PONE-D-23-41035Transition experiences of patients with post-stroke dysphagia: a longitudinal, qualitative studyPLOS ONE

Dear Dr. Zhang,

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PLOS ONE

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This work was supported by grants from the Natural Science Foundation of Guangdong Province (grant number 2022A1515012184).

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Additional Editor Comments:

Please perform all the revisions suggested.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: N/A

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: No

Reviewer #2: No

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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: No

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: I read with interest the manuscript by CHEN et al. Here there are some comments to improve the manuscript:

- The manuscript must be edited for English.

- Line 83. What do you mean by descriptive qualitative study? Please specify whether the study is retrospective or prospective. In fact, the study seems more like a case series.

- It is not clear to me whether the caregivers were included for all participants, or just for those who could not communicate.

- Line 105. How was this training performed?

- In the limitation section, authors should report that the study is severely limited by the low number of patients and caregivers enrolled, which prevents from drawing any conclusion. Also, the lack of control group, the lack of statistical analyses are also limitations to be presented.

- Conclusions must be limited to the very small cohort of patients included, and could not be generalized

Reviewer #2: I have reviewed the manuscript and found some areas for improvement:

The manuscript presents intriguing findings that could pave the way for further research in the field. It is well-written, with a concise and informative abstract.

While the topic is well-justified, it would be beneficial to understand how local healthcare settings manage post-stroke depression (PSD) patients. Additionally, incorporating a conceptual framework derived from transitional theory could enhance the theoretical underpinning of the study.

Considering the involvement of caregivers in the study, a slight modification to the title to include the keyword "caregivers' perception" may be warranted. Consequently, adjustments to the interview guide to accommodate caregivers' perspectives are necessary. To ensure clarity, it's important to explain in detail the longitudinal qualitative approach used in the study and refrain from numbering descriptions to avoid confusion with citation numbers. Structuring the in-depth interviews into proper paragraphs would enhance the rigor and trustworthiness of the data.

The inclusion of follow-up elements, as indicated in Table 3, suggests a longitudinal design approach. However, clarification is needed regarding the inclusion of participants who passed away during the study. Additionally, explanations are required regarding the varying number of interviews per participant, considering that qualitative interviews typically continue until data saturation is reached.

Table 4 suggests that all patients may need to be referred to other rehab centers for further evaluation, but this needs further elaboration. Regarding the quotes and evidence presented, it's essential to ensure alignment with the study's focus on stroke and dysphagia, rather than general stroke issues. Contradictory statements within subthemes should be addressed, and inaccuracies in explaining certain themes need correction.

Theme 2 should focus on the procedure for managing post-stroke patients, including whether referral to rehab centers or lower-level hospitals before discharge is necessary. It's important to balance perspectives between patients and caregivers, with a priority given to the patients' viewpoint, as per the study's title. Any inaccuracies in subtheme explanations should be rectified to maintain coherence and accuracy throughout the discussion.

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Reviewer #1: No

Reviewer #2: No

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Transition experiences of patients with post stroke dysphagia and family caregivers: a longitudinal, qualitative study

PONE-D-23-41035R1

Dear Dr. Zhang,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Keisuke Suzuki, MD, PhD

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: (No Response)

Reviewer #2: 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: (No Response)

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: Yes

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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: (No Response)

Reviewer #2: No

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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: (No Response)

Reviewer #2: Yes

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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: The authors successfully addressed all the comments provided. I believe the manuscript is now suitable for publication.

Reviewer #2: I have reviewed the revised version of the manuscript and found that all previously raised concerns have been thoroughly addressed by the authors. The current version of the manuscript exhibits significant improvement, offering enhanced clarity and readability. It merits recommendation for publication.

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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 #2: No

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