Dear Professor Robinson,
Thank you for asking me to referee this paper which I have read with considerable interest. My own work with a medical student studying covert recording in teenagers (published alas only in Asthma in General Practice) certainly contributed to the sceptical view of the usefulness of PEF recordings in that age group at least.
I think the topic is interesting and as far as I know original. My
few comments are attached for your perusal. The paper is worthy of publication,
but addresses a topic primarily of research methodology rather than clinical
application. Other journals might well publish it in its entirety but I
feel that a short report in the BMJ would be all that is merited.
Dr Kevin Jones’s comments
Although other papers have addressed the comparison of electronic and paper recordings of peak flow where the former is covert, I am not aware of previous papers which report adherence when the electronic option is made known to subjects. This work is therefore original, interesting and helpful to those wishing to design outcomes for clinical trials. Purely clinical application of these findings will necessitate the development of much cheaper devices.
The paper has been clearly and simply constructed with a defined purpose. The methods are adequately described except that the reason behind a run-in period of 7-28 days needs to be mentioned. I should prefer this section of the paper to begin with its third sentence and place the previous two elsewhere. I appreciate that two groups are not being compared in this paper, but some comment on the necessary sample size could still be made.
The results section again begins by forcing its reader to the tables which could be easily altered. Otherwise, I have no comments here. The discussion has two ‘however’s in the first paragraph and is somewhat long.
These are indeed all superficial points. The paper merits publication, but its suitability for the BMJ, either in its present form or as a short report, depends on its appeal to the general reader rather than to the designer of clinical trials in respiratory disease.
Dr Kevin Jones MA DM FRCGP
University of Newcastle