Reviewer’s report
Title: 
Psychometric Performance of the Arabic Versions of the Functional
Assessment of Cancer Therapy-Breast plus Arm Morbidity (FACT-B+4) in
Patients with Breast Cancer Related Lymphedema
Version: 
2 
Date: 
15 Jan 2022
Reviewer's report:
The number of people suffering from breast cancer is increasing year by year,
and lymphedema in particular can significantly reduce quality of life and is a
serious problem, so it is possible to evaluate and improve quality of life after
treatment. I can do it. It's important. It is considered very important to consider
the effectiveness of the endpoint. The procedure of conducting a pilot test in 14
cases, confirming the clarity, acceptability, and comprehension of the Arabic
FACTB + 4 version and conducting a prospective cross-sectional study seems
reasonable.
I'm a little worried about sample size, you mention that "it is based on the advice
from the report "Quality criteria for measurement properties of health status
questionnaires" which suggests that at least 50 participants should be necessary
to analyze relevant clinometric properties, while a sample size of 30 was
considered the minimum required sample." But I'm not sure it is enough sample
size or not, because I see the validity assessments made in other countries such
as Spanish, Brazilian and Italy, they used a little bit more numbers. As you
mentioned in discussion, the limited sample numbers may not reflect all the
Arabian populations due to the limited area of 
participants. Especially in your
study, all the population live in a central province of Saudi Arabia. In other
words, it cannot be denied that there may be a bias in educational background,
living environment and breast cancer treatment. However, it has been validated
in Arabs and this study is highly appreciated in terms of building evidence.
In addition, the nest step is that 10 of the 14 FACT-B+4 items are shown to be
effective, but it seems that the future task is how to improve the remaining items
that could not be shown to be effective.
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