PONE-D-24-11202Prevalence of Lumbar disc herniation and its associated factors: a cross-sectional study in GansuPLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Partly

Reviewer #2: No

Reviewer #3: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

Reviewer #3: No

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

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Reviewer #1: Thank you for the opportunity to review the manuscript titled "Prevalence of Lumbar disc herniation and its associated factors: a cross-sectional study in Gansu." This manuscript addresses an important public health issue by providing valuable epidemiological data on the prevalence of lumbar disc herniation (LDH) and its associated factors in Gansu, a region with unique geographic and demographic characteristics. The study's findings contribute significantly to our understanding of LDH and offer insights that could inform effective prevention and intervention strategies in similar regions.

Abstract:

Background and Objective:

Comment: The objective is clearly stated. However, the first sentence could be rephrased for better readability: "The prevalence rate of LDH and its influencing factors in Gansu is unclear. This study aims to analyze the prevalence of LDH and its influencing factors in Gansu."

Methods:

Comment: The methods section is concise and clear. Ensure that the sentence "A stratified multi-stage random sampling method was used obtain representative samples" includes the missing "to" after "used."

Results:

Comment: The results section is detailed but should be made more concise. For example: "The total number of surveyed individuals was 4545, with a prevalence rate of 22.77% for LDH."

Conclusion:

Comment: The conclusion is clear but could be slightly rephrased for clarity: "The prevalence of LDH was high, varying significantly with latitude, gender, and nationality, indicating potential lifestyle and demographic influences."

Introduction:

Comment: The introduction provides a good background but could be more focused.

Grammar: Correct "e.g.," to "e.g.," and ensure all citations are properly formatted.

Content: The statement "As Gansu is located in Northwest China, with a complex geographic location, variable climate, and unbalanced socioeconomic development" could be split into two sentences for clarity.

Materials and Methods:

Study Population:

Comment: The study population section is comprehensive. However, the sampling process description can be more concise.

Grammar: Correct "used obtain" to "used to obtain."

Data Collection and Definition:

Comment: This section is detailed but ensure consistency in listing variables (e.g., "Gender (male or female)" and "age (<=35 years, 35-49 years, 50-64 years ≥ 65 years)").

Grammar: Correct "central obesity as" to "central obesity, as."

Statistical Methods:

Comment: The statistical methods section is clear and appropriate. Ensure all terms (e.g., "Mann–Whitney U-test") are consistently formatted.

Results:

Comment: The results section is thorough but could benefit from clearer subheadings and more concise text.

Grammar: Ensure consistency in using past tense for describing results (e.g., "The prevalence of LDH was different in different latitudes and cities").

Tables and Figures:

Comment: Consider providing a brief description of each figure/table in the text.

Discussion:

Comment: The discussion is comprehensive but could be more focused on the key findings and their implications.

Grammar: Correct "high prevalence rate and a high disability rate in both developing and developed countries[3]," to "high prevalence and disability rates in both developing and developed countries[3]."

Content: Highlight the significance of key findings more prominently and discuss potential mechanisms and implications in greater detail.

Conclusion:

Comment: The conclusion is clear but could be slightly expanded to include practical recommendations based on the findings.

References:

General Comments:

Comment: The manuscript has several grammatical issues that need to be addressed for better readability. Consider proofreading or using a professional editing service.

Examples:

Correct "latitude –high latitude (OR=2.250)" to "latitude – high latitude (OR=2.250)"

Correct "unknow" to "unknown."

Reviewer #2: Dear Author,

"The authors aim to investigate the prevalence of Lumbar Disc Herniation (LDH) and its associated factors in Gansu, a region where this information is currently lacking. I appreciate the effort that has gone into this study. However, I must point out several significant concerns that need to be addressed before the paper can be considered for publication. As it stands, the paper does not meet the quality standards required for publication in this journal.

One of the most significant limitations of this study lies in the method used to diagnose LDH. The reliance on self-reported symptoms, where patients simply indicate the presence or absence of LDH, is a major concern. This approach is highly subjective, as many individuals may attribute any type of back or leg pain to LDH, regardless of the actual underlying cause. Conversely, patients with a previous LDH diagnosis might experience current symptoms unrelated to their herniated disc. Consequently, this methodology raises doubts about the accuracy of the LDH diagnoses and the reliability of the results in identifying associated factors.

Given this methodological limitation, I am not confident that the study's results can accurately explain the factors associated with LDH. The current approach undermines the validity of the findings and limits the study's contribution to the field.

Reviewer #3: The authors showed great understanding of the subject matter. The authors showed impressive empirical evidence and makes an original contribution to the subject matter. However, the manuscript need to well written to make it easier to read.

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Reviewer #1: No

Reviewer #2: Yes: Nuray ALACA

Reviewer #3: No

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Prevalence of Lumbar disc herniation and its associated factors: a cross-sectional study in Gansu

PONE-D-24-11202R1

Dear Jihong Hu,

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.

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Kind regards,

Md. Feroz Kabir, BPT, MPT, MPH, BPED, MPED

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: