PONE-D-24-08333Brace compliance process in adolescents with spinal deformities: a qualitative studyPLOS ONE

Dear Dr. Ranjbar,

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Additional Editor Comments:

 According to reviewers a major revision is needed before the publication.

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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: No

Reviewer #2: Partly

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

Reviewer #1: N/A

Reviewer #2: N/A

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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: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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

Reviewer #1: Dear editor,

Thank you for your kind invitation to review the study entitled "Brace compliance process in adolescents with spinal deformities: a qualitative study".

I congratulate the authors for the effort they put into this study. I think it is a very important study, but there is a significant methodological problem.

Asymmetric braces are effective in the treatment of scoliosis and Milwaukee brace has not been used in the treatment of scoliosis for about 20 - 25 years. In this sense, I strongly recommend the authors to update their information.

“The Milwaukee brace has a negative influence on quality of life, physiological problems, sleep disorders and many disadvantages in the areas of body image. However, the most significant of these is its appearance, which reduces its acceptance due to cosmetic deterioration and discomfort “

It is known that braces that are designed asymmetrically, with spaces where the body can go opposite the corrective zones, are effective.

Ref: Weiss HR, Çolak TK, Lay M, Borysov M. Brace treatment for patients with scoliosis: State of the art. S Afr J Physiother. 2021 Oct 26;77(2):1573. doi: 10.4102/sajp.v77i2.1573. PMID: 34859162; PMCID: PMC8603182.

Weiss, H. R., & Kleban, A. (2015). Development of CAD/CAM Based Brace Models for the Treatment of Patients with Scoliosis-Classification Based Approach versus Finite Element Modelling. Asian spine journal, 9(5), 661–667. https://doi.org/10.4184/asj.2015.9.5.661

Weiss, H. R., Lay, M., Seibel, S., & Kleban, A. (2021). Ist eine Verbesserung der Behandlungssicherheit in der Korsettversorgung von Skoliosepatienten durch Anwendung standardisierter CAD-Algorithmen möglich? [Is it possible to improve treatment safety in the brace treatment of scoliosis patients by using standardized CAD algorithms?]. Der Orthopade, 50(6), 435–445. https://doi.org/10.1007/s00132-020-04000-9

It is also unclear why the researchers used a Milwaukee brace and not a kyphosis brace in patients with kyphosis.

I suggest the authors to redesign their study. In this age group, it is important that they receive appropriate treatment, especially during the period of rapid progression of scoliosis.

Although the efficacy levels of scoliosis braces are reported differently in different studies, the most effective braces are asymmetric braces.

Furthermore, the authors wrote that cases between 10 and 14 years of age would be included, but the average age presented in the table is older than 14 years. When the standard deviation is added, it is seen that even 17-year-old individuals are included.

The authors did not present the Cobb angles of the patients.

It was reported that children who had just started using a brace would be included in the study, but it was reported that children had been using a brace for more than 8 months.

I suggest the authors not to use abbreviations in the abstract.

Reviewer #2: The authors present an interesting on a less debated argument. The qualitative approach in considering brace compliance in AIS and SK is very unusual and give interesting and useful information.

In the present form the manuscript is not suitalble for publication and need some clarifications and revisions.

The paper is too long and of difficult reading. The methods and results section are unproportionally long if compared to discussion and introduction

The qualitative approach is main purpose of the study but it could be useful to summarize questions of the review perhaps a table reporting all the question could de add to clarify.

In reporting the obatained results a more organic approach could be useful perhaps categorising the answers and giving some final picture of the collected results.

Have the authors noted a difference in compliance between the TLSO and Milwkee users? If yes have they found a clear reason?

The discussion section has to unique and no divided in section

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Reviewer #1: No

Reviewer #2: No

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Brace compliance process in adolescents with spinal deformities: a qualitative study

PONE-D-24-08333R1

Dear Dr. Ranjbar,

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,

Raffaele Vitiello

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 #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 #2: Yes

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

Reviewer #2: N/A

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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

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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

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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 #2: satisfactory revision , all the requested points have been clarified , the general reading of the manuscript is more comprehensible.

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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: No

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