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Dear Dr. Størling,
Congratulations!
Best regards,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
[# PeerJ Staff Note - this decision was reviewed and approved by Jafri Abdullah, a PeerJ Section Editor covering this Section #]
Dear Dr. Størling,
Two reviewers have commented and are largely positive. Please revise your manuscript according to the reviewer's comments.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
The manuscript is interesting and quite well written, having a good English. The study refers to a psychometric validation of a tool previously published (OST 2.0), which could be better and clearer described in Introduction or Methods section. The first 4 paragraphs intend to describe the instrument development process but is quite confuse. Literature references are update but not enough. The manuscript is well structured but includes so many tables.
This is really the second part of a previous published study about the OST 2.0, related to the patient with an ostomy perceived symptoms and signals about peristomal skin complications. According to reference literature in PRO tools it is relevant and necessary to publish together all the steps in the construction of a new tool, including since the items establishment and selection until the analysis of the evidences about its measure properties (reliability and validity). This is quite confuse in the current manuscript when the authors describe the tool previously developed and already published. It is not clear the design type described in the Methods section (RCT) as the current study is a methodological one (Psychometric? clinimetric?). Test-retest reliability maust be clarified (please, see my comments in the attached file). Definition of convergent validty for this study? Results include some methods issues (please see attached file). Measures properties were well selected and respective statistical analysis are appropriate. There are some established cutt-offs scores and/or classification systems which are not referenced. Results are clearly presented although there are many tables. Discussion section includes some questionable statements or interpretations (please, see attached document).
The statistical analysis are appropriate and conclusions are well stated.
Why did the authors not added the perceived symptoms (OST 2.0) in the original OST/ DET Score instead of create another instrument which excludes important items/ domains contained in the original OST? Both aspects (objective and subjective) are relevant in the peristomal skin assessent and monitoring. On the other hand and considering the patient centered care, he/ she must take part on his/her peristomal skin assessment, even if a second part of the DET Score could be sent for him/ her to monitor his/her skin.
The manuscript is clearly written. I notice a good observation about the shortcomings of the DET score as an existing tool for assessing peristomal skin damage. It is very dificult for patients to use it independently. Looking through the introduction, there really was a need for validation of the OST 2.0 questionnaire.
The methods and statistical analysis are justified and I have no comment on that part. The decision to corroborate and clarify the patient's possible misunderstandings with the qualitative part of the research was good.
The results are methodologically well processed.
Conclusions are well stated.
The Validation of the OST 2.0 resulted in a very useful tool for assessing peristomal skin damage. Is a useful tool for health professionals and patients.
The sample size for subjects for the psychometric validation could have been bigger, but on the other hand, enough considering the number of particles on the scale itself. It is very good that the PGI/CGI items were qualitatively tested prior to use to ensure patients understood the items intende
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