Author's response to reviews Authors: Antonio I Cuesta-Vargas (acuesta.var@gmail.com) Cristina Roldan-Jimenez (CRISTINA.ROLDAN005@gmail.com) Version:3Date:27 January 2016 Author's response to reviews: Itemized List of Changes from the Reviewers and Editorial MS: 4251951154494273- Validity and reliability of arm abduction angle measured on smartphone: a cross- sectional study. Dear Editor Please find a second revision of our manuscript entitled Validity and reliability of arm abduction angle measured on smartphone: a. We would like to thank the Reviewers for their comments. They have allowed us incorporating changes into the revised manuscript and to clarify some terms. A manuscript has been uploaded with tracked-changes as an additional supplementary file. We believe our manuscript is easier to understand as a result of the modifications. An itemized point-by-point response to the Reviewers comments is presented below. Version:2Date:30 November 2015 Reviewer:Wen-Hsu Sung Reviewer's report: Major Compulsory Revisions 1.The smartphone app that authors used in this study maned mrom can be found with the hyperlink (http://apple.vshare.com/821653103.html). The web page shows an app named "mrom Lite" and the introduction of it. But this app can be used only on an iphone or ipad, not on a Google Android system device (such as: Nexus 4 in this study). The app is also can't be found in the online Google store. Please state the reasons. Authors: Thank you. The app mrom Lite can be found in Apple Store as a free app which allows taking 5 photographs. However, mrom is the app which
allows taking as many photographs as the clinician desires. Google store link is available below: https://play.google.com/store/apps/details?id=es.hubiqus.mrom Level of interest:an article of limited interest Quality of written English:Acceptable Statistical review:yes, and I have assessed the statistics in my report. Declaration of competing interests: I declare that I have no competing interests. Reviewer's report Version:2Date:25 November 2015 Reviewer:Kellie C Huxel Bliven Reviewer's report: Manuscript: Validity and reliability of arm abduction angle measured on smartphone: a. The authors obviously took the time to consider the reviewer feedback provided from the initial review of this manuscript. Adequate explanations were provided to reviewer comments and also revisions were made to the manuscript. It is improved as a result. Specific comments are below. Background 1. This section is adequately revised and all concerns were addressed. No further comments or requests for revision in this section of the manuscript. Authors: Thank you. We are so pleased that part was improved. Materials and Methods 1. Overall, this section is also improved. The information has been improved so the reader can understand how the equipment works and what was done in the study. Areas to improve are the order information is presented, specifically description of participants see comment below (#4) that specifically addresses this concern. It may help for the authors to use subheadings within the larger Materials and Methods section, if this is an acceptable format for the journal. Authors: Thank you. We do agree with your comment. Hence, and according with comment #4, order information has been modified and next subheadings have been added: Study design, Participants, Ethics, Apparatus, Procedure and Data
analyses. Now we think that information from Materials are Methods section is easier to follow. More details regarding participants sections are presented in #4 response. 2. Major compulsory revision: The added description of the mrom app is good and helpful. Figures 1 and 2 were added in the revision, but they need to be referenced correctly in the Figure section. At the end of the manuscript, figure 1 is still the results followed by the images produced by the app. Prior to publication, numbering of the figures throughout the manuscript must be corrected. Authors: Thank you. In the previous version of the manuscript, figure 1 was a Bland-Altman plot. As proposed by reviewer #2 (comment #4), this plot vas eliminated. Hence, in the new version of the manuscript, figure 1 was presented as the app captured image and the measurement made (with reference points), while figure 2 was presented as the report with recommendations for clinical use. From our point of view, their description concurs with each figure, and there is no reference to previous plot (which was eliminated). 3. Discretionary revision: Page 6-7, lines 141-144: Did the examiners eyeball these landmarks and then use their finger to indicate the landmark? Or, was a stylus with a standardized size used to indicate the landmark on the screen of the Smartphone? If the touching the screen was not standardized, one must ask how much variability is introduced by differences in one s fingers. Depending on inter-rater reliability results, this may be a point to include in the discussion. Authors: Thank you. A standardized size couldn t be used as subjects presented different height and weight, so body references didn t appeared at the same space on the screen. However, the app mrom allows modifying reference points till the clinician is sure they are correctly placed, no matter differences in researchers s fingers. Major compulsory revision: The order of information presented in the Materials and Methods section is odd and could be improved to be consistent with typical presentation of information in study articles. For example, there is currently no information presented about the participants recruitment method, inclusion/exclusion criteria, etc. This typically follows the study design paragraph. Included in this participants section should Discussion Authors: Thank you. We do agree with your comment. Hence, and according with comment #1, Participant section has been included (following study design section, in lines 104-116). It contains information related to sample, recruitment and inclusion/exclusion criteria in both groups. 1. Major compulsory revision: If low sample size is the reason provided for the
results, this needs to be included as a limitation of the study. Also, the authors should calculate power of the results as well as an analysis to determine how many subjects would be needed to improve the power adequately. More info is needed to explain the sample size - - either that even though there were low numbers, the power was sufficient OR that low sample produced low power and X number of people are needed to achieve acceptable power. Authors: Thank you. As previously explained in comment #8 from review #1, a lower sample could have been the reason for inter-rater reliability obtained in the healthy group. Also, a wider range of motion in this group could have influenced the results. These facts were expressed modifying a paragraph from discussion section. As it this that this idea remains unclear, we have included sample size information in subjects section as follows: Priori sample size was calculated in 9 patients for an # error of 0.05, a statistical power of 0.8 and # error of 0.7, based on data from a systematic review on the use of inertial sensors to measure human movement [18] (lines 114-116). Through this paragraph we clarify information regarding sample size to the readers. Also, information from its calculation is presented below: 2. Minor compulsory revision: What are the clinical implications for using this mrom app to document progress over time. If the shoulder pathology data are more valid and reliable, does this mean as the patient progresses through treatment and becomes more healthy that the measurements are not as valid and reliable? If so, how/why could this mrom be advocated for use clinically given these results? Authors: Thank you. On the one hand, as asked in previous comment #6 from review #1, a paragraph regarding clinical implications from this app in conclusion section was eliminated ( Improving the usage of a Smartphone for clinical practice as a faster and easy-to-use Internet-based tool May assist the medical professional in providing follow-up treatment ). On the other hand, previous comments #5 and #7 from review #1 allowed us to improve the app description in the manuscript. Due to that information, readers now could understand how the app works and, hence, realize that besides sending a reliable shoulder AAA measure, It allows to attach an clinical report. Therefore, the clinical implications from mrom are that it allows clinicians to take a picture from AAA, measure it easily and, if necessary, send a report with recommendations for clinical use for patients, for medical record or for sharing it by email with other healthcare professionals. This could include several measures along the time and analyse patient s progresses through the time after a physical treatment or a surgical intervention. To clarify these statements, next information has been included in conclusion section: As clinical implications, this app may assist the medical
professional in providing follow-up treatment, allowing to obtain a reliable shoulder measure and to attach by email a clinical report (lines 340-342).. 4. be the ethical approval statements, which are now on Page 8, lines 181-187. The information about outcomes, Page 8, lines 171-193 could also be included in the participants section It is recommended that all of this information be presented together earlier in the materials and methods section. Authors: Thank you. According with comments #1 and #4, information order has been modified. Information which appeared in lines 171-180 regarding questionnaires has been moved to apparatus sections, as they were employed to obtain information about shoulder disability in patients (now lines 148-157). Information regarding ethical approval statements, now appears in ethics section right after participants section. (lines 117-124). Finally, information related to recruitment, which was in lines 188-193 has been moved to study design (lines 98-103). From our point of view, now information from Material and Methods sections is better ordered and easier to read and follow. 3. Level of interest:an article of importance in its field Quality of written English:Needs some language corrections before being published Statistical review:no, the manuscript does not need to be seen by a statistician. Declaration of competing interests: I declare that I have no competing interests Authors: Thank you. The present manuscript has been submitted for proofreading and editing in order to have grammar corrections checked. A certificate is attached.