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Thank you for your revised submission. I am satisfied that you addressed the remaining concerns and am happy to accept your paper for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Jeremy Loenneke, a PeerJ Section Editor covering this Section #]
There are a few more corrections to be done:
- Please explain about the starting signal in the
- Please use "adolescents with HI" and "people with HI" throughout the article
There are a few remaining corrections to be done.
- In the Procedure, participants were required to hear the starting signal. As participants have a hearing impairment, what starting signal was used?
- The Discussion should be more focused. I’m not sure how this statement is relevant: "For example, an analysis of aggregated data from the 2003-2009 National Health Interview Survey (NHIS) in the United States showed that obese men and women reported significantly higher rates of disability compared to their normal-weight counterparts." Also, is it relevant to compare a survey of US army soldiers in BCT?
- The authors stated that a limitation is the sample size is relatively small. However, in the Methods section, it was stated that the sample size was sufficient.
- Use person first language throughout the article. Authors use “adolescents with HI” and “HI adolescents”. Please use consistent terms throughout the article.
- There are a few mistakes in spacing, spelling, and grammar. Please correct them.
I have no further comments.
I have no further comments.
I have no further comments.
I have no further comments.
Thank you for your revised submission. The reviewers have identified a number of remaining concerns that must be addressed. In particular first person language and the contribution of the study. They have also suggested that the manuscript be edited and proofread. Please provide detailed point-by-point response in the resubmission.
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services if you wish - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title). Your revision deadline is always extended while you undergo language editing. #]
Professional English:
The manuscript would benefit from a thorough revision to enhance readability and clarity. Several examples of incomplete sentences and grammatical errors hinder the overall flow. I've made some explicit suggestions for the first 2 parts of your abstract for your consideration. But please check throughout the whole manuscript.
Abstract:
Background: This cross-sectional study aimed to address a critical gap in the understanding of the association between Body Mass Index (BMI) and physical fitness levels in adolescents with hearing impairment (HI) in China. This study investigated how different BMI levels impact the Physical Fitness Index (PFI) of HI adolescents.
Methods: This study employed a physical fitness test for HI adolescents attending special education schools. The test included eight components: height, weight, 50-meter sprint, standing long jump, sit and reach, endurance run, bent-knee sit-up (for girls), and pull-up (for boys). Test scores for each student were standardized by age and gender. Individual Z-scores were then calculated, and the sum of these Z-scores constituted the Physical Fitness Index (PFI). Logistic regression was used to analyze the relationship between BMI and PFI across different gender and age groups. Statistical significance was set at p < 0.05.
In-text citations: Update these citations to include the year of publication. Original: Wang et al.; Hulens et al. to Revised: Wang et al. ([YEAR]); Hulens et al. ([YEAR]) and also check throughout manuscript for similar errors.
Line 82 – Grade 1 and Grade 2 HI descriptors seem to be conflicting. Please check.
Literature gap – can you please confirm if this is the lack of information on BMI and PFI of adolescents with HI? If so, please explicitly highlight this to rationalize the strength of your study.
Last sentence of introduction: I made this suggestion, please check if the intent is similar to what you wanted. “This cross-sectional study aimed to investigate the physical fitness of children and adolescents with profound to severe HI (including Grade 1 & 2 deafness) and analyzed the relationship between their Body Mass Index (BMI) and physical fitness.”
Under 2.2 Data collection. I cannot verify if the mentioned informed consent refers to both parents and children. Please clarify again. If this is not done prior to data collection, please check with Editor and Journal requirement.
Rearranging the METHODS section to: 2.1 Participants, 2.2 Measurements, 2.3 Procedures, 2.4 Data Analysis to make the whole section tidier.
Power test analysis: It is recommended to include a power analysis to justify the chosen sample size and ensure sufficient statistical power to detect meaningful effects.
Results Section:
• Improve clarity: Briefly explain the purpose of each question/data point at the beginning of the Results section. For example:
- "This section presents the results of the study investigating the relationship between BMI and Physical Fitness Index (PFI) in children and adolescents with hearing impairment (HI)."
- "The following data describes the distribution of BMI and PFI scores..."
• Figures and Tables: Unfortunately, I cannot verify revised changes without seeing the latest versions of the tables and figures.
Discussion Section (Line 264 onwards):
• COVID-19 and BMI: The discussion around COVID-19 as a potential reason for BMI differences in the HI population warrants further exploration. While this could be a factor, it's important to acknowledge that similar findings might be observed in the general population. Consider strengthening this point by:
- Providing additional evidence: If you have data or research suggesting COVID-19 has a unique impact on the HI population regarding BMI, include it here.
- Shifting the focus: Alternatively, highlight that individuals with HI face similar challenges to the general population regarding factors that influence BMI.
• HI Elderly vs. Adolescents: The addition of a discussion on the HI elderly population is appreciated. However, to truly emphasize the novelty of your study, consider expanding the discussion on HI adolescents, particularly in relation to:
- Comparison with typical populations: How do the findings on BMI and PFI in HI adolescents compare to those of non-HI adolescents? Referencing relevant studies would strengthen this comparison.
- Gender Differences: The vast difference in correlation curves between girls and boys in the 13-15 age group (Figure 2) looks interesting and could have further explanation. Considering to build your discussion on this.
- Age Group Effects: Explore potential variations in the relationship between BMI and PFI across different age groups within the HI participants. This could involve analyzing PFI by age subgroups or discussing existing research on this topic.
Appreciate the revisions based on the comments. While this is an improved version, consider further refining the language throughout the manuscript. The discussion section, in particular, could benefit from additional analysis to emphasize the study's unique contribution.
I thank the authors for addressing my comments. I believe the quality of this manuscript has been strengthened. However, the English language of this manuscript should be checked further. And, people first language (e.g., people with HI) should be followed throughout.
Nil.
Nil.
Nil.
Thank you for your submission. The reviewers have identified a number of concerns that must be addressed. In particular in terms of the justification of the study, reliability and validity of the measures, and language.
[# PeerJ Staff Note: It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful #]
General Tone. Throughout the paper, ensure a consistent formal and academic tone.
Person-First Language. Replace references to "hearing impaired individuals" with person-first language.
Here are some options:
Adolescents with hearing impairment
Adolescents with hearing loss
Participants with hearing disabilities
Data Issues.
Lines 183, 191, 195, 197, 210, etc. (Sit-Up Data - Girls): Carefully review the data in these lines, particularly for the "sit-up (girls)" column. Verify any seemingly unrealistic values. Consider including a footnote or explanation in the methods section if there are specific reasons for these data points.
Lines 92, 132, 155, 188, etc. (Sit-and-Reach Data): Investigate the negative values in the "sit-and-reach" column (lines 92, 132, 155, 188, etc.). Sit-and-reach tests typically produce positive values indicating flexibility. Ensure these values are accurately recorded or consider excluding them and explaining the reason for exclusion in the data analysis section.
Professional writing. Double-check the entire paper for grammatical errors, typos, and sentence structure throughout. For example, you can combine these short paragraphs (line 59-60, line 72-79 & line 80-82) into one for better flow.
Here's an example:
Individuals with hearing impairment (HI) constitute a significant minority group within society, often facing limitations in accessing public health resources. Research on physical fitness in disabled populations has gradually gained traction in recent decades. However, existing evidence possesses limitations. Many studies rely on self-reported body mass index (BMI) data, which may not accurately reflect true BMI levels [17]. While prior research explores the connection between BMI and various elements of children and adolescents' physical fitness [18, 19], physical fitness itself is influenced by a multitude of factors [20, 21]. Additionally, research suggests significant variations in body composition across racial groups at the same BMI level, highlighting the complex interplay between factors impacting physical fitness [22]. As a result, the effectiveness of BMI as a comprehensive indicator of individual physical fitness and health status remains unclear. Furthermore, the non-linear relationship between BMI and physical fitness has received limited investigation.
This study addresses these gaps in knowledge by analyzing the physical fitness of children and adolescents with severe hearing impairment (including deafness Grade 1 or Grade 2). It aims to provide an analysis of the cross-sectional relationship between BMI and physical fitness in this population.
Ethics. The informed consent form appears to lack a crucial element for ethical approval: parental consent for participants who have not reached adulthood. To ensure ethical compliance, please consider one of the following: 1) Revise the study to include parental consent within the informed consent form; 2) Clarify and state in the manuscript that the method of consent taking is conformed to the Declaration of Helsinki.
Formula & Standardized Scores. The calculation method for the Physical Fitness Index (PFI) could benefit from a more detailed explanation and illustration. This would enhance transparency and allow readers to replicate the calculation. Additionally, please confirm if the z-scores were computed based on the specific participant data from this research cohort.
Reference Updates. Line 55: While reference 17 is cited, consider referencing a more recent source for the WHO classification of hearing loss: https://www.who.int/docs/default-source/imported2/childhood-hearing-loss--strategies-for-prevention-and-care.pdf?sfvrsn=cbbbb3cc_0
Line 145: Similar to the previous point, consider updating the reference for the WHO guidelines on BMI for adolescents with a more recent and direct WHO source: https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age
The paper would benefit from a more current and comprehensive review and understanding of the current international standards and consent taking requirement. This would strengthen the overall credibility of the research.
Specifically, there are a few areas that could be clarified to enhance the manuscript's clarity before further evaluation could be done. These clarifications would allow for a more thorough review of the study's purpose, methodological rigor, and potential contribution to the field.
*Line 57: I think Grade 1 refers to profound HI but Grade 2 refers to severe HI. There is a difference between “Profound” and “Severe”. If you take this comment, please update the rest of the manuscript accordingly.
*Line 59: A paragraph that is too short to stand alone.
*Lines 72-79: References cited here are mainly based on general populations rather than special ones. Moreover, the correlation (including the non-linear one) between BMI and physical fitness has been investigated in many previous studies. For example, Huang YC, Malina RM. BMI and health-related physical fitness in Taiwanese youth 9-18 years. Med Sci Sports Exerc. 2007 Apr;39(4):701-8. doi: 10.1249/mss.0b013e31802f0512. PMID: 17414809. The authors have to justify the need for the present study more carefully.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful
*Line 99-102: The Chinese National Student Physical Fitness Standard (CNSPFS) battery has not been validated for general populations. Its reliability and validity, and the reliability and validity of the 6 tests used for HI groups in the present study are unknown. The below article may provide some supporting evidence for the selection of these tests: Huang, J., Yang, J., Haegele, J. A., Wang, L., Chen, S., & Li, C. (2023). Feasibility and Reliability of Health-Related Physical Fitness Tests in Children and Adolescents with Hearing Impairment. Children, 10(2), 353.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful
*Line 143: May briefly explain why to use “-5, 0, and 5” as the cut-offs.
*Overall the discussion could be strengthened, in particular by comparing the present findings with previous research on physical fitness in people with disabilities (e.g. HI).
*Check typos throughout: e.g., line 10 (“the” to “The”), line 66 (“hearing-impaired” to “HI”)
*Check the awkward sentences throughout: e.g., line 11 “The application of logistic regression was employed…”; line 81 “and provide the latest cross-sectional relationship analysis between BMI and physical fitness”
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