PONE-D-23-41437The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic reviewPLOS ONE

Dear Dr. Niyonsenga,

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 paper reviews home-based rehabilitation strategies for parents of children with cerebral palsy, highlighting potential for improved adherence and program adaptation. However, limited research and methodological diversity constrain the study. Further detail on metrics and inclusion of graphical representations are recommended (see Reviewer#1 comments). While the narrative synthesis approach is suitable, addressing biases and study quality impact could enhance rigor. Acknowledged limitations include reliance on self-report measures and convenience sampling. The discussion should explore reasons for discrepancies among studies, including design and measurement variations (see Reviewer#2 comments).

Please submit your revised manuscript by Apr 01 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Jyotindra Narayan

Academic Editor

PLOS ONE

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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: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

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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: The paper presents a review of studies targeting home-based rehabilitation strategies in parents of children with cerebral palsy. The topic is interesting and might provide insights on how to increase adherence or adapt the program setting. However, the limited number of studies and the diversity of methodological approaches followed by each paper (which are also mentioned in the review) are limitations of the study. In addition, more details are required for some metrics and how they are measured, in particular, for metrics like self-efficacy or adherence. Please see my detailed comments below:

In the abstract, you define the term GMF (gross motor function), however, in the conclusion of the abstract, you use the term FGM. Do both terms describe gross motor function, or does the latter define something different?

In the introduction, the first sentence starts with the term CP; however, this abbreviation is introduced in the following sentence. Please address this issue.

In the introduction, you mention that the prevalence of CP in some countries is "1.8-2.3% per 1000 children," or in other words, 0.18‰-0.23‰. In the following sentence, you write that in Africa, the respective rate is "2-10 per 1000 live births." Do you mean 2-10% per 1000 children or 2‰-10‰?

C-CP is defined in the abstract. Please introduce this term in the main text as well.

Lines 90-91: Is this applicable only for families living in rural areas (e.g., involving parents in treatment decisions)?

Line 125: It is written that "The search terms were specially designed for the relevant database." Do you imply that the search terms were not the same for all the databases but differed across them? The terms mentioned in lines 126-131, are they connected with an AND or OR? Please provide a sample query you used for one database (e.g., PubMed). Did you also include terms starting with a prefix (e.g., adheren* which includes the terms adherence and adherent as keywords)?

Line 133: Please include a reference to the Covidence program.

Lines 135-138: Did you also include studies with computer-based rehabilitation for such children?

Line 143: Repetition related to Covidence.

Table and figures mentioned in the text (e.g., Table 1, line 156) are not available in the document or the PLOS ONE review system.

Lines 196-197: No study was conducted between 2005 and 2013?

Line 203: Please provide more details regarding the term adherence and how it is defined. Is it related to the "percent of suggested exercise done," or are exercise sessions done in a specific period of time? Does adherence change on a weekly basis, or is it defined as a single metric for the whole program duration? Does the duration of the program differ across the studies?

Lines 209-214: Given the issues related to the studies, how is it possible to have three studies with 9 stars (10 is the maximum grade)?

Line 208: The phrase "one was awarded 8 stars" is written twice.

Line 219: The sentence requires rephrasing.

In the section "Quality assessment of the included articles," more details related to the metrics or measures used in the studies (223-238) are needed.

Line 173: Please provide the number of the table.

Line 282: How was self-efficacy measured in those studies? The same for "low perception."

Line 260: The name of the section is "Caregiver-related factors," but parental-related factors are presented. Please explain.

In the results section, a description of the exercise sessions across the studies is needed to understand whether there are differences across the session settings. Thus, besides child/parental/therapist-related factors, program-related factors may exist too.

Reviewer #2: The manuscript presents a comprehensive review of factors influencing adherence to home exercise programs (HEP) for children with cerebral palsy, as perceived by their parents. The authors systematically searched databases up to March 2023 and included both quantitative and qualitative studies in their analysis. The findings are segmented into three main categories: child-related factors, caregiver-related factors, and therapist's guidance and advice. The review highlights the multifaceted nature of adherence to HEP, including the influence of the child's gross motor function, the caregiver's education level, depression, anxiety, self-efficacy, and the quality of therapist support.

Comments for Revision:

1. The manuscript could be strengthened by including graphical representations of the findings to better visualize the relationships between various factors and adherence. Including plots and diagrams can make the manuscript more impactful and is strongly recommended.

2. The narrative synthesis approach is well justified given the heterogeneity of the studies included. However, the authors might consider a more detailed explanation of how they addressed potential biases within the studies analyzed and the impact of study quality on the overall findings.

3. The paper acknowledges the limitations related to the quality of the included studies, such as the reliance on self-report measures and convenience sampling. It would be constructive to discuss how these limitations might affect the review's conclusions and what future research directions could mitigate these issues.

4. The results section highlights areas of agreement and disagreement among the studies reviewed. The discussion section could be strengthened by a deeper analysis of why these discrepancies might exist, considering factors such as study design, population differences, and measurement tools used.

5. Grammatical and typographical errors should be corrected to improve the readability of the manuscript.

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Reviewer #1: No

Reviewer #2: Yes: SUBHASH PRATAP

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PONE-D-23-41437R1The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic reviewPLOS ONE

Dear Dr. Niyonsenga,

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 and editors have carefully examined the revsied manuscript and found them satisfactorily. There are a few minor corrections needed as mentioned by one of the reviewers. The authors are suggested to address them for better readability of the contributions.==============================

Please submit your revised manuscript by Jul 07 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,

Jyotindra Narayan

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 #2: 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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: 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 #2: 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 #2: 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 #2: The author has revised the manuscript as per the reviewers recommendations. The manuscript can be accepted.

Reviewer #3: Thank you for submitting your work.

Here are my comments on the manuscript:

1) Introduction: Overall, please check citation formatting. Sometimes, there is space in between citation and text.

2) Material and methods: No comments.

3) Results: In table 1, there is no need to include title in first column, rather than that, I would suggest using the citation of particular paper. Also, there is too much text in table 1. Is it possible to divide table 1 into two tables or decrease the text in table 1.

4) Why are lines not numbered after line 251?

5) Title “Family Income and equipment” is not entirely in italics, is their reason for that.

6) Overall, please check your citations. In some of them, there is space and sometimes, there is not.

7) Please check for sentence errors in discussion. Line: “Therefore,, when planning treatments with families, therapists should consider their impact on adherence to these types of exercises”. Line: “It underscores the need to integrate “care “into the therapeutic equation, fostering a more holistic approach that considers the psychological, social, cultural of dimensions of rehabilitation”.

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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 #2: Yes: SUBHASH PRATAP

Reviewer #3: Yes: Alka Bishnoi

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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.

The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review

PONE-D-23-41437R2

Dear Dr. Niyonsenga,

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,

Jyotindra Narayan

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have addressed all the comments raised by the reviewers and editor. The manuscript is now being accepted. Congratulations to the authors for the quality work.

Reviewers' comments: