PONE-D-25-05662Factors associated with surgeon interpretation of PROM values and their prioritization of treatment based on those scoresPLOS ONE

Dear Dr. Ring,

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Academic Editor

PLOS ONE

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2. Thank you for stating the following in the Competing Interests/Financial Disclosure section: I have read the journal's policy and the authors of this manuscript have the following competing interests: David Ring reports other from Skeletal Dynamics, personal fees from Deputy Editor for Clinical Orthopaedics and Related Research, personal fees from Universities and Hospitals, personal fees from Lawyers, personal fees from Health Services and Resource Administration and Department of Justice, personal fees from Premier Healthcare Solutions, personal fees from Wolters Kluwer Health, grants from National Institutes for Health, personal fees from Everus, other fromMyMedicalHub, outside the submitted work.

Ryan Calfee receives grants from the NIMH, serves as Deputy Editor in Chief Journal of Hand Surgery and servers as Research Director American Society for Surgery of the Hand.

All other authors have no conflicts of interest to declare.

We note that one or more of the authors have an affiliation to the commercial funders of this research study: Premier Healthcare Solutions, Wolters Kluwer Health, Everus

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: Yes

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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

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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: This study explores how surgeons explain patient-reported outcome measures (PROMs) in clinical practice, and it is innovative in its topic selection. The research questions have significant clinical relevance, and the research methods are generally reasonable, but there are still several issues that require attention.

1.Lines 1-2: The title accurately reflects the study content, though it could be more concise. Consider: "Surgeon interpretation and clinical application of patient-reported outcome measures in upper extremity osteoarthritis."

2.Lines 70-94: The description of preliminary work is helpful for understanding the study development, but this section is somewhat lengthy and could be condensed.

3.Please revise the reference citation format in the manuscript.

4.The situation where full names and abbreviations such as PROMs or PROM, SOVG, etc. are used interchangeably needs to be checked throughout this manuscript.

5.Line 242: The interrater reliability finding (ICC = 0.21) deserves more prominent discussion as it suggests significant variability in PROM interpretation.

6.Lines 135�Although 67 surgeons completed 89% of the scenarios, there was a lack of analysis regarding the patterns of the incomplete scenarios and potential biases.

7.Among the 67 participants in the manuscript, 90% were male. I believe the author should consider the impact of this situation on the generalizability of the results.

8.It is suggested that the author should consider including a more diverse sample of surgeons in future research, including doctors of different genders and from different practice environments, in order to enhance the external validity of the research results.

9.The manuscript mentions that the implicit form of consent, "completion of the investigation indicates consent", poses hidden ethical risks in ethics.

Reviewer #2: The manuscript addresses an important and underexplored area; the topic is timely and highly relevant in the context of increasing emphasis on patient-centered care and shared decision-making. That said, there are several areas where the clarity, scientific precision, and logical flow of the manuscript, particularly in the results and conclusion sections, could be improved.

Line 24: The sentence is grammatically incorrect and unclear. It seems to be two thoughts merged into one.

Line 16: Typo: “associate” should be associated.

Line 64–70: Clarify timeline: Were stages sequential? Were participants the same?

Line 90-93: State clearly why the interrater reliability was assessed. What did poor ICC mean for the study design?

Line 119–124: Consider grouping the outcome variables with consistent phrasing to avoid redundancy.

Line 132: Clarify why participants were not informed of the study’s purpose was this to reduce bias? Add justification. Mention the IRB/ethics board or waiver of consent if applicable.

Line 157: It would be clearer to state “randomized patient characteristics were included as covariates.

Line 164–165: Consider citing a methodological reference that supports the practice of approximating multilevel power via simpler models.

Line 172: “Sample size used in this study seems to be sufficient” is too informal and speculative.

Line 203: “Average social deprivation” use more precise phrasing.

Line 243–244: Add specific β values or effect size examples for clarity and scientific weight.

Line 285–287: Important point about improbable score combinations. Flag this as a limitation.

Line 288: The checklist suggestion is excellent; provide an example or cite prior use in other specialties.

Line 294: “Average deprivation index” interpretation needs elaboration

Line 330–331: The phrase “rates and ratings” is vague. consider rephrasing it

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Reviewer #1: No

Reviewer #2: No

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Surgeon interpretation of patient-reported outcome measures in upper extremity osteoarthritis

PONE-D-25-05662R1

Dear Dr. Ring,

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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Kind regards,

Xindie Zhou

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #1:

Reviewer #2:

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: All comments have been addressed

Reviewer #2: 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: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: 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: Yes

Reviewer #2: Yes

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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: (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

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