PONE-D-24-24037Disability and pain after lumbar surgery – group-based trajectory analysisPLOS ONE

Dear Dr. Koivunen,

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Shabnam ShahAli, Ph.D.

Academic 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

Reviewer #3: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #2: Yes

Reviewer #3: No

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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

Reviewer #3: No

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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: The authors attempted to apply group-based trajectory analysis to a cohort of patients undergoing lumbar spine surgery. The topic is so interesting for rehabilitation issues, and the study was well done, that their efforts are commendable:

General comments:

1- What is your logic for analyzing and categorizing patients according to their leg pain, back pain, etc.? Is it based on the literature or did you select them exploratively? Please clarify this in the objectives of your study and also in the method.

2- Most of the study's supporting data are necessary to understand the study's results. It's better to provide them in the main text or as a figure or table.

Specific comments:

1- Abstract, p2, line 30: What does RRR stand for?

2- Introduction, p6: Please explain the objectives of the study in more detail with the rationales.

3- Material and methods, p7, line 115: Change 'logit regression model' to 'logistic regression model'.

4- Please rewrite the statistical analysis section of the manuscript. It is not clearly defined and raises so many questions for a reader.

5- Statistical analysis, p8, line 127: Why did you set the cut-off value to 10%?

6- Discussion, p15, line 241: What does PROMs stand for?

7- Discussion, p17, line 257: Please explain the probable reasons for these controversies?

8- Discussion, p17, line 267-268: What do you mean by “The register did not contain data on spinal surgery prior to the follow-up”?

9- Please define groups in Figure1, 2 &3.

Reviewer #2: Thank you for the opportunity to review this manuscript. There are some specific comments:

- Through the whole text please insert space between the statement and the reference. Also please insert the reference just after the author's name when it is applicable (for example line 54 after the name Willems et al.)

-please insert reference for the statement in line 101 and 102. Please do the same for lines 125 and 126.

Discussion:

-I would suggest explaining central sensitization as an explanation of pain maintenance even after the surgery (line 263).

Reviewer #3: The manuscript presents a well-structured observational study involving nearly 1,500 patients undergoing lumbar spine surgery, focusing on long-term outcomes such as pain relief and functional improvement over a two-year period. However, several points warrant attention:

Abstract: The background section lacks clarity and cohesion, requiring improvement. Additionally, the English writing throughout needs clarity and coherence.

Introduction: While the study's aim is clear, the background section could benefit from better cohesion leading toward the final conclusions.

Methodology: Clarification is needed regarding the administration of questionnaires to patients. The rationale behind the wide timeframe (2-4, 11-13, and 23-25 months post-surgery) for data collection should be elaborated upon. Although previous data were utilized, the specific rationale for this timeframe should be explicitly stated. Furthermore, details on how missing data were handled are crucial for assessing the study's robustness.

The study did not explore other patient-reported outcome measures (PROMs) that could provide a more comprehensive assessment of surgical success (e.g., quality of life measures, return to work). This omission and its implications should be discussed in the Discussion section.

Discussion: While the manuscript briefly compares findings with previous studies, a more comprehensive discussion integrating conflicting results and methodological differences across studies would enhance the interpretation of the findings.

The manuscript lacks exploration into potential mechanisms underlying observed associations (e.g., why higher BMI correlates with poorer outcomes). This mechanistic insight should be addressed in the discussion.

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Reviewer #1: No

Reviewer #2: Yes: Ghazal Kharaji

Reviewer #3: Yes: Sahar Boozari

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Disability and pain after lumbar surgery – group-based trajectory analysis

PONE-D-24-24037R1

Dear Dr. Koivunen,

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,

Shabnam ShahAli, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #1: (No Response)

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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 #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

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 #1: (No Response)

Reviewer #2: Yes

Reviewer #3: 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: (No Response)

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 #1: (No Response)

Reviewer #2: all comments have been addressed. please include less figures and tables in the manuscript if it is possible.

Reviewer #3: (No Response)

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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: No

Reviewer #3: Yes: Sahar Boozari

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