Musculoskeletal pain affects the age of retirement and the risk of work cessation among older people

Nils Georg Niederstrasser; Elaine Wainwright; Martin J. Stevens

doi:10.1371/journal.pone.0297155

Peer Review History

Original SubmissionOctober 5, 2023
30 Oct 2023 Decision Letter - Amin Nakhostin-Ansari, Editor PONE-D-23-31458Pain affects the age of retirement and the risk of work cessation among older peoplePLOS ONE Dear Dr. Niederstrasser, 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. ACADEMIC EDITOR: Thank you very much for submitting your manuscript to PLOS ONE. In addition to the concerns raised by the reviewers, please reorganize the methods section in accordance with the STROBE guidelines. The current format makes it challenging to follow the methods. Please submit your revised manuscript by Dec 14 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, Amin Nakhostin-Ansari Academic Editor PLOS ONE Journal 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 [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: No Reviewer #2: 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 Reviewer #2: 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: The data is valuable given the aging of populations around the world. Therefore, it is advisable to provide detailed information about the subjects of this study. In other words, what kind of work where they engaged in, what was the age distribution of their subjects, and what was the ratio of men to women? It also raises questions about whether they haven't been able to gather information about the location and duration of pain. Therefore, it is desirable to identify what information you can or cannot collect about the subjects of this study. In addition, data that can be presented should be presented in a table. Interestingly, musculoskeletal pain has been shown to be an independent predictor of early retirement and job interruption. However, information such as pain intensity, location, duration, and presence or absence of disease may be important for planning measures, but can you provide information on these points? Are these data not necessary to achieve the objectives of this study? The study found that frequent musculoskeletal pain remained a significant predictor of early retirement and the risk of leaving early, even after controlling for the effects of job satisfaction, depressive symptoms, self-perceived social status, gender, wealth, and working conditions. Your argument against this result is lacking. Are these results considered reasonable? Will the results depend on the cohort in this study, on factors such as English language differentiation, or will they be seen as common results globally? I think you can refer to it from multiple angles. Reviewer #2: The topic of this manuscript, dealing with consequences of musculoskeletal pain among individuals 50 years and more, is interesting. The data are issued from the English Longitudinal Study of Aging, which includes information about work cessation and retirement, with a rather long follow-up. The subjects are classified (at baseline) as often troubled by bone, joint or muscle pain, yes or no (self-report). The manuscript should be improved in order to be easier to understand for the reader: 1 - The title could be modified: « musculoskeletal pain » rather than « pain » 2 - The study design must be explained more precisely: data from wave 2 (baseline) were used for the predictors. Retirement and work cessation were recorded from wave 2 to wave 9, fourteen years later. For retirement, 1156 workers at baseline, 1073 retired over the course of 14 years. For work cessation, the corresponding numbers are 1281 and 1197. As if no one had been lost to follow-up? It is said that additional participants were added with each wave of the cohort to maintain the total number of participants. Are there “additional participants” included in the present study? 3 - The potential effect of legal age at retirement is discussed, but it would be useful to have some information about the context of retirement in England earlier in the paper, especially the fact that “workers can choose when to retire”. 4 – Work cessation and retirement: many subjects are in both categories. This is said in the discussion, but it should appear earlier in the paper, with numbers (how many subjects belonging to both categories). Would it be possible to study the category: work cessation (no paid employment last month) but not retired? 5 - Participants’ age was used to denote survival time in the Cox models. This is probably not very usual. It seems that it explains the results observed for age. Does it explain that physical job demands seems not to be associated with time to retirement? it is also surprising that a higher self-perceived social status is associated with an increased risk of ceasing work and retiring at an earlier age. 6 – Marital status is indicated as a variable in “results” but not included in the list of predictors. 7 - For retirement, HR=0.77 for report of musculoskeletal complains. This HR is probably for « no report », one expects an HR larger than 1, associated with report of pain (as for work cessation). 8 – In figures 1 and 2, since some variables are dichotomous, and other ones quantitative, it is not obvious to compare the HRs. It would be useful to have a footnote indicating, for some variables, that the HR corresponds to a change of one unit for the variable. The range of the scores should be clearly presented in the text, and added in table 1: 0 (?) to 8 for depression and psychosocial demands (but the mean is 0.1 for depressive symptoms in table 1), 1 to 100 for social status (leading to a significant HR equal to 1.01!). For decision authority, there is no indication about the range in the text. Minor comments Abstract, first line of « result »: « was » is lacking after « pain ». Same in the first line of discussion. « Frequent musculoskeletal pain » in the list of predictors: delete « they responded ». Figures 1 and 2: “depression” in figure 1, “depressive symptoms” in figure 2. Probably the same variable. (second) reference Bevan: some information is lacking (journal…) ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No 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. 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Revision 1
9 Nov 2023 Author Response Academic Editor: Please reorganize the methods section in accordance with the STROBE guidelines. The current format makes it challenging to follow the methods. We have rearranged the methods section following the strobe guidelines. Reviewer #1: Thank you for your suggestions. We have incorporated them and feel this has greatly improved the manuscript. The data is valuable given the aging of populations around the world. Therefore, it is advisable to provide detailed information about the subjects of this study. In other words, what kind of work where they engaged in, what was the age distribution of their subjects, and what was the ratio of men to women? It also raises questions about whether they haven't been able to gather information about the location and duration of pain. Therefore, it is desirable to identify what information you can or cannot collect about the subjects of this study. In addition, data that can be presented should be presented in a table. Thank you for the suggestions. We have added more information pertaining to the sample to Table 1, including the age distribution and ratio of men to women. Interestingly, musculoskeletal pain has been shown to be an independent predictor of early retirement and job interruption. However, information such as pain intensity, location, duration, and presence or absence of disease may be important for planning measures, but can you provide information on these points? Are these data not necessary to achieve the objectives of this study? Some information is available pertaining to pain intensity and type of work; however, this is difficult to incorporate, as the data span 14 years and the resolution of the available information is low, as assessments took place every two years. Therefore, the value of providing information pertaining to pain intensity and type of work for each participant may be misleading as there may be multiple changes throughout each interval that are not captured. The finding that mere presence of musculoskeletal pain has such a deleterious impact does, in our opinion, achieve the study’s objectives. We have clarified the discussion section to reflect this issue (see pg. 12). The study found that frequent musculoskeletal pain remained a significant predictor of early retirement and the risk of leaving early, even after controlling for the effects of job satisfaction, depressive symptoms, self-perceived social status, gender, wealth, and working conditions. Your argument against this result is lacking. Are these results considered reasonable? Will the results depend on the cohort in this study, on factors such as English language differentiation, or will they be seen as common results globally? I think you can refer to it from multiple angles. You raise an interesting point. The English Longitudinal Study of Ageing is representative of individuals aged 50 and over residing in England and so generalisability to other nations may be limited. Nevertheless, although the findings likely do apply to other nations with similar demographic profiles and are likely to hold global merit our results do not go this far and so we have acknowledged this limitation in the discussion section (see pg. 13). However, we do consider these results to be reasonable, as they match similar previous investigations. Reviewer #2: We thank reviewer 2 for their comments and suggested revisions. We have taken these on board and revised the manuscript to improve clarity. We feel the paper has been greatly improved following revisions based on suggestions by reviewer 2. 1. The title could be modified: « musculoskeletal pain » rather than « pain » Thank you for the suggestion. We have made the amendment. 2. The study design must be explained more precisely: data from wave 2 (baseline) were used for the predictors. Retirement and work cessation were recorded from wave 2 to wave 9, fourteen years later. For retirement, 1156 workers at baseline, 1073 retired over the course of 14 years. For work cessation, the corresponding numbers are 1281 and 1197. As if no one had been lost to follow-up? It is said that additional participants were added with each wave of the cohort to maintain the total number of participants. Are there “additional participants” included in the present study? There were no additional participants added to the study during the follow up period that were included in the analysis. The mention in the paper was a reference to the general data collection and recruitment methods employed by the ELSA team. Each wave (every two years), due to the age of participants, additional participants are added from that year’s Health Survey for England (HSE) to maintain a representative sample. Our study followed participants present in ELSA at wave 2, which means at wave 2 additional participants from the HSE were added to boost the numbers and maintain a representative sample. We only used data from participants present in wave 2 onwards in our analyses. We have changed the wording in the method section to clarify this point. The entire data set at baseline data (wave 2) comprised 8780 participants (before removal of incomplete data) out of which 2405 reported being in employment and 2582 reported not being retired and so were eligible for inclusion in the study. After removal of missing values due to incomplete data and loss to follow up the final numbers were 1281 and 1156 eligible participants respectively. We have amended the wording in the method section to clarify this point (see pg. 5-6). 3. The potential effect of legal age at retirement is discussed, but it would be useful to have some information about the context of retirement in England earlier in the paper, especially the fact that “workers can choose when to retire”. Thank you. We have added a short paragraph into the introduction with a brief overview of retirement in the UK which has been subject to several changes since 2010 (see pg. 4). 4. Work cessation and retirement: many subjects are in both categories. This is said in the discussion, but it should appear earlier in the paper, with numbers (how many subjects belonging to both categories). Would it be possible to study the category: work cessation (no paid employment last month) but not retired? We have added the number of participants (1156) belonging to both categories to the text (see pg. 6). This would indeed be a fascinating and worthwhile analysis. We looked into this, and selecting those who were not in paid employment in the last month and had not retired yet led to 91 eligible participants after removing participants with missing data for any of the relevant variables. Nevertheless, the exact analysis cannot be repeated, as these participants, by definition, do not have any data pertaining to job demands and characteristics and so the results would not be comparable to the current analyses. Furthermore, the resultant low sample size invites prudence in interpreting the results from this analysis. We therefore decided that, in the current context, this additional analysis does not bear any additional merit to the paper. 5. Participants’ age was used to denote survival time in the Cox models. This is probably not very usual. It seems that it explains the results observed for age. Does it explain that physical job demands seems not to be associated with time to retirement? it is also surprising that a higher self-perceived social status is associated with an increased risk of ceasing work and retiring at an earlier age. High physical job demands are associated with occupations involving manual labour. These jobs are further associated with lower pay which often precludes the individual from retiring at the point that the physical aspects of their job become too much to continue working. As a result, changes to less physically demanding jobs often ensue that result in continuous employment, albeit in different sectors. Higher self-perceived social status is often associated with wealth or perceived wealth. It is therefore reasonable to assume that those with higher self-perceived social status may have higher perceived or actual wealth and so have the option of retiring earlier. In other words, they may be able to afford not to work, as they can live off savings and pensions. 6. Marital status is indicated as a variable in “results” but not included in the list of predictors. Thank you for pointing out this oversight. This has been amended (see pg. 9). 7. For retirement, HR=0.77 for report of musculoskeletal complains. This HR is probably for « no report », one expects an HR larger than 1, associated with report of pain (as for work cessation). Thank you for pointing this out. We realise that we were not clear in how this was reported in the manuscript. You are correct that the HR below 1 is for the reverse, i.e., “no report”, and the number in the text should in fact be the inverse, hence, 1.30. We have changed the values to clarify this (see pg. 10). 8. In figures 1 and 2, since some variables are dichotomous, and other ones quantitative, it is not obvious to compare the HRs. It would be useful to have a footnote indicating, for some variables, that the HR corresponds to a change of one unit for the variable. The range of the scores should be clearly presented in the text, and added in table 1: 0 (?) to 8 for depression and psychosocial demands (but the mean is 0.1 for depressive symptoms in table 1), 1 to 100 for social status (leading to a significant HR equal to 1.01!). For decision authority, there is no indication about the range in the text. We thank the reviewer for this suggestion. We forgot to include that the summed score for the number of depressive symptoms was divided by 8, resulting in scores ranging from 0 to 1. Self-perceived social status is operationalised by dividing the range of 0 – 100 into 20 five-point increments. Therefore, the range is 0 – 20 and each single unit increase there, represents a five-point increase on a scale from 0 – 100. We initially presented the mean on a scale from 0 – 100, but realise that this may lead to confusion and have reverted to reporting the mean on a scale from 0 – 20 to better illustrate the impact of a single unit increase on this measure. Ranges have been added where missing in the method section (see pg. 7 – 9) and Table 1. Footnote to be added to both Figures: Please note that for self-perceived social status the hazard ratio indicates the change in risk per five-point increment on a scale from 0 – 100. Minor comments Abstract, first line of « result »: « was » is lacking after « pain ». Same in the first line of discussion. « Frequent musculoskeletal pain » in the list of predictors: delete « they responded ». Figures 1 and 2: “depression” in figure 1, “depressive symptoms” in figure 2. Probably the same variable. (second) reference Bevan: some information is lacking (journal…) Thank you for pointing out these oversights, which we have corrected. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0297155.r002
13 Dec 2023 Decision Letter - Amin Nakhostin-Ansari, Editor PONE-D-23-31458R1Musculoskeletal pain affects the age of retirement and the risk of work cessation among older peoplePLOS ONE Dear Dr. Niederstrasser, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Please submit your revised manuscript by Jan 27 2024 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, Amin Nakhostin-Ansari 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. 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: (No Response) ******** 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: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: (No Response) ****** 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: (No Response) ****** 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: (No Response) ****** 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: The comments raised in the previous version have been correctly adressed. This revised manuscript is easy to read and to understand Reviewer #3: I had the opportunity to review this interesting manuscript on effects of MSK pain on retirement age among older people. The idea is interesting and the manuscript is well-written. There are a few areas where I believe some enhancements could further elevate the quality of the manuscript. a. According to the title the study aimed to evaluate the effects of MSK pains on work cessation and more focus should be place on MSK pains in the introduction section rather than discussing chronic pain in general. b. Please briefly describe the sampling and data collection process. c. Please consider showing the flow of participant in a figure (method section – participant subheading). d. Please move the variables subheading to the next line. ****** 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. https://doi.org/10.1371/journal.pone.0297155.r003
Revision 2
18 Dec 2023 Author Response Academic Editor: 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. We have reviewed the reference list and made the following changes: Added Waddell & Burton 2006, Taylor 2017 due to omission from reference list. Amended De Wind 2014 to De Wind 2013 in the manuscript (the reference list is correct to cite both). Amended Bevan 2015 to Bevan 2015b, due to oversight. Added Fimland et al. 2018 in introduction due to reviewer 3’s suggestion to focus more on musculoskeletal pain. Reviewer #2: The comments raised in the previous version have been correctly addressed. This revised manuscript is easy to read and to understand. We thank reviewer 2 for the comments and suggestions, which we believe have greatly improved the paper. Reviewer #3: I had the opportunity to review this interesting manuscript on effects of MSK pain on retirement age among older people. The idea is interesting and the manuscript is well-written. There are a few areas where I believe some enhancements could further elevate the quality of the manuscript. Thank you for your comments and suggestions. We have revised the manuscript accordingly. 1. According to the title the study aimed to evaluate the effects of MSK pains on work cessation and more focus should be place on MSK pains in the introduction section rather than discussing chronic pain in general. Thank you for bringing this up. We have made changes to the introduction to highlight the manuscript’s focus on MSK pain, see page 3. 2. Please briefly describe the sampling and data collection process. We have added additional details pertaining to the sampling and data collection process on pages 5 and 6. 3. Please consider showing the flow of participant in a figure (method section – participant subheading). Thank you for this suggestion. We have included a figure. 4. Please move the variables subheading to the next line. We have moved the subheadings to the next line. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0297155.r004
2 Jan 2024 Decision Letter - Amin Nakhostin-Ansari, Editor Musculoskeletal pain affects the age of retirement and the risk of work cessation among older people PONE-D-23-31458R2 Dear Dr. Niederstrasser, 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, Amin Nakhostin-Ansari 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 #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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #3: (No Response) ****** 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 #3: (No Response) ****** 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 #3: I have read the revised manuscript and I am satisfied with the changes made by the authors. They have improved the clarity, accuracy, and relevance of their paper. ****** 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 #3: No ******** https://doi.org/10.1371/journal.pone.0297155.r005
Formally Accepted
24 Feb 2024 Acceptance Letter - Amin Nakhostin-Ansari, Editor PONE-D-23-31458R2 PLOS ONE Dear Dr. Niederstrasser, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Amin Nakhostin-Ansari Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0297155.r006

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