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We read with great interest the study by Swaminathan et al, which aimed to determine the effect of personal protective equipment (PPE) on the physical and mental well-being of patient-facing staff during the COVID-19 pandemic.1 It has been widely evidenced that COVID-19 has a profound impact on an individual’s physical and mental well-being,2 yet it is unclear to what extent PPE is a contributing factor. While we agree that the authors have provided valuable insight into this matter, we have some questions related to the design and reporting of this study.
The authors state that ‘the impact on mental well-being was studied with a visual analogue scale (VAS) score of 7 and above for anxiety’. Therefore, the presented data on physical and mental well-being are derived from subjective factors by self-selected doctors, nurses and other allied health professionals. The cut-off of a VAS score of 7 or above appears to falsely dichotomise those who experienced anxiety or depression and those who did not. Prior to creation of the questionnaire, was any work conducted to determine the psychometric validity and reliability of this derived measure? For example, the use of the Warwick-Edinburgh Mental Well-being Scale3 would yield objective data concerning the mental well-being of staff members. Second, the wording of the questions included become pertinent to the conclusions that can be drawn, and we would be interested to see the questionnaire that was distributed during the study period.
While the COVID-19 pandemic undoubtedly affects individuals’ physical and mental well-being, the methodology of the study is such that the authors can only establish an association between PPE and physical and mental well-being, rather than causation or magnitude of effect. We question the ‘undeniable negative impact’ the authors claim that PPE has on physical and mental well-being for those using it on the front line, and suggest that this warrants further, more thorough investigation.
The authors acknowledge that the cohort in this study is small, and conclusions have been made from a questionnaire-based survey of opinion. The subjective assessment of the effect of PPE on physical and mental well-being during the time of a pandemic is at significant risk of confirmation and perception bias. Combined with non-response bias, interpretation of non-validated VAS scores is vulnerable to misclassification bias, and the conclusions of the current study should be viewed with caution. However, as a historical snapshot of some of the issues created by PPE during a global health crisis, this study has gathered a wealth of valuable information.
Patient consent for publication
Contributors JS conceptualised the letter, and JMcV and MJ contributed with original ideas and reviewed the letter prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.