MATLAB Analysis of SP Test Results—An Unusual Parasympathetic Nervous System Activity in Low Back Leg Pain: A Case Report

Round 1

Reviewer 1 Report

The manuscript is well written and presented in logical manner. Here are my comments to reshape some parts: 

Introduction: Please write the gaps in previous literature. I would suggest rewriting this sentence, "The SP test applies thermovision in a novel way." It can be written similar to this, "...............in a newly developed unique way, which is more advanced that previous techniques". 

Discussion: Please include the strengths and limitation of the study, with future directions. 

Author Response

Thank you very much for reviewing our manuscript and giving us an opportunity to further proceed with our paper. We hope that the changes we have made will fulfil yours expectations and that the paper can now be favorably assessed

"The manuscript is well written and presented in logical manner. Here are my comments to reshape some parts:"

Thank you very much for this kind opinion.

Introduction: Please write the gaps in previous literature. I would suggest rewriting this sentence, "The SP test applies thermovision in a novel way." It can be written similar to this, "...............in a newly developed unique way, which is more advanced that previous techniques".

It has been corrected according to your suggestion.

The SP test applies thermovision in a newly developed unique way, which is more ad-vanced than previous techniques.

Discussion: Please include the strengths and limitation of the study, with future directions.

The limitation of the study and the clinical implications have been added at the end of the manuscript.

Reviewer 2 Report

ABSTRACT

Line 22: “SP” first time in the text. Detail the full name before abbreviature (perhaps: Skorupska protocol).

Line 24: only analyzed by MATLAB or the coding can be executed in alternative software?

INTRODUCTION

Line 46: describe, briefly, the methods currently used, and the issues related to them.

Lines 47-48: detail the mechanism that explains that.

Lines 48-49: describe, briefly, the tools for measurement.

Lines 50-51: why only MatLab and not others? The rationale is missing.

Line 58: First time introduced in the text the term “SP”. Describe the full name.

Lines 61-64: justify the results that reveal this advantage.

Lines 71-72: statement of contribution and motivation is missing. A link must be provided to justify the objective of the study.

METHODS

Lines 103-104: describe the replicability conditions. Period of the day, resting time, activity of the patient before assessments.

DISCUSSION

It would be important a final paragraph with practical implications, a message for the community to use in different conditions, and recommendations for future research. Moreover, Disclose study limitations.

Author Response

Thank you very much for reviewing our manuscript and giving us an opportunity to further proceed with our paper. We hope that the changes we have made will fulfil yours expectations and that the paper can now be favorably assessed

ABSTRACT

Line 22: “SP” first time in the text. Detail the full name before abbreviature  (perhaps: Skorupska protocol).

It has been corrected.

Line 24: only analyzed by MATLAB or the coding can be executed in alternative software?

Analyses of the SP test can be performed using other computing environments and other programming languages. However, the MATLAB software seems to be the best choice due to its robust build-in libraries and relatively easy solutions for advanced statistics and calculations. In the revised version of the article, we have rewritten the sentence. 

 INTRODUCTION

Line 46: describe, briefly, the methods currently used, and the issues related to them.

We have added the following paragraph:

Nociplastic pain is often identified by the absence of features that characterize nociceptive and neuropathic pain. Discrimination between different types of pain remains challenging. Clinical examination, quantitative sensory testing, and pain-type questionnaires are used for diagnosis.

Lines 47-48: detail the mechanism that explains that.

We have added the following paragraph:

Central sensitization is indicated as the major pathomechanism leading to nociplastic pain conditions. However, there is a lack of objective tools for the confirmation of the central sensitization (CS) process.  

Lines 48-49: describe, briefly, the tools for measurement.

 We have added the following paragraph:

It has been suggested that the ANS dysregulation is an important factor in the initiation and maintenance of CS processes. Changes in the ANS regulation, mainly through the sympathetic branch, provoke nociceptor activation indirectly by a vasoconstriction–vasodilatation imbalance or directly by sympathetic nociceptor activation, resulting in widespread pain, hyperalgesia, and allodynia

Lines 50-51: why only MatLab and not others? The rationale is missing.

We have rewritten the sentence to indicate that MATLAB is one of the possible software choices.

The automatic segmentation was performed using MATLAB, which is one of the possible software choices for detailed medical data analysis. We chose MATLAB because it al-lowed us to show new diagnostic possibilities thanks to its rich built-in libraries and relatively easy solutions for advanced statistics and calculations

Line 58: First time introduced in the text the term “SP”. Describe the full name.

It has been corrected.

Lines 61-64: justify the results that reveal this advantage.

We have added the following paragraph:

Thus, the size of the autonomic phenomenon and temperature changes (compared to the state before the stimulation) can be calculated every 3 seconds of the procedure. Moreover, MATLAB allows a fast analysis of thermal data contrary to the time-consuming manual IRT segmentation.

Lines 71-72: statement of contribution and motivation is missing. A link must be provided to justify the objective of the study.

At the end of the introduction, we have added as follows:

Thus, further development of the MATLAB analysis to better present the SP test results is necessary. 

 METHODS

Lines 103-104: describe the replicability conditions. Period of the day, resting time, activity of the patient before assessments.

We have added the following sentence:

According to our previous study, the validity and reliability of the two diagnostic  SP test parameters had almost perfect agreement (e.g., thigh: 0.880 and 0.938; calf: 0.902 and 0.956, respectively). The case presented in this study was examined based on the SP test protocol published in the validation study.

DISCUSSION

It would be important a final paragraph with practical implications, a message for the community to use in different conditions, and recommendations for future research. Moreover, Disclose study limitations.

At the end of the discussion, we have added final paragraphs to present the limitation of the study and clinical implications.

Kind regards,

authors