PONE-D-24-11330Distance interventions for enhancing preparedness in informal caregivers of older adults: A systematic review protocolPLOS ONE

Dear Dr. Dal Pizzol,

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.

Both reviewers provided valuable insights for enhancing the manuscript. Reviewer 1 suggested clarifying the concept of "preparedness" compared to "readiness," refining the background to specify the focus on elderly caregivers, reconsidering inclusion criteria for study design, addressing potential age range issues in participant criteria, searching trial registries for unpublished literature, and revising search strategies to ensure comprehensive coverage. Reviewer 2 recommended considering studies where caregiver preparedness is a secondary outcome, clarifying search protocol details and incorporating "Citation Chaser" for reference tracking, expanding data extraction to include additional relevant information, describing how results will be organized and disseminated to address existing literature gaps, and justifying the necessity of the review in light of existing research, emphasizing the specificity of the topic and potential limitations of previous reviews. Incorporating these suggestions will strengthen the manuscript and provide a more comprehensive review of distance interventions for informal caregivers of older adults. Please see the detailed comments below and reply if any comment is not addressed.

Please submit your revised manuscript by Jun 28 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Moustaq Karim Khan Rony, RN, MSS, MPH

Academic Editor

PLOS ONE

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Additional Editor Comments:

Both reviewers provided valuable insights for enhancing the manuscript. Reviewer 1 suggested clarifying the concept of "preparedness" compared to "readiness," refining the background to specify the focus on elderly caregivers, reconsidering inclusion criteria for study design, addressing potential age range issues in participant criteria, searching trial registries for unpublished literature, and revising search strategies to ensure comprehensive coverage. Reviewer 2 recommended considering studies where caregiver preparedness is a secondary outcome, clarifying search protocol details and incorporating "Citation Chaser" for reference tracking, expanding data extraction to include additional relevant information, describing how results will be organized and disseminated to address existing literature gaps, and justifying the necessity of the review in light of existing research, emphasizing the specificity of the topic and potential limitations of previous reviews. Incorporating these suggestions will strengthen the manuscript and provide a more comprehensive review of distance interventions for informal caregivers of older adults. Please see the detailed comments below and reply if any comment is not addressed.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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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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: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In “Distance interventions for enhancing preparedness in informal caregivers of older

adults: A systematic review protocol” and the authors explained the need for systematic review on this topic. I consider that the concepts described in this manuscript are worth studying but needs some revision.

#1 The concept of “preparedness” is similar with “readiness.” However, I perceived the author's intentional use of this term. I would like a little more explanation on the intent of using this term and how it differs from readiness.

#2 Background: In your background, I am not sure why you are focusing on the caregivers of “the elderly”. It looks like that your current background explains only the needs for the effect of distance interventions for informal caregiver.

#3 Inclusion criteria: You described inclusion criteria of your study as PICOS. However, I suggest you reconsider your study design framework（c, d）. You defined your inclusion criteria of study design, dealing with only RCTs or quasi-experimental design. RCTs are designed with a randomly assigned comparison group, so that they always have a comparator. Then, it is not necessary to state whether or not there is a control group. Whereas, the quasi-experimental design implies multiple study designs, of which pre-post design is one. The section [d] describes two different concepts: whether there is a comparison group and the study design. Are interrupted time series analysis and quasi-RCTs eligible? I suggest that inclusion or exclusion be defined by a more detailed description of the study design.

#4: Inclusion criteria: You defined inclusion criteria of participant as “caregivers of older adults.” If the participants in the study you will review cross the age of 60 (e.g., 50-70), how would you cope with such a case?

#5: Search protocol: You will use seven electrical databases however it does not contain trial registries. In a systematic review, I would suggest searching unpublished literature to minimize publication bias.

#6: Search strategies (Appendix3): You made search strategies as to your concern, but the concept of search strategies is too many so that your current search strategies in the row #1 might be missing out on important study. The Cochrane Handbook for systematic reviews indicates structure of a search strategy; “(i) terms to search for the health condition of interest, i.e. the population; (ii) terms to search for the intervention(s) evaluated; and (iii) terms to search for the types of study design to be included.” In the row #1 contains the way of measurement, using proximity operator. It provably rejects some noise but misses on important studies. If you want to reject some noise, I would recommend you add the row of study types in your search strategies, as Cochrane mentioned.

Reviewer #2: The research question is well-defined, and the inclusion and exclusion criteria are thorough and appropriate. Regarding the inclusion criterion "preparedness must be an intervention outcome," it raises the question that if the study did not specifically aim to intervene upon caregiver preparedness, but caregiver preparedness changed as a secondary outcome, will the study be excluded? For 4.2 search protocol, clarity is needed on the dates of the initial and any subsequent searches, ensuring that the latest search is up to date. Using “Citation Chaser” for reference and citation tracking of all included articles during data extraction is recommended. For data extraction, other information that might be meaningful to extract include year of publication, study purpose/objective, care-recipient diagnosis/severity, care-recipient age range (pediatric vs. non-pediatric), psychometrics of measurement tools/instruments that assess caregiver preparedness (if applicable), and analytical approach (if applicable). You have briefly mentioned this in the paragraph right above your aim that “Future reviews should consider how specific components of distance interventions, such as educational materials and emotional support, impact outcomes. Additionally, they need to compare different distance approaches targeting informal caregivers of older people.” To address this gap, it could be helpful if you can briefly describe how the results will be organized in 4.10 Dissemination section. For example, is there a method that helps categorize different types of intervention (caregiver-focused intervention vs. dyadic intervention; education-related intervention vs., non-education related intervention; caregiver task-focused intervention vs., caregiver emotion-focused intervention)? It will be meaningful to compare and contrast the effectiveness of interventions within each category.

While the study design, methodology, and writing style are satisfactory, there is a hesitance regarding the novelty of the topic. Session 2.1 “Why is this review needed in light of existing reviews” is not very persuasive. The three existing reviews (citation 16-18 in the manuscript) with similar topics are not very outdated (two in 2016, one in 2020). The three reviews focused on effectiveness of interventions for caregivers of patients with different diagnosis, including stroke, dementia, and heart failure. Although I agree with the author that including both formal and informal caregivers is a huge gap to address, we still need to question how helpful this review will add into the literature if we look at the effectiveness of interventions for caregivers for all kinds of diagnosis. The patient needs, caregiver routines, caregiver tasks, and emotional stress levels for different diagnosis can be very distinctive, which may lead to very different caregiver preparedness even with same intervention. Also, the previous studies “did not exclusively consider distance interventions approaches” does not seem like a strong limitation. To get the topic more focused and comparison more meaningful, we may suggest the author to consider focusing on only one type of caregivers (or caregivers with certain level of similarity besides age) but not sure if this is their goal.

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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: No

Reviewer #2: Yes: Dingyue Wang

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PONE-D-24-11330R1Distance interventions for enhancing preparedness in informal caregivers of older adults: A systematic review protocolPLOS ONE

Dear Dr. Dal Pizzol,

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.

Reviewer raised some more concerns about this protocol; please address these issues detailed below.

Please submit your revised manuscript by Sep 01 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,

Moustaq Karim Khan Rony, RN, MSS, MPH

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.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for your careful revision. However, I could not understand only one point I have already pointed out. I would like to ask you to reconsider this point.

1. I asked you as follows;#4 Inclusion criteria: You defined inclusion criteria of participant as “caregivers of older adults.” If the participants in the study you will review cross the age of 60 (e.g., 50-70), how would you cope with such a case? And then, your reply was as follows; As stated in our revised screening form, we will not include studies that aimed to involve older adults under the age of 60. I understood this inclusion criteria. However, if your review included a study that was not age-restricted and that study conducted a subgroup analysis by age, would the results of this subgroup analysis be covered in your study? Or how would they be treated? I am sorry, but I would appreciate additional clarification.

Reviewer #2: Overall, I am pleased with the authors' response and believe this manuscript has the merit of being published. Here are a few suggestions for consideration. The authors do not need to address them now in the protocol, but the following could be helpful to think about for the full manuscript.

Database Search: It might be beneficial to search in Sociology Source Ultimate (via EBSCOhost) because caregiver preparedness is a socially constructed concept. If this search does not yield additional articles, it can be ignored. Ultimately, the authors should decide if the current seven databases are sufficient to address the research question.

Search Update: The initial search occurred in December 2023. An update before the full manuscript publication would be helpful. According to the Cochrane Handbook, "The search must be rerun close to publication if the initial search date is more than 12 months (preferably 6 months) from the intended publication date, and the results screened for potentially eligible studies."

Data Extraction: The columns for “information about caregiving” and “intervention” may contain large amounts of information, making synthesis difficult later. Consider breaking them down into more manageable pieces.

These suggestions are intended to improve the final manuscript and are not required at this stage.

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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: No

Reviewer #2: Yes: Dingyue Wang

**********

[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.

Distance interventions for enhancing preparedness in informal caregivers of older adults: A systematic review protocol

PONE-D-24-11330R2

Dear Dr. Dal Pizzol,

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,

Moustaq Karim Khan Rony, RN, MSS, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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

**********

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

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Protocol study must be described in a rigorous, and I believe this protocol meets that criteria.

I myself have had some trouble with the handling of age categories. I look forward to an excellent study following this protocol.

**********

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: No

**********