PONE-D-20-29966

Fire acupuncture versus conventional acupuncture to treat spasticity after stroke

: A Systematic Review and Meta-analysis

PLOS ONE

Dear Dr. Xuan Qiu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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The reviewers have raised a number of points which we believe major modifications are necessary to improve the manuscript, taking into account the reviewers' remarks. Please consider and address each of the comments raised by the reviewers before resubmitting the manuscript. This letter should not be construed as implying acceptance, as a revised version will be subject to re-review.

==============================

Please submit your revised manuscript by Feb 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Wisit Cheungpasitporn, MD

Academic Editor

PLOS ONE

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2. Please include the date(s) on which you accessed the databases or records to obtain the data used in your study.

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5. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables should be uploaded as separate "supporting information" files.

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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: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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: Yes

Reviewer #2: No

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4. 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 #1: Yes

Reviewer #2: No

**********

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: PLoS One

December 6th, 2020

Manuscript ID: PONE-D-20-29966

Title: Fire acupuncture versus conventional acupuncture to treat spasticity after stroke: A Systematic Review and Meta-analysis

General comments:

Thank you for the opportunity to review this timely systematic review and meta-analysis on an important and understudied topic on spasticity after stroke. The authors performed a systematic review and meta-analysis following PRISMA checklist aimed to evaluate the clinical efficacy of fire acupuncture compared with conventional acupuncture to treat post-stroke spasms and provide a detailed summary of the commonly used acupoints.

The study is well-written and well-reported according to PRISMA checklist. Also, this study brings some interesting results and new insights as a potential contribution to the field of the Complementary Therapies. I believe that this is a novel paper with a topic that will be great interest for PLoS One readers.

I have some comments, suggestions in order to strengthen the potential contribution of this topic in any revision the author(s) might undertake.

Major Revision:

METHODS

Page 6. First paragraph: after “PRISMA statement” the reference 12” must be enclosed in square brackets [12]

I would like to know how the authors get the guiding question of this systematic review? Was an acronym used, for example PICO, or PICOS, or PICOT? If yes, please provide the structure and description and reference.

Page 6. Please to use MEDLINE/PubMed instead of PubMed as database.

Page 6. Authors need to show more clearly the final key of the search strategy in each of the 8 databases accessed, mainly respecting the combinations of controlled descriptors (eg: MeSh Terms (MEDLINE / PubMed), emtree terms (EMBASE) ; etc ...) and intersections with keywords and synonyms using the Boolean AND & OR operators. I recommend that the authors present the search strategy in each database in the form of a table, containing the date on which the search was processed.

Page 7. Data collection, extraction, and management.

Make it clear in the text when data were collected in the databases.

Another important point is to report how data was extracted (what information was extracted?)

I have checked the protocol registered in the PROSPERO CRD42020188959 and it is well described there. I suggest keeping the text in that part of the article: “A piloted data extraction form that has been discussed and developed by all the reviewers will be assessed and extracted independently by two authors (ZSM and QX). A standardized form will be used to extract data, including general information, study characteristic, participant characteristic, interventions characteristics , outcomes and so on. Any disagreement in data extraction will be resolved by discussion or negotiation with a third arbitrator (ZWF). Contact the author for more information if necessary. Each eligible trial will be assigned to a study ID in the following formats: the name of the first author + space + year of publication (e.g, Wang T 2019).”

Page 7. Risk of bias assessment.

Please replace the Cochrane Bias Risk Assessment (RoB-1) to the recently updated and updated Cochrane Tool (RoB-2), since RoB-1 is coming into disuse.The internal validity and risk of bias of trials should be assesd using RoB 2 - a revised Cochrane tool assessing risk of bias arising from five domains in randomised trials: the randomisation process, deviations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Each domain a risk of bias (low risk, some concerns, or high risk) based on the domain algorithm, and made an overall judgment (low risk, some concerns or high risk) using the described criteria (Sterne et al., 2019).According to RoB 2, risk-of-bias judgments for each domain have the following categories: low risk of bias, some concerns, or high risk of bias. Judgments are based on and summarise the answers to signalling questions. RoB 2 also includes algorithms that map responses to signalling questions to a proposed risk-of-bias judgment for each domain. Response options for an overall judgment are the same as those for individual domains. The study can be judged to have (1) a low risk of bias for all domains for this result (low risk of bias), (2) raise some concerns in at least one domain for this result but not to be at high risk of bias for any domain (some concerns), or (3) have a high risk of bias in at least one domain for this result or have some concerns for multiple domains in a manner that substantially reduces confidence in the result (high risk of bias). Overall risk of bias also generally corresponds to the worst risk of bias in any of the domains. However, if a study is judged to have some concerns about risk of bias for multiple domains, it might be judged as having a high risk of bias overall. (Sterne et al., 2019).

Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. doi:10.1136/bmj.l4898.

RESULTS

Table 1. Detail of studies include

Please, put the meaning of the second column (T / C) in the figure caption: (Treatment / Control group).

Still in the second column "Age range" replaced to "Age range (M ± SD)" and put the meaning in the legend - mean and standard deviation.

Check the studies Liu et al., 2018 and Chen et al., 2005, as there is no standard deviation. It is necessary to be consistent and maintain standardization.

The study by Sheng et al 2017 the control group should be average age 56.21 instead og 5 6.21 (remove the space)

The study by Wang et al., 2018 the average age of the control group is misspelled. In the results on page 9 it is stated that ”The ages of the patients ranged from 34 to 80 years. Therefore, I believe that instead of C: 99.13 ± 33.86 it must be wrong. Please check.

DISCUSSION

Page 17. Please, consider to include the reference doi:10.1177/2515690X19834169, together with the others [53,55].

“Interestingly, according to current research, acupuncture is a universally recognized non-drug treatment that can have a beneficial role in diseases that often accompany stroke, including depression, fatigue, and cognitive decline[53-55; Abrahão et al., 2019 ].”

Reviewer #2: 1. Search terms need to provided in complete. "as an example is provided in the Supplementary material" is not acceptable. Search terms in Eight databases are different (PubMed, Web of Science, the Cochrane database, EMBASE, CBM, CNKI, WanFang, and VIP) Please attach syntax used in each database as supplementary.

2. Who are “two independent investigators”?

3. It will be better to show kappa for the selection and data extraction. Please show the data of kappa of agreement during the systematic searches. How disagreements were solved during the systematic search among two independent reviewers?

4. Please make the data for this review publicly available, possibly through the Open Science Framework (osf.io). Items to include: list of excluded studies, commands for statistical analysis, spreadsheets or data used for the meta-analyses, etc. Making data publicly available will promote the reproducibility of the review and is best practices for systematic reviews and meta-analyses.

5. Figure1, suggest to use PRISMA 2009 Flow Diagram platform

6. Forrest plots and funnel plots need to be provided.

7. Random or Fixed effect was used, needs to be specified in the abstract.

8. Authors should discuss the reason of heterogeneity.

9. There is still a considerable heterogeneity as in your limitation. Meta-regression analysis is then strongly recommended.

10. -The PICOS of the meta-analysis should be clearly reported.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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 #1: Yes: Luís Carlos Lopes-Júnior

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-29966R1

Fire acupuncture versus conventional acupuncture to treat spasticity after stroke

: A Systematic Review and Meta-analysis

PLOS ONE

Dear Dr. Xuan Qiu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR: Our expert reviewer(s) have recommended some minor revisions to your manuscript. Therefore, I invite you to respond to the reviewer(s)' comments as below and revise your manuscript.

==============================

Please submit your revised manuscript by Apr 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Wisit Cheungpasitporn, MD

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

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 #1: All comments have been addressed

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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: No

Reviewer #2: Yes

**********

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 #1: PLoS One

February 13th, 2021

Manuscript ID: PONE-D-20-29966

Title: Fire acupuncture versus conventional acupuncture to treat spasticity after stroke: A Systematic Review and Meta-analysis

General comments:

Thank you for the opportunity to review again this timely systematic review and meta-analysis on this relevant topic

The authors have responded appropriately to all my suggestions and recommendations. The article is better presented in this version.

Just a few minor adjustments need to be made:

Minor Revision:

Abstract: Add in the “method” that the methodological evaluation or critical appraisal of the included articles was assessed using RoB-2. And in the results, to add that “according to the criteria of the RoB 2.0 tool, most of the studies are considered to have some concerns.

METHODS

Data collection, extraction, and management: write the phrase in the past instead of using the verb in the future.

Data syntheses: Same. Please use the past tense “Random effect model were used….”

RESULTS

Table 5. Please to replace the symbols “+/-” by the official of RoB-2

Low (+)

High (-)

Some concerns (?)

Also the column “Overal risk” shoud be presenting as the last column in this Table.

Ad hoc consultant.

Reviewer #2: Authors welcomed all suggestions and observations comprised in the first revision of the paper.

Authors have satisfied the comments of the reviewers

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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 #1: Yes: Prof. Dr. Luís Carlos Lopes Júnior

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Fire acupuncture versus conventional acupuncture to treat spasticity after stroke

: A Systematic Review and Meta-analysis

PONE-D-20-29966R2

Dear Dr. qiu,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Wisit Cheungpasitporn, MD

Academic Editor

PLOS ONE

Additional Editor Comments:

I reviewed the revised manuscript and the response to reviewers' comments. Revised Manuscript is well written. All comments have been addressed and thus accepted for publication.

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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: The authors have responded appropriately to all my questions and recommendations.

The manuscript is better presentable right now and, therefore, I approve this version for publication at PLOS ONE.

Dr. Luís Carlos Lopes Júnior

Reviewer #2: Authors welcomed all suggestions and observations comprised in the first revision of the paper.

No further change is necessary in the opinion of the reviewer.

Authors have satisfied the comments of the reviewers

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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 #1: Yes: Prof. Dr. Luís Carlos Lopes-Júnior

Reviewer #2: No