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]
Dear Kim Buchholtz
Thank you very much for all your time and effort, we really appreciate it.
We have corrected the areas you indicated. Areas of major revision are highlighted.
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.
→We rechecked and corrected our English grammar. We also added an explanation about physical therapy education of Japan, including the training process in the Introduction.
“In Japan, physiotherapist, who has approximately 5 years or 10 years of work experience, is quantified ‘experienced’ as someone with sufficient time in the field, regardless of their level, efficacy or quality of training. However, this definition is insufficient in establishing quality and uniformity among physiotherapists in Japan. In order to begin quantifying skill, it is first necessary to establish the feasibility of distinguishing between what the JPA considers ‘experienced’ from ‘novice’ based on basic physical therapy treatment technique and approach. The purpose of this study is to establish groundwork for standardization in education and evaluation.”
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?
→We added an explanation about an explanation of what the undergraduate physio training in Japan.
“Physiotherapy education in Japan began in 1963, and the JPTA was established in 1966. Undergraduate education for physical therapists in Japan consists of graduation from a three-year technical college, a four-year technical college or university program, as well as passing a national examination to become a licensed physiotherapist.”
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.
→We added an explanation about the context of physiotherapy training, both undergraduate and postgraduate, in Japan.
“A total of at least 800 hours of practical training is required during the course of study, however, educational methods vary depending on the facility where the training takes place and instructor. In addition, students may enter graduate school after graduation from training school, however, this is left to the decision of the individual, and not all physiotherapists go on to graduate school.”
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.
→The tasks we have done this time are part of the WS that will be done in treatment. Therefore, it was not performed while walking, and was performed in the resting standing position in the frontal plane.
We added an explanation about reason of why the WS has been selected as the technique measured.
“While there are many opportunities to practice ROM exercises, MMT, and muscle strengthening exercises in training school education, WS is a skill that is often learned after going into clinical practice. The influence of undergraduate education can be disregarded because it is learned post-graduation. For this reason, WS was chosen as the participant in this study. In addition, it was assumed to be a component until loading to the lower leg of one foot in the WS technique. This technique is a therapeutic technique and force plates are not used in therapeutic situations. However, if it becomes clear that force plates can be used to confirm the technique, it will be possible to objectively evaluate and improve the technique in future undergraduate and clinical education.”
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?
→We have reexamined the statistical study of the method using correlation statistical analysis and we have accordingly revised our discussion.
Japanese Physical Therapy Association didn’t have training courses when we took the data and it had training courses since 2022. Therefore, we can’t get the information from the participants on how much additional training they have had/which courses they have attended.
“Correlational statistical analysis was used to confirm whether years of experience changes the degree of WS.”
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.
→We have revised our discussion.
“The results of this study confirm that the correlation between the data obtained and years of therapists’ experience is weak or absent. Form the results, suggest that there may be no difference in therapist’s command of the basic physiotherapy skills past their 6th year. Therefore, it was considered that the duration of years of therapists’ experience was not necessarily related to physiotherapy skill, at least in the performance of the skill evaluated in this study. However, the participants of this study had from 6 to 27 years of experience as therapists. Therefore, they all met the minimum of 5 years of therapists’ experience as per the clinical practice supervisor requirement in Japan. In the future, it will be necessary to include physiotherapy students, clinical physiotherapists and physiotherapy educators in their first to fifth year, and increase the number of participants to examine the differences in skill regarding the basic physiotherapy principles between different years of therapists’ experience. In addition, it will need to get information from the participants on how much additional training they have had/which courses they have attended.”
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.
→We are thinking that undergraduate and clinical education are important for physiotherapy. Therefore, we believe that it is important to assess the practitioners as a preliminary step and the study provides an understanding of the current situation about it. In addition, if we can confirm it is possible to use force plates for technical evaluation, we expect that objective evaluation will be possible and can be used in undergraduate and clinical education.
The following text was added.
“This technique is a therapeutic technique and force plates are not used in therapeutic situations. However, if it becomes clear that force plates can be used to confirm the technique, it will be possible to objectively evaluate and improve the technique in future undergraduate and clinical education.”
Best Regards,
Yumi Okayama, PT, Ph.D.
Department of Physical Therapy,
Osaka University of Human Sciences,
Osaka, Japan.
Mail: [email protected]
Dear Authors
Thank you for your responses.
I have a few further comments to consider:
Background:
1st paragraph: You state that physiotherapists who have ‘5 years or 10 years of work experience’…. can you clarify, is it 5 or 10? Because this is important later when you discuss years of experience. Is there a reference for how this is defined? At the end of the 3rd paragraph you mention this again, so make sure that it is consistent throughout your document and in the discussion.
3rd paragraph: When you mention the more experiences physios teach the less experienced, is this in a CPD setting or in a work setting?
5th paragraph: You state that ‘For this reason, WS was chosen as the participant…’ WS is actually the assessment? Or intervention? The sentence starting: ‘ In addition, it is assumed to be a component…’ is very unclear, what do you mean by this? Your last sentence mentions that it can be used to improve the technique in UG education, but you have previously stated that it is not used in UG training?
6th paragraph: You have mentioned that this is a basic skill, but are using it to assess level of experience, so it should be considered and advanced skill perhaps?
Methods:
2nd paragraph: You should reference the WS and explain what the aim was. What would be considered good vs bad so that the reader can interpret it. How much weight shift would be considered adequate? This would help to explain why you have measured the GRF and the COP and what the numbers mean related to the experience of the physio.
Discussion and conclusion:
1st paragraph: ‘Subsequently, correlation between data and years…’ You have mentioned correlational analyses in the methods, and here, but you have not presented these results. If you would like to discuss them then you need to include them in the results section.
4th paragraph: This hypothesis is a very big assumption when you do not have any information on the postgraduate training of the participants. I suggest considering other reasons for this.
6th paragraph: The first sentence is not a full sentence and needs to be grammatically corrected.
Kind Regards
Dear Kim Buchholtz
Thank you very much for all your time and effort, we really appreciate it.
We have corrected the areas you indicated. Areas of major revision are highlighted.
Background:
1st paragraph: You state that physiotherapists who have ‘5 years or 10 years of work experience’…. can you clarify, is it 5 or 10? Because this is important later when you discuss years of experience. Is there a reference for how this is defined? At the end of the 3rd paragraph you mention this again, so make sure that it is consistent throughout your document and in the discussion.
→We corrected the sentences. We also added the reference.
Ministry of health, Labour and Welfare. (2019). Guidelines for guidance of physiotherapist and occupational therapist training facilities. Retrieved on 10 April 2022 from https://www.japanpt.or.jp/assets/pdf/info/20181009_02/02_Guideline_hikakuhyo_181005.pdf
「In Japan, physiotherapists who have approximately 5 years of work experience, qualify as ‘experienced’ as someone with sufficient time in the field, regardless of their level, efficacy or quality of training (Ministry of health, Labour and Welfare, 2019).」
3rd paragraph: When you mention the more experiences physios teach the less experienced, is this in a CPD setting or in a work setting?
→It’s in a work setting. We added it.
「In the area of skills, the more experienced physiotherapists teach the less experienced in clinical practice, and they teach based on individual therapists’ experience in a work setting.」
5th paragraph: You state that ‘For this reason, WS was chosen as the participant…’ WS is actually the assessment? Or intervention? The sentence starting: ‘ In addition, it is assumed to be a component…’ is very unclear, what do you mean by this? Your last sentence mentions that it can be used to improve the technique in UG education, but you have previously stated that it is not used in UG training?
→WS is the assessment item of this study to confirm the difference in skill. We corrected the sentences.
WS doesn’t contain in undergraduate education in Japan at present. Therefore, we are thinking it should contain WS if we can clarify index of skill.
「For this reason, WS was chosen as the participant of this study to confirm the difference in skill. In addition, only one element of WS was the primary focus in this study; loading to the lower leg of one foot from upright standing and returning to a neutral position for repetition in the WS technique.」
6th paragraph: You have mentioned that this is a basic skill, but are using it to assess level of experience, so it should be considered and advanced skill perhaps?
→We don’t think WS is an advanced skill and we think WS is a basic skill. Therefore, we used it. We are thinking we should try to research not only WS but also other skills (ROM-ex, MMT, MS-ex).
Methods:
2nd paragraph: You should reference the WS and explain what the aim was. What would be considered good vs bad so that the reader can interpret it. How much weight shift would be considered adequate? This would help to explain why you have measured the GRF and the COP and what the numbers mean related to the experience of the physio.
→In this study, we don’t think good or bad because we can’t judge them. We are thinking this study is a preliminary step and we would like to confirm whether COP and GRF are difference according to years of experience.
Discussion and conclusion:
1st paragraph: ‘Subsequently, correlation between data and years…’ You have mentioned correlational analyses in the methods, and here, but you have not presented these results. If you would like to discuss them then you need to include them in the results section.
→We include them in the results section.
「The correlation coefficient between years of experience and degree of WS was r = -0.24 for the ratio of COP displacement and r = -0.07 for the maximum GRF.」
4th paragraph: This hypothesis is a very big assumption when you do not have any information on the postgraduate training of the participants. I suggest considering other reasons for this.
→We changed the way we expressed it.
「On the other hand, it was hypothesised that the factor that showed significant differences in the ratio of COP displacement and the maximum GRF between institutions was staff at each institution.」
6th paragraph: The first sentence is not a full sentence and needs to be grammatically corrected.
→We changed the sentence.
「It is considered that helping to gain knowledge in physiotherapy skills by quantifying and standardizing the aspect of body movement during treatment by a physiotherapist or physiotherapy student is also expected to help educators in the development of teaching methods.」
Best Regards,
Yumi Okayama, PT, Ph.D.
Department of Physical Therapy,
Osaka University of Human Sciences,
Osaka, Japan.
Mail: [email protected]