PONE-D-23-39099Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients.PLOS ONE

Dear Dr. Duncan,

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 21 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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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Jianhong Zhou

Staff 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: Yes

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: Your manuscript presents an insightful mixed-methods study comparing transplant athletes with average transplant recipients regarding physical activity barriers and facilitators. This work contributes to the understanding of physical activity in transplant recipients, a vital area of research. However, I have identified several areas that could be strengthened to enhance the clarity, rigor, and impact of your study.

Statistical Analysis and Reporting:

while the statistical methods are standard and the coding process for qualitative data appears robust, the manuscript could be strengthened by providing more detail on the checking of statistical assumptions, explaining the rationale behind the sample size, and including effect sizes and confidence intervals. Additionally, normality and homogeneity of variances.

It's not clear whether a power analysis was conducted to determine the sample size for quantitative comparisons, which raises questions about the study's power to detect meaningful differences.

Generalizability of Findings:

Consider discussing the limitations regarding the generalizability of your findings. While your study provides valuable insights, the specific nature of your sample may limit its applicability to other transplant recipient populations.

Reviewer #2: Review comments on manuscript entitled "Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients"

Comments to the Author

Thank you for the opportunity to review this study. The idea of research is very interesting, organized and well written reasonable. The authors have done great effort to accomplish this work. However, there are some comments and suggestions.

Section-by-section comments

Title: Well structured, concise and informative.

Abstract:

- It is recommended to write the abstract in sections including (background, aim, methods, results, conclusion)

- It is recommended to write 5-7 keywords in alphabetical order.

Introduction :

- Well structured

Methodology:

- Well structured

Statistical analysis:

- Well structured

Discussion:

- Well structured

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Reviewer #1: No

Reviewer #2: No

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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: Review comments.doc

PONE-D-23-39099R1Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients.PLOS ONE

Dear Dr. Duncan,

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 note that I served as the 2nd reviewer on the resubmission, and as the 2nd academic editor I did not provide feedback on the first submission. In my comments below I noted several areas where the manuscript does not currently meet the publication criteria (e.g., COREQ checklist, data availability, detail required on statistical analysis). 

Please submit your revised manuscript by Jul 25 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,

Heather Macdonald, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments:

Please note that the first academic editor on this manuscript was not available to handle the revision, so it was transferred to me. I also served as the 2nd reviewer as one of the reviewers on the first submission was not available to review the resubmission.

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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: (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 #2: Yes

Reviewer #3: Partly

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

Reviewer #2: Yes

Reviewer #3: No

**********

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: No

**********

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: Review comments on Manuscript Number: (PONE-D-23-39099R1) entitled ‘’ Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients''.

Overall, this study provides a novel approach. The idea of research is very interesting, well written and reasonable. I would like to thank the authors for their successful work to address the reviewers' comments. The authors have done great efforts to accomplish this work. They fulfilled all comments and made necessary changes throughput the manuscript. I recommend accepting the manuscript its revised form.

Reviewer #3: Please note that I did not review the initial submission. This is an interesting mixed methods study of barriers to and facilitators of physical activity in transplant athletes. The manuscript is generally well written and presents interesting findings, but I note some key points that should be addressed.

1. As per PLOS ONE guidelines, please consider including the COREQ checklist (http://journals.plos.org/plosone/s/submission-guidelines#loc-qualitative-research).

2. In their response to initial reviews, the authors provided a doi for the quantitative data. Unfortunately, the doi did not work for me and I was unable to access the data. I tried searching for ORDO without luck. Please provide the correct link/doi for the data.

3. Regarding the comparisons with data from study by Van Adrichem et al., I see that descriptive data is available for each participant in the Van Adrichem study, but for the other comparisons (e.g., % that reported physical limitations, among others) - did the authors conduct test to compare proportions? Please clarify and modify the methods accordingly. Please also clarify how effect size was determined. Is this Also, as per the paragraph on "Participant selection" in the Van Adrichem study, "the exact level of physical activity was not assessed" so it does not seem appropriate to describe that cohort as having average activity levels.

4. In the last paragraph of the introduction, the authors mention 2 study aims. Yet, the 2nd aim is not mentioned in the abstract, and I did not see any results presented to support this aim.

5. Figure 1 requires modifications as the axis labels do not accurately describe the data presented - is this meant to be the % of TxA who reported barriers/facilitators?

Additional comments

1. Abstract, Aim: Consider modifying the description of the study population ("physically active transplant recipients") to more accurately describe the group (transplant athletes) as is used elsewhere in the manuscript.

2. Abstract, Aim: Use past tense - change analyses to analysed. Similarly change the aims in the introduction to past tense (The first aim of this study was to...").

3. What is meant by "visual artefact"? Please consider including the "visual artefact" in the manuscript or as supplemental material. Perhaps it could be included with the interview guide.

4. Line 63: Change the wording of "...recipients indicated to..."

5. Line 83: Gender refers to Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people - please clarify how gender was assessed in this study.

(https://researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-6)

6. Line 160: How did the authors determine the training intensity of the TxA that didn't volunteer for an interview?

7. Line 164: Remove the period after size.

8. Lines 452-453: Please provide references to support the statement about the wider transplant community and the adult population in general.

9. Lines 466-468: Similar to my comment above, data to support the 2nd aim was not presented in the results. Hours of training are mentioned on line 199, but this doesn't appear to be specific to the time of the WTG.

10. Line 484: Change IronMan to Ironman

11. Line 506: Please modify the wording of "...an whether in line..."

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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

Reviewer #3: No

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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.

Attachments

Attachment

Submitted filename: comments.doc

PONE-D-23-39099R2Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients.PLOS ONE

Dear Dr. Duncan,

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 addressing my comments. I noted a few additional points below that require clarification. 

Please submit your revised manuscript by Aug 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,

Heather Macdonald, Ph.D

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 #3: (No Response)

**********

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 #3: (No Response)

**********

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

Reviewer #3: (No Response)

**********

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 #3: (No Response)

**********

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 #3: (No Response)

**********

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 #3: Thank you for responding to my comments. There remain a few issues to be addressed:

1. Unfortunately, the COREQ checklist was not included with the PDF submission. Please also consider referring to all supplementary files as such in the manuscript rather than using the term "Appendix".

2. Apologies for my confusion, but I am still unclear how the authors obtained the data from the Van Adrichem et al. study that was used to conduct the Mann Whitney U tests. The authors provide the data for the TxA in an excel file - do they have a similar file for the Van Adrichem study? Please clarify in the manuscript.

3. If a specific question about gender was not asked, please change gender to sex throughout the manuscript, as male/female are categories used to describe sex not gender.

4. Regarding the training intensity of the TxA that didn't volunteer - please include the information about Strava in the manuscript.

5. Regarding Figure 1 - sorry to harp on this, but I still feel that the figure title could be modified to more clearly reflect what is presented. The figure shows a scatterplot of the proportion of TxA that reported barriers to and facilitators of to PA. I feel it is important to clarify the proportion aspect - it is not a scatterplot of just barriers and facilitators on their own. Also, in the figure, the title at the top is not needed since you have a figure caption. Consider also using different colours or perhaps symbols for the type of transplant. It is not possible to distinguish between the heart and kidney participants, and the bone marrow circles are also difficult to distinguish with the black outline.

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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 #3: No

**********

[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.

Barriers and facilitators to physical activity: a comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients.

PONE-D-23-39099R3

Dear Dr. Duncan,

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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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,

Heather Macdonald, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: