The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden–The CAMP cohort study

Emmanuel Aboagye; Eva Skillgate; Nathan Weiss; Iben Axén

doi:10.1371/journal.pone.0308945

Peer Review History

Original SubmissionMarch 12, 2024
31 May 2024 Decision Letter - Jenny Wilkinson, Editor PONE-D-24-08211The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden – the CAMP cohort study.PLOS ONE Dear Dr. Aboagye, 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 15 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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Additional Editor Comments: Thank you for your submission, reviewers' reports are provided and both reviewers have commented on the quality of the work. They have also provided some suggestions for strengthening the work and you are invited to consider these as revisions to your manuscript. [Note: HTML markup is below. Please do not edit.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. 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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: Thank you for your manuscript and contribution to this body of knowledge. There are a few helpful details that would support your readers. 1. In the background, presenting specifics or examples of the voluntary recommendations would give context to the results. 2. A rationale for the use of a dichotomy when the original scale only had one 'no' options would prevent readers from questioning this decision. Reviewer #2: The study is sound, robust in the business review, though there is a big opportunity being missed here (I think...). This data is a significant opportunity to compare to data from other areas, the USA, Australia, Continental Europe, Asia etc... What was business reduction in other countries in the same time period? Specific comparison to manual therapy only may not be able to made, but the economic downturn globally was massive. This study shows this Sweden it was minimal, controlled, and adaptable under less stringent government policy and the long term public health impact may have been to the better. Make the comparison as an additional component of the study. From the title there is the opportunity to show the limited impact in Sweden, not just the impact in Sweden without comparison. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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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: PONE-D-24-08211_cwm.pdf https://doi.org/10.1371/journal.pone.0308945.r001
Revision 1
14 Jun 2024 Author Response Response to Reviewers’ comments Thank you for considering our submission. The authors have gone through the reviewers' reports and have address the comments on the work which the authors believe has improved the quality of the work. The authors thank the reviewers for their suggestions for strengthening the work. Reviewer #1: Thank you for your manuscript and contribution to this body of knowledge. There are a few helpful details that would support your readers. 1. In the background, presenting specifics or examples of the voluntary recommendations would give context to the results. Thank you for the comment. The authors have presented specific examples of the voluntary recommendations in the introductory paragraphs to provide context to the results. ‘‘Sweden's approach to COVID-19 differed from many other countries, as it did not enforce nationwide lockdowns and imposed fewer and less stringent restrictions. The response involved implementing various measures throughout the pandemic to control the virus's spread and lessen its impact on healthcare, individuals, and businesses. Sweden's strategy focused on non-binding restrictions, emphasizing personal responsibility through practices like social distancing, hand hygiene, and self-isolation when experiencing mild symptoms. Additional guidelines included remote work, virtual schooling, essential-travel-only policies, and limitations on public gatherings. The main authority overseeing Sweden's COVID-19 protocols was The Public Health Agency of Sweden, with regional directives also in place to manage local outbreaks, if needed.’’ 2. A rationale for the use of a dichotomy when the original scale only had one 'no' options would prevent readers from questioning this decision. The authors believe the reviewer is referencing the question asked to participants to comment on the following statement: “Official recommendations have interfered with clinical practice”, with the answer alternatives: “Not at all”, “Yes, to some degree”, “Yes, to a moderate degree”, “Yes, to a large degree”, and “I have not been clinically active during the COVID-19 pandemic”. The variable was later dichotomized by categorizing all the ‘‘yes-responses’’ into 1 = ‘‘yes’’ and “Not at all” to 0 = ‘‘no’’. The decision to dichotomize the variable is conceptually clear. All responses indicating any degree of interference with clinical practice ("Yes, to some degree", "Yes, to a moderate degree", "Yes, to a large degree") were grouped together as a "yes" response, indicating some level of disruption. The "Not at all" response was categorized as "no", indicating no disruption. All "yes" responses share the common characteristic of indicating disruption, which justifies treating them as a single group. This dichotomization simplifies the analysis and interpretation by focusing on the presence or absence of disruptions. The authors think that this needs to be addressed briefly in the discussions of potential limitations in the manuscript. Reviewer #2: The study is sound, robust in the business review, though there is a big opportunity being missed here (I think...). This data is a significant opportunity to compare to data from other areas, the USA, Australia, Continental Europe, Asia etc... What was business reduction in other countries in the same time period? Specific comparison to manual therapy only may not be able to made, but the economic downturn globally was massive. This study shows this Sweden it was minimal, controlled, and adaptable under less stringent government policy and the long term public health impact may have been to the better. Make the comparison as an additional component of the study. From the title there is the opportunity to show the limited impact in Sweden, not just the impact in Sweden without comparison. Thank you for the comment. The authors agree with the reviewer that comparing the data to data from other areas including the USA, Australia, Continental Europe, Asia etc. concerning business reduction in the same period would have been better. However, that opportunity is limited for this study since the authors do have any other data from other countries or the continent. The authors have included a paragraph to highlight comparison with previous research. ‘‘The study is one of the few to investigate the economic impact of the COVID-19 policy restriction on businesses, and the strategies adopted by businesses and employers. Public health policies put in place during the COVID-19 pandemic have been assessed for their effectiveness in reducing transmission and minimizing health outcomes like death [21]. Limited research discusses the association between COVID-19 policy restrictions and economic impact, though not thoroughly examined. A descriptive study across eleven countries showed how chiropractors used innovative strategies such as telehealth and outreach to communicate and care for patients [12]. A global survey found that most chiropractors (85%) followed regulatory advice by using telehealth, personal protective equipment, and other measures in their practice [11]. Economic support such as wage and business subsidies were also mentioned, which were accessible in certain countries like Canada, Sweden, to help businesses and employers cope with costs and job losses. Although, the findings in the previous research are consistent with our findings in terms impact and strategies adopted by businesses and employers further research needed on global impact of manual therapists during pandemics. This information could advise government bodies and professional associations that manual therapists can implement a multifaceted strategy to provide financial support initiatives during future pandemics. These efforts have the capability to empower business owners, strengthen their resilience, and foster growth in the face of ongoing challenges.’’ Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0308945.r002
2 Aug 2024 Decision Letter - Jenny Wilkinson, Editor The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden – the CAMP cohort study. PONE-D-24-08211R1 Dear Dr. Aboagye, 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, Jenny Wilkinson, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0308945.r003
Formally Accepted
8 Aug 2024 Acceptance Letter - Jenny Wilkinson, Editor PONE-D-24-08211R1 PLOS ONE Dear Dr. Aboagye, 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 Jenny Wilkinson Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0308945.r004

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