Factors affecting chronic low back pain among high school baseball players in Japan: A pilot study

Hidetoshi Nakao; Ryota Imai; Taro Hamada; Masakazu Imaoka; Mitsumasa Hida; Takeshi Morifuji; Masashi Hashimoto

doi:10.1371/journal.pone.0280453

Peer Review History

Original SubmissionAugust 5, 2021
2 May 2022 Decision Letter - Matias Noll, Editor PONE-D-21-25318 Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study PLOS ONE Dear Dr. Nakao, 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, follow the reviewer suggestions to improve your manuscript. Please submit your revised manuscript by Jun 16 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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Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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: Authors did a study on Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study. However, I think the study contains many factual errors and needs to be substantially revised to be considered for publication. The first concern I have, regards the language use. I think the study needs substantial English language editing to make it more clear for the readers. Secondly, the authors need to tell us about the importance of their study and findings they reached. Introduction The authors start introduction with the sentence IN LINE 45 : „ whereas chronic LBP (CLBP), defined as LBP lasting at least three months, is observed in 1–40% of all baseball players.“ it is needed to be rechecked. Some sentences need to be more clear for the reader such as in line 51: In addition, reports have identified psychosocial factors and central sensitization as risk factors for CLBP [3, 4]; what does mean… Sometimes authors present us with statements that need to be followed with references, but the references are omitted. For example, on page …: The mental aspects of chronic pain 50 include depression, anxiety, catastrophizing, kinesiophobia, and a decline in self efficacy. What literature are the authors referring to? The introduction section more or less provides hints to the relevant background but I cannot see how the experimental questions can be drawn from the given information. For instance, in line 59 the statement of the problem has finished with this sentence, Preventing or rehabilitating LBP in high school players may reduce LBP prevalence among college and professional athletes” The hypotheses cannot be drawn from the information provided? I think it is needed to be revised in a standard manner, because it is not the aim of the study. METHODS We see very important inconsistency: in the Abstract the authors mentioned In the results section, authors reported many p values! That is far too many for the scope of this study and the authors almost certainly committed type 1 error, as the number of p values is as big as the sample. What grip strength was measured? Is it relevant to the aim of the study? What scale did select to measure functional tests in this study? Does “performed or not performed” is a suitable scale to measure this variable? Is the level and history of athletes considered in sample selection? How authors control this variable? Althoutgh, this investigation is a poilot, but the sample size is needed to to be sufficient for this research based on power, alpha level and ….? Is the sample size sufficient for this research? In the manuscript, which results support the discussion on “Our study suggested that kinesiophobia is a significant cause of CLBP among…” Was this study a cause-effect study or not? With regards to results, kinesiophobia is the most important factor in CLBP? What about other measured variables? I also recommend a language check by a native speaker since there are errors all over the text ****** 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: Yes:** Fatemeh Alirezaei Noghondar [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: plose.docx https://doi.org/10.1371/journal.pone.0280453.r001
Revision 1
28 Jun 2022 Author Response June 14 2022 Professor Dr Matias Noll Academic Editor PLOS ONE Dear Professor: Revised manuscript ID PONE-D-21-25318: Factors affecting chronic low back pain among high school baseball players in Japan: a pilot study We are grateful for the opportunity to revise our manuscript and for the helpful comments from the reviewers. The comments were highly insightful and enabled us to improve the quality of our paper. Please find attached the point-by-point responses to the reviewers’ comments. We hope that our revisions have made the manuscript suitable for publication in PLOS ONE Sincerely, Hidetoshi Nakao Faculty of Social Work Studies Department of Physical Therapy Josai International University 1 Gumyo, Togane City Chiba 283-8555, Japan Tel.: +81-475-55-8800 Fax: +81-475-55-8811 Email: h_nakao@jiu.ac.jp Authors did a study on Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study. Comments from Reviewer 1: However, I think the study contains many factual errors and needs to be substantially revised to be considered for publication. The first concern I have, regards the language use. I think the study needs substantial English language editing to make it more clear for the readers. Secondly, the authors need to tell us about the importance of their study and findings they reached. Introduction Response: Thank you for the insightful comments. The revised manuscript has been edited for English language by Editage, a professional English editing service. I have attached the proofreading certificate at the end of this document. Furthermore, significant changes have been made in the revised manuscript (revised text is represented in red) to highlight the importance of this study and conclusions. The authors start introduction with the sentence IN LINE 45 : „ whereas chronic LBP (CLBP), defined as LBP lasting at least three months, is observed in 1–40% of all baseball players.“ it is needed to be rechecked. Response: Thank you for your helpful comment. The age range of baseball players with chronic LBP is wide. In the revised manuscript, we have segregated the LBP prevalence according to age groups. The revised text is as follows (Line number 47–50 and page number 4): LBP occurs not only in adulthood but also among young athletes [1]. The LBP prevalence among young baseball players of 12�15.5 years of age ranges from 8.3�15% [2]. Furthermore, LBP affects up to 48% of Japanese college baseball players [3], and the prevalence is also high in older baseball players. Some sentences need to be more clear for the reader such as in line 51: In addition, reports have identified psychosocial factors and central sensitization as risk factors for CLBP [3, 4]; what does mean… Sometimes authors present us with statements that need to be followed with references, but the references are omitted. For example, on page …: The mental aspects of chronic pain 50 include depression, anxiety, catastrophizing, kinesiophobia, and a decline in self efficacy. What literature are the authors referring to? Response: Thank you for the comment. The text in the revised manuscript was edited to improve clarity. Furthermore, we have included citations in the text to improve clarity on the references. The revised text is as follows (Line number 64–68 and page number 5): Chronic pain constitutes both the physical and mental aspects; the mental aspects include depression, anxiety, catastrophizing, kinesiophobia, and a decline in self-efficacy [10-14]. In addition, reports have identified psychosocial factors and central sensitization as risk factors of CLBP [15, 16]. Psychosocial factors may hinder the athlete from resuming the sport and affect their performance. The introduction section more or less provides hints to the relevant background but I cannot see how the experimental questions can be drawn from the given information. For instance, in line 59 the statement of the problem has finished with this sentence, Preventing or rehabilitating LBP in high school players may reduce LBP prevalence among college and professional athletes” The hypotheses cannot be drawn from the information provided? I think it is needed to be revised in a standard manner, because it is not the aim of the study. Response: Thank you for the comment. We agree with you. Hence, in the revised manuscript, we have included a paragraph that illustrates the hypothesis and motivation behind this study. Although we have revised the entire Introduction section, the reason for conducting this study is mentioned in the last paragraph of this section. The revised text is as follows (Line number 69–73 and page number 5): To the best of our knowledge, a study examining the association of body compositions and CLBP intensity in high school baseball players is lacking. Hence, this study aimed to examine the factors, such as physical composition, pain evaluation, and load related to LBP, that contribute to CLBP among high school baseball players. We also aimed to identify factors that promote and alleviate CLBP. METHODS We see very important inconsistency: in the Abstract the authors mentioned In the results section, authors reported many p values! That is far too many for the scope of this study and the authors almost certainly committed type 1 error, as the number of p values is as big as the sample. Response: Thank you for the comment. We agree with you. We have reduced the number of p values reported as this study aimed on assessing the physical composition and pain intensity associated with chronic LBP, and identifying the baseball-related loads associated with chronic LBP. The main objective of this study is listed in the last paragraph of the Introduction section of the revised manuscript. The revised text is as follows (Line number 69–73 and page number 5): To the best of our knowledge, a study examining the association of body compositions and CLBP intensity in high school baseball players is lacking. Hence, this study aimed to examine the factors, such as physical composition, pain evaluation, and load related to LBP, that contribute to CLBP among high school baseball players. We also aimed to identify factors that promote and alleviate CLBP. What grip strength was measured? Is it relevant to the aim of the study? Response: Thank you for the comment. We agree that there is no relationship between the grip strength and LBP. Therefore, we have removed all information pertaining to grip strength in this study in the revised manuscript. What scale did select to measure functional tests in this study? Does “performed or not performed” is a suitable scale to measure this variable? Response: Thank you for the comment. In the revised manuscript, we have removed the functional test because it was less important than the other variables. Is the level and history of athletes considered in sample selection? How authors control this variable? Response: Thank you for the comment. Table 1 displays the number of years of experience and position of the athletes at baseline at the onset of LBP. The number of years of experience of players in each group was similar. We recognize that there were many pitchers in the CLBP group; however, since the players’ positions were diverse, we opine that it will be the participants of analysis as the number of data increases in the future. The players studied were all baseball players from the same high school; therefore, we added the amount of practice and frequency of participants as follows. The revised text is as follows (Line number 85–89 and page number 6): The practice frequency of players was six days a week with an average of 4–5 hours per day. Japanese high school baseball games are conducted during the off-season period between December and March, and there are no external games. The practice activities during this period are running, defensive and batting practices, and strength training, and the number of pitching practice decreases. Althoutgh, this investigation is a poilot, but the sample size is needed to to be sufficient for this research based on power, alpha level and ….? Is the sample size sufficient for this research? Response: Thank you for the comment. This study increased the number of participants during the recruitment period. Although the number of participants with chronic LBP did not change, we calculated the effective sample size using the TSK value as an example using the SPSS software. We also provided references on the number of valid pilot studies (line number 141–149 and page number 9–10). In the manuscript, which results support the discussion on “Our study suggested that kinesiophobia is a significant cause of CLBP among…” Was this study a cause-effect study or not? With regards to results, kinesiophobia is the most important factor in CLBP? What about other measured variables? Response: Thank you for the comment. We observed that TSK showed an increase in the longitudinal comparison of athletes with chronic LBP. Other variables either remained the same or reduced, making TSK a CLBP-related factor. Therefore, we examined related factor longitudinal rather than cause-effect. I also recommend a language check by a native speaker since there are errors all over the text Response: As per your suggestion, we have submitted our manuscript to Editage for professional English language editing. Attachments Attachment Submitted filename: Responce to Reviewers.docx https://doi.org/10.1371/journal.pone.0280453.r002
14 Nov 2022 Decision Letter - Yaodong Gu, Editor PONE-D-21-25318R1Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot StudyPLOS ONE Dear Dr. Nakao, 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 Dec 29 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. 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, Yaodong Gu Academic Editor PLOS ONE Additional Editor Comments: The main purpose of this study shall be clearly described. [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: (No Response) 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 #2: No Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: I Don't Know Reviewer #3: 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 #2: Yes Reviewer #3: 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: No Reviewer #3: 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: This article is a polit study, but only briefly describes the purpose of this study can help implement corrective measures for improving LBP. The significance of this study is not specified in detail In the article, which results support the discussion about kinesiophobia is an important cause of CLBP. The conclusion is too simple and needs to be further summarized Reviewer #3: Review comment This manuscript entitled “Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study” primarily propose to examined the factors associated with CLBP among high school baseball players. But there are only few questions should be addressed before this manuscript can be accepted for publication. You can revise this paper more properly. I suggest that you improve the description below. Specific comments 1.At the end of the abstract section, the hypothesis for this study seems to be missing. Please add this section to the manuscript. 2.A description of the application of the results in this study seems to be missing in the discussion and conclusion section. In fact this is necessary to enhance the quality and clarify the significance of this study. 3.In fact LBP is not only present in the baseball player community, but also in the table tennis and tennis player communities. Therefore, add description content into discussion section on LBP of racket sports is necessary. This would enhance the perspective of this study. ****** 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: No Reviewer #3: Yes: Yuqi He ******** [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.0280453.r003
Revision 2
20 Nov 2022 Author Response Authors did a study on Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study. Comments from Reviewer 2: This article is a polit study, but only briefly describes the purpose of this study can help implement corrective measures for improving LBP. The significance of this study is not specified in detail In the article, which results support the discussion about kinesiophobia is an important cause of CLBP. The conclusion is too simple and needs to be further summarized Response: Thank you very much for reviewing our manuscript and offering valuable advice. We have addressed your comments with point by point response, and revised the manuscript accordingly. We agree with your observation. I have added extra information to the discussion section, specifically focusing on the association of kinesiophobia with CLBP and the importance of managing TSK score during exersice for CLBP. The revised text is as follows (Lines 241–249): Thus, kinesiophobia affects joint movement ability; therefore, continuing training with running and squats poses a risk. However, aerobic exercises auch as walking and strength execises specific to the thoracic, lumbar, and posterior hip regions have been reported to be effective in imporoving CLBP. Therefore, an exercise program with a controlled TSK score is recommended for atheletes with CLBP. Our present findings suggest that higher TSK in CLBP is seen among high school baseball players with lumbar spondylolysis. Future studies should investigate the association between kinesiophobia and spondylolysis in other sports, such as racquet and contact sports, as they may also have high TSK scores and lumbar spondylolysis rates in CLBP. We agree with you regarding your suggestion that the conclusion is simple, and we have made significant revisions. The revised text is as follows. (Lines 256–262) Our study aimed to examine factors, such as physical composition, pain evaluation, and load related to LBP, that contribute to CLBP among high school baseball players. We identified kinesiophobia and lumbar spondylolysis as factors related to CLBP. Therefore, particular attention should be given to kinesiophobia during running and barbell squat training, especially in young athletes. Furthermore, the TSK score and presence of lumbar spondylolysis should be considerd when creating an exercise program for high school baseball players with CLBP. Comments from Reviewer 3: This manuscript entitled “Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study” primarily propose to examined the factors associated with CLBP among high school baseball players. But there are only few questions should be addressed before this manuscript can be accepted for publication. You can revise this paper more properly. I suggest that you improve the description below. Dear Reviewer 　 Thank you very much for reviewing our manuscript and offering valuable advice. We have addressed your comments with point by point response, and revised the manuscript accordingly. Specific comments 1.At the end of the abstract section, the hypothesis for this study seems to be missing. Please add this section to the manuscript. Response: Thank you for your helpful comment. Accordingly, the following sentence was inserted at the end of the abstract section. The revised text is as follows (Lines 42–44): Kinesiophobia and the presence of lumbar spondylolysis should be considerd when creating an exercise program for high school baseball players with CLBP. 2.A description of the application of the results in this study seems to be missing in the discussion and conclusion section. In fact this is necessary to enhance the quality and clarify the significance of this study. Response: Thank you for the insightful comment. I have added the discussion regarding the necessity of TSK scores assessment for athletes with CLBP for continuation of exercise. The revised text is as follows (Lines 241–245): Thus, kinesiophobia affects joint movement ability; therefore, continuing training with running and squats poses a risk. However, aerobic exercises such as walking [35] and strength training specific to the thoracic, lumbars, and posterior hip regions have been reported to be effective in imporoving CLBP [36]. Therefore, an exercise program with a controlled TSK score is likely recommended for atheletes with CLBP. 3.In fact LBP is not only present in the baseball player community, but also in the table tennis and tennis player communities. Therefore, add description content into discussion section on LBP of racket sports is necessary. This would enhance the perspective of this study. Response: Thank you for your helpful comment. We agree with your observation. We have added relevant information to the discussion section regarding the need to pursue the assessment of association of kinesiophobia and lumbar spondylolysis with CLBP in other sports as a topic for future study. The revised text is as follows (Lines 246–249): Our present findings suggest that higher TSK in CLBP is seen among high school baseball players with lumbar spondylolysis. Future studies should investigate the association between kinesiophobia and spondylolysis in other sports, such as racquet and contact sports, as they may also have higher TSK scores and lubar spondylolysis rates in CLBP. https://doi.org/10.1371/journal.pone.0280453.r004
2 Jan 2023 Decision Letter - Yaodong Gu, Editor Factors Affecting Chronic Low Back Pain Among High School Baseball Players in Japan: A Pilot Study PONE-D-21-25318R2 Dear Dr. Nakao, 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, Yaodong Gu Academic Editor PLOS ONE Additional Editor Comments (optional): N/A 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: 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 #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 ****** 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: (No Response) Reviewer #3: Thank you for author answerd all the comments in an appropriately way. In my point of view, this article could be accept to publish. ****** 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: No Reviewer #3: Yes: Yuqi He ******** https://doi.org/10.1371/journal.pone.0280453.r005
Formally Accepted
17 Jan 2023 Acceptance Letter - Yaodong Gu, Editor PONE-D-21-25318R2 Factors affecting chronic low back pain among high school baseball players in Japan: a pilot study Dear Dr. Nakao: 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 Professor Yaodong Gu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0280453.r006

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