PONE-D-21-15405

Measurement validity of an electronic training device to assess breathing characteristics during inspiratory muscle training in weaning failure patients

PLOS ONE

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[I have read the journal's policy and the authors of this manuscript have the following competing interests: the POWERbreathe KH2 devices, used in this study were provided by HAB - POWERbreathe International Ltd., (Warwickshire, England) for study purposes at no additional cost.].

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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: Yes

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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: Yes

Reviewer #2: Yes

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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: 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: 28-Jun-2021

PLOS ONE

PONE-D-21-15405: Measurement validity of an electronic training device to assess breathing characteristics during inspiratory muscle training in weaning failure patients

This is a manuscript that does not raise a clinical question. It was designed to compare the measurements of selected respiratory parameters obtained by a new electronic device (Powerbreathe KH2, POWERbreathe International Ltd, UK) with the ones obtained more traditionally, using a portable spirometer (Pocket-Spiro USB/BT 100, M.E.C, Belgium). The authors aimed to validate the measures of the new device. The question brought about by the study is relevant considering that it checks if a device with a potentially wide application generates reliable numbers.

The study succeeds in its general purpose, but below are some comments to clarify some points posed in the manuscript.

1. In the title. Weaning failure is more an event than a stable situation. It would be convenient to replace “weaning failure” by “difficult weaning”. In this sense, this change would apply to the whole manuscript.

2. In the abstract. Both devices (the EITD and the spirometer) could have their model and manufacturer mentioned here.

3. Line 135. Replace the word confident por confidence

4. Line 137. Replace the word “patients effects” with “patients' effects”.

5. Table 1. Please replace “VC” by “VT”. Abbreviations “VT” and “PImax” need to be explicated in the table legend.

Reviewer #2: This is an interesting study which concludes that an electronic inspiratory training device (EITD; POWERbreathe KH2) provides valid measurements of breathing characteristics (inspiratory muscle work and peak power) when compared to the gold standard device (Pocket-spiro) during inspiratory muscle training in weaning failure patients. The important clinical implications of this study are clear, and relate to the ability of the EITD to provide breathing characteristics during training in real-time, allowing for therapists to optimise the training stimulus during every training session, and helping motivate the patient via visual feedback.

The manuscript is well written and the analyses were well conducted. My main query with this study relates to the disparity of the sample size within this manuscript and the abstract presented by the authors at the European Respiratory Society (ERS) congress 2020 (included in the European Respiratory Journal proceedings ) entitled “Measurement validity of an electronic inspiratory loading device during inspiratory muscle training in weaning failure patients” [1]. Within the congress abstract there are 30 participants included, with 2594 breaths from 64 training sessions analysed compared to 13 participants and 1002 breaths from 27 training sessions analysed in the current manuscript. The findings of both versions are similar, with an even higher ICC and lower relative bias (% difference) between the devices within the ERS abstract for most variables. However, mean inspiratory resistance during training was much lower in the ERS abstract (24% of maximal inspiratory pressure; PImax) compared to this manuscript (46% PImax). Please could you comment on the reason behind the lower sample size and higher training intensity within this manuscript compared to previously reported results [1]. Were training sessions at a lower inspiratory resistance (i.e. lower % PImax) excluded from the analysis within this manuscript and could this have affected the results in any way?

Specific comments:

Table S1. – For the peak inspiratory pressure logistic regression model coefficient, I think there is a typo - please clarify the value.

1. Van Hollebeke, M., Poddighe, D., Clerckx, B., Hermans, G., Gosselink, R., & Langer, D. (2020). Measurement validity of an electronic inspiratory loading device during inspiratory muscle training in weaning failure patients.

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Reviewer #1: No

Reviewer #2: No

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Measurement validity of an electronic training device to assess breathing characteristics during inspiratory muscle training in weaning failure patients

PONE-D-21-15405R1

Dear Dr. Langer,

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.

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Kind regards,

Shane Patman, PhD

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

**********

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

**********

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: Thank you for clarifying the reason behind the disparity in sample sizes. I agree that by focusing the validation of the device in an intervention group only, the clinical implications of this study are improved. I have no further suggestions.

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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.

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Reviewer #2: No