PONE-D-24-53797Study protocol for a systematic review with meta-analysis to compare digital stress tests regarding their psychological and physiological stress responsesPLOS ONE

Dear Dr. Rohleder

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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

Reviewer #3: 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

Reviewer #3: 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: Yes

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #2: No

Reviewer #3: No

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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

Reviewer #3: 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: As I am an academic librarian I am mostly confining my thoughts to the data collection/search strategy stage.

GENERAL COMMENTS

This paper intends to map the literature on virtual stress testing and to compare the responses provided by different tests. It is therefore not a systematic review but a scoping review. I encourage the authors to consult guides on this type of knowledge synthesis.

This change of review type has implications for the nature of the search and for the structure of the final paper.

THE SEARCH

The search strategy provided in Appendix 2 is confusingly presented, has multiple flaws, and does not appear to have been constructed logically and with clear separation of concepts. It would be very helpful if the authors could just provide the final search string in a clear way - to answer the question "What are you actually going to type into PubMed"?

For example, "Stress OR social OR reactivity OR arithmetic OR induction OR public OR speech OR strain OR challenge OR MIST OR stroop OR TSST OR social-evaluative OR threat OR psychosocial OR virtual" combines with OR a variety of different concepts, all of which are thus, of course, alternatives. Why are "virtual" and "stress" both alternatives when they are different concepts?

SEARCH-WIDE COMMENTS

1. SYSTEMATIC REVIEW ACCELERATOR: While this is a useful tool, note that it only translates SYNTAX and does not separately translate subject headings/controlled vocabulary such as between MeSH/Emtree. This is very important because automatic term mapping between MeSH/Emtree can lead to vastly overinflated search results which will be highly time-consiuming to search. The authors will also need to include a degree of manual translation.

2. CHOSEN DATABASES:

* Google Scholar. This certainly has its uses in knowledge synthesis, but clearly does not provide a discrete body of literature than can be downloaded into Rayyan. Will the authors be screening at the search stage? How will they translate their search? How will they ensure reproducibility? What is the strategy here? I strongly recommend removing this database, or noting that it was used in early stages to help with seed articles for other searches.

* CINAHL or Emcare would have been a good choice of additional database.

3. OTHER COMMENTS

* OUTCOMES: Why are you excluding conference proceedings? Part of the rationale for a scoping review is to map the state of the art of a particular field. What if a conference proceedings leads you to a later journal article you would otherwise have missed? It is particularly odd considering that you are happy to include clinical trials, presumably including incomplete trials.

* Have you deliberately decided against hand screening and grey literature searching?

* I don't understand "...which are based on an unsystematic literature search" (bottom p12). Did you start with an unsystematic search and then improve it? Or am I reviewing an unsystematic search?

OTHER COMMENTS ON SPECIFIC CONCEPT STRATEGIES

* Is the final search a combination of the sections starting ""humans"[MeSH Terms] NOT...", "digitalisation"[All Fields]..." and "stress"[All Fields]", or is it the combined search provided at the bottom?

* If it is the former, then please see the comments below.

* If it is the latter, then:

* why have all the wildcards been removed?

* why have you removed most of the subject headings?

* why are you combining "virtual" with "stress" using an OR?

* "Humans" concept: This is poorly constructed and has consequences for the search which I am sure are unintended.

* By using a NOT, the authors are removing not only articles discussing just infants etc, but also any articles discussing those ALONG WITH adults. It is a highly dangerous option and is guaranteed to remove relevant articles.

* By combining this concept with AND, the authors are removing all unindexed articles as the concept is defined using only subject headings. As articles are not always indexed quickly this will remove a significant number of recent articles of relevance. I am sure the authors did not intend for either of these consequences.

* The authors should instead employ one of the many available hedges for age group limitation, or consult an information professional/librarian with expertise in these searches.

* "Virtual/digital stress tests" concept: Clearly this is a combination of the concepts of "virtual/remote/telehealth" and "stress testing".

* "Virtual" subconcept:

* Why is the term "virtual" in the "stress" concept?

* Starting with "digital*[all fields] or digitiz*[all fields] or digitis*[all fields]" would be more concise and ensure that all terms include spellings with "s" and "z", which the authors fail to do. See https://pubmed.ncbi.nlm.nih.gov/help/#wildcards.

* For smartphones I recommend instead "exp Computers, Handheld/ OR exp Cell Phone/"

* Multiple other issues such as not including "smart phone", "smart device" etc (spaces, plus synonyms) and missing terms such as "telehealth". A check of previous systematic reviews on these subjects should have been conducted to mine appropriate search terms.

* "Stress" concept:

* The presence of terms like "stroop s"[all fields] demonstrates that the authors created this search using Automatic Term Mapping rather than actually considering the terms they used individually. This is very much not recommended for knowledge synthesis projects as it leads to searches lacking in rigour, the tool is mainly aimed at helping the lay public with searches.

* "social*"[all terms] would remove most of the noise from this search, see above.

* The authors spend much time in their excellent introduction discussing tests like V-TSST and then fail to include them in the search. Why?

* "Social behavior" is way too broad a MeSH term. Why not "Stress, Psychological"?

* Consider also "exp Psychological Tests/" combined with various stress/anxiety terms.

* Much of the remainder of the strategy for this concept OR's concepts like "psychosocial OR virtual", surely these should be AND'ed. Aren't both necessary?

FINAL RECOMMENDATIONS

In any other scientific study great care would be taken to ensure the quality of the data, and to work with an expert who can ensure that quality. Knowledge syntheses are no exception. I strongly urge the authors to engage the services of one of the librarians at their university library to assist with their search and to improve its quality, taking into account the observations above. Note that these observations are not complete and are intended to guide the authors into more wide-ranging improvements.

Because this search is inadequate, meaning that the resulting conclusions will be build on a poor foundation, I have recommended a major review. This is necessary to tackle the shortcomings of the search and ensure great rigour and reliability in the final product.

Reviewer #2: Dear Authors,

Reviewing the protocol for a new review is always an exciting endeavor, and I agree that it is a necessary step to ensure an evidence-based outcome. I would like to draw your attention to a few discussion points in your manuscript, and I hope these remarks prove helpful for your future work:

According to the statements in the text, it is unclear whether the provided draft search string is subject to further revisions or represents the final outcome. The material appears to be presented in future tense, yet the search string seems to have already been finalized.

It would be advisable to specify the study designs that will be included (e.g., RCTs, non-RCTs, etc.).

Do you plan to review grey literature? Additionally, are there any language restrictions for the studies (for example, studies written only in English)?

It might be beneficial to provide a clearer classification regarding the primary outcome of the publication. I am confident that you have a plan for this, but a more explicit description would enhance clarity.

I hope these comments will be useful as you refine your manuscript.

Reviewer #3: Overall, the manuscript is interesting and outlines a protocol for a meta-analysis or systematic review aiming to provide a comprehensive overview of various digital stress tests and to compare the elicited stress responses on both psychological and physiological levels. However, the Introduction is quite lengthy, spanning nearly seven pages. While the authors provide a thorough background, they introduce detailed descriptions of the different protocols too early. I recommend moving this detailed information to the Methods section. Additionally, the advantages and disadvantages of each protocol would be more appropriately discussed in the Discussion section. Overall, both the Introduction and the Discussion sections need to be substantially reworked, and this is the main issue with the paper in its current form.

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Reviewer #1: Yes: Martin Morris

Reviewer #2: Yes: Iuliia Pavlova

Reviewer #3: Yes: Antonia Kaltsatou

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Study protocol for a systematic review with meta-analysis to compare digital stress tests regarding their psychological and physiological stress responses

PONE-D-24-53797R1

Dear Dr. Rohleder,

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,

Efrem Kentiba, PhD

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 #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 #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 #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 #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 #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 #2: Dear Authors, thank you for detailed answers. I do not have further comments or corrections. Kind regards,

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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 #2: Yes: Iuliia Pavlova

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