-->PONE-D-26-12800-->-->Artificial Intelligence in Myofascial Pain Syndrome: A Comparative Analysis of Readability, Quality, and Reliability Among ChatGPT, Gemini, and Perplexity-->-->PLOS One

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-->-->ACADEMIC EDITOR: Please see reviewer 1's comments, revise the manuscript appropriately and resubmit.

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Reviewers' comments:

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-->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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Reviewer #1: Yes

Reviewer #2: Yes

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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 is a well-structured and timely manuscript. The topic is relevant, the methodology is reasonably rigorous, and the findings have clear clinical implications. Below is a constructive, peer-review-style critique, organized by section, with specific strengths, weaknesses, and suggestions for improvement.

Overall Assessment

1. Abstract & Material and Methods :Critical Error in Model Version Reporting

• Issue: You state you used "ChatGPT (GPT-5.2)" as of December 9, 2025. GPT-5.2 does not exist as of March 2026. OpenAI has released GPT-4, GPT-4 Turbo, GPT-4o, and o1-series models, but not GPT-5.2. This is a serious factual error that undermines credibility.

• Recommendation: Immediately verify and correct the model version. Most likely you used GPT-4 or GPT-4 Turbo. If you used a version released in late 2025, specify the exact model name (e.g., "GPT-4o-2024-11-20").

2. Results section: Statistical Analysis Issues

• Issue A: You report p-values for pairwise comparisons (e.g., "p=0.015" for ChatGPT vs. Perplexity on GFOG) but do not state whether you applied Bonferroni correction (mentioned in Methods) to all pairwise tests. With 3 models, there are 3 comparisons per metric. At α=0.05, Bonferroni-adjusted significance would be p < 0.0167. Your reported p=0.015 would be significant, but p=0.005 would also be significant. However, some comparisons (e.g., Table 2, ChatGPT vs. Perplexity, FKGL p=0.005) are fine. Clarify which p-values are corrected.

• Issue B: You state "statistically significant difference was found between the median readability values of all answers and the sixth-grade readability" (p<0.001). What statistical test was used for this? It appears you compared a single median value against a fixed threshold (6.0). Was this a one-sample Wilcoxon signed-rank test? This must be explicitly stated.

• Issue C: Table 5 (correlation) reports many coefficients >0.9 (e.g., JAMA vs. mDISCERN = 0.934). Such high correlations suggest potential collinearity or that scales measure nearly identical constructs. This should be discussed as a limitation.

3. Material and Methods :Missing Essential Information

• Issue A: You mention "two independent researchers (Y.E. and E.O.)" but these initials are not defined in the manuscript (no author list provided). Are these authors or external reviewers? Clarify.

• Issue B: No information on inter-observer agreement calculation beyond ICC values. What was the confidence interval for each ICC? What constitutes "good to excellent"? Provide benchmarks (e.g., <0.5 poor, 0.5-0.75 moderate, >0.75 good).

• Issue C: You state "browser history and cookies were completely cleared" and used "Incognito" mode. However, you did not mention using a VPN to control for geographic variation in search results. Since Google Trends data showed varying interest by country (Philippines, Thailand, USA), server location could bias results. This is acknowledged in Limitations, but it should also be stated in Methods that no VPN was used.

4.Abstract and Discussion: Writing and Clarity Problems

• Issue A: Abstract is overly dense. The sentence beginning "While AI platforms exhibit high potential..." is 58 words long. Break it into shorter sentences.

• Issue B: You introduce an undefined acronym "MPSs Learning Achievement" in the Discussion (first paragraph). This appears to be an error. Delete.

• Issue C: The phrase "MPS [MPSsive Activity Syndrome]" appears in the Conclusion. This is incorrect. MPS stands for Myofascial Pain Syndrome throughout the manuscript. Remove the erroneous expansion.

• Issue D: In the Introduction, page 2: "limited range of motionan decreased functional capacity" – missing space and likely typo ("and").

• Issue E: Results section: "The research focused on eighteen key keywords" – redundant. "Eighteen keywords" suffices.

5. Discussion section: Interpretation and Discussion Weaknesses

• Issue A: You state "ChatGPT exhibits the most optimized performance in terms of readability" but readability is not necessarily a virtue if it comes at the cost of accuracy. ChatGPT had lower quality/reliability scores. This trade-off is mentioned but not adequately explored. Add a paragraph discussing whether easier readability might actually increase risk if the content is less reliable.

• Issue B: You cite a study on fibromyalgia (reference 35) but do not mention whether those findings align with or contradict your own. Specifically, that study found Gemini offered higher quality for fibromyalgia, whereas you found Perplexity superior for MPS. Discuss possible reasons (different condition, different version of models).

• Issue C: The conclusion that AI should be a "secondary advisory mechanism" is reasonable but vague. What specific safeguards do you propose? (e.g., mandatory disclaimer labels, AI-generated text being reviewed by a human clinician before patient access, integration with EHRs?)

6. Minor Concerns

Suggested Title Revision

Current title is very long (20+ words). Consider shortening while preserving key elements:

Option A: "Readability, Quality, and Reliability of AI-Generated Information on Myofascial Pain Syndrome: A Comparative Analysis of ChatGPT, Gemini, and Perplexity"

Option B: "Are AI Chatbots Readable and Reliable for Myofascial Pain Syndrome Information? A Comparison of Three Large Language Models"

Reviewer #2: I would term this study as a prototype of studies to come when it concerns AI and health care. No physical patents were studied or involved in this study. The study involves the comparison of various systems with the benchmark of 6th grade literacy. This is highly contextual. The study acknowledges its limitations. E Health Literacy is becoming very common and clarity of AI programs will mature, evolve and become more sophisticated in a short span of time. Ultimately human interfaces will decide which AI programs will be most referred to and consulted.

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Reviewer #1: Yes: Mohammed Elrabie Ahmed

Reviewer #2: Yes: Christopher de Souza

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Readability, Quality, and Reliability of AI-Generated Information on Myofascial Pain Syndrome: A Comparative Analysis of ChatGPT, Gemini, and Perplexity

PONE-D-26-12800R1

Dear Dr. Ozduran,

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,

Gauri Mankekar, MD,PhD,FACS

Academic Editor

PLOS One

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