PONE-D-25-11037Prevalence and predictors of Biker’s hand syndrome among the professional bike riders in Bangladesh: A cross-sectional studyPLOS ONE

Dear Dr. Sohel Ahmed,

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 21 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.

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,

Nik Hisamuddin Nik Ab. Rahman

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

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

[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?

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: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

**********

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

**********

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 cross-sectional study investigates the prevalence and predictors of Biker’s Hand Syndrome (BHS) among 630 professional ride-share motorcyclists in Bangladesh. Using the Cornell Hand Discomfort Questionnaire, it reports a high prevalence of hand discomfort (58.3% right, 51.3% left) and identifies significant associations with age, BMI, years of riding, engine capacity, grip suitability, and bike-body fit. The study is methodologically sound, with appropriate sampling and statistical modeling. It addresses a research gap by focusing on hand-specific musculoskeletal disorders in a developing country occupational setting. Its practical implications are clear—highlighting ergonomic risk factors that could inform health policy, rider training, and bike design. However, the reliance on self-reported symptoms without clinical validation limits diagnostic certainty, and factors like comorbidities or road conditions were not explored. Despite these limitations, the findings offer valuable direction for ergonomic interventions and occupational health strategies in the ride-sharing sector.

A few major issues need to be addressed before publication.

1. Lack of Clinical Validation of Biker’s Hand Syndrome: While the authors acknowledge using a self-reported questionnaire, they do not explicitly discuss the limitation of lacking clinical or neurological confirmation (e.g., no physical or diagnostic assessment to differentiate BHS from other hand disorders). This remains a significant methodological limitation.

2. Omission of Confounding Variables: The study does not mention or control for comorbidities such as diabetes, arthritis, or history of repetitive hand use, which could influence symptom reporting. These are important omissions that were not addressed in the limitations.

3. No Justification for Right vs. Left Hand Modeling Strategy: Although right and left hand data are reported separately, the rationale for modeling them independently is not discussed, and inter-hand correlation is not addressed. This may affect interpretation of results.

A few minor issues need to be addressed before publication.

1. Terminology and Clarity: “Biker’s Hand Syndrome” is treated as a distinct condition without formal clinical recognition. A brief clarification of the term’s novelty or how it relates to established conditions (e.g., hand-arm vibration syndrome) would improve clarity.

2. Formatting and Typographical Issues: Minor inconsistencies remain (e.g., “echo friendly” instead of “eco-friendly”), but these are easily corrected.

3. Limited Depth on Preventive Strategies: Although prevention is mentioned (e.g., bike fit, stretching), these suggestions are not supported with specific references or actionable guidelines, making the recommendations feel superficial.

4. Lack of Visual Summary: A flowchart of the sampling and data analysis procedure or a forest plot summarizing regression findings would improve accessibility, especially for visual readers.

5. CHDQ Validation Context: The CHDQ is cited, but its cultural adaptation and validation for Bangladeshi riders is not explained. This should be clarified to support its use in this specific context.

Formatting and spelling issues:

1. Line number: Please add line number to help the reviewer to read and locate the issues

2. echo friendly (pdf p.15, article p.9, Survey administration section): should be eco-friendly

3. hand gripper that provides comfort (abstract and conclusion): it would be better “comfortable hand gripper”

4. MBI (pdf p.20, article p.14, Discussion): BMI

5. affirmative or negative response (pdf p. 12, article p.6, Ethical consideration section): it would be better “consent or decline”

Reviewer #2: Review Comments to the Author

The manuscript presents a timely and relevant study on the prevalence and predictors of biker’s hand syndrome among professional motorcycle riders in Bangladesh—a growing occupational group facing significant musculoskeletal challenges. The topic is important from both public health and ergonomic perspectives, particularly in low- and middle-income countries where ride-sharing services are expanding rapidly. The study design, data collection methods, and statistical analyses are generally sound, and the findings offer valuable insights into a largely understudied occupational health issue. However, several revisions are needed to improve clarity, methodological transparency, and scientific rigor before the manuscript can be considered for publication.

The Introduction effectively establishes the context of motorcycle use in Bangladesh and defines biker’s hand syndrome with reference to pain, discomfort, and functional impact. The justification for the study is reasonable, highlighting a gap in the literature regarding professional riders. However, the claim that “no study has yet been conducted on this serious issue” is likely an overstatement. While the specific focus on ride-sharing riders in Bangladesh may be novel, similar conditions have been studied in cyclists and motorcyclists elsewhere. A more precise statement—such as “no prior study has specifically investigated hand discomfort among professional ride-sharing riders in Bangladesh”—would be more accurate and defensible. Additionally, the introduction would benefit from a clearer conceptual framework linking individual, occupational, and environmental factors to the development of hand syndrome.

The Methods section is generally well-structured, but several improvements are needed. First, the definition of “professional biker” requires clarification. Does this term refer exclusively to ride-sharing drivers (e.g., Pathao, Uber), or does it include other types of motorcycle-based workers? A clear operational definition (e.g., income source, daily riding hours) should be provided. Second, while the use of two-stage cluster sampling is appropriate, the process of randomization is not sufficiently detailed. Please specify how clusters (e.g., bus stations, markets) were selected—was a sampling frame used, or was selection based on convenience? Third, although the Cornell Hand Discomfort Questionnaire (CHDQ) was used, only the presence/absence of pain was reported, not severity or frequency. This limits the depth of analysis. Please justify this decision and clarify whether the full CHDQ was administered. Additionally, while back-translation was performed, there is no mention of pilot testing results or reliability assessment (e.g., Cronbach’s alpha) in the target population, which is essential for validating translated instruments.

The Results section is comprehensive and well-presented, with clear reporting of descriptive statistics, prevalence rates, bivariate associations, and multivariable regression models. The separate analysis of right and left hand symptoms is clinically meaningful. However, several issues require attention. First, the dependent variable in the logistic regression—“presence of pain in any of six hand regions”—should be explicitly defined in the text or in a table footnote. Second, while adjusted odds ratios (aOR) and 95% CIs are reported, p-values for each predictor are missing. These should be included for full transparency. Third, model fit statistics (e.g., Hosmer-Lemeshow test result, p-value) and multicollinearity diagnostics (e.g., VIF values) should be reported to support the validity of the regression model. Fourth, the finding that normal BMI is associated with higher odds of hand syndrome compared to obesity is counterintuitive and requires careful interpretation in the Discussion—possibly due to confounding or differential exposure patterns.

The Strengths, Limitations, and Future Recommendations section acknowledges key limitations, including the cross-sectional design and inability to infer causality, which is commendable. However, the claim that the findings are generalizable to the “entire nation’s populace” is inaccurate and should be revised. The study was conducted in only two metropolitan areas and among a specific occupational group, limiting broader applicability. Instead, the authors should emphasize urban generalizability and suggest future studies in rural or semi-urban settings. The omission of road surface quality and traffic conditions as measured variables is a valid limitation, as these factors significantly influence hand vibration and strain. Future studies should consider incorporating objective or self-reported measures of these environmental exposures.

Finally, the future research recommendations are somewhat generic. To enhance impact, they should be more specific and actionable—such as recommending longitudinal designs to assess symptom progression, or intervention studies evaluating ergonomic modifications (e.g., handlebar design, glove use). Comparative studies with non-professional riders or other transport workers could also deepen understanding of occupational risk factors.

Minor issues include repetitive phrasing, inconsistent use of terms (e.g., “pain, ache, or discomfort”), and lack of a figure showing the CHDQ hand map (regions A–F). Including such a figure would greatly improve clarity. Additionally, ensure all statistical software (e.g., SPSS, R) and version numbers are reported.

In summary, this is a valuable contribution to occupational health research with strong potential. With the suggested revisions—particularly in clarifying methods, improving statistical reporting, refining interpretations, and enhancing future directions—the manuscript will be well-suited for publication in an international journal.

**********

6. 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:  Pu-Chun Mo

Reviewer #2: 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 . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Introduction.pdf

Prevalence and predictors of Biker’s hand syndrome among the professional bike riders in Bangladesh: A cross-sectional study

PONE-D-25-11037R1

Dear Dr. Ahmed,

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,

Nik Hisamuddin Nik Ab. Rahman

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: