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Thank you for revising your manuscript to address the concerns of the reviewers. Reviewer 2 now recommends acceptance and I am satisfied that the comments of reviewer 1 have been addressed. The manuscript is now ready for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Celine Gallagher, a PeerJ Section Editor covering this Section #]
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I enjoyed reviewing this manuscript. It is excellent and contributes to the body of knowledge on this topic. It is well written and very interesting.
I do have a few suggestions for minor revisions:
1. Be consistent with the use of WeChat versus wechat.
2. There could be more clarification on the actual support given by WeChat. It is unclear as to the entirety of its capabilities. I get the impression there is educational support and the ability to send pictures. What else does it do, and how frequently are people utilizing it?
3. It is unclear as to what patients are offered WeChat in your facility. Is it that all patients are offered it and some use it, and some do not? This may introduce some bias in your study.
4. Discussion paragraph lines 499-512 are well written, but I believe they can be deleted. While I agree offloading is important, there is no relation given to your study, ie, did WeChat provide reminders for use of offloading devices?
5. Line 86 - from the beginning of the article, this sentence implies that all patients were hospitalized. This is unclear if only inpatients are offered WeChat?
6. I note that patients who died were excluded from evaluation. Did you look at amputations or mortality among the 2 groups? That would be interesting.
This article reports on a study that evaluated a WeChat mobile application for the care and follow-up of individuals with diabetic foot ulcers. This is a relevant topic for the care of patients with diabetic foot ulcers and one that integrates new technologies into healthcare.
However, there are numerous aspects of the study's methodology that need clarification, which could potentially limit the internal validity of the results and conclusions.
Methods
• The study is described as a retrospective cohort, yet it mentions an intervention group, a control group, and a follow-up period. This is unclear and potentially contradictory. The authors need to fully explain and justify whether a retrospective cohort design is appropriate to answer the stated hypothesis and objectives.
• If this is a cohort study (even a retrospective one), the exposure factor and the outcome variable must be clearly indicated.
• The methodology section contains characteristics of a non-randomized experimental (quasi-experimental) design or a non-randomized clinical trial, with both an intervention and a control group. The authors must review, clarify, and properly justify these aspects. If a prior study protocol exists, its accessibility should be mentioned.
• Depending on the study's design, the authors should follow the appropriate reporting guidelines: STROBE for a cohort design, CONSORT for an experimental design, or RECORD for non-randomized studies. In its current form, especially in the methods section, the manuscript does not properly adhere to the recommendations of these guidelines, making the information unclear and poorly structured.
• The method of patient assignment to the intervention and control groups is not described.
• The care and treatment received by patients in the control group must be described.
• The interventional procedures that some patients received in both groups should be detailed.
• The study was conducted at a hospital specializing in maternity and pediatrics. This could limit the patient population included. The authors should explain and justify the study population, clarifying whether it only included women or if men were also part of the study.
• No information is provided about the sampling method or a prior calculation of the necessary sample size. The final sample size is 131 patients, so the authors must justify that this sample has sufficient power for the analyses performed.
• More information is needed about the platform used for the educational module. Was it within the WeChat application or on a separate website? This point needs a better description.
Research Tools
• Two questionnaires are mentioned, but the authors do not specify how data were collected on diabetic foot ulcer healing, size, and evolution.
Statistical Analysis
• Analyses to evaluate the "effectiveness" of the intervention are mentioned, but if this is an observational cohort design, only association can be evaluated, not effectiveness (as a causal factor). This point relates to the previous comments about the study design
Discussion
• The healing rate is mentioned as the main finding, but this was not previously indicated as the primary outcome variable, nor was it stated how it was measured in a reliable and valid way. This is an important point to clarify.
Conclusions
• The conclusions must be revised based on the study design. If it is an observational study, the language should be more flexible, as it cannot be claimed that an effect of the intervention has been demonstrated.
Introduction
• Line 73: Reference 1 does not seem appropriate to support the use of WeChat for patient care. Please revise.
• The authors should briefly explain the WeChat application for international readers, as it may not be well-known outside of China.
• Objectives: The study's aim and specific objectives must be clearly described. The hypothesis guiding the study is not stated.
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