Motivators and barriers to research participation for individuals with cerebral palsy and their families

Kristina M. Zvolanek; Vatsala Goyal; Alexandra Hruby; Carson Ingo; Theresa Sukal-Moulton

doi:10.1371/journal.pone.0262153

Peer Review History

Original SubmissionJuly 20, 2021
7 Sep 2021 Decision Letter - Ritesh G. Menezes, Editor PONE-D-21-23605Motivators and barriers to research participation for individuals with cerebral palsy and their familiesPLOS ONE Dear Dr. Sukal-Moulton, 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 Oct 22 2021 11:59PM. 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 'Response to Reviewers' letter that responds to each point raised by the academic editor and reviewer(s). 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We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide [Note: HTML markup is below. Please do not edit.] 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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: The manuscript is very good, the essence and concept are very clear and precise. A topic of this reserarch has importance in the motivations and increase number of respondents in the future research. It will be useful for future researchers in these fields. Reviewer #2: Thank you for the opportunity to review this interesting article. It is a worthwhile contribution to the literature, to understand the facilitators and barriers to people with CP and their families participating in research. Excellent introduction, sets up the study well. Methods: Considering the topic, even though opinions were sought, it seems a shame there were no people with CP or family members involved as partners in this research? I see now that three family members seem to be acknowledged. Why are they not authors if they were involved in design and recruitment? Did you discuss interpretation of responses with them? How were the categories and questions decided upon? Were families involved in this or did they just review for readability? How was a scale of 1-100 decided upon? The authors don't seem to have used a checklist such as CHERRIES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550605/ Results: A good number of responses (although response rate not reported). It would be helpful if % were written in Table 1, not just numbers. Motor type refers to spasticity/dyskinesis etc, but here it refers to topography. Table 2 is difficult to interpret, especially what the three right hand columns are referring to. This needs further explanation. Is the main finding that they differ or don't differ? We are unable to tell from the table what the difference is (i.e. with GMFCS which GMFCS levels are associated with the variable of interest). Discussion: There is limited literature supporting or critiquing the findings throughout the discussion. However, there are some very helpful findings from this survey, congratulations to the investigators. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
14 Oct 2021 Author Response Reviewer(s)' Comments to Authors and Responses (1) The manuscript is very good, the essence and concept are very clear and precise. A topic of this research has importance in the motivations and increases the number of respondents in the future research. It will be useful for future researchers in these fields. Thank you for your comments and for taking the time to review the manuscript. (2) Thank you for the opportunity to review this interesting article. It is a worthwhile contribution to the literature, to understand the facilitators and barriers to people with CP and their families participating in research. Thank you for this encouraging comment. (3) Excellent introduction, sets up the study well. Thank you. (4) Methods: Considering the topic, even though opinions were sought, it seems a shame there were no people with CP or family members involved as partners in this research? I see now that three family members seem to be acknowledged. Why are they not authors if they were involved in design and recruitment? Did you discuss interpretation of responses with them? We appreciate this thoughtful comment. As we’ve now clarified in the acknowledgements section, the three individuals listed are research colleagues of the authors, and we have rectified the accidental omission those affected by CP in this section. Paragraph 2 of the methods section explains that we sought feedback from six individuals affected by CP on the clarity of survey questions, the completeness of content, and the importance of the survey goals. While these individuals were incredibly generous with their time, there were timing constraints associated with the pandemic that made a more substantial commitment difficult. Furthermore, we did not have funding to appropriately compensate them for larger contributions to the work. In relation to those affected by CP that participated in the survey, we plan to disseminate the results to all individuals who consented and selected the optional element to be informed. (5) How were the categories and questions decided upon? Were families involved in this or did they just review for readability? The original concept for this study was borne from organic discussions among our research team, so the objectives of the study were mostly established before engaging with stakeholders. However, we did make it clear that we were open to feedback at all levels and the stakeholders who responded focused on the way that questions were asked and how the survey was functioning. We clarified this in paragraph 2 of the methods section. (6) How was a scale of 1-100 decided upon? We used the REDCap digital version of the visual analog scale (VAS) for three personal interests variables (research importance, value research participation, compensation importance) to easily quantify subjective opinions, similar to the VAS used in pain literature. We’ve updated this in paragraph 4 of the methods section. (7) The authors don't seem to have used a checklist such as CHERRIES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550605/ Thank you for bringing this to our attention. We completed the CHERRIES checklist and uploaded it as a separate document. (8) Results: A good number of responses (although response rate not reported). It would be helpful if % were written in Table 1, not just numbers. Motor type refers to spasticity/dyskinesis etc., but here it refers to topography. Overall response rate (91.4%) has been clarified in the first paragraph of the Results section. Table 1 has been modified to include the percentage of respondents in addition to the numbers for each demographic. Per the reviewer’s suggestion, “motor type” was changed to “motor topography” to reflect the information more appropriately in this category of Table 1. (9) Table 2 is difficult to interpret, especially what the three right hand columns are referring to. This needs further explanation. Is the main finding that they differ or don't differ? We are unable to tell from the table what the difference is (i.e. with GMFCS which GMFCS levels are associated with the variable of interest). Thank you for your remarks regarding the clarity of Table 2. We have removed the test statistics and degrees of freedom from each column to make the table more digestible, and we added a column to specify the statistical test used for each variable. Significant results in the three right-hand columns indicate differences between the particular respondent grouping (e.g. GMFCS levels, CP types) and the variable of interest. Please note that supplemental Table S1, which is referenced in the text (second paragraph of the ‘Travel Needs’ Results section), lists the significant pairwise comparisons. This table can be referenced for specific differences in GMFCS levels, etc. for each variable. (10) Discussion: There is limited literature supporting or critiquing the findings throughout the discussion. However, there are some very helpful findings from this survey, congratulations to the investigators. The reviewer raises a valid point; we are limited by the sparsity of existing literature on this topic. We have done our best to identify and discuss relevant previous work. This is all the more reason to do similar studies to gain a broader understanding of the needs and priorities of the cerebral palsy community. Attachments Attachment Submitted filename: PLOS ONE Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0262153.r002
22 Nov 2021 Decision Letter - Ritesh G. Menezes, Editor PONE-D-21-23605R1Motivators and barriers to research participation for individuals with cerebral palsy and their familiesPLOS ONE Dear Dr. Sukal-Moulton, 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 30-November-2021. 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 'Response to Reviewers' 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: https://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, Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B. 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. [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 #2: All comments have been addressed Reviewer #3: (No Response) Reviewer #4: (No Response) ******** 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 #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: I Don't Know Reviewer #4: I Don't Know ****** 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 #2: Yes Reviewer #3: Yes Reviewer #4: 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 #2: Yes Reviewer #3: Yes Reviewer #4: 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 #2: Thank you for your responses to the reviewers. I have nothing further to add, and look forward to seeing the paper in the literature. We all have a lot to improve on in this space. Reviewer #3: page 8, line 332-333 can you please add more clarity to this sentence: "In addition to direct payment, compensation for other costs associated with travel should be considered." There is an ethical difference between giving someone an incentive to sign up for a research study (e.g., $50 gift card), and reimbursing their expenses (e.g., travel, parking). What exactly do you mean by "direct payment"? In your paper, please be clear on use of words that are meant to describe a recruitment incentive and expense compensation. Reviewer #4: First, I would like to thank the authors for their patience during my review of this manuscript. I personally thank the authors for conducting this thoughtful survey - despite the pandemic setbacks. I recommend this encouraging paper for acceptance to PLoS ONE. Recognition of the obstacles that caregivers and individuals with CP face when being included in research is a necessary addition to the literature and empowerment of the disability community. A few comments and suggestions below: 1. In general, there is a narrative of "indirect benefit" vs "direct benefit" in the Travel Needs and Preferences category under Part III of Methods section. From my understanding, research does not directly benefit those who participate (that would be more of a QI initiative) but rather in some instances there may be the prospect of benefit. Authors can read more here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945615/ Friedman et al argue about “direct” and “indirect” benefits in the context of research on vulnerable populations and children and try to outline what counts as a potential direct benefit, if any. 2. “Research” is referred to broadly. Maybe in the future it would be useful to understand if the barriers to research are associated with the type of research involvement (e.g., research comparing routine standard of care interventions vs research on pre-approval CP therapeutics). 3. Page 14, line 255: Mean response time is reported for “travel time for indirect benefit study” vs “travel time for direct benefit study”. Again, it’s still not clear if this is the participant's perception of the benefit that they may derive from their participation in the study? Research aims to benefit future patients and often participation is altruistic, where research outcomes can benefit the scientific understanding of CP for future treatment and intervention. There is uncertainty around the interventions/therapies being studied. Your findings regarding the barrier “travel time” in light of “direct” vs “indirect” benefits could possibly help ethics review committees make prospective decisions on whether the research in question offers an appropriate risk-benefit profile, as certain prospects of benefit can be seen as decreasing impact of barriers and maybe even the risk involved to those participating. More studies like this survey are recommended. I think a brief explanation on what the authors mean by "indirect benefit study" and "direct benefit study" would be meaningful. Maybe an inherent barrier is education regarding the purpose of research, since "indirect benefit" and "direct benefit" is seen impacting barriers like travel time. Mention of therapeutic misconception (inflating likelihood of benefit from research participation by seeing research as routine care) would be useful. Read here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690536/ 5. Page 18, line 335: Again, is this their perception of benefit? 6. Page 18, line 352: This is an excellent point among many. Valuable and well-designed research should be informed by stakeholder and patient perspectives. 7. Limitations are well addressed. Great solutions proposed on CP stakeholder engagement. 8. Page 19, line 363: “…true partners in research that aims to benefit people like them." Congratulations to the authors on this important work! ******** 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 #2: Yes:** Sarah McIntyre Reviewer #3: No Reviewer #4: 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. https://doi.org/10.1371/journal.pone.0262153.r003
Revision 2
14 Dec 2021 Author Response Reviewer(s)' Comments to Authors and Responses (1) Thank you for your responses to the reviewers. I have nothing further to add and look forward to seeing the paper in the literature. We all have a lot to improve on in this space. We appreciate your comments and for taking the time to review the manuscript. (2) Page 8, line 332-333 can you please add more clarity to this sentence: "In addition to direct payment, compensation for other costs associated with travel should be considered." There is an ethical difference between giving someone an incentive to sign up for a research study (e.g., $50 gift card), and reimbursing their expenses (e.g., travel, parking). What exactly do you mean by "direct payment"? In your paper, please be clear on the use of words that are meant to describe a recruitment incentive and expense compensation. Thank you for your comments. We intended “direct payment” to be defined as the gift card or check that participants receive as incentive for study participation, but understand the concern that you’re sharing. Therefore, we have edited the sentence per your suggestion to: “In addition to financial incentives for participation, compensation for other expenses associated with travel should be considered” (pg. 18, lines 340-341 in the manuscript with tracked changes). (3) First, I would like to thank the authors for their patience during my review of this manuscript. I personally thank the authors for conducting this thoughtful survey - despite the pandemic setbacks. I recommend this encouraging paper for acceptance to PLOS ONE. Recognition of the obstacles that caregivers and individuals with CP face when being included in research is a necessary addition to the literature and empowerment of the disability community. Thank you for your kind comments and for taking the time to review the manuscript. (4.1) In general, there is a narrative of "indirect benefit" vs "direct benefit" in the Travel Needs and Preferences category under Part III of Methods section. From my understanding, research does not directly benefit those who participate (that would be more of a QI initiative) but rather in some instances there may be the prospect of benefit. Authors can read more here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945615/. Friedman et al argue about “direct” and “indirect” benefits in the context of research on vulnerable populations and children and try to outline what counts as a potential direct benefit, if any. Thank you for this insightful comment. While we agree with the definitions outlined by Friedman et al., our approach differed in the survey design. We have added definitions of the “potential for a direct benefit study” vs. an “indirect benefit study” using the language that was in our survey (pg. 6, lines 148-152 and Table 2 in the manuscript with tracked changes). Our intention when asking these questions was to differentiate between studies such as clinical trials (potential for direct benefit) and basic science investigations (indirect benefit). We agree that we did not control for participants’ understanding and interpretation of the likelihood for direct benefit, which is the rationale for using the same definition for readers. This limitation has been addressed in the discussion section (pg. 18, lines 357-360). (4.2) Page 14, line 255: Mean response time is reported for “travel time for indirect benefit study” vs “travel time for direct benefit study”. Again, it’s still not clear if this is the participant's perception of the benefit that they may derive from their participation in the study? Research aims to benefit future patients and often participation is altruistic, where research outcomes can benefit the scientific understanding of CP for future treatment and intervention. There is uncertainty around the interventions/therapies being studied. Your findings regarding the barrier “travel time” in light of “direct” vs “indirect” benefits could possibly help ethics review committees make prospective decisions on whether the research in question offers an appropriate risk-benefit profile, as certain prospects of benefit can be seen as decreasing impact of barriers and maybe even the risk involved to those participating. More studies like this survey are recommended. We have provided the definitions of “potential for direct benefit” vs. “indirect benefit” according to the language in the survey (pg. 6, lines 148-152 and Table 2). Our question about travel time was related to convenience rather than risk and is therefore likely less relevant to an ethics committee determination. We agree that how benefits are perceived by potential participants is important and should be studied in the future. (4.3) I think a brief explanation on what the authors mean by "indirect benefit study" and "direct benefit study" would be meaningful. Maybe an inherent barrier is education regarding the purpose of research, since "indirect benefit" and "direct benefit" is seen impacting barriers like travel time. Mention of therapeutic misconception (inflating likelihood of benefit from research participation by seeing research as routine care) would be useful. Read here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690536/ As mentioned above, we defined these terms very broadly for participants. We have edited the limitations section of the discussion to acknowledge that we did not address considerations such as therapeutic misconception (pg. 18, lines 357-360). We agree that this is an important topic for investigation in future studies. (4.4) Page 18, line 335: Again, is this their perception of benefit? Yes, this is the participants’ perception of benefit. We have addressed this by clarifying the phrase in the relevant sentence: “...studies with and without potential for direct benefit” (pg. 18, line 343). (5) “Research” is referred to broadly. Maybe in the future it would be useful to understand if the barriers to research are associated with the type of research involvement (e.g., research comparing routine standard of care interventions vs research on pre-approval CP therapeutics). Thank you for this comment. We agree that this would be an interesting direction for future exploration. (6) Page 18, line 352: This is an excellent point among many. Valuable and well-designed research should be informed by stakeholder and patient perspectives. Thank you for this kind comment. (7) Limitations are well addressed. Great solutions proposed on CP stakeholder engagement. Thank you, we’re glad to see a shift towards this engaged approach occurring in research and hope to accelerate it. (8) Page 19, line 363: “…true partners in research that aims to benefit people like them." This sentence has been edited as proposed (pg. 19, lines 378- Attachments Attachment Submitted filename: PLOS One Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0262153.r004
17 Dec 2021 Decision Letter - Ritesh G. Menezes, Editor Motivators and barriers to research participation for individuals with cerebral palsy and their families PONE-D-21-23605R2 Dear Dr. Sukal-Moulton, 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, Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B. Academic Editor PLOS ONE 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 #3: 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 #3: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: (No Response) ****** 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 #3: (No Response) ****** 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 #3: (No Response) ****** 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 #3: (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 #3: No https://doi.org/10.1371/journal.pone.0262153.r005
Formally Accepted
13 Jan 2022 Acceptance Letter - Ritesh G. Menezes, Editor PONE-D-21-23605R2 Motivators and barriers to research participation for individuals with cerebral palsy and their families Dear Dr. Sukal-Moulton: 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 Prof. Dr. Ritesh G. Menezes Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262153.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .