PONE-D-22-30062Physical therapy in the intensive care unit: A comparative study of three Asian countriesPLOS ONE

Dear Dr. Cheng,

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, which you can find below in this mail.

Please submit your revised manuscript by Mar 09 2023 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,

Elisa Ambrosi

Academic Editor

PLOS ONE

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  2.Please amend your current ethics statement to address the following concerns:a) Did participants provide their written or verbal informed consent to participate in this study?b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. 3. Thank you for stating the following financial disclosure:  "This work was supported by the Ministry of Science and Technology in Taiwan (111-2410-H-039-004-), China Medical University Hospital (DMR-110-172), and China Medical University (CMU111-MF-89)".  Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.  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. 

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: I Don't Know

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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

Reviewer #1: Yes

Reviewer #2: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Authors

Thanks a lot for the opportunity you have offered me to revise the fascinating manuscript " Physical therapy in the intensive care unit: A comparative study of three Asian countries". I thank the authors for their effort in producing this exciting review during the COVID-19 pandemic. It is perfectly aligned with my area of research and expertise; thus, I am confident to offer a valuable peer review.

As a significant strength, this manuscript describe the practice of PT in the intensive care unit (ICU), which differs between various country. This proposal is interesting in the field and adds information to the existing evidence in the literature.

As a major weakness, the manuscript sometimes lacks details and clarity concerning methodological steps that would help improve the understanding of the manuscript. Therefore, I have suggested some strategies to improve authors' reporting and increase the quality of their work.

Overall, my peer-review is a major revision: I suggest revising the manuscript to improve the pitfalls presented. The final goal is to improve the overall clarity of the message to help the reader understand this fundamental topic. I look forward to reading the revised version of the manuscript.

Thanks again, and good luck with researching in this challenging time.

@Major revisions

#METHODS

*General. I suggest that authors adhere to the suggested reporting for STROBE observational studies (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61602-X/fulltext#article_upsell). Furthermore, if their survey is electronic, I recommend that they also use the reporting of CHERRIES (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550605/). Accordingly, authors should reorganize the manuscript following these guidelines for the sections materials and methods, results and discussion. Moreover, they should declare clearly the adoption of this guideline in the Methods section.

*Survey development. The authors should be clearer. How was the survey created (e.g., which references and how did it differ from what existed in the literature)? How many questions made up each section? What type of questions were used (e.g. open or closed)? How many answer possibilities were there (e.g. single or multiple)? How many pages were there? These elements should be presented in more detail. Furthermore, the authors should include the survey in the original target languages and in English as Supplementary files.

*Survey testing. Was the survey tested with a pilot? Please be specific.

*Administration. How was the survey administered (paper or online)? How were the participants contacted? Was it free to fill out, or was there an obligation? How long did it last? Were there any economic incentives for completion? How was the possibility of multiple compilations avoided?

*Analysis of the survey. How were missing data handled?

@Minor revisions

#TITLE:

*I suggest authors add in the title the study design (e.g., : an observational study)

#ABSTRACT

*result. Please add statistical values to sustain your statement (e.g., %, n= …).

#KEYWORDS:

*I suggest authors add "rehabilitation", "physical medicine" "Physiotherapists", "survey".

#RESULTS:

*The rate of response is low. This point is a limitation of authors' study. I suggest they declare it in the limitation section.

#DISCUSSION:

*General. The discussion is well organized, but it is a little bit longer. I suggest authors shorten and focus more on it. For example, it is better to avoid the repetition of the results. Discussing the findings with existing evidence or comparing them with different scenarios (e.g., European and American countries) is suitable.

*Direct access of PT. The topic of direct access in physiotherapy is very relevant and strongly discussed also in other fields (e.g. musculoskeletal, e.g. Maselli et al. Direct Access to Physical Therapy: Should Italy Move Forward? Int J Environ Res Public Health. 2022 Jan 4;19(1):555. doi: 10.3390/ijerph19010555). I think this point needs to be developed by emphasising that there is a call to action at international level to develop direct access patient management skills.

*Interprofessional work. Authors have reported the importance of interprofessional work (e.g., between physiotherapists and nurses) in the ICU setting. This element emerged strongly also from different qualitative studies involving nurses, especially during the COVID-19 pandemic. For example, Fontanini et al. have reported the importance of interprofessional work in the ICU setting. I suggest authors look at this paper for their discussion (Italian Nurses' experiences during the COVID-19 pandemic: a qualitative analysis of internet posts. Int Nurs Rev. 2021 Jun;68(2):238-247. doi: 10.1111/inr.12669).

*Managerial perspectives. Authors frequently suggest practical actions for managers. Some of these actions are similar to those proposed for emotional intelligence leaders in managing complex healthcare scenarios (e.g., improve communication, awareness, multidisciplinary works, etc). I suggest authors look at this recent publication in the rehabilitation field by Dell'Isola's research group. Maybe, this publication can add some points to the authors' discussion. (COVID-19 and Health Care Leaders: How Could Emotional Intelligence Be a Helpful Resource During a Pandemic? Phys Ther. 2021 Sep 1;101(9):pzab143. doi: 10.1093/ptj/pzab143).

*Limitations. The rate of response is low. This point is a limitation of the authors' study. I suggest they declare it in the limitation section. Moreover, in this section, the authors should call for future research in the field aimed at overcoming the limits presented in their study.

#CONCLUSION

*Implications. According to their findings, I suggest authors organize this section in implications for clinical practice, education and management. This will be very informative.

#LANGUAGE

*There is a need for a language revision by a native English speaker. For example, there are different grammar mistakes. Moreover, various too many long sentences are presented, limiting the manuscript's readability. Please have a look at the language of the manuscript.

Reviewer #2: Dear Author,

First of all, why did the author choose few Asian countries and the major flaw is validity of the questionnaire used. The questionnaire was not translated as per the standard protocol.

The sample size is small.

The justification to perform the study is not provided

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

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

Reviewer #1: No

Reviewer #2: No

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-22-30062R1Physical therapy in the intensive care unit: An observational comparative study of three Asian countriesPLOS ONE

Dear Dr. Cheng,

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 Jun 10 2023 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,

Elisa Ambrosi

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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Partly

**********

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

Reviewer #1: I Don't Know

Reviewer #3: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

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

Reviewer #1: Yes

Reviewer #3: 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 #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 #1: Dear Authors

Thanks a lot for the opportunity you have offered me to revise again the fascinating manuscript " Physical therapy in the intensive care unit: A comparative study of three Asian countries". I thank the authors for having improved the manuscript following the suggestions of reviewers.

Despite the ameliorations, I invite the authors to add the reference of the STROBE and CHERRIES in the main manuscript.

Thus, after having resolved these minor revisions, the paper will be ready to be accepted and published.

I am available to revise the paper again.

Best regards.

Reviewer #3: Dear author, here are my suggestions:

1. I suggest replacing the term “observational comparative” with “cross-sectional study” in all the manuscript

2. Please, insert in the method section all the reporting guidelines that you have used to write the manuscript (e.g. “This protocol is reported in accordance with …)

3. In the method section, please justify how you decided to use Fisher’s exact test instead of the chi–square test. Also, specify how you evaluated all the statistical test assumptions.

4. The study suffers from a possible selection bias. Indeed, physical therapists (PT) who use social media do not represent all the PT who work in an ICU setting (e.g., probably younger and more prone to use online resources for their training). Therefore, I suggest inserting this limitation of the study in the discussion.

5. The statistical analysis conducted (univariable hypothesis testing) does not permit to conclude that the interventions applied in the ICU setting are different because of country differences. The sample of PT in the three countries analyzed is different for significant variables such as age and PT-patient ratio. Therefore, there are many confounders in the relationship of PT intervention – country. I suggest conducting a regression analysis adjusting for possible cofounders to determine the predictors of the different interventions applied. Otherwise (e.g., the sample size is too small to perform a regression), I suggest inserting the lack of an adjustment in the analysis as a major limitation of the study.

Kind regards

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

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

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

Reviewer #1: No

Reviewer #3: No

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[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.

Physical therapy in the intensive care unit: A cross-sectional study of three Asian countries

PONE-D-22-30062R2

Dear Dr. Cheng,

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,

Elisa Ambrosi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: 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 #1: 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 #1: 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 #1: Dear Authors

Thanks a lot for the opportunity you have offered me to revise again the fascinating manuscript " Physical therapy in the intensive care unit: A comparative study of three Asian countries". I thank the authors for having improved the manuscript following the all my suggestions. Thus, the paper is ready to be accepted and published. Congratulations. Best regards.

Reviewer #3: The authors have adequately addressed all my comments raised in a previous round of review. My reccomandation is to 'Accept' the manuscript.

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

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

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

Reviewer #1: No

Reviewer #3: Yes: Daniel Feller

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