Benefits and harms of copyright restrictions and conditions on burnout and other psychometric assessment scales

Robert G. Badgett; Sudha Xirasagar; Hayrettin Okut

doi:10.1371/journal.pone.0350023

Peer Review History

Original SubmissionDecember 8, 2025
4 Mar 2026 Decision Letter - Piotr Stec, Editor -->-->PONE-D-25-65524-->-->Benefits and harms of copyright restrictions and conditions on burnout and other clinical assessment scales--> PLOS One Dear Dr. Badgett, 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. What seems to be important to both reviewers is making the context of your research clearer to the audience from other research fields. The readership pool is potentially much wider than you assumed, and some explanations could improve the text. Another important issue raised by the reviewers is to what extent the licensing model is a decisive factor. Please submit your revised manuscript by Apr 17 2026 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 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, Piotr Stec Guest 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 2. 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. 3. 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? 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: Yes ******** -->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: I have reviewed the manuscript entitled Benefits and harms of copyright restrictions and conditions on burnout and other clinical assessment scales. This manuscript evaluates whether copyright restrictions applied to widely used clinical assessment tools may reduce their long term scientific impact by limiting reuse adaptation and scholarly development. The authors compare MEDLINE citation trends for two copyright restricted scales against four freely usable instruments using a theme relevant annual citation ratio and spline regression models through 2023. The central finding is that copyright restricted scales demonstrate declining citation ratios over time compared with permissively licensed instruments which show sustained or increasing use. The authors argue that restrictive licensing may undermine long term relevance and propose a blended copyright model permitting non commercial scholarly reuse while maintaining commercial licensing rights. The topic is timely and important particularly in light of the increasing emphasis on open science and research tool accessibility. The manuscript addresses an important and underexplored policy issue namely the downstream scientific impact of licensing restrictions placed on measurement tools used in healthcare research. The proposed conceptual mechanism in which restrictive licensing discourages derivative scholarship and thereby reduces long term uptake is logical and policy relevant. In addition the theme relevant annual citation ratio represents an innovative attempt to normalize research adoption across heterogeneous time horizons and the spline regression modeling approach described in the Methods section appears appropriate for evaluating non linear adoption trajectories across decades. However there are several important methodological and interpretive concerns that should be addressed. The primary outcome assumes that the presence of a scale name in the title or abstract reflects meaningful research use as described in the Methods section. In practice many studies employ validated tools without naming them in the abstract and derivative instruments or modified versions may not explicitly reference the original scale name. Furthermore citation practices vary substantially across journals and fields. As a result the selected metric may introduce systematic bias against older or widely internalized instruments whose usage becomes implicit over time. Although the authors acknowledge limited recall associated with title and abstract searches in the Discussion section this limitation may be more central to the validity of the study’s inference than is currently suggested. Relatedly the attribution of causality may be overstated in its present form. Observed declines in citation ratios for restricted tools may reflect construct drift evolving definitions of burnout or cognition the emergence of competing theoretical frameworks methodological shifts toward ultra brief screening tools or broader disciplinary trends such as post pandemic measurement priorities rather than copyright conditions per se. The manuscript would benefit from a more cautious causal framing or from sensitivity analyses that address innovation cycles construct fragmentation or time to replacement dynamics. The selection of comparator instruments also warrants further justification. The inclusion of APGAR and CAGE introduces heterogeneity in construct type clinical context temporal diffusion patterns and baseline institutional adoption that may limit interpretability of licensing policy effects. These instruments differ substantially from burnout or cognitive screening tools and may therefore not represent ideal comparators in this analysis. In addition there is a terminology issue that should be addressed for scholarly tone and precision. The Abstract and Introduction use the phrasing “restrictive copyrighting … with permissive copyrighting (copylefting)”. While grammatically intelligible the term “copylefting” is an informal neologism rather than a standard legal or scholarly term. In academic publishing this wording may appear advocacy oriented or imprecise. The authors may wish to consider replacing this phrasing with terminology such as “permissive licensing” “copyleft licensing” or “Creative Commons based licensing for non commercial scholarly use” in order to improve clarity and stylistic neutrality without altering meaning. There are also several minor issues that should be corrected. The Mini Mental Status Examination appears with inconsistent capitalization in several locations and the phrase “Maslach Burnout Inventory(MBI)” is missing a space. Some policy discussion in the latter portion of the manuscript would benefit from citation to empirical implementation studies rather than commentary literature. In addition the estimate that fewer than ten percent of Open Science Framework projects included a noncommercial use statement would benefit from methodological clarification. Overall this manuscript raises an important and policy relevant hypothesis but currently over attributes observed longitudinal citation trends to licensing conditions without sufficiently addressing alternative explanations. Clarification of terminology particularly replacing informal usage such as “copylefting” additional discussion of construct evolution and improved justification of comparator selection would strengthen both interpretability and scholarly tone. I therefore recommend major revision. Reviewer #2: After reading the paper proposed I have a clear idea of the idea that authors pretend to expose and emphasize. The premise and the conclusions are clear, but sometimes is needed a little bit more of exposition and divulgation to explain the former importance of the copyright publications as a reason for their choosing. Furthermore, it's not clear the non-citation aspects of the election. Many times -and this is a serious problem in the present model of researching, dissemination and academic careers- the election of one review or another is focused not only or specifically in the impact but in the prestige -former or not- of each publication. Of course, citations are the way to consolidate the academic and scientific name of a review, but many times researchers are looking for a quick curriculum feedback instead of having a medium to long-term perspective. ****** -->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:Habil. Dr. Marlena Jankowska Augustyn, Assoc. Prof. (University of Silesia in Katowice), MBA (Deakin) 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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. -->--> https://doi.org/10.1371/journal.pone.0350023.r001
Revision 1
16 Apr 2026 Author Response Editor’s comments: 1. making the context of your research clearer to the audience from other research fields a. We made edits to the abstract, introduction, and title to encourage an audience beyond healthcare. 2. Another important issue raised by the reviewers is to what extent the licensing model is a decisive factor. a. A new third paragraph in the introduction addresses this and notes there is little know about the content creator’s decision – and whether the creator or the creator’s employer makes the decision. Reviewer 1: 1. I have reviewed the manuscript entitled Benefits and harms of copyright restrictions and conditions on burnout and other clinical assessment scales. This manuscript evaluates whether copyright restrictions applied to widely used clinical assessment tools may reduce their long term scientific impact by limiting reuse adaptation and scholarly development. The authors compare MEDLINE citation trends for two copyright restricted scales against four freely usable instruments using a theme relevant annual citation ratio and spline regression models through 2023. The central finding is that copyright restricted scales demonstrate declining citation ratios over time compared with permissively licensed instruments which show sustained or increasing use. The authors argue that restrictive licensing may undermine long term relevance and propose a blended copyright model permitting non commercial scholarly reuse while maintaining commercial licensing rights. The topic is timely and important particularly in light of the increasing emphasis on open science and research tool accessibility. a. Thank you for your comment, no manuscript revision needed. 2. The manuscript addresses an important and underexplored policy issue namely the downstream scientific impact of licensing restrictions placed on measurement tools used in healthcare research. The proposed conceptual mechanism in which restrictive licensing discourages derivative scholarship and thereby reduces long term uptake is logical and policy relevant. In addition the theme relevant annual citation ratio represents an innovative attempt to normalize research adoption across heterogeneous time horizons and the spline regression modeling approach described in the Methods section appears appropriate for evaluating non linear adoption trajectories across decades. a. Thank you for your comment, no manuscript revision needed. 3. However there are several important methodological and interpretive concerns that should be addressed. The primary outcome assumes that the presence of a scale name in the title or abstract reflects meaningful research use as described in the Methods section. In practice many studies employ validated tools without naming them in the abstract and derivative instruments or modified versions may not explicitly reference the original scale name. Furthermore citation practices vary substantially across journals and fields. As a result the selected metric may introduce systematic bias against older or widely internalized instruments whose usage becomes implicit over time. Although the authors acknowledge limited recall associated with title and abstract searches in the Discussion section this limitation may be more central to the validity of the study’s inference than is currently suggested. a. We share this concern and on the surface our “metric may introduce systematic bias against older or widely internalized instruments whose usage becomes implicit over time” is a plausible concern. However, our findings that the older surveys (supplemental Figure S3) that the older surveys are continuing to have rising usage suggests that if this bias occurred, it was insufficient to obscure continued rising citation ratios in the older, permissive surveys. We added this observation to the limitation paragraph of our discussion. 4. Relatedly the attribution of causality may be overstated in its present form. Observed declines in citation ratios for restricted tools may reflect construct drift evolving definitions of burnout or cognition the emergence of competing theoretical frameworks methodological shifts toward ultra brief screening tools or broader disciplinary trends such as post pandemic measurement priorities rather than copyright conditions per se. The manuscript would benefit from a more cautious causal framing or from sensitivity analyses that address innovation cycles construct fragmentation or time to replacement dynamics. a. We entirely agree with the reviewer. Construct drift with time, changing social mores/conditions, allied but distinct populations require evolving scales , and methodological shift towards tools that are shorter must be accommodated by “validated” scales but permitted to be modified within limits to address the need. These exigencies are very possible, and that is the point of our paper. We submit that, rather than being a limitation of our study, the examples offered by the Reviewer support our central theme that restrictive permissions harm survey evolution and prevent “drift” that exists in real life from being reflected in the measure, and prevent refinement of the survey to reflect distinctly different behaviors or allied populations or construct drift. An excellent example is how the UWES was refined by its creators to the UWES-3, which they kindly permit reusage. However, legally, that cannot happen with restrictive copyrights which reinforces our point . b. To make the results and discussion more readable, We moved the second paragraph of the discussion to become the final paragraph of the results. This allowed grouping the two paragraphs that described investigations of secondary rises in the use of assessment tools. 5. The selection of comparator instruments also warrants further justification. The inclusion of APGAR and CAGE introduces heterogeneity in construct type clinical context temporal diffusion patterns and baseline institutional adoption that may limit interpretability of licensing policy effects. These instruments differ substantially from burnout or cognitive screening tools and may therefore not represent ideal comparators in this analysis. a. We thank the reviewer for noting this potential limitation of the study. We have now added a limitation paragraph that reads as follows: “Another limitation is distinct differences in scale user profession and setting of the instruments compared: APGAR and CAGE instruments are used in different types of clinical settings and participant types, which in turn differ from management science/organization behavior scales typically used by researchers. These differences may affect their citation rate due to extraneous reasons other than copyright conditions, such as the frequency of use in original research studies. While this remains a structural limitation of the comparisons presented, the consistency of findings in all paired comparisons of permissive with restricted instruments supports a role of copyright limitations in scale use and evolution” 6. In addition there is a terminology issue that should be addressed for scholarly tone and precision. The Abstract and Introduction use the phrasing “restrictive copyrighting … with permissive copyrighting (copylefting)”. While grammatically intelligible the term “copylefting” is an informal neologism rather than a standard legal or scholarly term. In academic publishing this wording may appear advocacy oriented or imprecise. The authors may wish to consider replacing this phrasing with terminology such as “permissive licensing” “copyleft licensing” or “Creative Commons based licensing for non commercial scholarly use” in order to improve clarity and stylistic neutrality without altering meaning. a. We agree and deleted “copyleft” from the manuscript and modified the sections that had “copyleft”. 7. There are also several minor issues that should be corrected. The Mini Mental Status Examination appears with inconsistent capitalization in several locations and the phrase “Maslach Burnout Inventory(MBI)” is missing a space. The spacing issue was corrected and the MMSE edits were made to only use “Mini-Mental”. Some policy discussion in the latter portion of the manuscript would benefit from citation to empirical implementation studies rather than commentary literature. Citations have been added, but we noted that the citations are to related issues and we do not find prior studies of our specific topic on assessment tools. In addition the estimate that fewer than ten percent of Open Science Framework projects included a noncommercial use statement would benefit from methodological clarification. a. Please see revisions to second paragraph of the introduction. 8. Overall this manuscript raises an important and policy relevant hypothesis but currently over attributes observed longitudinal citation trends to licensing conditions without sufficiently addressing alternative explanations. Clarification of terminology particularly replacing informal usage such as “copylefting” additional discussion of construct evolution and improved justification of comparator selection would strengthen both interpretability and scholarly tone. I therefore recommend major revision. a. Thank you for summarizing. Reviewer 2: 1. After reading the paper proposed I have a clear idea of the idea that authors pretend to expose and emphasize. The premise and the conclusions are clear, but sometimes is needed a little bit more of exposition and divulgation to explain the former importance of the copyright publications as a reason for their choosing. 2. Furthermore, it's not clear the non-citation aspects of the election. a. We assume the reviewer means financial aspects of the choice of copyright type. We agree and wish more information about revenue streams were available. 3. Many times -and this is a serious problem in the present model of researching, dissemination and academic careers- the election of one review or another is focused not only or specifically in the impact but in the prestige -former or not- of each publication. Of course, citations are the way to consolidate the academic and scientific name of a review, but many times researchers are looking for a quick curriculum feedback instead of having a medium to long-term perspective. a. We agree that authors may other factors than citation counts in choosing a journal to publish, but our method will catch all journals indexed at PubMed, regardless of prestige. No edits made. b. We may have missed usages such as quick curriculum feedback, and this argument could extend to quick patient surveys, Maybe the unreported usage continues, but if so, did the unreported usages more likely to have used the surveys with restrictive terms? This is an interesting and plausible hypothesis as illegal use may certainly not be published. However, if the unreported usage was more likely with restrictive surveys, it would still support our assertion that blended copyrights may retain revenue as the illegal use is likely by noncommercial entities and unfunded. Thank you for this comment. Attachments Attachment Submitted filename: Response to Reviewers - Plos One - 2026-04-16.docx https://doi.org/10.1371/journal.pone.0350023.r002
7 May 2026 Decision Letter - Piotr Stec, Editor Benefits and harms of copyright restrictions and conditions on burnout and other psychometric assessment scales PONE-D-25-65524R1 Dear Dr. Badgett, 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, Piotr Stec Guest Editor PLOS One Additional Editor Comments (optional): Dear Authors, Thank you very much for your work and for teh extensive comments on reviewers' remarks. Yout effort is really appreciated. Best regards Piotr Stec https://doi.org/10.1371/journal.pone.0350023.r003
Formally Accepted
Acceptance Letter - Piotr Stec, Editor PONE-D-25-65524R1 PLOS One Dear Dr. Badgett, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Piotr Stec Guest Editor PLOS One https://doi.org/10.1371/journal.pone.0350023.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .