Content of review 1, reviewed on September 23, 2020
Generally, the paper is well written and addresses some gender issues that might help to clarify some of the differences of the outcomes in studies employing the same tDCS protocol. However, the paper, as it stands, has some minor shortcomings:
From Workman et al., 2020d: “Results Of the 34 subjects recruited, two could not endure the PRE-STIM TICKLE contact quality check at the beginning of the second visit and withdrew from the study, and one attended the baseline session but did not keep any remaining appointments and was lost to contact. The remaining 31 completed all scheduled sessions. Of these, four had FI results that did not meet the FI bias-correction cut-off (FI ≤ 0%), and their data were not included in the FI statistical analysis (total n = 27); however, the tolerability and blinding reports of these subjects were still included (total n = 31)”
In the present paper, authors report that only a subset of participants from the work of “Workman et al., 2020d” were analyzed (Page 6: 12 women and 11 men; total 23), but it is not totally clear why some participants have been excluded from the analysis and following which criteria. Please, explain this point in the paper.
What’s the motivation of choosing a free report to describe participants’ sensations using 1-10 Likert scale? Most of tES studies investigate stimulation sensations using a standardized questionnaire having a 5 or 7-points structure, as the one proposed by Fertonani and colleagues (Fertonani et al., 2015; http://dx.doi.org/10.1016/j.clinph.2015.03.015). Moreover, for practical data analysis goals, the Likert scale should not exceed 7 points. This ensures better well-categorised answers (see Abascal & Rada, 2013; https://doi.org/10.1080/13645579.2013.799736). A 10 points scale might carry some difficulties to analyse and interpret participants’ responses.
Authors state that oversaturating the sponges might cause undesired distribution of current. Some studies report the quantity of saline solution used to increase conductivity (Mencarelli et al., 2020; https://doi.org/10.1002/jnr.24690), which might be cited, to reinforce this part of discussion (Page 10).
Inghilleri and colleagues (Inghilleri et al., 2004) investigated the MEPs amplitude variability related to the sex differences using a TMS protocol and they did not employ tDCS. I think that in this section of your paper (Introduction: Page 4) - where you are writing about tDCS outcome inconsistency and biological sex - this citation might be confounding for the reader. Moreover, Inghilleri’s work it is widely discussed in the results section.
In the results section you write about the necessity to improve blinding in future tDCS studies using active sham, and you cite Richardson et al, 2014 (Page 11). The use of a novel active sham protocol have been more recently investigated by Neri and colleagues (Neri et al., 2020; https://doi.org/10.1016/j.brs.2019.11.004) and this work should be cited.
After the clarification of these points, I believe that your work might be published on this journal
Source
© 2020 the Reviewer.
Content of review 2, reviewed on October 13, 2020
The paper has improved a lot and most of the points are better explained, however, the reason why some participants have been excluded from Workman et al. 2020d study is not clear and needs to be clarified.
You wrote that you excluded some subjects in order to match subjects by age/sex, but it seems that participants from Workman’s study already matched for age:
From Workman: “females = 22; mean _ SD, age = 24 _ 3.6 years”.
From your work: “12 women: mean ± SD: age = 25.1 ± 3.9 years; men: age = 24.2 ± 3.3 years”.
Therefore, please report data and analysis results of the sensations of all participants of the previous study.
Source
© 2020 the Reviewer.
Content of review 3, reviewed on November 24, 2020
All of my previous points have been addressed. I have no further issues to raise.
Source
© 2020 the Reviewer.
References
D., W. C., C., F. A., John, K., Thorsten, R. 2021. Women report more severe sensations from 2 mA and 4 mA transcranial direct current stimulation than men. European Journal of Neuroscience.
