Impact of age, sex and surgery type on engagement with an online patient education and support platform developed for total hip and knee replacement patients

Rebecca Martin; Natalie Clark; Paul Baker

doi:10.1371/journal.pone.0269771

Peer Review History

Original SubmissionJanuary 29, 2021
6 Dec 2021 Decision Letter - Marie-Pascale Pomey, Editor PONE-D-21-03212Impact of age, gender and surgery type on engagement with an online patient education and support program developed for hip and knee replacement patientsPLOS ONE Dear Dr. Martin, 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 Jan 20 2022 11:59PM. 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. 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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. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files" 3. For more information on PLOS ONE's expectations for statistical reporting, please see https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting. Please update your Methods and Results sections accordingly. 4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. [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: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No ****** 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 ****** 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 ****** 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: Intervention: This is a study investigating the use of an Internet-based patient education and support program for patients having hip and knee joint replacement. The patient education and support program is briefly described in the introduction and in the methodology section, but no details are given to what specific educational information is given to patients. This information should be provided using something such as the TIDIER Framework, description of evidence informing the educational materials, and readability level. This is particularly important given the readers do not have access to the program. OR is it publicly available? Having more details on the program is important for readers to appraise the study results. Background: The introduction does not provide the background and current state of the literature on patient education and support program. As well, it does not highlight the importance of conducting this study. The introduction is focused on the authors’ specific situation and does not acknowledge previous research done. The introduction should be revised to focus on previous research in this area to highlight knowledge gap. This would provide the justification needed to understand the importance of conducting this study. Methods: The authors should revise the objectives to make them clearer and more specific (e.g., to specify population of interest). There are minimal methods included – what is the study design and research methods used? It appears to be more of a quality improvement type initiative rather than a study. Results in the abstract related to age appears to be contradictory in the 2 sentences. In the conclusion, the intervention is described as being effective. How as effectiveness measured? From my understanding of the results, it was only access that was measured. Results: The result section is difficult to understand and follow. The authors should revised to make it clearer. Furthermore, authors should provide a table of the statistical test conducted with the results (e.g., T-Tests and results). For example, both mean and median is presented with a p value but it is unclear what statistical analysis was done to achieve the p value. For access to the education program, results indicate that patients accessed it 29.1 times. Are you able to also add the time periods for when it was accessed? Was it over 1 month or over 6 months? Of concern is that a significant number of patients never accessed the program. Was anything done to understand why or to help them gain the knowledge elsewhere? The authors aim to 1) analyze demographic characteristics of patients using the PES, 2) determine how and when patients access the PES, and 3) investigate if there are differences in 1 and 2 based on age and gender. The discussion and conclusion states that the PES support high level of patient engagement and activity independent of age and gender. However, the reader does not see how the data collected is related to patient engagement and activity as the relationship is not clear. Patient engagement and activity were not specifically measured by the study. The abstract conclusion states it was effective but how was effectiveness measured? The background indicates that patients should be actively involved in decisions about their care – how was this measured? Also it describes patients inclusion in decision making is important but this intervention was only provided after they were placed on the list for surgery. How did the intervention support decision making? The narrative uses gender but the results only report on sex (male, female) – how was gender measured? If it was based on male/female, then please change to sex. The discussion is hard to follow as it includes a broad discussion of different topics related to PES that do not all appear to be of importance for this study. The authors should revised to make clear discussion points related to their specific findings. For example, start with a statement that links findings from this study with the broader literature discussed. Currently it discusses broader literature and the final sentence makes a link. I suggest the broader literature should be moved to the background and focus the discussion on discussing the results of this study as it relates to the literature. The last paragraph discusses the data but does not link to broader literature – what do people like to use from the broader literature – phones, tablets, or computers. Conclusions – please remove ‘effectively engages’ or add evidence in the results that indicates how they were engaged and how effectiveness was measured. No study limitations are provided – this is important to add. Specific comments: Line 9: Gender should not be written with an “s”. Line 13. The authors should spell out the dates. Line 23. Please give the number found instead of writing “p=NS”. Lines 42-43. The authors should review the sentence as it is difficult to understand. Line 52. Please specify overall satisfaction. Satisfaction with what? Line 78. Patients are made aware of the program by which individual and how? Line 102. The authors should spell out the dates. Line 108. Why did a 30-minute cap was used? How long is interacting with the PES supposed to be? The readers need more information on that decision. Line 114-119. This section is unclear making it difficult to clearly understand how the data will be statistically analyzed. The authors should revise the section. Line 121. Informed consent should be discussed at the beginning of the methodology section. Lines 133-135. Were patients characteristics similar between hip and knee replacement sample? Line 135. Please modify “Range” to “range”. Line 136. The total time access should be discussed with the average of time the program was access (lines 140-145). Line 140. The authors should not describe patients are “hip patients” or “knee patients”. The authors should refer to the participants as “patient who underwent hip replacement” or something similar to this. Line 142. Please be consistent across the manuscript when referring to PES (is “platform” referring to PES?). Line 144. What is the difference between number of time access and interaction with the PES? Lines 142-145. The reader does not understand why access to the program is described with mean (SD) and also with median (IQR). Lines 138-149. This section is confusing for the reader making it difficult to follow. The authors should revised to make it clearer. Line 159. “…the program per access when compared with patients aged <50 years. Patients aged ≤50 years…” Please be consistent with aged. Is it <50 years or ≤50 years? Line 173. Please insert “statistically” before “significant”. Lines 174-175. The authors should review the sentence as it is difficult to understand. Lines 190-203. This should be in the introduction. Lines 210-212. “The finding that there was no difference in the rate of engagement for the older population compared to the younger groups is a new and reassuring finding, particularly given the growth in these types of information platforms within orthopaedics.” Can the authors provide more information of why it is a “reassuring finding”. Lines 225-231. This study did not measure health literacy of participants. As a result, “Having an online PES has helped us to combat this possible disadvantage.” should be revised as this is a strong conclusion not supported by study aims and results. Figure 4 – YAY is in the title and it should be BY. Also the headings do not line up correctly in the PDF. ****** 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 [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. 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Revision 1
20 Feb 2022 Author Response Marie-Pascale Pomey Academic Editor PLOS ONE Date: 31st January 2022 Dear Academic Editor, Manuscript number: PONE-D-21-03212 Manuscript Title: Impact of age, gender and surgery type on engagement with an online patient education and support program developed for hip and knee replacement patients Thank you for your time in reviewing our manuscript and providing us the opportunity to revise our work for reconsideration for your journal. The authors have considered each of the reviewers comments, please see the below responses in italics to each of the comments. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. 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 Authors response: Manuscript formatted as per PLOS one guidelines 2. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/be uploaded) as separate "supporting information" files" Authors response: Tables have been included following the paragraph they are mentioned in. 3. For more information on PLOS ONE's expectations for statistical reporting, please see https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting. Please update your Methods and Results sections accordingly. Authors response: Statistical reporting updated as per the guidelines. 4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Authors response: Paul -Where can the minimal data set underlying the results be found? Review comments to the Author Intervention: This is a study investigating the use of an Internet-based patient education and support program for patients having hip and knee joint replacement. The patient education and support program is briefly described in the introduction and in the methodology section, but no details are given to what specific educational information is given to patients. This information should be provided using something such as the TIDIER Framework, description of evidence informing the educational materials, and readability level. This is particularly important given the readers do not have access to the program. OR is it publicly available? Having more details on the program is important for readers to appraise the study results. Authors response: We have revised the “Materials and Methods” section to include more detail. Please see “Intervention: Description of the Online Digital Platform (ODP) Intervention”. Background: The introduction does not provide the background and current state of the literature on patient education and support program. As well, it does not highlight the importance of conducting this study. The introduction is focused on the authors’ specific situation and does not acknowledge previous research done. The introduction should be revised to focus on previous research in this area to highlight knowledge gap. This would provide the justification needed to understand the importance of conducting this study. Authors response: We have revised the first paragraph and added an additional reference relating to the NICE clinical guidelines. We have adjusted the introductory paragraph regarding health literacy which highlights why patient education and support was provided and why it is useful. The systematic review in the discussion has been moved to the introduction section to provide more literature. Methods: The authors should revise the objectives to make them clearer and more specific (e.g., to specify population of interest). There are minimal methods included – what is the study design and research methods used? It appears to be more of a quality improvement type initiative rather than a study. Results in the abstract related to age appears to be contradictory in the 2 sentences. In the conclusion, the intervention is described as being effective. How as effectiveness measured? From my understanding of the results, it was only access that was measured. Authors response: We have revised the three objectives at the end of the introduction section so they are more clear and specific and are in line with what have analysed in the results section. We have revised the conclusion and removed reference to “effectiveness”. Results: The result section is difficult to understand and follow. The authors should revised to make it clearer. Furthermore, authors should provide a table of the statistical test conducted with the results (e.g., T-Tests and results). For example, both mean and median is presented with a p value but it is unclear what statistical analysis was done to achieve the p value. Authors response: Table 1 has been amended to include the p values. The Results section has also been revised and should be clearer to follow. Mean value has been removed and has instead been discussed in terms of median and IQR as the data is skewed. For access to the education program, results indicate that patients accessed it 29.1 times. Are you able to also add the time periods for when it was accessed? Was it over 1 month or over 6 months? Authors response: The time period that was analysed is as discussed in the methods section (21st September 2017 to 28th May 2020). We have reiterated this. Of concern is that a significant number of patients never accessed the program. Was anything done to understand why or to help them gain the knowledge elsewhere? Authors response: This has been added in as a limitation within the discussion section. The authors aim to 1) analyze demographic characteristics of patients using the PES, 2) determine how and when patients access the PES, and 3) investigate if there are differences in 1 and 2 based on age and gender. The discussion and conclusion states that the PES support high level of patient engagement and activity independent of age and gender. However, the reader does not see how the data collected is related to patient engagement and activity as the relationship is not clear. Patient engagement and activity were not specifically measured by the study. The abstract conclusion states it was effective but how was effectiveness measured? Authors response: Revised the aims/objectives of the manuscript. The background indicates that patients should be actively involved in decisions about their care – how was this measured? Also it describes patients inclusion in decision making is important but this intervention was only provided after they were placed on the list for surgery. How did the intervention support decision making? Authors response: The background has been reworded to describe how patients should be actively involved in their care, this includes decision-making, active participation and self-management. Within this manuscript, we look at patient engagement (number of times accessed, how long they spent on the platform) with the platform which is how we have measured how actively involved patients have been with their own care. Please see “Intervention: Description of the Online Digital Platform (ODP) Intervention” within the Materials and Methods section for a more in depth description of the intervention and how this supports decision making and when they are provided the content. The narrative uses gender but the results only report on sex (male, female) – how was gender measured? If it was based on male/female, then please change to sex. Authors response: All references to “gender” have been changed to “sex”. The discussion is hard to follow as it includes a broad discussion of different topics related to PES that do not all appear to be of importance for this study. The authors should revised to make clear discussion points related to their specific findings. For example, start with a statement that links findings from this study with the broader literature discussed. Currently it discusses broader literature and the final sentence makes a link. I suggest the broader literature should be moved to the background and focus the discussion on discussing the results of this study as it relates to the literature. The last paragraph discusses the data but does not link to broader literature – what do people like to use from the broader literature – phones, tablets, or computers. Authors response: We have reworked the discussion and have also added in some additional references (e.g. supportive literature for the use of phones, tablets and computers). Conclusions – please remove ‘effectively engages’ or add evidence in the results that indicates how they were engaged and how effectiveness was measured. Authors response: Have removed “effectively engages” and reworded this to “demonstrates high levels of patient engagement”. Engagement was measured via how patients used the platform (e.g. time spent, number of times accessed) all of which have been analysed and reported within the manuscript. No study limitations are provided – this is important to add. Authors response: We have added a section for limitations and discussed those that did not activate their accounts or access the content. Specific comments: Line 9: Gender should not be written with an “s”. Have changed all references to ‘gender’ to ‘sex’, the ‘s’ has automatically been removed as result. Line 13. The authors should spell out the dates. Have spelled out the dates. Line 23. Please give the number found instead of writing “p=NS”. Number found has been given. Lines 42-43. The authors should review the sentence as it is difficult to understand. Sentence has been reviewed. Line 52. Please specify overall satisfaction. Satisfaction with what? Sentence has been reviewed. Line 78. Patients are made aware of the program by which individual and how? Clarified this is done at the patient’s initial consultation and by their treating surgeon. Line 102. The authors should spell out the dates. Have spelled out the dates. Line 108. Why did a 30-minute cap was used? How long is interacting with the PES supposed to be? The readers need more information on that decision. This sentence has been elaborated. Line 114-119. This section is unclear making it difficult to clearly understand how the data will be statistically analyzed. The authors should revise the section. Revised, this should read clearer now. Line 121. Informed consent should be discussed at the beginning of the methodology section. Updated within the study methods section. Lines 133-135. Were patients characteristics similar between hip and knee replacement sample? Table one has been updated and now has total, THR and TKR each categorised into sex and age categories and also includes registered, activated and accessed. Line 135. Please modify “Range” to “range”. Corrected. Line 136. The total time access should be discussed with the average of time the program was access (lines 140-145). Moved this sentence. Line 140. The authors should not describe patients are “hip patients” or “knee patients”. The authors should refer to the participants as “patient who underwent hip replacement” or something similar to this. Have re-referred to these patients consistently as assigned to “total hip replacement (THR) carepacs” or “total knee replacement (TKR) carepacs”. It is not possible to say underwent THR/TKR as some of these patients would not have had their operation yet and are viewing pre-operative information. Line 142. Please be consistent across the manuscript when referring to PES (is “platform” referring to PES?). Have referred to the platform as ‘online digital platform (ODP)’. Line 144. What is the difference between number of time access and interaction with the PES? The wording has been changed as we note access and interaction has been used interchangeably to mean the same thing. Interaction has been changed to accessed. Lines 142-145. The reader does not understand why access to the program is described with mean (SD) and also with median (IQR). Revised – discussed using median and IQR, removed mean. Lines 138-149. This section is confusing for the reader making it difficult to follow. The authors should revised to make it clearer. Revised this section. Line 159. “…the program per access when compared with patients aged <50 years. Patients aged ≤50 years…” Please be consistent with aged. Is it <50 years or ≤50 years? Corrected. Line 173. Please insert “statistically” before “significant”. Inserted. Lines 174-175. The authors should review the sentence as it is difficult to understand. Reworded. Lines 190-203. This should be in the introduction. Moved to the second paragraph in the introduction. Lines 210-212. “The finding that there was no difference in the rate of engagement for the older population compared to the younger groups is a new and reassuring finding, particularly given the growth in these types of information platforms within orthopaedics.” Can the authors provide more information of why it is a “reassuring finding”. Reinforced with previous qualitative research on our online digital platform. Lines 225-231. This study did not measure health literacy of participants. As a result, “Having an online PES has helped us to combat this possible disadvantage.” should be revised as this is a strong conclusion not supported by study aims and results. Health literacy paragraph revised. Figure 4 – YAY is in the title and it should be BY. Also the headings do not line up correctly in the PDF. Corrected. All of the above amendments have been reflected in the manuscript. We welcome additional comments if any. Thank you for your time in reconsidering our manuscript and we look forward to your response. Sincerely, Rebecca Martin, Natalie Clark and Paul Baker Secretary to Prof Baker Department of Trauma and Orthopaedics, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW Email: rmartin37@qub.ac.uk Telephone: 07889005185 Attachments Attachment Submitted filename: Cover Letter in Response to Reviewers Comments NC RM 2.docx https://doi.org/10.1371/journal.pone.0269771.r002
1 May 2022 Decision Letter - Marie-Pascale Pomey, Editor PONE-D-21-03212R1Impact of age, sex and surgery type on engagement with an online patient education and support platform developed for total hip and knee replacement patientsPLOS ONE Dear Dr. Martin, 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 June 15, 2022. 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: 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, Marie-Pascale Pomey 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): First reviewer: Point 4. defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Authors response: Paul -Where can the minimal data set underlying the results be found? Can you answer to the question ? https://doi.org/10.1371/journal.pone.0269771.r003
Revision 2
10 May 2022 Author Response A minimal data set for hip related data and knee related data can be found under supporting information. Attachments Attachment Submitted filename: Cover Letter in Response to Reviewers Comments NC RM 2.docx https://doi.org/10.1371/journal.pone.0269771.r004
30 May 2022 Decision Letter - Marie-Pascale Pomey, Editor Impact of age, sex and surgery type on engagement with an online patient education and support platform developed for total hip and knee replacement patients PONE-D-21-03212R2 Dear Dr. Martin, 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, Marie-Pascale Pomey Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0269771.r005
Formally Accepted
13 Jul 2022 Acceptance Letter - Marie-Pascale Pomey, Editor PONE-D-21-03212R2 Impact of age, sex and surgery type on engagement with an online patient education and support platform developed for total hip and knee replacement patients Dear Dr. Martin: 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. Marie-Pascale Pomey Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0269771.r006

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