Thank you for the opportunity to review this article. I appreciate the effort taken to perform these tests and to write this study, but have a few concerns that would need to be addressed before it is ready for publication.
- Complete, coherent, and well-organized presentation:
There are some small English grammar errors that need some attention, but they do not affect the understanding of the paper. A final English check would be good before publication. For example: In the 1st and 3rd paragraph there are 2 sentences starting with ‘And’… this should be corrected to be appropriate for scientific writing. This error also appears in the Discussion section. The paper is presented in a logical manner, but the content is missing some key information to understand the links between education and study selected.
- Sufficient explanation of the significance of the problem:
I think a little more context in the introduction would be helpful, for example, an explanation of what the undergraduate physio training in Japan consists of (how many years, clinical exposure, level of degree). Some information on how long physio has been accredited in Japan could also help to provide background on why there is a gap in this area. This will help the reader to understand why ‘education for novice physios is not enough in Japan’ as stated in the background. Can you provide some examples of possible post graduate studies? Which courses are available, are there masters degree to specialise? What do physios usually do to gain additional skills?
- Clear demonstration of the relevance to the field (beyond the case presented):
- Original contribution to the topic of physiotherapy education:
This has potential to be interesting if the link to physiotherapy education can be strengthened. It would be very interesting to understand more about the context of physiotherapy training, both undergraduate and postgraduate, in Japan.
- Compelling presentation of the problem within a theoretical framework (where appropriate):
6. Establishment of a relationship between the problem and other relevant literature:
It is difficult to understand why the WS has been selected as the technique measured. Based on the reference used, it doesn’t appear to be a validated assessment tool. It seems to have been used as a treatment technique in the article (Pizzi et al) which was on gait in hemiplegia rather than WS. To make it clear what specific items you are using to determine skill, it would be helpful to include in the methods exactly which components in the WS technique you are measuring and how they would indicate skill in the therapist. If you can clearly justify the link between the technique used and how experience could be detected using this technique then it will significantly increase the importance of this paper. It would also help to show whether the physios recruited were generally working on neuro patients, because this must also be considered in terms of experience. If they have been a physio for 10 years but only seen neuro patients for 2 years then maybe the experience is not accurate? I think it would also be helpful to discuss when this skill is usually taught at an undergrad or postgrad level as it is not something that I have seen taught in this manner on force plates at other English-speaking universities (in Europe and Africa) and it is possible that there are differences in the curricula across the continents. This would help greatly to understand the decision for using this assessment as a measure of skill.
- Appropriate research design and method:
The design of the study is appropriate, but a clear rationale for the use of the assessment is needed. It is not clear how the test is an indication of competence or skill. In the background you mention experienced defined as 5 years, but then in your analysis you have used 11 years, so this needs to be clearly explained in your methods section. Maybe remove the reference of 5 years from the background section to avoid confusion. Is it possible to get information from the participants on how much additional training they have had/which courses they have attended so that you can include information on both experience in terms of years, but also additional training which could influence skill?
- Accurate and useful interpretation:
As the initial justification of the study is not clear, it is difficult to fully review whether the interpretation is accurate. In your discussion you mention that ‘there may be no difference in therapists command of the basic physiotherapy skills past their 6th year’… I think this is a very large assumption. You do later explain that it may be specific to this skill, but it might not be an appropriate to state this assumption at all.
- Sound argument and analysis:
- Effective conclusion about the implications for physiotherapy education, research, and/or practice:
The link between education and the technique used to assess the practitioners is not clear. This needs to be explained in greater detail so that the reader can clearly understand the implications in education of physio and how this research can be used to develop further skill training for physios.[jetpack-related-posts]