discussed in the Discussion) - how long does this intervention last? Days? Hours? Minutes?

                 - the conclusion should also mention that any studies that are done should look at being larger, time dependent, RCTs to answer these questions.

Author Response

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Round 2

Reviewer 1 Report

The serious issues I raised last time have not been addressed. The concern for the placebo effect, because it would have been obvious for CG subject that they were allocated to control group. Also, the TUG test results were worse for WBVEG. 

Author Response

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Reviewer 2 Report

The manuscript has been revised appropriately and the current form is suitable for publication.

Author Response

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Reviewer 3 Report

Standard proofreading need to be done.

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Reviewer 4 Report

Still needs extensive English re-editing. This paper is produced by good science but much is still "lost in translation". Needs to be rewritten.

First sentence of Introduction is repetitive and needs to be removed.

Author Response

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Round 3

Reviewer 1 Report

Now the manuscript has been improved a lot.

Author Response

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