PONE-D-23-02941

Study protocol: A cross-sectional survey of clinicians to identify barriers to clinical practice guideline implementation in the assessment and treatment of persistent tic disorders

PLOS ONE

Dear Dr. Martindale,

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.

Your Study Protocol has been assessed by four reviewers, and their comments are available below. They appreciate the importance of your research question, but also provided suggestions to improve the reporting and presentation of your study. Please carefully address all concerns raised.

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“I have read the journal's policy and the authors of this manuscript have the following competing interests:

JMM has no conflicts that affect the content of this manuscript. In the past two years, she has received honoraria from the Tourette Association of America. In addition, she participates in research funded by the Tourette Association of America and the Child Neurology Foundation.

HS has no conflicts that affect the content of this manuscript.  Dr. Sarva has done consulting work for Neuroderm, Bluerock, Novo Nordisk, and CALA Health. In addition, she has received clinical trial support from Neuroderm, Bluerock, Prevail, Covance, and NIH. 

IAM has no conflicts that affect the content of this manuscript.  She has participated in research funded by AbbVie, Boston Scientific, Eli Lilly, Neuroderm, and Revance but has no ownership interest in any pharmaceutical company.  In addition, she has received travel compensation or honoraria from the Tourette Association of America, Parkinson Foundation, Medscape, Efficient CME, and Cleveland Clinic, and royalties for writing a book with Robert Rose publishers. 

DM has no conflicts that affect the content of this manuscript. In the past two years, he has received personal compensation for consultancies by Roche, Sunovion, and Merz Pharmaceuticals but has no ownership interest in any pharmaceutical company. He has also received travel compensation or honoraria from the Dystonia Medical Research Foundation of Canada, Movement Disorders Society, and the American Academy of Neurology, and book royalties from Springer-Verlag and Oxford University Press. In addition, he received research support from Ipsen Corporate, Owerko Foundation, Dystonia Medical Research Foundation Canada, Parkinson Canada, and the Michael P Smith Family.

DLG has received compensation for expert testimony for the U.S. National Vaccine Injury Compensation Program through the Department of Health and Human Services. He has received payment for medical expert opinions through Advanced Medical/Teladoc. He has served as a consultant for Applied Therapeutics, Eumentics Therapeutics, and Emalex. He has received research support from the NIH and the DOD. He has received salary compensation through Cincinnati Children’s for work as a clinical trial site investigator from Emalex (clinical trial, Tourette Syndrome) and EryDel (clinical trial, Ataxia Telangiectasia). He has received book/publication royalties from Elsevier, Wolters Kluwer, and the Massachusetts Medical Society.

TP has no commercial or financial relationships that could be construed as a potential conflict of interest. TP receives research support from Alberta Health, the Alberta Children’s Hospital Research Institute, and the Public Health Agency of Canada.

KJB has no conflicts that affect the content of this manuscript. In the past two years, author KJB consulted for SK Life Science, Inc., served as faculty for CME programs by Medscape and Mededicus, and served as an expert rater for the Huntington Study Group, which had contracted with Neurocrine Biosciences. In addition, his institution received research funding from Emalex Biosciences for treatment studies with ecopipam.

CG has no conflicts that affect the content of this manuscript. A Freigeist Fellowship of the Volkswagen Stiftung supports him. He has received honoraria from the Movement Disorder Society and BIAL for educational activities. He received honoraria from Biomarine Pharmaceuticals as Ad Hoc Advisory Board.“

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

Reviewer #4: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a well written protocol that is likely to be followed by many researchers to conduct future research in this topic.

Apart from a few repetitive words in certain sections, the protocol is well written and easy to follow.

it might be useful to discus the modified Delhi process briefly in line 105

It might also be useful to discuss who was involved in the panel mentioned in line 106.

Reviewer #2: It is a good study, and certainly generates relevant questions for practicing providers who deal with TIC disorder. I'm concerned about the length of the survery which is 30 pages long, and wonder if the providers would have enough time from their clinical responsibilities to be able to adequately complete the survey. May be creating a timeline for collecting the surveys might help with the timely analysis of the data.

Reviewer #3: The study protocol design aims to identify how clinical practices differ from existing AAN and ESSTS guidelines and the categories of barriers leading to these clinical care gaps. The study protocol includes seven sections, covering demographics, clinical assessment, general treatment considerations, psychoeducation, behavioral interventions, pharmacological interventions, and deep brain stimulation. The survey will be published in a relevant scientific journal and communicated to respondents and relevant institutions. The study protocol design is well-written and provides sufficient details for conducting the research.

Here are some suggestions

It is unclear how the survey will be distributed to potential participants. Will it be sent to all movement disorder specialists, or a specific subset? How will participants be recruited?

The survey development process seems to rely heavily on the input of a small group of experts. It may be beneficial to incorporate the perspectives of a broader range of clinicians and patients, as they may have different insights on barriers to guideline implementation.

It is unclear whether the survey will include any open-ended questions or opportunities for participants to provide qualitative feedback. Including these types of questions may provide more in-depth insights into the barriers and challenges faced by clinicians.

Reviewer #4: Congratulations for authors for this scholarly article. The manuscript draws up a comprehensive database search to find research papers. Moreover, limitations are clearly discussed.

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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: Lakshit Jain MD

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes: Pratik Bahekar

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Study protocol: A cross-sectional survey of clinicians to identify barriers to clinical practice guideline implementation in the assessment and treatment of persistent tic disorders

PONE-D-23-02941R1

Dear Dr. Martindale,

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.

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Kind regards,

Tarik A. Rashid, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have made the appropriate changes as requested, and all the concerns raised have been responded to appropriately. I have no further concerns in regards to this protocol.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Lakshit Jain MD

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