PONE-D-23-00756Physiotherapists clinical reasoning to prescribe exercise for patients with persistent pain: a qualitative study research protocol.PLOS ONE

Dear Dr. Kelly,

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.

==============================

The reviewers recommended major revisions. The comments provided by the reviewers are included at the end of this email. Please address each one before submitting your revision.

==============================

Please submit your revised manuscript by May 26 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,

Dr Claudio Di Lorito

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

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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

**********

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: No

**********

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.

Reviewer 1 comments:

INTRODUCTION

• You are using exercise and physical activity interchangeably. I suggest you stick to exercise and not physical activity since physical activity cannot be prescribed (line 150, 155). It is exercise that can be prescribed.

METHODS

A lot of information has been mixed up in the methods section. Authors are providing information that is not necessary for a publication. For example, some details (lines 215 to 252) can be summarized in a single sentence and then just referenced. Authors are writing the methodology section as if this is a thesis, yet this is a manuscript for publication. I suggest you cut down any unnecessary details in the methods section and write the methodology section concisely with the following subheadings:

• Study design and type

• Study place

• Study population

• Sample size/ sampling

• Data collection

• Data management and analysis

• Ethical considerations

• Dissemination of results

Some further comments in the methods section are below:

Study design

• Information under study is largely describing the data collection process and the tools used for data collection. Authors need to indicate what study design will be used as this has not been described under the study design section.

• Some information in lines 181 to 187 is misplaced. This information should come the ethical consideration. In addition, this section (ethical considerations) is missing and needs to be included.

Study population

• Information on sample size has been misplaced (lines 253 to 263) under data collection. This information should be under a sub heading sample size which follows the study population sub section.

• Under sample size, authors should be specific on how participants will be sampled. What sampling frame will be used?

Data analysis

• Provide information on how data trustworthiness will be ensured.

DISCUSSION

Study limitations

• Since this is a protocol, indicate how you intend to mitigate the limitations that you foresee.

Reviewer 2 comments:

Thank you for submitting this protocol for review. It is certainly a useful piece of work to understand the clinical reasoning of clinicians and something that has been poorly explored previously. I have outlined a few questions and amendments to strengthen the protocol

Abstract

Background – uses NICE abbreviation, suggest no abbreviations on an abstract, spell out in full for international readers. Can we avoid using the word patients as many service users do not view themselves as patients, particularly in the outpatient setting

Methods – again using UK abbreviation Write out in full

Ethics statement – needs more detail. Please explain why NHS IRAS/HRA ethics will not be required. What do you mean consent will be gained in the written format. Please give further details. Has ethics already been obtained?

Data section (page 5). I am confused as you state that no data sets were produced or analysed as part of the study but this study is generating a new data set (qualitative data from interviews). Please clarify and amend

Full manuscript

Background

- You state that chronic pain and persistent pain are more or less the same. Why have you chosen to call it persistent pain throughout the manuscript as this could be confusing for your reader?

- Chronic/persistent pain is complex. Are you focusing on clinical reason in certain conditions/populations (i.e MSK related, organ related, multi-morbidity, fibromyalgia)? Clarifying this would help focus the mind of your readers.

- Please define exercise and physical activity (as they are two distinct, though related terms)

- Although you have focused on physiotherapists as the main prescribers of exercise, I think you could expand the final paragraph of this section (page 14) to consider how other professionals could learn from these findings. For example exercise physiologists etc

Method

- You state that the interview guide has been developing using literature. Can you elaborate? Have you completed a systematic/mapping review to identify literature? How can you be sure there isn’t any available evidence?

- Please confirm if consent will be written or electronic

- Robust qualitative research includes reflexive diaries. I note you have said that you will keep field notes but reflexive diaries are also needed and should be incorporated into the analytical framework

- I am unclear why you need two people to complete a semi-structured interview. Why would JN observe and make notes? This is unsual for this method so please explain the rationale. The bias of two interviewers to one participant could potentially introduce bias into the method through social power. This needs to be explained further

- If you are using data saturation to determine your sample size please define your working definition of saturation

- There is limited detail on the analysis section. I note that you are suing the framework method which has seven stages of analysis (linked to the Gale reference). The authors have not followed this nor provided enough detail on their analytical method. For this to be published the seven stages need to be outlined.

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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: Dr. Enock Chisati

**********

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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-23-00756R1Physiotherapists clinical reasoning to prescribe exercise for patients with chronic pain: a qualitative study research protocol.PLOS ONE

Dear Dr. Kelly,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but a few minor comments need addressing to 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 Sep 25 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,

Claudio Di Lorito

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:

Dear Authors

Thank you for the revisions. Two reviewers have checked your re-submission and they are happy to proceed with publication if you addressed the minor comments included. Please carefully addressed these reminaing comments, so we can proceed with publication of your manuscript.

Best Wishes

Claudio Di Lorito

[Note: HTML markup is below. Please do not edit.]

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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #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 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 #2: I would like to congratulate the work done previously by the authors and very concise help and valuable help by the reviewers, in the presentation of the manuscript.

I have 2 minor additions which I suggest be added to the manuscript.

Line 95: What is your understanding/theoretical stand point in relation to complex pain, you state which approach is needed but not how you define and understand complex pain. This could be clarified.

95: “Management of chronic pain is complex, requiring a person-centred assessment [1]and multimodal approach [3].”

Clinical reasoning is a key component

Line 146-147 you define clinical reasoning for physiotherapists as a “context dependent way of thinking and decision making in professional practice to guide practice actions” [18]

Even though you describe an inductive approach in your framework analysis it seems unrealistic and maybe critical, that you do not have an informed starting point by having a model/theoretical understanding of clinical reasoning. This should be elaborated and clarified in the analysis section in Methods as this will influence the future analysis.

Reviewer #3: Thank you for your work. I feel that you managed to respond well to previous comments from colleague reviewers. There is no need for extra reviews after that.

**********

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: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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

Attachments

Attachment

Submitted filename: PONE-D-23-00756R1 Reviewer 1.docx

PONE-D-23-00756R2Physiotherapists clinical reasoning to prescribe exercise for patients with chronic pain: a qualitative study research protocol.PLOS ONE

Dear Dr. Kelly,

Thank you for submitting your  revised manuscript to PLOS ONE. After careful consideration, we feel that it has 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.

Kindly modify your abstract as previous into a structured abstract as follows with the following sub-headings, as recommended by the peer-reviewer:

1. Background (here include the purpose /aim of the study with a brief background).

2. Methods (summary of methods)

3. Results (summary of results/expected outcomes)

4. Conclusion.

Also address any other observations or comments by the peer- reviewers.

Please submit your revised manuscript by Nov 05 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,

Sylvester Chidi Chima, M.D., L.L.M, LLD.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. 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

**********

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: 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

Reviewer #2: 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

Reviewer #2: 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: No

Reviewer #2: 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 should re organize the abstract to be logical with the following sub headings:

1. Background (which should also include the purpose /aim of the study).I advise they cut down and provide just a summary of the background.

2. Methods (summary of methods)

3. Results (summary of results)

4. Conclusion.

There is no need to provide a discussion in the abstract.

Reviewer #2: I can accept the arguments provided by the authors No further comments. Good luck with the coming project.

**********

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 #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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

Physiotherapists clinical reasoning to prescribe exercise for patients with chronic pain: a qualitative study research protocol.

PONE-D-23-00756R3

Dear Dr. Kelly,

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,

Sylvester Chidi Chima, M.D., L.L.M, LLD.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

We have received 3 Accept recommendations from previous peer reviewers for this study protocol. The fourth review appears to duplication of previous reports and may be considered by the authors during their full study

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 #4: Partly

**********

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 #4: Partly

**********

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 #4: No

**********

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

Reviewer #4: Yes

**********

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

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

Reviewer #1: Yes

Reviewer #4: 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: Authors of the manuscript have appropriately addressed all the comments. I have no further comments.

Reviewer #4: Introduction

I understand the work claims to be the first study (line 274) seeking to under standing clinical reasoning processes of physiotherapists when describing exercise. When such a claim is made I think it is important that other articles around experience of PTs and clinical reasoning article more generally are acknowledged to give a context and a better focus on the gap so for the introduction and discussion I have had a quick search of articles (I am not an expert in this area so forgive me if these are not bang on) but I would think some of them need to be acknowledge so the context of this statement can be fully understood and acknowledgement to past work and the gaps are identified.

Frontiers | The Needs and Experiences of Patients on Pain Education and the Clinical Reasoning of Physical Therapists Regarding Cancer-Related Pain. A Qualitative Study (frontiersin.org)

Exercise prescription for patients with non-specific chronic low back pain: a qualitative exploration of decision making in physiotherapy practice - ScienceDirect

Full article: Clinical reasoning and critical reflection in physiotherapists’ examinations of patients with low back pain in its early phase: a qualitative study from physiotherapists’ point of view (tandfonline.com)

The clinical reasoning of pain by experienced musculoskeletal physiotherapists - ScienceDirect

Articles that contain some information

Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies - ScienceDirect - this review cites 5 past articles

Aspects influencing clinical reasoning and decision-making when matching treatment to patients with low back pain in primary healthcare - ScienceDirect

Self‐management and chronic low back pain: a qualitative study - Crowe - 2010 - Journal of Advanced Nursing - Wiley Online Library

Self-management support for people with non-specific low back pain: A qualitative survey among physiotherapists and exercise therapists - ScienceDirect

Full article: The suitability and utility of the pain and movement reasoning model for physiotherapy: A qualitative study (tandfonline.com)

Context articles

Full article: Factors influencing physical therapists’ clinical reasoning: qualitative systematic review and meta-synthesis (tandfonline.com)

Full article: Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study (tandfonline.com)

Promoting Participation in Physical Activity and Exercise Among People Living with Chronic Pain: A Qualitative Study of Strategies Used by People with Pain and Their Recommendations for Health Care Providers | Pain Medicine | Oxford Academic (oup.com)

Methods

Lines 169-177

You call the research you are planning a generic qualitative study. The reference you use states this:

One research approach that falls under this broad category is known as generic qualitative research, which is subsequently subdivided into genres of interpretive description and descriptive qualitative research (Caelli et al., 2003).

Later on the author give a perspective on a philosophical stance – e.g.,

generic studies seek to understand how people interpret, construct, or make meaning from their world and their experiences. Furthermore, she writes that generic studies are epistemologically social constructivist, theoretically interpretive studies that focus on “(1) how people interpret their experiences, (2) how they construct their worlds, and (3) what meaning they attribute to their experiences” (Merriam, 2009, p. 23).

Given the above do you need to be more specific as to whether you work will be a descriptive or interpretive description approach? If so, there may be a better reference to use also do you need to mention something about social constructivism?

You mention interviews here but this is methods so can go later on?

Do you want to separate out aspects of setting, context and reflexivity?

Lines 178-184

The development of the guide could be expanded and include if you will do pilot interviews?

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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.

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Reviewer #1: No

Reviewer #4: No

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