Review History


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Summary

  • The initial submission of this article was received on June 20th, 2025 and was peer-reviewed by 2 reviewers and the Academic Editor.
  • The Academic Editor made their initial decision on September 10th, 2025.
  • The first revision was submitted on September 25th, 2025 and was reviewed by 1 reviewer and the Academic Editor.
  • A further revision was submitted on October 13th, 2025 and was reviewed by the Academic Editor.
  • A further revision was submitted on October 16th, 2025 and was reviewed by the Academic Editor.
  • The article was Accepted by the Academic Editor on October 20th, 2025.

Version 0.4 (accepted)

· · Academic Editor

Accept

Thank you for your thorough revision. The updated version appropriately addresses all previous comments, including the extension of the literature search, correction of inconsistencies, and updates to the Discussion. The manuscript now reads clearly and is well formatted.

We appreciate your careful attention to detail and your responsiveness to the editorial feedback. Your manuscript is now suitable for acceptance in its current form.

[# PeerJ Staff Note - this decision was reviewed and approved by Mike Climstein, a PeerJ Section Editor covering this Section #]

Version 0.3

· · Academic Editor

Minor Revisions

Thank you for extending the literature search up until October 2025 and incorporating all the required points.

A few minor suggestions: I have noticed some word spacing and line spacing inconsistencies—please revise the entire manuscript to ensure coherence and uniform formatting.

In the Discussion section (line number 526), the old number of 24 RCTs is still mentioned; please amend this accordingly. Additionally, please include the total number of studies in the Abstract for clarity.

Kindly review the manuscript carefully to correct any remaining spelling or grammatical errors.

Thank you.

Version 0.2

· · Academic Editor

Major Revisions

Thank you for your submission and careful work on this meta-analysis. After further editorial review, we have identified an important issue that must be addressed before the manuscript can be considered for publication.

Your current literature search ends in September 2024. For a meta-analysis, it is essential that the search be as up to date as possible to ensure all relevant studies are included. As it currently stands, studies published in 2025 would be omitted, which could compromise the validity and completeness of your findings.

We therefore request that you:

1) Extend your database search to include studies published in 2025.

2) Incorporate any new eligible studies identified into your analyses.

3) Update the Results, Discussion, and Conclusions accordingly.

4) Revise the PRISMA flow diagram and search strategy details to reflect the updated search.

5) Clarify the inconsistency between the number of studies mentioned in the abstract (24 RCTs) and those described in the results section (20 studies, n=639).

6) As most of the included studies are from earlier years (with only one from 2023 and one from 2024), please acknowledge this as a limitation in terms of the recency of evidence.

Once these revisions are completed, please resubmit the updated manuscript and provide a detailed point-by-point response outlining the changes made.

Reviewer 1 ·

Basic reporting

The authors have addressed the reviewer's comments and needs no further revision.

Experimental design

The manuscript has been revised successfully.

Validity of the findings

Supplementary materials looks good and provides further support to the readers.

Version 0.1 (original submission)

· · Academic Editor

Minor Revisions

Thank you for your submission. Both reviewers found the topic relevant and recommend minor revision. Please:
1) Proofread carefully to correct grammatical errors and inconsistent terminology.
2) Expand background on SCI populations with respiratory impairment and include chronic SCI evidence where relevant.
3) Clarify prior conventional rehabilitation approaches for lung function.
4) Add detail on RMT interventions (delivery, time, thresholds, devices, adverse effects) in tabular form.
5) Correct typographical errors noted.
We look forward to your revision.

**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.

Reviewer 1 ·

Basic reporting

1. The manuscript needs to be proofread to correct the grammatical errors such as “full stop” which is used inappropriately throughout the manuscript.
2. Incomplete background of SCI in relation to pulmonary recovery

Experimental design

No comment

Validity of the findings

No comments

Additional comments

Comments
1. The manuscript needs to be proofread to correct the grammatical errors such as “full stop” which is used inappropriately throughout the manuscript.
2. In the introduction section, authors have stated pulmonary problems in SCI, however it is equally important to describe the specific SCI population that experiences respiratory impairments. For example, patients with higher level SCI (cervical-thoracic) mostly experience respiratory dysfunction compared to paraplegics, therefore, authors could include such information which would provide better understanding to readers.
3. Line 92-95: There are studies which have investigated and reported improvement in respiratory function using RMT even in chronic SCI population, it is suggested that authors include chronic patients’ information to increase the feasibility and clinical application of this intervention.
4. What kind of conventional rehabilitation have been used in the past for rehabilitation of lung function. It is suggested to describe before the RMT in the introduction section.
5. I thank you for explaining each outcome measures in addition to generating the table that helped further to explore RMT studies conducted, however adding another table that details the RMT intervention delivery, time, threshold, device, adverse effects and other parameters may provide a clearer picture to the readers, clinicians and researchers regarding its effectiveness.

Reviewer 2 ·

Basic reporting

The manuscript is written in English and generally maintains a clear, professional style. The use of terminology is consistent with the field.
The term "ventilator training" is used in line 124 and not again, it would be ideal to keep terminalogy consistent.
There is a typing error on line 315.
overall the article is well written

Experimental design

no comment

Validity of the findings

no comment

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