Abstract
Dear Editor,
We are pleased to receive the letter and appreciate the authors’ interest in our study: ‘Volume of water added to crushed ice affects the efficacy of cryotherapy: a randomised, single-blind, crossover trial’ [1].
As stated in our limitations section, we agree with them that assessing intramuscular temperature directly would provide a more accurate analysis on the effects of cryotherapy. However, this approach would be invasive, increasing risks of subjects’ participation and drop out in the study. We are aware skinfold thickness (subcutaneous adiposity) could affect the effectiveness of cryotherapy. As mentioned in our limitations section, we believe future studies should address subjects’ anthropometric characteristics (e.g. skinfolds) to better understand how they could alter the effect of cryotherapy. Evidence is unclear regarding the appropriate duration of application for specific skinfold thickness [4], and we believe that varying the time duration for each subject would add an avoidable confounder variable to this study.
We followed several specific procedures to ensure data quality as described in methods section. Since our study is a crossover trial, each subject received all three cryotherapy preparations in a randomized order [2], thus the assessed effect is a result of the comparison between each preparation in the same subject [5].
Finally, we agree that treatment, not limited to cryotherapy, must be individualized [3]. We hope that in future an accurate and feasible approach to measure and account for differences in skinfold thickness when customizing the treatment will be available in clinical settings. However, this study examined how the volume of water added to the ice preparation enhanced or reduced tissue cooling.
Funding: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil ( CAPES ) – Finance code 001 .
Ethical approval: This study obtained ethical approval from the Human Research Ethics Committee of Federal University of Santa Catarina (1.771.454).
Conflict of interest: None declared.