PONE-D-22-14223The effect of an extension speech training program based on Chinese idioms in post-stroke nonfluent aphasia:a randomized controlled trialPLOS ONE

Dear Dr. Xiaojun

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Rizaldy Taslim Pinzon

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PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

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

Reviewer #1: I Don't Know

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Reviewer #1: Yes

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Reviewer #1: No

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Reviewer #1: This study was a randomized controlled trial in which patients with post-stroke non-fluent aphasia were randomly assigned to either treatment with speech training based on Chinese idioms or treatment with conventional speech rehabilitation. The study included 67 patients and took place over a two-week period. The intervention is an interesting one and could likely be generalized to other countries. The authors could greatly improve the paper by providing more details and the results than are given. I am also not sure why they would have conducted a per-protocol, rather than an intent-to-treat, analysis. What was their reasoning for this?

Other comments:

CONSORT:

(2b) The objectives/hypothesis, although referenced, are not explicitly stated: (e.g., “We hypothesize that the idiom based speech training program will be more effective at xxxxx , as demonstrated by increased scores on xxx, than the conventional speech training program.”)

(7a) The authors state that the study was powered for an effect size=0.8. Could they please indicate what this means in terms of score improvement, or difference in expected scores between the two groups?

Methods

p.6. Were only patients with a first stroke included in the trial, or could patients with a history of stroke be enrolled?

The authors state that both parametric and non-parametric tests were used to compare samples as appropriate. Table 1 should reference which tests were used for each comparison, and any non-normal data should be summarized using the median and interquartile range (some of the test scores do not appear to be normally distributed).

The authors report scores of the two groups after rehabilitation treatment, but in fact, the correct comparison is between the before-and-after differences between the two groups. Therefore, the pre- and post-differences, rather than the “post” scores for each, should be reported. From the description of statistical tests used, it appears that the authors analyzed the data correctly (since both paired and unpaired tests were used). A table which clearly shows the within and between group differences would be useful to clarify this (Group 1, differences between pre- and post-intervention measurements, the same for Group 2, and the comparison between Group 1 and Group 2).

Did the authors consider doing a repeated measures analysis so that they could adjust for co-morbidities, prior strokes (if allowed), age, etc.?

Results

Please write out BA and TCM before using abbreviations.

Again, it is not clear to me why a per protocol analysis was done rather than an intent-to-treat analysis. The authors need to explain and justify their reason for so doing.

Discussion

The first paragraph of the Discussion belongs in the Introduction and should be incorporated there (some of it is redundant). The Discussion section is the place to discuss the meaning of the results, not outline the reasons for the study itself.

Second paragraph: I believe that the authors mean that the CHANGE in scores was higher in Group 1 than in Group 2. This should be clarified throughout the paper. It is never clear what the percentage changes in the two groups were, or how big of a difference there was between them, since only post-intervention scores are reported.

Fourth paragraph. The second sentence has the following note: “[Error! Reference source not found.” This implies that that the paper was not carefully proofread before submission. The actual references for these “studies” need to be added.

Fifth paragraph: The authors should refrain from using the words “we…proved…” Their study supports an association between their method and improved language skills after stroke, but does not prove it.

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Reviewer #1: No

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PONE-D-22-14223R1Effect of an extension speech training program based on Chinese idioms in patients with post-stroke non-fluent aphasia: A randomized controlled trialPLOS ONE

Dear Dr. He Xiaojun

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.

Some issues that highlight by the reviewers are not answered yet. Do the authors make an adjustment of the other confounding factors ? education level, side of weakness, type of treatment ? Why do you use either PP and intention to treat rather than only ITT analysis ? Please submit your revised manuscript by 12November 2022. 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.

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• 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Rizaldy Taslim Pinzon

Academic Editor

PLOS ONE

Additional Editor Comments:

Thank you for your prompt responses. Do the authors make an adjustment of the other confounding factors ? education level, side of weakness, type of treatment ? Why do you use either PP and intention to treat rather than only ITT analysis ? Please do not use point bullets for the eligibility of your subjects.

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Reviewers' comments:

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PONE-D-22-14223R2Effect of an extension speech training program based on Chinese idioms in patients with post-stroke non-fluent aphasia: A randomized controlled trialPLOS ONE

Dear Dr. He Xiaojun

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.

Thank you for making some revision.Please begin the discussion with the meaning of the results, not outline the reasons for the study itself.If you do intention to treat analysis, please begin with the flowchart. Please remove the bullet for the intervention section.Please complete the p value, in the intra group analysis. 

Second paragraph: I believe that the authors mean that the CHANGE in scores was higher in Group 1 than in Group 2. This should be clarified throughout the paper. It is never clear what the percentage changes in the two groups were, or how big of a difference there was between them, since only post-intervention scores are reported. Please submit your revised manuscript by 10 December 2022. 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.

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• 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Rizaldy Taslim Pinzon

Academic Editor

PLOS ONE

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Reviewers' comments:

[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.]

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Effect of an extension speech training program based on Chinese idioms in patients with post-stroke non-fluent aphasia: A randomized controlled trial

PONE-D-22-14223R3

Dear Dr. Xiaojun,

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,

Jan Christopher Cwik, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I thank all reviewers for their time and effort in reading this manuscript. Also, thank you for your engagement during the successful revision process.

Reviewers' comments: