Negative health impacts of navigating the healthcare system for musculoskeletal conditions: A scoping review protocol

Geneviève Jessiman-Perreault; Paige Campbell; Dawn Henley; Danika Tribo; Ania Kania-Richmond; Breda H. F. Eubank

doi:10.1371/journal.pone.0311970

Peer Review History

Original SubmissionJuly 6, 2024
15 Aug 2024 Decision Letter - Amin Nakhostin-Ansari, Editor PONE-D-24-26506Negative health impacts of navigating the healthcare system for musculoskeletal conditions: A scoping review protocolPLOS ONE Dear Dr. Eubank, 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 Sep 29 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, Amin Nakhostin-Ansari Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please provide a complete Data Availability Statement in the submission form, ensuring you include all necessary access information or a reason for why you are unable to make your data freely accessible. If your research concerns only data provided within your submission, please write "All data are in the manuscript and/or supporting information files" as your Data Availability Statement. [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: Yes 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: Yes 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: 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 #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: Excellent concept and research question. The methodology has been well thought of. A couple of main things to address: Settings was not well described and no sub-group analysis planned. Is this specific to some countires or region? The perception or consequences of navigating health system will be different for different countries. So analysis needs to be done with this lens. The search strategy is not very comprehensisve and may not pick up many MSK issues. This needs looking into. Reviewer #2: Thanks for the protocol. This looks a well thought out and detailed study protocol. Just a couple of things I wasn't sure about: 1. Is this study looking at qualitative or quantitative papers? I’m assuming both but it might be good to explicitly state this. 2. Do you have plans for regional i.e. country specific analysis? I’d be tempted to add location of cohort to your extraction sheet. You may find very interesting differences between different countries and regions due to differing social contexts. 3. The search strategy limits articles to adult populations, but I don’t think this is detailed in inclusion/exclusion criteria. What age group are you looking at? 4. Inclusion criteria 2nd para, models of health. Is this part of the inclusion criteria? It seems a little disjointed. If so I think the paper should state something like ‘the health impact described must fit within one of eight dimensions’ or ‘we define health impact as’ 5. Will you be searching the ref lists of included papers? i.e. backwards and forwards searching. Will any papers be included by expert recommendation etc? 6. Are you including people seeking medical help for traumatic injury? Your paper seems written up in the context of longer term conditions but if a study looks at emergency admissions for knee trauma or sports injury would that be included? 7. How are you dealing with more generalised conditions, such as patient seeking help for general MSK pain (most of which will fall into knee, low back and shoulder)? Are these excluded, if so it may be useful to specify that papers exploring generalised conditions which may include knee, low back and shoulder are excluded) 8. The first sentence of the discussion seems overly complex, I think it may be better as two sentences, Also are resources narrowing everywhere? If it’s a global study that assumption may not be true everywhere. This is a really interesting study and I look forward to reading the outcomes. ****** 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: Opeyemi Babatunde Reviewer #2: Yes: Martin J Stevens ******** [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. https://doi.org/10.1371/journal.pone.0311970.r001
Revision 1
27 Aug 2024 Author Response TOPIC: Review response letter MANUSCRIPT ID: PONE-D-24-26506 Dear Dr Amin Nakhostin-Ansari and Editorial Team: As per your instructions, received by email on August 15, 2024, this is our response letter accompanying the submission of manuscript (PONE-D-24-26506) to PLOS One. Below we provide a response to each point raised by the two reviewers from PLOS One, with reference to where changes can be viewed in the submitted manuscript. We thank the reviewers for their helpful review and comments and have detailed the changes made in the submitted manuscript. Editor Comment 1: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Author Response 1: We have adhered to the style requirements to the best of our knowledge. Editor Comment 2: Please provide a complete Data Availability Statement in the submission form, ensuring you include all necessary access information or a reason for why you are unable to make your data freely accessible. If your research concerns only data provided within your submission, please write "All data are in the manuscript and/or supporting information files" as your Data Availability Statement. Author Response 2: We have updated our data availability statement in the submission site to state: "All data are in the manuscript and/or supporting information files" Reviewer 1 Comment 1: Excellent concept and research question. The methodology has been well thought of. A couple of main things to address: Author Response 1: We thank the reviewer for their encouraging comment and for taking the time to provide a review of our manuscript. Reviewer 1 Comment 2: Settings was not well described and no sub-group analysis planned. Is this specific to some countires or region? The perception or consequences of navigating health system will be different for different countries. So analysis needs to be done with this lens. Author Response 2: We have included a new category in our extraction template to chart each paper based on study setting (e.g., acute, primary, community) and location of study (e.g., region, country). These changes are located on page 15, Table 2, lines 152-153 and page 16, line 159. Reviewer 1 Comment 3: The search strategy is not very comprehensisve and may not pick up many MSK issues. This needs looking into. Author Response 3: Thank you for your comment and the opportunity to further explain our search strategy. We purposively selected the most common MSK conditions (low back, knee, shoulder) and those that typically require healthcare system intervention. Additionally, these three MSK conditions have been identified as priority conditions in Alberta, Canada as this scoping review will inform current initiatives of the MSK-Transformation Project of Alberta Health Services in Canada. We worked with a trained research librarian to craft the search strategy and piloted the strategy to ensure that exemplar papers we previously identified were captured in the search. Although our strategy will not capture all MSK conditions (e.g., hand, hip) we do believe it is comprehensive enough to capture papers examining the focal MSK conditions (i.e., knee, low back, shoulder). We have revised the methods (Page 6-7, lines 115-119) and limitation section (Page 17, lines 189-192) to provide more details on the search strategy and acknowledge that our strategy is not intended to capture all MSK conditions. Reviewer 2 Comment 1: Thanks for the protocol. This looks a well thought out and detailed study protocol. Author Response 1: We thank the reviewer for their kind comment and thoughtful review. Reviewer 2 Comment 2: Is this study looking at qualitative or quantitative papers? I’m assuming both but it might be good to explicitly state this. Author Response 2: The reviewer is correct; this study is reviewing both qualitative and quantitative papers. We have clarified this point in text (Page 6, lines 102-103). Reviewer 2 Comment 3: Do you have plans for regional i.e. country specific analysis? I’d be tempted to add location of cohort to your extraction sheet. You may find very interesting differences between different countries and regions due to differing social contexts. Author Response 3: We have included a new category in our extraction template to chart each paper based on study setting (e.g., acute, primary, community) and location of study (e.g., region, country). This change is located on page 15, Table 2, lines 152-153 and page 16, line 159. Reviewer 2 Comment 4: The search strategy limits articles to adult populations, but I don’t think this is detailed in inclusion/exclusion criteria. What age group are you looking at? Author Response 4: We are looking at adult populations (i.e., 18 or older). We have revised the inclusion criteria to include this criterion (Page 5, lines 83-84). Reviewer 2 Comment 5: Inclusion criteria 2nd para, models of health. Is this part of the inclusion criteria? It seems a little disjointed. If so I think the paper should state something like ‘the health impact described must fit within one of eight dimensions’ or ‘we define health impact as’ Author Response 5: We have revised the second paragraph to incorporate the reviewer’s suggested language (Page 5, lines 90-91). Reviewer 2 Comment 6: Will you be searching the ref lists of included papers? i.e. backwards and forwards searching. Will any papers be included by expert recommendation etc? Author Response 6: We will be searching the reference lists for included papers (i.e., citation chaining), we have now included this statement in the methods section (Page 13, lines 140-146). Prior to connecting with the research librarian, our team (which included bone and joint health experts) assembled a small number of exemplary papers which met the inclusion criteria. We tested the accuracy of the search strategy by checking if the exemplary papers were included within the results from the search. If not, the strategy was revised. We have now included some text in the methods section explaining this additional step (Page 6-7, lines 115-119). Reviewer 2 Comment 7: Are you including people seeking medical help for traumatic injury? Your paper seems written up in the context of longer term conditions but if a study looks at emergency admissions for knee trauma or sports injury would that be included? Author Response 7: Yes, we are including both chronic and acute MSK conditions. We have revised the manuscript to include this detail (Page 6, line 109). Reviewer 2 Comment 8: How are you dealing with more generalised conditions, such as patient seeking help for general MSK pain (most of which will fall into knee, low back and shoulder)? Are these excluded, if so it may be useful to specify that papers exploring generalised conditions which may include knee, low back and shoulder are excluded) Author Response 8: Generalized MSK pain is included in our search strategy. The rationale for this is that MSK pain is typically the reason individuals will seek healthcare and thus have to navigate the healthcare system. Many of these individuals who seek help for pain do go on to be diagnosed with an MSK condition. We have revised the manuscript to include generalized pain as part of the search (Page 6, line 110-111). Reviewer 2 Comment 9: The first sentence of the discussion seems overly complex, I think it may be better as two sentences, Also are resources narrowing everywhere? If it’s a global study that assumption may not be true everywhere. Author Response 9: We have revised the first sentence of the discussion to split it into two sentences (Pages 16-17, lines 172-177). In addition, we have provided two citations to support the narrowing of healthcare services for chronic (including MSK) conditions globally. First, we cite a WHO press release that discusses the progress of one of the World Health Organization Sustainable Development Goals: the expansion of essential health services. In this article the authors report that since 2015 there have been no improvements in access to health services for non-communicable diseases and this is in the face of increasing global populations. Second, we cite an article examining unmet need for rehabilitation using data from the Global Burden of Disease project, this article finds that need for rehabilitations has increased by 63% from 1990 to 2019 internationally. We again thank the editor and reviewers for their comments, and we hope these revisions are satisfactory. Attachments Attachment Submitted filename: PONE-D-24-26506_Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0311970.r002
13 Sep 2024 Decision Letter - Amin Nakhostin-Ansari, Editor PONE-D-24-26506R1Negative health impacts of navigating the healthcare system for musculoskeletal conditions: A scoping review protocolPLOS ONE Dear Dr. Eubank, 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 Oct 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. 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, Amin Nakhostin-Ansari 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 #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 Reviewer #3: 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 #2: Thanks for your response which answers all my queries. I believe the changes and clarifications make the paper clearer. Good luck with the study Reviewer #3: I have reviewed the manuscript with great interest and enthusiasm. The significance of the title is noteworthy, and the manuscript is presented in an appropriate format. It would benefit from minor revisions to further enhance its clarity and impact. Upon addressing these revisions, the manuscript appears well-suited for publication in PLOS ONE. - In the eligibility criteria, the manuscript mentions the use of an eight-dimension health model to define health impacts. While this is a solid approach, it would benefit from a clear definition of what constitutes a health impact in each dimension (e.g., what qualifies as a financial or environmental health impact). Include specific examples or parameters that would be categorized under each dimension of health (social, emotional, physical, etc.) to improve replicability. For instance, would loss of employment due to prolonged pain fall under financial health impacts? Clarifying these boundaries will enhance the scoping review's focus. - The manuscript emphasizes that no geographical limits will be applied to the search strategy. This global approach is commendable, but there should be consideration for regional variability in healthcare systems. Consider adding an analysis or categorization by country/region to assess if the negative health impacts vary by healthcare system structures or if not applicable, authors should discuss it in limitations. - The manuscript's search strategy focuses on the three most common MSK conditions (low back, knee, shoulder). While this focus is understandable, it might limit the scope of the review as other MSK conditions, such as hip and neck issues, are also prevalent and burdensome. - Patients with MSK conditions often have comorbidities (e.g., obesity, cardiovascular issues) that might complicate their navigation through the healthcare system. It could be beneficial if authors clarify how the review will handle studies where comorbidities are present. ****** 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: Martin J. Stevens Reviewer #3: Yes: Mohamad Mehdi Khadembashiri ******** [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: Revisions.docx https://doi.org/10.1371/journal.pone.0311970.r003
Revision 2
20 Sep 2024 Author Response TOPIC: Review response letter MANUSCRIPT ID: PONE-D-24-26506R1 Dear Dr Amin Nakhostin-Ansari and Editorial Team: As per your instructions, received by email on September 13, 2024, this is our response letter accompanying the submission of manuscript (PONE-D-24-26506 R2) to PLOS One. Below we provide a response to each point raised by the two reviewers from PLOS One, with reference to where changes can be viewed in the submitted manuscript. We thank the reviewers for their helpful review and comments and have detailed the changes made in the submitted manuscript. Reviewer 2 Comment 1: Thanks for your response which answers all my queries. I believe the changes and clarifications make the paper clearer. Good luck with the study Author Response 1: We thank the reviewer for their response and for taking the time to provide a review of our manuscript. Their suggestions contributed to a much stronger manuscript. Reviewer 3 Comment 1: I have reviewed the manuscript with great interest and enthusiasm. The significance of the title is noteworthy, and the manuscript is presented in an appropriate format. It would benefit from minor revisions to further enhance its clarity and impact. Upon addressing these revisions, the manuscript appears well-suited for publication in PLOS ONE. Author Response 1: We thank the reviewer for their encouraging comment and for taking the time to review our manuscript. Reviewer 3 Comment 2: In the eligibility criteria, the manuscript mentions the use of an eight-dimension health model to define health impacts. While this is a solid approach, it would benefit from a clear definition of what constitutes a health impact in each dimension (e.g., what qualifies as a financial or environmental health impact). Include specific examples or parameters that would be categorized under each dimension of health (social, emotional, physical, etc.) to improve replicability. For instance, would loss of employment due to prolonged pain fall under financial health impacts? Clarifying these boundaries will enhance the scoping review's focus. Author Response 2: Thank you for your comment and the clarify our chosen model of health. We have revised the manuscript to include definitions and examples of each of the eight dimensions of the health model in the newly include Table 1 on Page 5-6. Of note, upon reviewing our referred sources again, we opted to collapse financial health into a large group of “occupational health”. The reviewer’s example of loss of employment due to prolonged pain due to untreated MSK conditions would fall under occupational health impacts. Reviewer 3 Comment 3: The manuscript emphasizes that no geographical limits will be applied to the search strategy. This global approach is commendable, but there should be consideration for regional variability in healthcare systems. Consider adding an analysis or categorization by country/region to assess if the negative health impacts vary by healthcare system structures or if not applicable, authors should discuss it in limitations. Author Response 3: Thank you for this suggestion. We had previously included country/region in our extraction criteria. We have now revised our extraction criteria to include type of healthcare system (e.g., universal healthcare system, social health insurance, private health insurance, out-of-pocket system, mixed system, community-based or faith-based healthcare systems) (see Table 3, formerly Table 2 on page 15). In addition, we have clarified in our methods section our intention to conduct a stratified synthesis by type of health system to examine any differences in negative health impacts by healthcare system structure. This sentence on page 17 lines 170-173 now states, “In addition, given that we have not placed any geographic limits on this scoping review, we will examine whether there are any differences in negative health impacts, or causes of impacts, based on the type of healthcare system in place in the study setting.” Reviewer 3 Comment 4: The manuscript's search strategy focuses on the three most common MSK conditions (low back, knee, shoulder). While this focus is understandable, it might limit the scope of the review as other MSK conditions, such as hip and neck issues, are also prevalent and burdensome. Author Response 4: The reviewer is correct; this study is limited in its examination of conditions such as hip and neck issues. We purposively selected three of the most common MSK conditions (low back, knee, shoulder) and those that typically require healthcare system intervention. Additionally, these three MSK conditions have been identified as priority conditions in Alberta, Canada as this scoping review will inform current initiatives for the healthcare system in Alberta, Canada. Although our strategy will not capture all MSK conditions we do believe it is comprehensive enough to capture papers examining the focal MSK conditions (i.e., knee, low back, shoulder). We have recognized this limitation on page 18 lines 191-194. Reviewer 3 Comment 5: Patients with MSK conditions often have comorbidities (e.g., obesity, cardiovascular issues) that might complicate their navigation through the healthcare system. It could be beneficial if authors clarify how the review will handle studies where comorbidities are present. Author Response 5: The reviewer is correct, patients with MSK conditions often have comorbidities when seeking healthcare, therefore we have included an additional column in our extraction criteria on patient characteristics where these details can be extracted and summarized to provide important contextual information in the synthesis. We have revised the extraction table (Table 3, formerly Table 2 on page 15). We again thank the editor and reviewers for their comments, and we hope these revisions are satisfactory. Attachments Attachment Submitted filename: PONE-D-24-26506 R2_Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0311970.r004
30 Sep 2024 Decision Letter - Amin Nakhostin-Ansari, Editor Negative health impacts of navigating the healthcare system for musculoskeletal conditions: A scoping review protocol PONE-D-24-26506R2 Dear Dr. Eubank, 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, Amin Nakhostin-Ansari Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0311970.r005
Formally Accepted
16 Oct 2024 Acceptance Letter - Amin Nakhostin-Ansari, Editor PONE-D-24-26506R2 PLOS ONE Dear Dr. Eubank, 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. Amin Nakhostin-Ansari Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0311970.r006

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