Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: A modified Delphi study

Naziru Bashir Mukhtar; Mira Meeus; Ceren Gursen; Jibril Mohammed; Vincent Dewitte; Barbara Cagnie

doi:10.1371/journal.pone.0253757

Peer Review History

Original SubmissionOctober 16, 2020
30 Dec 2020 Decision Letter - Ukachukwu Okoroafor Abaraogu, Editor PONE-D-20-32518 Development of culturally sensitive pain neuroscience education materials for African (Hausa) patients with chronic spinal pain: a modified Delphi study PLOS ONE Dear Dr. Mukhtar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has some merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. This is an interesting manuscript that addresses a timely topic area in physiotherapy pain eduation, particulay addressing a region of the world that is under represented in liturature. This will definately be of interest to the journal readership and I commend the authors for initiating this type of research in Africa context. That said, I will like authors to make changes to the manuscript, or write rebuttals in response to ALL the comments, querries and suggested changes from both reviwevers. Please submit your revised manuscript by 31st of January 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. 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Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for including your methods section "The research protocol was approved by the Hospital ethics committee of ‘X’ University." Please amend your current ethics statement to include the full name of the ethics committee/institutional review board(s) that approved your specific study, or to remove this." Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”). 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Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, I commend you on the bold step taken by embarking on this research,it is quite apt and relevant.However,I wish to point your attention to some areas that may need some corrections and elaborations. 1.Material and method section. a.The focus group discussion was not properly constituted.For me,I felt you needed a neurologist also as a panel member and some patients with pain to share their experience.This is the least you could have done,Physiotherapists alone may not be sufficiently resourceful enough to help with constructs for developing pain related education materials. Your content analysis could also have been highlighted in the appendix,for purpose of scrutiny.You mentioned that you adapted and developed ,I basically find these two words very confusing.Did you adapt the material from another work or did you develop a novel material for the PNG education? Please you need to be very precise and clear in your documentations. b.You had a focus group discussion in which you developed a preliminary PNG and HE education material in English language and later translated these materials to Hausa language.For me,your translation and cultural adaptation was very substandard and shallow.Translating research materials and cultural adaptation has a standard procedure there are basically six stages which must be compulsorily adapted to make such acceptable in standard research. STAGE 1:initial translation(Two forward translation by at least two bilingual translators they should have different profile background) STAGE 2:Synthesis of translation STAGE 3:Back translation STAGE 4:Expert committee STAGE 5:Test of the pre-final version. STAGE 6:Submission and appraisal of all written reports by developers/committee. All these important steps were not followed,these therefore makes your translation highly sub-standard and unacceptable for a research of these magnitude. The processes of translation and cultural adaptation are very central in this work and less attention was paid on it but rather you spent all your time discussing the audit trail which was the Delphi study.The Delphi study is important but the main crust of this work is the translation to Hausa language. I think you need to do a major revision of this work to make it standard and acceptable,its indeed a good and nice innovation but it must be done to international standard to make it acceptable for publication. Reviewer #2: Reviewer's Comment: 1. Replace with Hausa Speaking Patients. I do not see the need for Africa given that the instrument can be used by a non-African who speaks and understands Hausa very well or better than other languages. 2. "significant" on page 13: Change language except you have a statistical evidence 3. "Table 5" on page 14: Referring to the wrong table, I guess 4. "Table 6" on page 14: No table 6??? 5. Insert number (n = ?) for the number of experts that participated in rounds 1 and 2 as shown in Figure 1. 6. The discussion needs to be rewritten to reflect both deductive and inductive reasoning based on other published studies. The discussion appears like a repetition of the result section. This should be avoided. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Dr. Echezona Nelson Dominic EKECHUKWU [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-20-32518_ Reviewers Comment.pdf https://doi.org/10.1371/journal.pone.0253757.r001
Revision 1
6 Apr 2021 Author Response We wish to thank the reviewers who have provided very useful corrections and suggestions that have improved the overall quality of our work. It is our hope that the current revised version of the manuscript presents a better and more focused information that will be helpful to readers. As requested, we have now provided a point by point response to the reviewers' comments below; Reviewer I: a. The focus group discussion was not properly constituted. For me, I felt you needed a neurologist also as a panel member and some patients with pain to share their experience. This is the least you could have done, Physiotherapists alone may not be sufficiently resourceful enough to help with constructs for developing pain related education materials. Your content analysis could also have been highlighted in the appendix, for purpose of scrutiny. You mentioned that you adapted and developed, I basically find these two words very confusing. Did you adapt the material from another work or did you develop a novel material for the PNG education? Please you need to be very precise and clear in your documentations. Response: We thank the reviewer for raising these critical points. Firstly, the focus group discussion was aimed at providing preliminary materials that will be sent to experts during Delphi rounds, therefore, including all experts in the focus group will amount to duplicating the Delphi study. Secondly, in the current practice of PNE, neurologists are not considered experts unless they have specific expertise in PNE. In general, the concept of injury being synonymous to pain is always avoided in PNE, which maybe the belief of many physicians. Consequently, we considered physiotherapists with expertise in PNE to be enough for the purpose of developing a preliminary material, which was later subjected to Delphi rounds comprising experts. Thirdly, the words adaptation and development were used in our study because, as mentioned in the method section, we adapted the pain teaching materials from an existing PNE materials (Orhan et al. cited in our method section), and we also developed a novel interview aspect that has not been in existence in the PNE field. Nevertheless, we have included some modification in the method section for better clarity. Finally, part of the content analysis is provided for better understanding (see Table 3 and Table 4 for some of the contents analysed and the decisions taken by the authors) b. You had a focus group discussion in which you developed a preliminary PNG and HE education material in English language and later translated these materials to Hausa language. For me, your translation and cultural adaptation was very substandard and shallow. Translating research materials and cultural adaptation has a standard procedure there are basically six stages which must be compulsorily adapted to make such acceptable in standard research. STAGE 1:initial translation(Two forward translation by at least two bilingual translators they should have different profile background) STAGE 2:Synthesis of translation STAGE 3:Back translation STAGE 4:Expert committee STAGE 5:Test of the pre-final version. STAGE 6:Submission and appraisal of all written reports by developers/committee. All these important steps were not followed, these therefore makes your translation highly sub-standard and unacceptable for a research of these magnitude. The processes of translation and cultural adaptation are very central in this work and less attention was paid on it but rather you spent all your time discussing the audit trail which was the Delphi study. The Delphi study is important but the main crust of this work is the translation to Hausa language. I think you need to do a major revision of this work to make it standard and acceptable, its indeed a good and nice innovation but it must be done to international standard to make it acceptable for publication. Response: We thank the reviewer for raising this important issue. First, the aim of our study is to develop a culture-sensitive material. Therefore, the focus of our study is not on translation and cultural adaptation of an existing material. As such, a translation and cultural adaptation procedure is not reflected in our study. Second, the composition of the experts that participated in our study was not homogenous (English speaking and Hausa speaking). Hence, we had to first developed a preliminary material in English language through a focus group, since we lack PNE experts that are Hausa speaking. And it was these materials that were then translated through an acceptable procedure. Moreover, since the materials had to be subjected to Delphi rounds and it was expected that there will be changes based on the comments of experts after each round, translating the material via the method mentioned above may not be practical or feasible, and will not permit for the development of the tool through a Delphi procedure. Furthermore, a similar procedure has been used for the development of PNE materials in a previous study (Orhan et al -cited in our methods section). If the translation procedure suggested by the reviewer will be followed, then after each round of the Delphi we have to make similar translation which will be counterproductive and my encourage dropouts among our experts. Reviewer II: 1. Replace with Hausa Speaking Patients. I do not see the need for Africa given that the instrument can be used by a non-African who speaks and understands Hausa very well or better than other languages. Response: We thank the reviewer for the valuable suggestions. Hausa speaking patients is now reflected throughout the manuscript. We have also removed African in reference to the tool we developed throughout the manuscript including the title. 2. "significant" on page 13: Change language except you have a statistical evidence Response: The word significant has been replaced with substantial 3. "Table 5" on page 14: Referring to the wrong table, I guess Response: We have previously collapsed Table 5 and 6 together, which earlier interfered with or Table numbering, but we have now effected the corrections. 4. "Table 6" on page 14: No table 6??? Response: Noted and corrected (As responded on item 3 above) 5. Insert number (n = ?) for the number of experts that participated in rounds 1 and 2 as shown in Figure 1. Response: The ‘n’ has been reflected in the Figure. We lost the ‘n’ in the earlier submission due to inappropriate box-zooming. 6. The discussion needs to be rewritten to reflect both deductive and inductive reasoning based on other published studies. Response: There are limited number of studies published for PNE tool development using a qualitative approach, hence we had to discuss our findings based on the existing studies including the peculiarities and novelties of our study. However, we made sure that the discussion section is improved upon, as much as possible, after also taking into account the lack of published studies in the same field adopting similar methods. Attachments Attachment Submitted filename: Response to Reviewers_.docx https://doi.org/10.1371/journal.pone.0253757.r002
17 May 2021 Decision Letter - Ukachukwu Okoroafor Abaraogu, Editor PONE-D-20-32518R1 Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: a modified Delphi study PLOS ONE Dear Dr. Mukhtar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. In makind decision on this manuscript, I sort and recieved comments from the same reviewers who reviewed the manuscripts earlier on. Whilst reviewer 1 recomends minor correction, reviewer 2 recommend to accept. Reviewer 1 still argues that whilst having the knowledge of PNG education is an added advantage for the members of the preliminary focus group the composition of focus group for kind of study should comprise member with a broader skill including skill in the language of the instrument. Reviewer 1 will want authors to clarify the specialties of your panelist for the Delphi study. Reviewer will also want authors to acknoleged the composition of physiotherapists only panel, as well as not following the conventional delphi process as limitations to this study. Whilst I understand that certain factors might warrant adaptation of research method and procedures, I agree with the reviwer that these limitations need to be adequately acknowleged and highlighted so that readers interprete findings in the light of limitations. I will therefore invite authors to answer to reviewer 1 requeries and submit a revision. My decision is a minor revision. Please submit your revised manuscript by 16th June 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ukachukwu Okoroafor Abaraogu, BMR PT, MSc, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): Dear Authors, I have now recieved comments from the same reviewers who reviewed the manuscripts earlier on. Whilst reviewer 1 recomends minor correction, reviewer 2 recommend to accept. Reviewer 1 still argues that whilst having the knowledge of PNG education is an added advantage for the members of the preliminary focus group the composition of focus group for kind of study should comprise member with a broader skill including skill in the language of the instrument. Reviwer 1 will want authors to clarify the specialties of your panelist for the Delphi study. Reviewer will also want authors to acknoleged the composition of physiotherapists only panel, as well as not following the conventional delphi process as limitations to this study. Whilst I understand that certain factors might warrant adaptation of research method and procedures, I agree with the reviwer that these limitations need to be adequately acknowleged and highlighted so that readers interprete findings in the light of limitations. I will therefore invite authors to answer to reviewer 1 requeries and submit a revision. My decision is a minor revision. Dr Ukachukwu Abaraogu Department of Medical Rehabilitation University of Nigeria Nsukka/Glasgow Caledoinian University United Kigndom [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. Having the knowledge of PNG education for me is an added advantage for the members of the preliminary focus group. That does not replace the issues of professionalism and training. By training the anesthetist is the specialist in pain management and matters, I only mentioned a neurologist in my initial comment. Preparing the preliminary material for any research is crucial and should not be trivialized. Having a panel for Delphi study does not necessary mean that they are to do the initial work of developing, their role is to modify the document. Saying that getting the right people for the preliminary document will be a waste of time is very wrong. I would rather suggest you have it as a limitation, stating that the initial document was developed only by physiotherapist with PNG education knowledge, and that no other pain specialist and professionals was involved in the initial focus group discussion. You should also note that because Orhan et al used and cited it in their work does not make the pattern a golden standard. 2. Can I ask you to kindly provide the specialties of your panelist for the Delphi study for our perusal? Pushing all responsibilities to the panelist to me may not be fair, is any of our panelist an expert in Hausa language by training? Kindly note that the six stages of translation I mentioned to you are standard and internationally accepted. I would rather suggest that you acknowledge also as a limitation your not following the process due to lack of personnel than trying to explain it away. Citing Orhan et al is not sufficient, are they experts in translation and instrumentation? Saying that your work is not focused on translation is not correct, you set out to develop a culturally sensitive pain neuroscience education material for Hausa speaking patients. The translation aspect is equally important. Goodluck. Reviewer #2: Thanks for your corrections. My correction and comments have been addressed. The manuscript is much better now and fit for publication. Thanks. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: LETTER TO AUTHORS.doc https://doi.org/10.1371/journal.pone.0253757.r003
Revision 2
22 May 2021 Author Response May 20, 2021 Ukachukwu Okoroafor Abaraogu, BMR PT, MSc, PhD Academic Editor PLOSONE Dear Academic Editor, Submission of re-revised manuscript (PONE-D-20-32518) We wish to express our profound gratitude for considering our revised manuscript in the PLOS ONE Journal and recommending a minor revision. We also thank the reviewers who have gone through the revised manuscript and have provided their feedbacks that have improved the overall quality of our work. It is our hope that, after this additional revision, the current version of the manuscript presents a better and more focused information that will be helpful to readers. As requested, we have now provided a point by point response to the Reviewer I Reviewer I: 1. Having the knowledge of PNG education for me is an added advantage for the members of the preliminary focus group. That does not replace the issues of professionalism and training. By training the anesthetist is the specialist in pain management and matters, I only mentioned a neurologist in my initial comment. Preparing the preliminary material for any research is crucial and should not be trivialized. Having a panel for Delphi study does not necessary mean that they are to do the initial work of developing, their role is to modify the document. Saying that getting the right people for the preliminary document will be a waste of time is very wrong. I would rather suggest you have it as a limitation, stating that the initial document was developed only by physiotherapist with PNG education knowledge, and that no other pain specialist and professionals was involved in the initial focus group discussion. You should also note that because Orhan et al used and cited it in their work does not make the pattern a golden standard. Response: We thank the reviewer for raising these critical points and we totally agree with the reviewer. We have now updated our limitation section and included the lack of other professionals in pain management as a limitation for the focus group discussion. 2. Can I ask you to kindly provide the specialties of your panelist for the Delphi study for our perusal? Pushing all responsibilities to the panelist to me may not be fair, is any of our panelist an expert in Hausa language by training? Kindly note that the six stages of translation I mentioned to you are standard and internationally accepted. I would rather suggest that you acknowledge also as a limitation you’re not following the process due to lack of personnel than trying to explain it away. Citing Orhan et al is not sufficient, are they experts in translation and instrumentation? Saying that your work is not focused on translation is not correct, you set out to develop a culturally sensitive pain neuroscience education material for Hausa speaking patients. The translation aspect is equally important. Response: We thank the reviewer for raising these important issues as well. The expertise of the Delphi panel members has been presented under the ‘Delphi panel experts’ from pages 160 to 170. None of the panel experts was a Hausa language expert (by training). However, we have identified our inability to translate the developed materials using standard translation procedure as a limitation for the study (see limitations). Moreover, we have also presented the qualifications, and acknowledged the Hausa language experts involved in the translation of the materials (see limitations and acknowledgments). Attachments Attachment Submitted filename: Response to Reviewers .docx https://doi.org/10.1371/journal.pone.0253757.r004
14 Jun 2021 Decision Letter - Ukachukwu Okoroafor Abaraogu, Editor Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: a modified Delphi study PONE-D-20-32518R2 Dear Dr. Mukhtar, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ukachukwu Okoroafor Abaraogu, BMR PT, MSc, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No https://doi.org/10.1371/journal.pone.0253757.r005
Formally Accepted
18 Jun 2021 Acceptance Letter - Ukachukwu Okoroafor Abaraogu, Editor PONE-D-20-32518R2 Development of culturally sensitive pain neuroscience education materials for Hausa-speaking patients with chronic spinal pain: a modified Delphi study Dear Dr. Mukhtar: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ukachukwu Okoroafor Abaraogu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0253757.r006

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