PONE-D-20-35630

The pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in chronic back pain patients: a cohort study

PLOS ONE

Dear Dr. Kowark,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Stephan Doering, M.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. 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: No

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

Reviewer #2: Yes

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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: No

Reviewer #2: Yes

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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: In general, the paper needs extensive revision of English. Just in the first sentence of the abstract several typos can be observed. In fact, the paper needs to be completely rewritten focusing on low back pain, and not chronic pain.

The abstract needs to be completely rewritten, it is impossible to understand

Introduction: this section needs to be completely rewritten focusing on low back pain, and not chronic pain in general. Specific data on LBP should be included, not about chronic pain in general. In addition, it should be better reorganized.

Methods: No data on inclusion and exclusion criteria are provided. Psychometric data of the outcomes is needed. Definition of cut-off values of HADS scores is needed. Better explanation of how pain drawings were assesses should be also clarified.

Results: It is poorly written. This section should be more scientifically written.

Reviewer #2: The present manuscript reports on the validation of pain drawing, as a screening tool for additional factors like anxiety, depression and quality of life, which are often impaired in pain patients and comorbidity with depression and anxiety is also often high in those patient samples.

The paper is quite well written, the methods are sound, but the authors need to be more specific throughout the manuscript and also need to consider specific variables like age, sex and pain duration in their analyses and interpretation. Otherwise, in my opinion, it is not really a validation study and does then also not really inform the clinical field.

Abstract:

- Subheadings "Results:" and "Conclusions" are missing.

- Would also add information of the pain drawing in the Methods section and also information on the performed analyses.

- Would suggest to specify the direction of the correlations.

- The statement of the authors is not clear for the sentence "Further, we detected.....".

- The authors speak about “calculated values”, but exactly which calculated values / how calculated, and based on which criteria have the authors decided that these "calculated" values are not high enough

- The language in the Abstract, specifically the Results and Conclusions part is a bit vague - since the aim of the study is to determine validity of an instrument for specific factors, the authors need to be clear and specific.

Introduction:

- The authors speak a lot about treatment / the treatment situation in the beginning of the Intro. The patient drawing is tool for diagnostics - this can of course also improve treatment if used for example for treatment success in specific areas or for the evaluation of sub-groups that might need specific treatment, but the background needs to be more related to the characteristics of the pain drawing first and the describe exactly why, i.e. in which way, it is important also for treatment and then why it is needed to know whether it is also associated with pain-related factors like anxiety, depression and quality of life. Here, I would think the authors could speak for example specifically about individual sub-groups for treatment etc.

- The structure and content of the Intro is thus not totally convincing as to why the present study is of such important and has major add on knowledge, particularly also for the treatment of pain patients. Would suggest to re-structure/re-fine the Intro accordingly.

Materials and Methods:

- What about covariates like age, sex and pain duration? These are important aspects that needs to be considered in such a validation study. Also, when thinking about sub-groups for treatment, those variables are also important as variables of interest, and not only as control variables.

Results:

- Patient characteristics would specifically be mean scores with sex and age information – would therefore suggest to add sex and age to the Table and also add respective Figures (separately for male and female and plotted against age for example) for the Supplement

- Would also suggest to include some Results Figures in the main text instead of only Tables to make the results directly visible, including the range of the scores etc.

Discussion and Conclusions:

- As mentioned for the Abstract and Introduction, the authors need to be more specific here in terms of the meaning of such a validation study. Age, sex and pain duration also needs to be discussed here.

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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.

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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.

PONE-D-20-35630R1

Pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in back pain patients: a cohort study

PLOS ONE

Dear Dr. Kowark,

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.

Please submit your revised manuscript by July 28, 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,

Stephan Doering, M.D.

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.

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

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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: No

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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

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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: No

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: The paper ios much improved but still extensive work. The introduction does not jusfity the current study. Muc more data on pain draws and psychological variables in LBP is clerarly needed. An hypothesis is also needed.

The use of restrospective data should be mentioned as a huge limitation. Recognition bias should be discussed.

The results section should be completely rewritten it is highly difficult to read. Authors repeat once and twice the same sentences with different outcomes

The discussion needs extensive revision, subheadings are not clinically.

Reviewer #2: The authors have done a good job in revising the mansucripts - all my comments have been addressed, no further issues left.

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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.

Pain drawing as a screening tool for anxiety, depression and reduced health-related quality of life in back pain patients: a cohort study

PONE-D-20-35630R2

Dear Dr. Kowark,

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.

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Kind regards,

Stephan Doering, M.D.

Academic Editor

PLOS ONE