PONE-D-20-02964

Precision and reliability of tape measurements in the assessment of head and neck lymphedema

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study aims to evaluate the precision (standard deviation of measurements of the same subject) and reliability (intraclass correlation coefficient) of tape measurement techniques performed by different measurers in the assessment of head and neck lymphedema. It addresses an important complication of treatment among head and neck cancer patients, impacting on post-treatment morbidity as well as the patient’s quality of life. I would appreciate though if more details were shared by the authors namely:

1. The clinical profile of the diseased subjects (e.g., histopathologic type, stage and neck node involvement, kinds of surgery undergone by each, particularly if neck dissection was done, radiotherapy, etc.). Ideally one would like to see a spectrum of lymphedema that approximates real life practice in order to gauge the directness and applicability of the study. I am also clear how the diagnosis of lymphedema was made in the diseased subjects.

2. The training which the measurers underwent and probably the pre and post training reliability as a measure of the effectiveness of the training

3. The actual tape measures used (are these medical grade? Were they the same for all measurers and how were the tape measures cared for, stored), and what time of the day were the measurements made (lymphedema may worsen later in the day after prolonged upright position)

4. How were the facial and neck landmarks site marked? How precisely were these identified? And how were they kept similar for each measurer? The differences may be due to site marking variations.

Why the authors got the results that they obtained were not adequately explained. For example, the mandibular angle appears to be associated with high standard deviations and low ICCs. Why is this so?

Finally it is very possible that no single measurement can identify significant lymphedema but would a combination of measurements do the job better? The statistical analysis does not appear to show this.

Reviewer #2: This study evaluates various precision and reliability tape measurements of the facial landmarks and circumferences of the head and neck in patients with lymphedema as well as controls. While this study does have a sizeable n, there are few shortcomings to the study. Additionally , studies similar to this one have already been published before, although not cited within the manuscript. (Purcell A, Nixon J, Fleming J, McCann A, Porceddu S. Measuring head and neck lymphedema: The "ALOHA" trial. Head Neck. 2016 Jan;38(1):79-84.,

Nixon J, Purcell A, Fleming J, McCann A, Porceddu S. Pilot study of an

assessment tool for measuring head and neck lymphoedema. Br J Community Nurs.

2014 Apr;Suppl:S6, S8-S11.

While it is recommended that this study, after thorough revision mainly for grammar, is resubmitted for consideration, this manuscript would be better suited for publication in a more subspecialty specific journal like Head and Neck, Otolarygnology White journal, etc.

General comments:

It is a good practice to use active voice instead of passive voice which you have throughout the manuscript. As an example:

The study’s protocol was approved by the appropriate hospital ethics committee.

Instead you should write -> The appropriate hospital ethics committee approved the study’s protocol.

There are multiple commas missing throughout the article, especially before ‘and’ and ‘but’, please correct

There are multiple articles missing throughout the manuscript, please see few examples below and take time to correct the manuscript:

affect reliability of -> affect the reliability of

method in clinical assessment -> method in the clinical assessment

no study related to precision and reliability -> no study related to the precision and reliability

The objective of this study is to evaluate the precision -> The objective of this study is to evaluate the accuracy.

-It is a good practice to not repeat the same words within the same sentence or right after the sentence that used the word before, instead choose synonyms like example provided.

Methods:

From these 20 measurers -> From these 20 measures

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Reviewer #1: Yes: Jose M. Acuin

Reviewer #2: No

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Precision and reliability of tape measurements in the assessment of head and neck lymphedema

PONE-D-20-02964R1

Dear Dr. Chotipanich

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Peter Dziegielewski, MD, FRCSC

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: After a thorough and extensive revision of the manuscript, the content presented reads efficiently and in a grammatically sound presentation. The addressed changes of the text, as well as figures, clarify the presented data inc a transparent manner. Currently, the study has a complete discussion as well as appropriately detailed limitations. Overall all of the included Figures and Tables are necessary and appropriate.

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No