Factors associated with non-specific low back pain in field hockey: A cross-sectional study of Premier and Division One players

Nick Dobbin; Craig Getty; Benn Digweed

doi:10.1371/journal.pone.0305879

Peer Review History

Original SubmissionMarch 25, 2024
30 Apr 2024 Decision Letter - Shazlin Shaharudin, Editor PONE-D-24-12011Factors associated with non-specific low back pain in field hockey: a cross-sectional study of Premier and Division One players.PLOS ONE Dear Dr. Dobbin, 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 Jun 14 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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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: No ****** 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: Given the study focuses solely on athletes, it would be more accurate to use a consistent term like "athlete" or "player" throughout the text instead of "participants." Abstract Line ‘Data collected include information on NS-LBP and participant characteristics, injury history, training related factors, and work and personal factors were obtained.’, here, omit the words ‘were obtained’. Introduction To provide the most up-to-date picture of low back pain (LBP) prevalence in different sports, it would be beneficial to update the introduction and discussion sections on prevalence with findings from a recent study by Ansari and Sharma (2023) [Ansari, S., & Sharma, S. (2023). Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study. The Physician and Sportsmedicine, 51(4), 361–370. https://doi.org/10.1080/00913847.2022.2108351] on chronic LBP of non-specific originin university athletes. Additionally, incorporating risk factors explored in this research would strengthen the introduction's overview of relevant studies on the topic. There seems to be an error in citation number eight. The author's name is listed as Frett, but it should be Fett. Please update all references and the bibliography entry accordingly Material and methods It is recommended to use sub-headings in this section, example, ethical considerations and study registration, study setting and design, participants/sample size/eligibility criterion, data collection/questionnaire, statistical analyses, etc. Were the data from the pilot testing version included in the present study? What measures were used to depict the data, mean (SD)/ n (%), add details of these in the statistical analyses part. How were the variables fit into a univariate regression, was a significant correlation test was used to ascertain its inclusion in the univariate regression? Add details in the statistical analyses section on how the categorization of the variables was done for analyses. Results It is recommended to provide some of the basic demographic data in terms of mean (SD). Discussion Lines 260-271: Add findings from the studies: Moradi V, Memari A-H, and ShayestehFar M, et al. Low back pain in athletes is associated with general and sport specific risk factors: a comprehensive review of longitudinal studies. Rehabil Res Pract. 2015;2015 2015:850184 . DOI:10.1155/2015/850184. Wilson F, Ardern CL, Hartvigsen J, et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-Analysis. Br J Sports Med. 2021;55(11):601–607. Lines 318-323, To understand how sleep might influence LBP risk across different sports, it's worth including sport-specific results from the below mentioned study on sleep and LBP: Ansari, S., & Sharma, S. (2024). Sleep Status and Chronotype in University Athletes with and without Chronic Low Back Pain: A Cross-Sectional Study. Sleep Science. Reviewer #2: Abstract: in method, please state study design, sampling method. Include how many club involved for 194 participants keyword: add low back pain Introduction: line 100 after field hockey (ref) materials and method: Please add exclusion criteria Please specify the statistical test Result: please include P value in Table 1 Table 1= referent or reference? line 168-169 the sentence is not clear ****** 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. 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Revision 1
29 May 2024 Author Response Response to Reviewers General Comments We thank the reviewers for their time and effort reviewing our manuscript. We are pleased that you both felt we have produced a technically sound paper that is well-written and used appropriate statistical analysis. In response to the “No” concerning data availability, we do intend to provide a DOI to the data upon acceptance. This was stated in our initial submission. We provide a point-by-point response below to the valuable feedback you have provided. Thank you Reviewer #1: Given the study focuses solely on athletes, it would be more accurate to use a consistent term like "athlete" or "player" throughout the text instead of "participants." We thank the reviewer for their feedback here. We would prefer to use the term participants to ensure we are in accordance with the phrasing used in the PLOSone guidelines. Also, we do highlight that the term participant is generally preferred by those who are voluntarily participating in a research study. Abstract Line ‘Data collected include information on NS-LBP and participant characteristics, injury history, training related factors, and work and personal factors were obtained.’, here, omit the words ‘were obtained’. Thank you, this has been omitted. Introduction To provide the most up-to-date picture of low back pain (LBP) prevalence in different sports, it would be beneficial to update the introduction and discussion sections on prevalence with findings from a recent study by Ansari and Sharma (2023) [Ansari, S., & Sharma, S. (2023). Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study. The Physician and Sportsmedicine, 51(4), 361–370. https://doi.org/10.1080/00913847.2022.2108351] on chronic LBP of non-specific originin university athletes. Additionally, incorporating risk factors explored in this research would strengthen the introduction's overview of relevant studies on the topic. Thank you for the suggestion. We have opted not to include this research study in the section on prevalence as we have placed the emphasis on high quality articles that have synthesised results that represent a wide range of athletic groups, ages etc. We don’t feel going specific to university-level athletes across 6 sports with the prevalence representing chronic LBP is appropriate here. Indeed, the prevalence reported in this paper is 7.7 to 15.6% which is considerably lower than the 44% in this study and 33-67% elsewhere. When discussing field-hockey specifically, we have referenced the only hockey papers available. In terms of the risk factors, it’s rather tricky to incorporate this into our study given the focus on chronic pain as noted above. It’s not clear if an association with chronic LBP can be extrapolated to make inferences for a single (or multiple) incidents of LBP over a 12-month period. For example, in Jonsdottir et al. (2019) study, they found that deprivation, gender and vigorous exercise was associated (positively or negatively) with chronic LBP but not acute LBP. Whilst other risk factors were more consistent for acute and chronic, the magnitude was substantially difference in some cases (e.g., 65+ years). As such, drawing comparisons between the study by Ansari and Sharma (2023) with our study could be problematic and best avoided in our opinion. Jonsdottir, S., Ahmed, H., Tómasson, K. and Carter, B. (2019). Factors associated with chronic and actue back pain in Wales: a cross-sectional study. BMC Musculoskeletal Disorders: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2477-4 There seems to be an error in citation number eight. The author's name is listed as Frett, but it should be Fett. Please update all references and the bibliography entry accordingly Our apologies, this has now been corrected. Material and methods It is recommended to use sub-headings in this section, example, ethical considerations and study registration, study setting and design, participants/sample size/eligibility criterion, data collection/questionnaire, statistical analyses, etc. Thanks for the suggestion. We have now included three sub-heading to divide the Materials and Methods section. Were the data from the pilot testing version included in the present study? Thanks for highlighting this. We can confirm that the data from the pilot was not included; this has now been made clear in the paper. What measures were used to depict the data, mean (SD)/ n (%), add details of these in the statistical analyses part. This has now been included in the manuscript. We’ve added some additional information in the statistical analysis section and added “(n)” in Table 1 How were the variables fit into a univariate regression, was a significant correlation test was used to ascertain its inclusion in the univariate regression? As we have taken a three-phrase approach to the regression, we did not determine if “significant” associations existed using a Chi Square test and Cramér’s V to construct the model. There were several reasons for this decisions: 1). We sought to take a theory-derived approach to the justification rather than purely statistical. As such, we allowed the associations to emerge without preliminary testing. 2). The approach of running a univariable and multivariable model before constructing a final model is regarded as best practice and will likely control for redundant variables caused by high collinearity. We also considering this to be particularly suitable when considering the number of independent variables in this study. 3). We did not wish to include or exclude variables based on associations and “significance” as this is recognised as limiting in exploring the association between risk factors and disease/pain/conditions etc. It is highly likely that this approach means removing variables at a univariable level despite potentially providing clinically useful information when placed in a multivariable or the final model. 4). Some grouping such as playing position had small sample sizes and were slightly underrepresented. As such, this low statistical power in a simple test of association could result in misleading conclusions. Add details in the statistical analyses section on how the categorization of the variables was done for analyses. We have included some insight on how the categories were formed in the ‘Data Collection and Questionnaire Development’ section and referred the reader to Table 1 rather than listing all of these in the Methods. We hope this is OK. Results It is recommended to provide some of the basic demographic data in terms of mean (SD). We cannot provide means and standard deviations as the data was collect as categorical data. As such, the descriptive data is included in-text or in table one as absolute numbers. Discussion Lines 260-271: Add findings from the studies: Moradi V, Memari A-H, and ShayestehFar M, et al. Low back pain in athletes is associated with general and sport specific risk factors: a comprehensive review of longitudinal studies. Rehabil Res Pract. 2015;2015 2015:850184 . DOI:10.1155/2015/850184. Wilson F, Ardern CL, Hartvigsen J, et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-Analysis. Br J Sports Med. 2021;55(11):601–607. Thanks for the suggested papers. The top one has not been included as this doesn’t support provided any additional or robust evidence to support or refute the point being made in the paper. Also, we are not prepared to include a paper from a publishing company who has recently retracted 8000 papers due to their paper-mill problems. The paper by Wilson has been re-cited in this paragraph. Lines 318-323, To understand how sleep might influence LBP risk across different sports, it's worth including sport-specific results from the below mentioned study on sleep and LBP: Ansari, S., & Sharma, S. (2024). Sleep Status and Chronotype in University Athletes with and without Chronic Low Back Pain: A Cross-Sectional Study. Sleep Science. Thanks for the suggestion. We have not included this for the following three reasons: 1). This study focused on chronic LBP which is not what has been captured in our study. 2). Sleep quantity was not associated with chronic LBP as a single measure in this study. 3). We only briefly referred to this as the OR crossed 1.0, so it was not a focus of our discussion given the mixed findings. The sentence noted focuses on occupational fatigue rather than sleep quantity. Reviewer #2: Abstract: in method, please state study design, sampling method. Include how many club involved for 194 participants We have not provided the study design and sampling method. We are reluctant to include the number of clubs involved as we don’t know this accurately enough. Whilst we do know that 18 clubs agreed to share the questionnaire and participate, we did not collect club information to protect their anonymity. Therefore, it’s unclear to us if all 18 clubs are represented in the final 194 responses, and it wouldn’t be right for us to assume this. keyword: add low back pain Low back pain is captured in the title, so we are unsure why this needs including as it doesn’t alter the discoverability of the work. Introduction: line 100 after field hockey (ref) Reference 6 and 7 have now been included. Materials and method: Please add exclusion criteria This has now been included. Please specify the statistical test We might require some additional direction here as we have specified that a uni- and multi-variable logistic regression model within the statistical analysis section. If this point was referring to prevalence, we have now included the equation within the manuscript. Result: please include P value in Table 1 We have now included these as superscript numbers. Table 1= referent or reference? We have opted to replace referent in the table with “ref” and then explain “ref = reference/referent category” to minimise any confusion. Our understanding is that both are acceptable within a logistic regression, but you’re correct to suggest reference is more commonly adopted. We hope this approach is acceptable. line 168-169 the sentence is not clear We have rephrased this slightly to enhance the clarity. It now reads “Finally, 20% of our sample were, at the time of completing the questionnaire, competing as an international field hockey player.” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0305879.r002
6 Jun 2024 Decision Letter - Shazlin Shaharudin, Editor Factors associated with non-specific low back pain in field hockey: a cross-sectional study of Premier and Division One players. PONE-D-24-12011R1 Dear Dr. Dobbin, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Shazlin Shaharudin Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0305879.r003
Formally Accepted
18 Jun 2024 Acceptance Letter - Shazlin Shaharudin, Editor PONE-D-24-12011R1 PLOS ONE Dear Dr. Dobbin, 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. Shazlin Shaharudin Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0305879.r004

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