PONE-D-23-34184Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a Meta-analysisPLOS ONE

Dear Dr. Yang,

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 Feb 18 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,

Mohammad Ali

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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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: Thank you for the review registration, however, the review was conducted very poorly and needs major corrections before it can be published. At its current stage, this review would mislead the public about the effect of Tai Chi on LBP and is, therefore, not fit for publication. I would encourage you not to rush it because this is a very important review.

ABSTRACT

1. The risk of bias and GRADE findings were not reported.

METHODS

1. Literature retrieval strategy: You need to present the complete search strategy for at least one database so that people can replicate your search terms if they intend to do so. You just presented a very rough search strategy without indicating which database it was.

2. Inclusion criteria: Did you include all comparators for this review? The comparison groups were not mentioned at all.

3. Secondary outcomes: What did you mean by the assessment of dysfunction? Did you mean disability/functional limitations?

4. How did you extract studies? How did you resolve disagreements?

5. Statistical methods: How were study groupings performed? Did you check clinical homogeneity? This is very necessary in meta-analysis.

6. Statistical methods: Could you state the criterion that informed your choice for using “fixed effect models” in the meta-analyses? You have stated the criteria for the random effect models.

RESULTS

1. You excluded 19 irrelevant studies after the full-text screening. Your readers would want to know whether the 1p papers warrant exclusion. You need to present a table of excluded studies with reasons otherwise we will not know if you have performed a thorough review.

2. Please indicate in Table 1 where the extracted studies are funded or not funded.

3. In Figure 1, what did you mean by studies included in the review (n=1) and reports of included studies (n=13)? This is not the way of reporting the PRISMA flow chart.

4. I note that you have “experimental and control groups” in your forest plots, and I understand that Tai Chi is the experimental group, however, you failed to clearly state control groups. Were you lumping all other treatments as control groups? If yes, this is not the way to do meta-analyses because you have differing comparators in Table 1 and they all can’t be lumped as “control”. If you do that you are then hiding the effects of other interventions (massage, medication, exercise etc). You need to redo all your meta-analyses.

5. Sensitivity analyses were performed but the criteria were not mentioned.

6. The way you performed the subgroup analyses is very confusing.

7. You reported adverse events, but you failed to mention this in your primary and secondary outcomes.

DISCUSSION AND CONCLUSION

1. I cannot comment on these now because there are a lot of issues with the report of this review.

2. If you choose to submit this review again, I will do a more thorough review if I am invited again.

Reviewer #2: Review of manuscript D-23-34184:

Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a meta-analysis

Thank you for the opportunity to read the presented topics. The authors addressed the important issue of analyzing the impact of various variants of Tai Chi exercises on the level of back pain.

The meta-analysis method was used for evaluation, including manuscripts published in Chinese and English.

In terms of the methodology used, the work was prepared correctly and the procedure used was also correct.

In terms of formal preparation of the work, I find some shortcomings:

1. The literature presented in table 1 (line 209) needs to be sorted, the layout should be arranged according to an ordinal variable (year of publication) and the width of the columns should be adjusted so that the data in the columns is legible. The numbering of items [37], despite explanations in the work, should be adapted to their appearance in the text.

2. The provisions regarding the presentation of analysis results in the text should be unified; please adopt uniform provisions, mainly the use or intervals between the results.

Example:

Line 147-148

Line 235-236 [WMD (95% CI) = - 0.85 (-1.10, -0.60), p < 0.000],

Proposed entry [WMD (95% CI) = -0.85 (-1.10, -0.60), p<0.000],

Line 244-246 suggested entry [WMD (95% CI) = -0.69 (-1.89, -0.50), p=0.26],

Line 272 -273

Please correct the entire manuscript in this respect, the work is an interesting aspect of the impact of Tai Chi exercises and these shortcomings largely make it illegible and less accessible to the reader.

A good example of a study is a work prepared using the same method:

Liang T, Zhang X, Wang Y et al. Intervention effect of taijiquan exercises on the ankle joint of the elderly – meta analysis. ARCH BUDO. 2023;19

Archives of Budo - Abstract (archbudo.com)

I hope that the comments I have presented will be helpful to you.

Reviewer #3: Overall Impression:

This manuscript presents a well-conducted meta-analysis investigating the efficacy of different parameters of Tai Chi for the treatment of chronic low back pain. The study design is appropriate, the data analysis is sound, and the conclusions are well-supported by the evidence.

Strengths:

Comprehensive search strategy: The authors searched eight major databases, which minimizes publication bias.

Clear inclusion and exclusion criteria: This ensures the homogeneity of the included studies and the validity of the results.

Appropriate statistical analysis: The authors used Review Manager 5.4 software, a widely recognized tool for meta-analyses, to analyze the data.

Exploration of influencing factors: The authors investigated the effects of various factors, such as Tai Chi style, intervention duration, and frequency, on the efficacy of Tai Chi.

Large sample size: The analysis included 12 randomized controlled trials with a total of 994 participants, providing strong evidence for the conclusions.

Clinical relevance: The findings of this study have significant implications for the management of chronic low back pain and provide valuable information for healthcare professionals.

Weaknesses:

Limited discussion of heterogeneity: While the authors acknowledge the presence of heterogeneity in the analysis, the discussion could be further expanded to explore the potential sources of heterogeneity and their impact on the results.

Lack of subgroup analysis for specific Tai Chi styles: The study investigated the overall effect of Tai Chi, but further analysis for different styles (e.g., Yang style, Sun style) could provide more specific guidance for practitioners.

Limited exploration of potential harms: While the study focuses on the benefits of Tai Chi, a brief discussion of potential adverse effects or contraindications would be beneficial for clinicians.

Recommendations

Minor comments

* In page 3, line 60, write in words by-avoiding the symbols

* In page 3, line 62, low back discomfort? I think the focus of the study is CLBP. Be specific and use the same terminologies consistently.

*Page number 4, line 67-70, this crucial sentence requires reference from high quality studies

*Please write the full form of PRISMA

*

Major comments

* It would be nice if you can give the complete set of keywords specific to each database as additional material

* I would suggest you to irpove the writing in the eligibility criteria section. You might avoid the numbers and write in paragraph form

* The intervention included different forms of Tai Chi, such as Tai Chi alone, Tai Chi

131 in combination with other usual treatments, or Ai Chi: in this case, how do you determine if the effect is from tai chai or from the co intervention? what if the whole effect was from the co intervention? how do you deal with this?

It is a critical issue that the review includes studies with both Tai Chi alone and Tai Chi combined with usual care (or any other co-intervention), making it difficult to disentangle the independent effect of Tai Chi on chronic low back pain. This methodological limitation can lead to an overestimation of the true effect of Tai Chi. (he articles eligibility criteria mentioned that they included all the article with tai chai alone or tai chai with usual care. I am wondering in this case, how do we know that if the real effect is from usual care or from tai chai? for example for a specific study, the total effect can be 80% and 50% contribution from tai chai and 30% from usual care. In a different study with an effect of 80% and the whole 80% can be from the usual care an dno effect from tai chai. This might give a falls assumption of that tai chai is useful than soething else. )

Here are some potential solutions to address this issue:

1. Subgroup analysis: The authors could conduct subgroup analyses to compare the effects of Tai Chi alone and Tai Chi combined with usual care. This would provide a better understanding of the individual contribution of each intervention.

2. Sensitivity analysis: The authors could perform a sensitivity analysis by excluding studies with Tai Chi combined with usual care and assess the impact on the overall results. This would help to assess the robustness of their findings to the inclusion of these studies.

3. Meta-regression analysis: The authors could conduct a meta-regression analysis to explore the extent to which the effect of Tai Chi is moderated by the presence or absence of usual care. This would provide more nuanced information about the relationship between Tai Chi and chronic low back pain.

* Secondary outcome measures were assessment of dysfunction? could you please clarify this?

*Generally, the results and discussion section looks fine to me

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Reviewer #1: Yes: Musa Sani Danazumi

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Review of manuscript D-23-34184.docx

PONE-D-23-34184R1Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a Meta-analysisPLOS ONE

Dear Dr. Yang,

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 May 11 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,

Mohammad Ali

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 #1: All comments have been addressed

Reviewer #2: (No Response)

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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: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: Yes

**********

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: Yes

Reviewer #2: No

**********

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: Thank you for addressing all my queries. Your review is now standard and I would recommend it for publication.

Reviewer #2: Thank you for the corrections you made.

However, it should be pointed out that the manuscript was not prepared with sufficient care.

The main comments are marked in the manuscript (yellow).

1 you use the "Time new Roman" font, but on lines 153, 155, 161 you use the "SimSun" font. Similarly in Table 2.

2 Table 1 requires correction - the proposal was introduced in part of the table (yellow), in the previous version the table was difficult to read.

3 introduced literature references line 212, 214, 216 are using the SimSun font.

4, the basic error indicating lack of care is the prepared list of literature. Positions 12 and 30 are repeated, as are positions 28 and 38.

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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: Yes: Musa Sani Danazumi

Reviewer #2: Yes: Kruszewski Artur

**********

[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.

Attachments

Attachment

Submitted filename: Manuscript (2).docx

PONE-D-23-34184R2Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a Meta-analysisPLOS ONE

Dear Dr. Yang,

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.

==============================

Thank you for your effort in revising the manuscript according to the reviewers' comments. However, the manuscript is not yet ready for publication. The definition of low back pain (LBP) provided by the authors is incomplete. LBP can extend throughout one or both legs, and chronic LBP and nonspecific chronic LBP are not identical. The references (ref 1, 2) do not support the definition given in the manuscript.

Readers and the scientific community may question how a group of authors could conduct such an important systematic review without knowing the correct definition of LBP and the distinction between CLBP and NSCLBP.

Corrections were expected throughout the review process.

Chronic low back pain (CLBP) and nonspecific chronic low back pain are related but not entirely synonymous terms. 

CLBP: This refers to low back pain that persists for a duration of 12 weeks or longer. It can have various causes, including injury, degenerative conditions, or underlying health issues. CLBP can be classified into specific and nonspecific categories.

Nonspecific CLBP: This term describes chronic low back pain for which a specific cause cannot be identified through medical tests or examinations. It's a diagnosis of exclusion, meaning other potential causes, such as fractures, infections, or tumors, have been ruled out.

So, while all nonspecific chronic low back pain is chronic low back pain, not all chronic low back pain is nonspecific. Some cases of CLBP can be attributed to specific identifiable causes, such as spinal stenosis, herniated discs, or inflammatory conditions.

==============================

Please submit your revised manuscript by Jun 10 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,

Mohammad Ali

Academic Editor

PLOS ONE

[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

**********

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

**********

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

Reviewer #2: 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 #2: Yes

**********

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

**********

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: Thank you for taking into account all the comments submitted earlier. I am confident that the improvements made have improved the quality of the manuscript.

**********

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: Artur Kruszewski

**********

[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.

PONE-D-23-34184R3Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a Meta-analysisPLOS ONE

Dear Dr. Yang,

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 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,

Mohammad Ali

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 #4: (No Response)

Reviewer #5: (No Response)

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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 #4: (No Response)

Reviewer #5: Yes

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

Reviewer #4: (No Response)

Reviewer #5: 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 #4: (No Response)

Reviewer #5: Yes

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

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Reviewer #4: (No Response)

Reviewer #5: 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 #4: I have reviewed the manuscript, an after considering the suggestions of three review processes, the manuscript meet methodological PLOS standards for publication

Reviewer #5: Dear Editor

Thank you for the opportunity to review this manuscript. There are some specific comments:

Abstract

- Specify the inclusion criteria for the review instead of mentioning search keywords.

- Mention the start date of the database search.

- Please either mention the names of all the databases that have been searched or delete the names of the two databases that you have mentioned.

- Specify the methods used to assess the risk of bias in the included studies.

- Mention the unit of inversion time "(> 30 and ≤ 30)". It is not clear whether it is the number of sessions or the duration of each session.

- Line 53: " Tai Chi and Tai Chi alone": Does first tai chi mean Tai Chi as an additional therapy?

Introduction

- Line 91: "In recent years in recent years". Words are repeated twice.

Method

- In line 105: Literature retrieval strategy- PICO should be considered in the search strategy. However, the outcome/ outcomes are not clear in the provided search strategy.

- Line 127, 128: "Chinese and English only". It can be written: only Chinese and English language literature were included.

Discussion

- The discussion is too long. Please summarize the text

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Reviewer #4: No

Reviewer #5: Yes: Shabnam ShahAli

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Effects of different parameters of Tai Chi on the intervention of chronic low back pain: a Meta-analysis

PONE-D-23-34184R4

Dear Dr. Yang,

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,

Mohammad Ali

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Well done. Thank you. 

Reviewers' comments: