Dear editor

We have carefully reviewed the recent study “Musculoskeletal Ultrasound Assessment of the Clinical Efficacy of the Combination of Acupressure and ‘Three Methods of Neck Movement (TCM)’ Therapy in the Treatment of Cervical Spondylosis: A Study Protocol for a Randomized Controlled Trial”.¹ Unlike previous studies, this research introduces a novel approach and a new treatment for neck-type cervical spondylopathy (NTCS).

With the increase in ultrasonic resolution and the development of new technology, ultrasonography is more widely used in the diagnosis of diseases of the musculoskeletal system.² Musculoskeletal ultrasound can clearly display the structural details of the cervical spine and its surrounding tissues, which can provide a precise basis for pre- and post-treatment assessment, and visualize the effects of massage on the cervical musculature. However, this technique relies heavily on the skill level and experience of the operator. As same as another study,³ all measurements should be taken by the same experienced sonographer to maintain consistency in image acquisition. Also, the sonographer should undergo specific training on the standardized protocol before the study commences. However, this was not mentioned in the article.

Second, the age of the patients included in the general studies is 18 to 60 years old.^4,5 Due to lifestyle changes, cervical spondylosis is showing a trend towards youthfulness as the article mentioned. However, the patients included in this research are 40 to 60 years old. This raises a question: whether the age selection can be broader? Inclusion of young people may allow for more comprehensive validation of the effectiveness of the intervention and alignment with current medical needs.

Thirdly, patients in the intervention test group were required to take the TCM treatment twice a day. Is the TCM performed under the direction of doctors or by patients’ themselves? If it is the latter case, there needs to be standardized criteria for determining patients’ competence and a method for monitoring completion. Clarifying this may improve understanding of the study design and its implications.

Additionally, we noted a minor error in the article, this study evaluated efficacy at a total of four time points, but it written as three time points. Although this error may have no impact on the study, the correction will ensure the accuracy and reliability of the study.

In conclusion, we are looking forward to the results of this study. Meanwhile, we hope that this study can provide an important basis for the role of TCM combined with acupressure in NTCS and provide new ideas for traditional Chinese medicine treatment of cervical spondylosis.