An In-Silico Study on the Therapeutic Effect of Low Back Belts: Biomechanical Correlation between Belt Design and Patient Morphology
, Jérôme Molimard 1, Baptiste Pierrat 1, Romain Pannetier 2 and Reynald Convert 2
Round 1
Reviewer 1 Report
In this paper, a comparative study of eight different lumbar belts, representative on French market, was carried out on four typical morphologies of patients to assess their therapeutic effects and identify
the correlation between the therapeutic parameters and mechanical ones.
This study sounds more like comparison of different belts available in French market like what pros and cons of each belt. I think this lacks scientific contribution towards knowledge. It is difficult to to understand the implications of this research towards scientific contribution.
Author Response
Dear Reviewer,
We thank you for your remarks and appreciation. We tried to reveal the therapeutic effects of lumber belts on different typical morphologies and finally found that they are less efficient for large shapes that could have more back pain.
We are always working on this topic and moved to with patients' movement. As soon as we have good results, we will present them to scientific communities.
Best regards,
Woo-Suck HAN
Reviewer 2 Report
Thank you for giving me this opportunity to review this article. The article is well written, though I have some serious concerns regarding the article. Mention the title more self-explanatory and clear. Abstract:- Mention the study duration and study setting.
- Mention the exact amount of pressure applied to the belts.
- Mention the statistical tests used for the study.
- Need more information in the parts of the result like the correlation values, association values, p scores, etc….
- The conclusion should be concise and self-explanatory and drawn on the basis of study reports.
- The novelty of the study is missing, including more recent references emphasizing the need for this study.
- Include the clinical significance of this study to clinicians, patients, and researchers.
- Include the study design, study setting, and study duration.
- Give the criteria for selecting the patients with reference. (different morphology)
- Mention the safety concerns measured in the study.
- Include the statistical tests used for the study.
- Need more information in the parts of the result like the correlation values, association values, p scores, etc….
- Add more recent references explaining the mechanism of changing outcome variables through the administration of different types of belts.
- Add the real-time limitations faced by the researchers during the study.
- Include the strengths of the study.
- The conclusion should be concise and self-explanatory and drawn on the basis of study reports.
Author Response
Dear Reviewer,
Thank you for your remarks and appreciation. We tried to reveal the therapeutic effects of lumber belts on different typical morphologies and finally found that they are less efficient for large shapes that could have more back pain.
We are always working on this topic and moved to with patients' movement. As soon as we have new results, we will present them to scientific communities.
Best regards,
Woo-Suck HAN
Author Response File: 
Author Response.docx
Reviewer 3 Report
The reported work focuses on therapeutic low back belts. Although the subject is interesting and topical, the manuscript lacks quality and rigor. The whole article must be improved by providing objective information and by analyzing/concluding based on it. The following points must be addressed.
1. Authors visualize that some parameters could be significant for attendance to the treatment (see Abstract, line 19). However, the “treatment” is not identified anywhere in the paper. This “treatment” must be clearly and explicitly identified (requirements, frequency, duration, tensions, etc.).
2. Like the previous point, efficacy metric/metrics (see Abstract, line 19) must be clearly and explicitly identified.
3. A list of “material properties” that were obtaining by “mechanical testing” must be provided in an explicit form (see Abstract, lines 15 and 16). The way these tests were performed mut be, rigorously, documented and reported (type, number, values, average, etc.).
4. Authors mention the interest in making “better use” of “mechanical effects” (see line 290). Because it is not clear what these effects are, they must be clearly and explicitly identified.
5. Authors identify the “belt’s stiffness” as an important parameter (see Abstract, line 22). They provide, for each belt, the “Global stiffness” value (see Table 1). The relationship between stiffness and “Global stiffness” must be clarified. If a relationship between this “Global stiffness” parameter (Table 1) and a Global stiffness matrix exists, it must be reported.
6. The way the values in Table 1 were obtained must be clarified. If these values were obtained by mechanical testing, see request 3.
7. The four “typical” morphologies reported in the paper must be, clearly, characterized considering the average height and weight of a group of citizens. For instance, 1.85 m < tall (height) < 1.60 m and 58 kg < thin(mass) < 68 kg.
8. Related to the previous point, authors must sustain why the next morphologies are not considered in the study: tall-fit, small-fit, medium height-large, medium height -thin, and medium height-fit.
9. To provide a clear context of the study, health problems that are identified as causes of low back pain must be reported in the manuscript.
10. To define clear safety operation conditions, authors must establish crucial pression values.
11. There are several typos that must be corrected. See for instance “efficicay” (line 41), “vertebras” (line 66), and “as” (line 180).
12. Authors refer to three previous works ([5], [10], [15]) as recent references (see lines 38, 86 and 115). Nevertheless, these works were published in 2012, in 2014, and in 2019, respectively. Seven years passed between the first and the last of these publications. I highly recommend using objective statements. Otherwise, it will not be possible to define a suitable temporal context.
13. Authors must document and discuss why the method proposed by [10] is “tedious and time consuming” (see line 86).
14. The “improvement” associated with the model reported by [16] (see line 121) must be clearly and rigorously presented.
15. The “key” design parameters mentioned by authors in line 131, must be clearly identified, as well as the reasons allowing the use of this adjective.
16. “Therapeutic and biomechanical impacts” of belts on patients (see lines 134 and 301) must be objectively characterized.
17. The notation of mathematical elements (see lines 145 to 147: p, T1, T2, R1, R2) must be homogenized, so that it is the same in equations (italics and subscripts, for example) and in the text. Otherwise, it is not convenient to use T1 or T2 for tensions and thoracic vertebrae (see Figure 4e). Moreover, the difference between the two radii (R1 and R2) must be clarified.
18. The way equation (1) is applied is not clear. Since Laplace law determines the pressure difference between two sides (in/out) of a boundary surface separating two fluids, the use of equation (1) must be sustained in a rigorous way. For instance: a figure illustrating the two different weft directions of the lumbar belts could be provided, highlighting the two tensions T1 and T2 as well as the two curvature radii R1 and R2. Moreover, the context when R1=R2 must be explained if it is a possible event.
19. It must be sustained, and clearly explained, how “applying correctly the pressure” depends on the belt shape (see line 172). Maybe, a flowchart of the Matlab program (see line 174), together with its rigorous explanation, can be used to do so.
20. A figure illustrating centers and deformations with respect to lumbar vertebrae L3 and L4 must be provided (see lines 180 to 182).
21. Authors must provide values and units of the characteristics that are mentioned in page 5 (lines 190 to 211 and 231 to 232).
22. Authors must clarify or characterize what loadings due to movement are (see line 215) and provide an example.
23. English writing/grammar must be improved. I strongly recommend seeking the support of a native English speaker.
24. Elements which are mentioned in lines 225 to 227 must be illustrated in Figure 1.
25. The quality of Figure 1 must be improved. I recommend the use of vector-based figures that guarantee a better quality. Moreover, 8 views in Figure 1 do not guarantee that the information is useful. I recommend providing 3 views with complete and rigorous explanations.
26. All “mechanical properties” which are mentioned in line 242 must be, explicitly, provided. Moreover, Table 2 only provides values of one property (not properties) that must be clearly identified with its name.
27. A figure illustrating the explanations in lines 247 to 253 must be provided.
28. Precise values of the “pressures” mentioned in lines 260 to 262 must be provided.
29. To highlight differences among subfigures in Figure 2, a precise explanation with documentation (labels) of each part must be provided.
30. It seems that explanation provided in lines 263-261 is wrong with respect to the referenced subfigures. Verify and, if it is the case, correct.
31. The statement related to the correlation between average pressure and stiffness must be, clearly and explicitly, supported (see line 267).
32. There is no Figure 4(f). Correct this error (line 296).
33. More detailed comments on each figure with better documentation (labels and markers, for instance) must be provided.
34. The meaning of every one of the acronyms, used in the manuscript, must be provided, as well as those associated with anatomical elements.
35. The statement concerning “some error”, as a consequence of additional rigidity (straps), must be clearly explained (see lines 326 and 327).
36. Some options to relax the so-called “strong assumption”, related to linear elasticity (see line 331) must be provided and, rigorously, discussed.
37. Authors must enrich the discussion related to the information in Table 3.
38. A detailed figure to illustrate the statements in lines 346 to 349 must be provided.
39. Authors must clarify what R2 is in lines 359 and 360, and what R2 is in line 147. Confusing notations must be avoided.
40. An explanation with a rich discussion, associated to Figure 6, must be provided.
41. The following characteristics must be, clearly and rigorously, defined: efficiency index, wearability index, pressure index, angle index. Maybe a mathematical way could be helpful.
42. Statements in lines 392 to 396 must be, rigorously, sustained and well documented.
43. “Conclusions and future works” Section is based on subjective information and statements. Since the reported work is based in numerical simulations, numerical values can be obtained and reported. This situation must be, significantly, improved. For instance, what a “very near future” means?
44. Authors must provide the required information in the Acknowledgments paragraph.
45. Only 11% of the references (2 works) are recent (between 2018 and 2022) and they were published by the same group of authors. The state of the art must be enriched with more recent and diversified works.
Author Response
Dear Reviewer,
Thank you for your detailed remarks and advises. We tried to reveal the therapeutic effects of lumber belts on different typical morphologies and finally found that they are less efficient for large shapes that could have more back pain.
We are always working on this topic and moved to with patients' movement. As soon as we have new results, we will present them to scientific communities.
Best regards,
Woo-Suck HAN
Author Response File: Author Response.docx
