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Authors have addressed all of the reviewers' comments, and the paper has been significantly improved after revisions.
I think this paper can be accepted for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Jeremy Loenneke, a PeerJ Section Editor covering this Section #]
Dear Authors
I congratulate you for conducting this study. I see that the revisions have been made meticulously. Some revisions may have been overlooked. The references in the Introduction section of the article are insufficient. You should use these two articles as references.
Reference 1: Kaya, M. H., Erbahçeci, F., Alkan, H., Kocaman, H., Büyükturan, B., Canlı, M., & Büyükturan, Ö. (2022). Factors influencing of quality of life in adolescent idiopathic scoliosis. Musculoskeletal Science and Practice, 62, 102628.
Reference 2: Yetiş, M., Yildiz, N. T., Canli, M., Kocaman, H., Yildirim, H., Alkan, H., & Valamur, İ. (2024). Determination of predictors associated with pain in non-surgically treated adults with idiopathic scoliosis. Journal of Orthopaedic Surgery and Research, 19(1), 406.
**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.
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The manuscript's primary strength lies in its comprehensive attempt to evaluate various exercise therapies for AIS using Bayesian network meta-analysis. However, significant concerns exist regarding the methodology and reporting. The inclusion criteria need refinement, particularly concerning patient age ranges and concurrent brace usage, as these factors significantly impact the interpretation of exercise therapy effectiveness. Several included studies have participants over 18 years old or use concurrent brace therapy, which compromises the ability to isolate exercise effects.
The introduction requires enhancement with more recent references and expanded epidemiological data to better establish the study's context and significance. The methods section would benefit from clearer definitions of interventions and control conditions, as well as more detailed reporting of the statistical approach. The results could be strengthened through additional subgroup analyses considering important clinical factors such as initial Cobb angles and Risser scores.
[# 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. #]
-The language of the work is fluent and understandable. Literature references are adequately referenced in the manuscript. Article structure, figures and tables are appropriate.
-I think that the references used in the introduction of the manuscript are not sufficient.
-Although a few references are the same, they are reused as if they were different sources. Please revise the references of the study.
-The abbreviations used in the study should be abbreviated in the first place they are mentioned and their abbreviations should be used when they are mentioned in a second place. Review the abbreviations again.
-The study hypotheses summarise the study in an appropriate way.
The article was planned and executed in accordance with the structure and objectives of the journal.
The research question is well defined.
It was conducted in accordance with ethical rules.
The study was conducted in an innovative way to the literature. The findings of the study were planned appropriately together with the differences and similarities of the studies in the literature.
Congratulations for conducting this study. I think that the quality of the study will improve after some revisions. I think that the study will be an example for researchers and clinicians working in AIS patients.
The English language of the article is written in a clear and understandable way.However, the articles selected and included in the meta-analysis should be reviewed again.
Research question is well defined and it is a very important topic.
The findings should be re-analysed and presented in the light of properly selected articles.
Dear editor, I would like to thank you for your kind invitation to review the article entitled “Evaluating exercise therapies in adolescent 1 idiopathic scoliosis: insights from a bayesian network meta-analysis .”
First of all, I would like to congratulate the researchers for their efforts.
The authors aimed to fill the existing research gap by systematically reviewing published randomized controlled trials (RCTs) concerning exercise interventions for Adolescent Idiopathic Scoliosis (AIS).
Critique of the Included Studies in the Meta-Analysis
Fabio Zaina's study included patients who were also wearing braces, which prevents the evaluation of exercise efficacy alone.
The study by Kocaman et al. has been cited twice in the meta-analysis. Additionally, the reported Risser scores and age values in Kocaman et al.'s study are inconsistent. This discrepancy should be addressed by the authors.
In HwangBo's study, the mean age of the patients exceeds 18 years. Similarly, in the study by Kim and HwangBo, the mean age of the patients is above 15 years. The risk of progression in an 11-year-old child with a Risser score of 0 is not comparable to that of an adolescent with a Risser score of 5. Therefore, exercise efficacy should be analyzed with these parameters taken into account.
In the study by Gür et al., patients were using symmetric braces. Consequently, it is not possible to determine whether the therapeutic effect was due to the brace or the exercise intervention.
Schreiber et al.’s study does not specify what constitutes "standard care."
It is possible to provide further examples to illustrate these methodological issues.
I greatly value the efforts and contributions of the authors. I acknowledge the substantial work they have undertaken for this meta-analysis. However, I believe that a more in-depth examination of the included studies is necessary. Without such scrutiny, the presented findings may not accurately reflect reality.
I fully agree that exercise therapy is highly valuable in the management of adolescent idiopathic scoliosis (AIS), and I appreciate the authors' efforts to highlight this. However, to determine the true efficacy of exercise therapy, it is essential to analyze patients who are not simultaneously using braces.
Another crucial point is that the risk factors for progression in an 18-year-old patient with a 10-degree scoliosis differ significantly from those of a 10-year-old patient with a 20-degree scoliosis. Maintaining the Cobb angle in patients during periods of rapid growth, particularly those with Risser scores of 0–2, should be considered a significant achievement.
I suggest that the authors reevaluate the studies included in their meta-analysis, taking into account risk factors, initial Cobb angles, age groups, and brace use. Reanalyzing the data with these considerations would enhance the reliability and relevance of the results.
I wish the authors success in their continued research endeavors.
Thank you for the opportunity to review this manuscript for your journal. The study addresses an important area in the field by utilizing Bayesian network meta-analysis to evaluate exercise therapies for Adolescent Idiopathic Scoliosis (AIS). However, there are several critical areas that require substantial improvement. First, while the methodology is generally sound, the introduction must include a more thorough discussion on the prevalence of AIS and its clinical implications. This is essential to establish the significance of the research in the context of AIS management. Second, the clarity of the manuscript is lacking. The authors need to explicitly outline the interventions applied to control groups in the inclusion criteria. Additionally, a clear description of the standard treatment components is necessary, particularly regarding brace usage and adherence. This information is crucial for understanding the treatment context and evaluating the validity of the findings. Overall, while the manuscript attempts to provide insights into therapeutic interventions for AIS, the lack of detail and clarity in key areas significantly undermines its impact. The authors must address these deficiencies to ensure the research can effectively inform clinical practice and future studies in this field.
Thank you for the opportunity to review this manuscript for your journal. The study addresses an important area in the field by utilizing Bayesian network meta-analysis to evaluate exercise therapies for Adolescent Idiopathic Scoliosis (AIS). However, there are several critical areas that require substantial improvement. First, while the methodology is generally sound, the introduction must include a more thorough discussion on the prevalence of AIS and its clinical implications. This is essential to establish the significance of the research in the context of AIS management. Second, the clarity of the manuscript is lacking. The authors need to explicitly outline the interventions applied to control groups in the inclusion criteria. Additionally, a clear description of the standard treatment components is necessary, particularly regarding brace usage and adherence. This information is crucial for understanding the treatment context and evaluating the validity of the findings. Overall, while the manuscript attempts to provide insights into therapeutic interventions for AIS, the lack of detail and clarity in key areas significantly undermines its impact. The authors must address these deficiencies to ensure the research can effectively inform clinical practice and future studies in this field.
Thank you for the opportunity to review this manuscript for your journal. The study addresses an important area in the field by utilizing Bayesian network meta-analysis to evaluate exercise therapies for Adolescent Idiopathic Scoliosis (AIS). However, there are several critical areas that require substantial improvement. First, while the methodology is generally sound, the introduction must include a more thorough discussion on the prevalence of AIS and its clinical implications. This is essential to establish the significance of the research in the context of AIS management. Second, the clarity of the manuscript is lacking. The authors need to explicitly outline the interventions applied to control groups in the inclusion criteria. Additionally, a clear description of the standard treatment components is necessary, particularly regarding brace usage and adherence. This information is crucial for understanding the treatment context and evaluating the validity of the findings. Overall, while the manuscript attempts to provide insights into therapeutic interventions for AIS, the lack of detail and clarity in key areas significantly undermines its impact. The authors must address these deficiencies to ensure the research can effectively inform clinical practice and future studies in this field.
Thank you for the opportunity to review this manuscript for your journal. The study addresses an important area in the field by utilizing Bayesian network meta-analysis to evaluate exercise therapies for Adolescent Idiopathic Scoliosis (AIS). However, there are several critical areas that require substantial improvement. First, while the methodology is generally sound, the introduction must include a more thorough discussion on the prevalence of AIS and its clinical implications. This is essential to establish the significance of the research in the context of AIS management. Second, the clarity of the manuscript is lacking. The authors need to explicitly outline the interventions applied to control groups in the inclusion criteria. Additionally, a clear description of the standard treatment components is necessary, particularly regarding brace usage and adherence. This information is crucial for understanding the treatment context and evaluating the validity of the findings. Overall, while the manuscript attempts to provide insights into therapeutic interventions for AIS, the lack of detail and clarity in key areas significantly undermines its impact. The authors must address these deficiencies to ensure the research can effectively inform clinical practice and future studies in this field.
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