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Thank you for thoroughly addressing the reviewers' concerns. I recommend publication of your revised manuscript. Congratulations.
Dear authors,
There is significant discrepancy between the reviews I have received.
Please respond to the comments thoroughly and to the best of your ability.
Kind regards.
Dear authors,
in my opinion, you have significantly improved Your manuscript.
Congratulations!
Kind regards
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The article used clear English and relevant references. The tables are confusing, as the main topic is not well presented in the table. If TMD is the main topic, it should be explicitly laid out in the table. I understand that the author extracted TMD diagnosis from physical function domain in OHIP. It should be clarified more for readers who are not familiar with the tools.
I am concerned about the topic's validity. As it highlighted anxiety and TMD, it should be observed in the patient population.
College students are known to have high anxiety, but most of the times, they have low TMD severity. So it's not the perfect population for the topic. Especially when it's purely subjective, no clinical exam is performed.
I have commented in the experimental design section.
Thank you for the opportunity to review the manuscript. I appreciate that the authors utilized PROMIS in the study, though the tables do not elaborate it well.
I encourage the authors to observe TMD impacts and psychological factors from a different angle to have a higher validity and novelty.
Dear authors,
Thank you for submitting your work to PeerJ. Four reviewers have expressed their opinions about your manuscript and I have also reviewed it myself. There are serious concerns regarding the methodology and the study design that need to be addressed before the manuscript can be considered for publication.
Please refer to the reviewers' comments and the comments below:
1. There is no assessment of the method error.
2. How was the power analysis done? Which variable was used as the main outcome? You have conducted a series of analyses with many variables, which impacts the robustness off the results due to the small sample size. Some subgroups have less than 10 subjects! Such small sample sizes raise questions when it comes to subjective evaluations with questionnaires.
3. Please describe the methodology in more detail. Where the surveys filled out in the classroom or was it a visit designated to take part in the study. Where the subjects informed about the study as a group or individually?
4. What is the novelty of the study? The message which is conveyed to the readership is not original.
No comment.
No comment.
No comment.
The manuscript is well prepared and could be very interesting for the readers.
However, before publication, I would suggest some improvements.
ABSTRACT
1. line 55: It should be students' academic performance, not pupils' academic performance.
2. Keywords OHIP, PROMIS, and OHRQoL are not indexed in MeSH.
BACKGROUND
1. line 80: The abbreviation TMD is mentioned for the first time in the text without explanation. I suggest adding the abbreviation next to the full name/term - temporomandibular joint dysfunction (TMD) in line 78.
MATERIALS AND METHODS
1. line 126: The first sentence should be rephrased; cross-sectional is a research design, not a survey design.
2. Survey instruments (lines 149 – 156): Did the research use the PROMIS questionnaire in English or Arabic? The stated reference [23] proved the validity and reliability of the PROMIS questionnaire in English. If this research has used the Arabic version then this version should be tested for validity, reliability, etc.
RESULTS
1. lines 216-217: Is it justified to compare marital status given that only two participants are married (2.4%), and 81 (87.6%) are not?
2. lines 215-219: It is not necessary to repeat all the data twice, in the text and the table.
3. line 220: Mean OHIP value is 0.60, and SD 0.61 – this may indicate high variation between values and abnormal distribution for data. In such cases, it is advisable to use median and range instead of mean and SD.
4. lines 226-229: Table 4 is not mentioned in the text.
5. lines 230–233: Table 5 is not mentioned in the text.
6. lines 234-235: Table 6 is not mentioned in the text. Also, it is necessary to state the methods by which anxiety, psychosocial issues, and physical function were assessed. For example: A general linear model analysis revealed that an increase in anxiety levels (PROMIS) was significantly associated with an increase in psychosocial issues (OHIP) …..
DISCUSSION
1. line 265: deOliverra needs a capital letter, and this surname does not match the surname written in the reference section [31].
2. line 275: It is unnecessary to say „normative norms“, it should be rephrased.
3. line 288: aptitude -> attitude
REFERENCES:
1. Write the exact surname for reference 31.
2. Some references (1,12,22,31) are written in uppercase, it needs to be changed.
Abstract
Row 42, the sentence is unclear: The mean value for OHIP was 0.60, or 0.61, with a standard deviation of 0.61;
Background
The full forms and abbreviations of TMJ (row 79) and TMD (row 80) should only be used when mentioned for the first time (not in row 82 for TMJ and in row 88 for TMD).
Results
Row 215-219: The descriptive data from Table 2 is unnecessarily repeated in the text. One of those should be left out. It can be seen from table 2 that there are only two respondents in the sample who are married, so that any analyzes and conclusions in relation to marital status are meaningless!
I cannot find data in the text, that is in Results, concerning Table 5 and Table 6.
Reference
The writing style is not consistent, some references were written in uppercase, rows: 328, 361, 385, 393, 423.
See my comments in attached PDF file.
See my comments in attached PDF file.
See my comments in attached PDF file.
See my comments in attached PDF file.
The authors reported their study structurally using proper formal English. The study's background is adequate, with the correct references. The author brought forward the importance of assessing psychosocial factors in recognizing TMD. Having dental students as the subject can provide anxiety-stress factors as they experience high psychological distress. However, the intensity and impact of TMD in a non-patient population is often low, which can jeopardize the validity of the study.
I am mostly concerned about the design of the study. The title indicated that a TMD diagnosis or complaint is available. However, the authors used OHIP-TMD, which captures the impact of TMD, not the main complaint. If the authors used item number 6,7,8 of OHIP TMD in isolation to capture TMD complaints (which the authors did not), they are not specific for TMD. It can be other orofacial pain complaints, even odontogenic pain.
My suggestion is to rewrite the article and focus on the psychosocial factors of the students not related to TMD. For that, adding the sample size might be needed.
For the reason stated in the experimental design, I am doubting the validity of this study.
none
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