Review for 10.1186/s12876-024-03452-z (2024)

Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 1 Date: 12 Jun 2024
Reviewer's report:
In this paper, Tsunoda et al. reports a retrospective comparison of the differences in the FISI
assessment in fecal incontinence management among 100 patients using three modalities: A1:
Patient's own description using a conventional questionnaire, A2: Patient's own description
using a modified FISI which includes written explanations, and A3: Description from a
physician's interview.
It has been conventionally recognized that the responses to a questionnaire can differ depending
on the text of the questionnaire and the person by whom the questionnaire is given, and it is
interesting that the authors clearly demonstrated the differences. The findings presented in this
paper can be used as a reference for readers when they use any kind of questionnaire.
If the following modifications are appropriately made, the paper is considered to be worthy of
publication.
P2 Abstract and P8 conclusion:
A questionnaire is designed to evaluate the final total score, not the results of individual items.
The results of this paper should clearly state that there was no significant difference in the total
score between A1 and A3 (Table 4), and then state that 37% of cases (Fig. 2) showed a difference
of more than 8 points in the total score between A1 and A3, and that there was a difference in
selection for each individual item. The current expression in the abstract and conclusion may
mislead the reader to think that the total score, which is the original purpose of the score, also
differs significantly between A1 and A3.
P6L8 Discussion:
Please describe the clinical significance of FISI total scores differing by more than 8 points and
whether there is a consensus on how many points or more the difference is clinically significant.
P6L20 Discussion:
The results suggest that the A3 method may be useful not only for the FISI total score but also
for the use of items, especially in the elderly. On the other hand, if physicians are conducting
research using questionnaires, there is a concern that bias among physicians may occur and affect
the uniformity of the results if the questionnaires are written by physicians after oral interview.
In the future, it would be desirable to create a Japanese version of the FISI that has undergone
a validation study.
P6L30 Discussion:
The fact that the results of A2 differed significantly from those of A3, which was contrary to
prior expectations, may also suggest that it is desirable to create a Japanese version of the FISI
after a future validation study. It may also suggest that when using the current FISI, not only
using the A3 methodology for the elderly, but also the same methodology should be followed
when using the FISI over time.
P1 Authorship:
In Authorship, three authors are listed, but two authors are listed under the title. Please add
Satoshi Matsuda if he is also an author.
P3 Methods:
Please provide the source of the modified FISI. If it is original to the authors, please state so.
P12 Table 3:
Please arrange the abbreviation descriptions under the table in Table 3 in the order they appear
in the Table.