Dear Dr. Page,

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• Reviewer 1’s comments regarding the clarity of the sample description, relevance to French-speaking populations, and possible applications in trial recruitment.
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• All comments by Reviewer 3.

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PLOS ONE

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 [Research grant received from the Ministry of Health and Social Services of the Quebec Government]. 

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Additional Editor Comments: Please note that I have acted as a reviewer for this manuscript, and you will find my comments below, under Reviewer 3

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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?

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: I Don't Know

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: This is an assessment of PORTRAIT-10, a newly developed questionnaire for complex medical needs with the INTERMED-Self Assessment (IMSA), the Pain Catastrophizing Scale (PCS), and the Pain Self-Efficacy Questionnaire (PSEQ) in a French speaking population.

The manuscript is rigorous and well written. It seems to give a thorough analysis of the practical aspects of the questionnaire. I like the way that they have presented their analysis. It is important to note that I am not an expert in this methodology employed but, it seems to follow logical, from what I can see, likely best practice guidelines.

I do not have any general concerns about the article. It might be useful to specify that the article is relevant to the French speaking population in the title.

In the abstract on line 48, it might be nice to see the characteristics (age/pain duration, sex) specific to the respondent population only included - is this 199?

In the introduction, the authors may wish to include that this type of assessment would also have some utility in assessments for patients in trial recruitment, which is key as therapeutic interventions for patients with chronic pain are limited.

Lines 71-75 convey an important message well.

If there is any more information available on the study population this might be useful to understand the generalisability of the analysis.

Perhaps, a little more information on any real-world evidence of improving healthcare outcomes by understanding the health complexity in this way.

Do the authors have any idea why the attrition rate was high, although there are still good numbers of respondents.

Reviewer #2: Title

Current: "Reliability and validity of PORTRAIT-10, a short tool to assess complex health care needs in people living with chronic pain"

Proposed Modification: "Reliability and Validity of the PORTRAIT-10 Tool for Assessing Complex Health Care Needs in Chronic Pain Patients."

Reason: The title is clear, but removing the word "short" would result in a more concise and effective version.

Abstract

Paragraph 1 (Introduction):

Current: "Because of the multidimensional components of chronic pain (CP), individuals often present with complex biopsychosocial needs."

Proposed Modification: "Chronic pain (CP) presents multidimensional components, leading individuals to experience complex biopsychosocial needs. However, efficient tools to assess these needs remain scarce."

Reason: Adding the concept that efficient tools to assess these needs are scarce.

Paragraph 2 (Study Objective):

Current: "PORTRAIT-10 is a short tool designed to measure the complexity of patients’ needs."

Proposed Modification: "PORTRAIT-10 is a tool designed to assess the complexity of patients’ needs."

Reason: Removing the word "short," as it does not add value to the meaning.

Conclusion of the Abstract:

Current: "Further research is needed to document the psychometric properties of the instrument in large samples of individuals living with different chronic conditions including CP."

Proposed Modification: "Further research is needed to explore the psychometric properties of PORTRAIT-10 in larger and more diverse chronic pain populations and to evaluate its impact on clinical outcomes."

Reason: Adding the aspect of clinical impact to guide future research.

Introduction

Paragraph 1:

Current: "Pain is a multidimensional experience comprised of sensory, affective, and evaluative dimensions."

Proposed Modification: "Pain is a multidimensional experience encompassing sensory, affective, and evaluative dimensions, with a biopsychosocial approach being essential in the management of chronic pain."

Reason: Adding a reference to the biopsychosocial approach, which is crucial in chronic pain management.

Paragraph 2:

Current: "Failure to consider the global pain experience can negatively affect its assessment and treatment."

Proposed Modification: "Failure to consider the global pain experience often leads to suboptimal treatments, such as over-reliance on pharmacological interventions, which may not address the underlying biopsychosocial factors."

Reason: Adding the concept of suboptimal treatment, including excessive reliance on medications.

Materials and Methods

Section 2.1 (Recruitment and Participants):

Current: "The study was proposed by email to members of the Quebec Association of Chronic Pain..."

Proposed Modification: "Participants were recruited via email from the Quebec Association of Chronic Pain, and inclusion criteria included individuals aged 18 and older with chronic pain lasting more than three months. Exclusion criteria included..."

Reason: More clarity on selection criteria.

Section 2.2 (Procedure):

Current: "The survey was opened between February 16th and April 8th 2023."

Proposed Modification: "Data collection occurred between February 16th and April 8th 2023, with participants completing online questionnaires on two separate occasions."

Reason: More detail on data collection.

Results

Section 3.2 (Factor Structure of PORTRAIT-10):

Current: "The Bartlett’s test of sphericity was significant (X2(45) = 381.57, p < 0.001)..."

Proposed Modification: "The Bartlett’s test of sphericity indicated the data was suitable for factor analysis (X2(45) = 381.57, p < 0.001), demonstrating that the items on PORTRAIT-10 are sufficiently correlated to warrant factor analysis."

Reason: Adding a clear explanation for non-expert readers.

Discussion

Paragraph 1:

Current: "The exploratory factor analysis revealed a 4-factor solution that aligns with the conceptual framework of PORTRAIT-10."

Proposed Modification: "The exploratory factor analysis revealed a 4-factor solution that aligns broadly with the conceptual framework of PORTRAIT-10, although some factors, such as biological and pain-related complexity, do not perfectly correspond with the conceptual model."

Reason: More precision on the alignment of factors with the conceptual model.

Articles to cite:

Diotaiuti, P., Valente, G., Mancone, S., Grambone, A., Chirico, A., & Lucidi, F. (2022). The use of the Decision Regret Scale in non-clinical contexts. Frontiers in Psychology, 13, 945669. https://doi.org/10.3389/fpsyg.2022.945669

Diotaiuti, P., Corrado, S., Mancone, S., Palombo, M., Rodio, A., Falese, L., Langiano, E., Siqueira, T. C., & Andrade, A. (2022). Both Gender and Agonistic Experience Affect Perceived Pain during the Cold Pressor Test. International Journal of Environmental Research and Public Health, 19(4), 2336. https://doi.org/10.3390/ijerph19042336

Where to cite: The two articles should be cited in the Discussion section to support statements regarding pain experience, complexity assessment, and the role of psychological and social variables. You can cite as follows:

"As demonstrated in previous studies (Diotaiuti et al., 2022), the complexity of pain can be influenced by psychological and social factors, which are essential in understanding the biopsychosocial aspects of chronic pain."

"Furthermore, Diotaiuti et al. (2022) have shown that gender and experience with agonistic tasks can affect perceived pain, which could be relevant for understanding pain perception in the chronic pain population."

Reviewer #3: The study is methodologically sound, and the results support the validity and reliability of the instrument. The topic is highly relevant, and the tool has potential for clinical use.

I list below the points I ask you to consider:

- Better discuss how the characteristics of the sample (online, predominantly female) may limit generalizability of the results.

- Clarify the conceptual interpretation of the four factors, especially the overlap between biological and global complexity.

- Acknowledge that Cronbach’s alpha is moderate. Internal consistency ranged from marginal to acceptable (α = 0.67–0.73), and this should be acknowledged as a limitation.

- Comment on the low communalities for the support and income items and their potential need for refinement.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes:  Pierluigi Diotaiuti

Reviewer #3: Yes:  Lorenzo Righi

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Attachments

Attachment

Submitted filename: Plos one review-16-02_25.docx

<p>Reliability and Validity of the PORTRAIT-10 Tppl for Assessing Complex Health Care Needs in French-Speaking People Living with Chronic Pain

PONE-D-24-58139R1

Dear Dr. Gabrielle Page,

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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Angelo Marcelo Tusset

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors presented a fully revised version, meeting all the requested corrections and the criteria required for publication of this Journal.

After these considerations, I consider the paper accepted in its current form.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #4: All comments have been addressed

Reviewer #5: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #4: Yes

Reviewer #5: Yes

**********

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

Reviewer #4: Yes

Reviewer #5: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #4: Yes

Reviewer #5: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #4: Yes

Reviewer #5: Yes

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Reviewer #4: The authors studied chronic pain in multidimensional components. They showed PORTRAIT-10 that is a tool designed to measure the complexity of patients’ needs, documenting the psychometric properties of this tool. The manuscript is interesting and well written. Suggestion, "Conclusion" is short and needs to be improved, as well as the resolution of the figures are not good.

Reviewer #5: The authors made the corrections suggested by the reviewers, and the article can be published as is, meeting the publication standards required by the journal.

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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 #4: No

Reviewer #5: No

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