The perception of individuals with low back pain regarding reassuring information: Insights based on physiotherapists messages

Ron Shavit; Talma Kushnir; Yaniv Nudelman; Shmuel Springer

doi:10.1371/journal.pone.0323580

Peer Review History

Original SubmissionApril 10, 2025
27 Jun 2025 Decision Letter - Steve Zimmerman, Editor Dear Dr. Springer, 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. --> -->-->The reviewer's comments are available below. Could you please carefully revise the manuscript to address all comments?-->-->?> Please submit your revised manuscript by Aug 10 2025 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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Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: INTRODUCTION - well written. Some comments below. 1. lines 32-38 - would suggest using the phrase biopsychosocial approach to come in line with the language being used in research and clinical practice. The authors are essentially saying this in their writing, just would make it explicit. 2. lines 56-63 - here it appears there is one referenced statement after another. Thank you for the amount of research and references provided, it is important. However, I am curious if the authors can expand a bit in between those three referenced sentences adding how that may relate to clinical practice. Just a suggestion please. 3. Overall, the introduction is longer than I have typically seen in more recent manuscripts. However, for this particular paper, I think it is completely justified. METHODS 1. Line 134 - thematic analysis was used. Why did the authors choose thematic analysis rather than grounded theory for this study? I am not challenging, I am asking as I think readers would want to know as not everyone is familiar with these terms. 2. Lines 174-175 - inclusion criteria - self reported LBP, any LBP with or without radicular symptoms? This to me will make a difference when you are studying reassurance. Please clarify. 3. I did not see a discussion of sample size for this survey. Can the authors provide some guidance or thoughts on this and if this was considered to be able to provide a response rate? 4. Statistics are solid and clearly articulated with the objective identified for each analysis run. RESULTS Excellent summary of the results with appropriate tables and figures. DISCUSSION 1. lines 285-287 - I think this first sentence needs to have stronger language as it is critical to start the discussion. The phrase "shed light" while appropriate is not strong enough language. Please revise. I say this because the next sentence has the evidence to back up stronger language. 2. In the limitations section, I would ask the authors to consider that in this study it appears that any back back was include whether their was radicular symptoms or not. I think this is a limitation as different reassuring strategies may be needed with different types of LBP. Overall, I would like to thank the authors for this important manuscript that addresses a critical area of management in individuals with LBP. ****** 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 ******** [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 https://doi.org/10.1371/journal.pone.0323580.r001
Revision 1
9 Jul 2025 Author Response Response to reviewer’s comments on manuscript PONE-D-25-18786 We thank the editor and the reviewer for the opportunity to consider a revised version of our manuscript. We have revised the paper and incorporated the reviewer's suggestions. Below, we summarize each of the comments raised by the reviewer and present our responses. Changes are highlighted in yellow. Journal Requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: We have carefully revised our manuscript to ensure that it meets PLOS ONE's style requirements, including file naming conventions, as requested. 2. Peer review at PLOS ONE is not double-blinded (https://journals.plos.org/plosone/s/editorial-and-peer-review-process). For this reason, authors should include in the revised manuscript all the information removed for blind review. Response: As requested, we have reinserted all information that was previously removed for blind review into the revised manuscript. 3. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly Response: There are no legal or ethical restrictions on sharing the data from our study. We have uploaded the anonymized data set necessary to replicate our findings to a stable, public repository at the following link: https://lifesciences.datastations.nl/dataset.xhtml?persistentId=doi:10.17026/LS/PZJ0K5 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript Response: We have moved the ethics statement to the Methods section and removed it from all other sections of the manuscript, as requested. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Response: We have added captions for all Supporting Information files at the end of the manuscript and have updated the in-text citations accordingly to match PLOS ONE’s guidelines. 6. 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. Response: We have reviewed our reference list to ensure that it is complete and correct. No retracted papers are cited in our manuscript, and no issues were identified. 7. 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. Response: We have processed all figure files using the PACE tool and re-uploaded them after ensuring they meet PLOS requirements. Reviewer 1. Lines 32-38 - would suggest using the phrase biopsychosocial approach to come in line with the language being used in research and clinical practice. The authors are essentially saying this in their writing, just would make it explicit. Response: Thank you for your comment. We have revised the text to explicitly use the phrase “biopsychosocial approach” to align with current research and clinical practice terminology, as suggested. Please see line 43 of the revised manuscript. 2. Lines 56-63 - here it appears there is one referenced statement after another. Thank you for the amount of research and references provided, it is important. However, I am curious if the authors can expand a bit in between those three referenced sentences adding how that may relate to clinical practice. Just a suggestion please. Response: We have expanded this section to clarify how these findings relate to clinical practice, as suggested. Please see lines 63-66 and 68-70. 3. Overall, the introduction is longer than I have typically seen in more recent manuscripts. However, for this particular paper, I think it is completely justified. Response: Thank you for your comment and for your understanding regarding the length of the introduction. We appreciate your feedback and are glad to hear that the length is justified for this manuscript. 4. Line 134 - thematic analysis was used. Why did the authors choose thematic analysis rather than grounded theory for this study? I am not challenging, I am asking as I think readers would want to know as not everyone is familiar with these terms. Response: Thank you for your comment. We opted for thematic analysis because our aim was to identify and organize patterns in the data to answer specific research questions, rather than to develop a new theoretical framework, which is more in line with grounded theory. We have added a brief explanation in the Methods section explaining why we chose thematic analysis rather than grounded theory to assist readers who are unfamiliar with these terms. Please see lines 146-148 of the revised manuscript. 5. Lines 174-175 - inclusion criteria - self reported LBP, any LBP with or without radicular symptoms? This to me will make a difference when you are studying reassurance. Please clarify. Response: Thank you for your comment. Our study aimed at people with low back pain. However, it is possible that people with different clinical presentations, such as radicular symptoms, may require a different type of reassurance. Based on the reviewer's comment, we have noted this as a limitation in the Discussion. Please refer to lines 390-392 of the revised manuscript. 6. I did not see a discussion of sample size for this survey. Can the authors provide some guidance or thoughts on this and if this was considered to be able to provide a response rate? Response: Thank you for your comment. We targeted a sample size of 500 participants, which was calculated using the 95% margin of error formula with an estimated margin of error of 4.5%. We have added clarification in the Methods section. Please see lines 183-185 of the revised manuscript. 7. Statistics are solid and clearly articulated with the objective identified for each analysis run. Response: Thank you for your comment and positive feedback regarding the clarity and appropriateness of our statistical analysis. 8. Excellent summary of the results with appropriate tables and figures. Response: Thank you for your comment and positive feedback on the summary of results, tables, and figures. 9. Lines 285-287 - I think this first sentence needs to have stronger language as it is critical to start the discussion. The phrase "shed light" while appropriate is not strong enough language. Please revise. I say this because the next sentence has the evidence to back up stronger language. Response: Thank you for your comment. We have revised the opening sentence of the Discussion to use stronger language, as suggested. Please see lines 301–302 of the revised manuscript. 10. In the limitations section, I would ask the authors to consider that in this study it appears that any back pain was include whether their was radicular symptoms or not. I think this is a limitation as different reassuring strategies may be needed with different types of LBP Response: Thank you for your comment. We have added this point as a limitation in the Discussion section. Please see lines 390-392 of the revised manuscript. 11. Overall, I would like to thank the authors for this important manuscript that addresses a critical area of management in individuals with LBP. Response: Thank you for your comments and for your positive feedback on our manuscript. We appreciate your thoughtful review. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0323580.r002
31 Jul 2025 Decision Letter - Nicola Diviani, Editor The perception of individuals with low back pain regarding reassuring information: insights based on physiotherapists messages PONE-D-25-18786R1 Dear Dr. Springer, 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. For questions related to billing, please contact billing support . 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, Nicola Diviani Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: Thank you for addressing my comments. I have no further suggestions for this paper. I want to thank the authors for their work. ****** 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 ******** https://doi.org/10.1371/journal.pone.0323580.r003
Formally Accepted
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