-->PONE-D-25-59222-->-->Facilitators of and barriers to interprofessional learning between nurses and physiotherapists in clinical hospital practice: A scoping review-->-->PLOS One

Dear Dr. Åhlund,

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PLOS One

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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: No

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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: No

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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: No

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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: General comment

1. As this review aims to identify facilitators and barriers to interprofessional learning between nurses and physiotherapists in clinical hospital practice, I recommend structuring the findings accordingly. This structure would improve clarity, readability, and alignment with the review objectives.

2. Please provide reference for the statement provided in the results and discussion.

3. I recommend professional English language editing to enhance the clarity, coherence, and readability of the manuscript.

Abstract

- The title is not specific to older adults and could be revised to better reflect the study scope. Consider shortening the Background section of the abstract and including key methodological details, such as the review period and the number of databases searched, to improve clarity and completeness.

- You may consider to include the future direction of your study in the abstract.

Introduction

- The Introduction is rather lengthy. Consider condensing the background information and focusing on the key rationale, research gap, and objectives of the review.

- Rather than providing extensive background information, the authors should critically highlight the existing knowledge gap, the fragmented nature of the evidence, and the rationale for undertaking a scoping review.

Methods

- Line 99-100: The manuscript follows the Arksey and O’Malley framework; however, the subheadings are not aligned with its methodological stages. Consider revising the subheadings accordingly. Please include the PRISMA checklist in the supplementary.

- Line 105 – 108: You may consider to include the details of PCC mnemonic that used in this study to improve reader’s understanding.

- Line 111 – 113: Please include the reason of database selection and study duration.

- Line 128 – 130: The term “somatic adult hospital context” may not be familiar to an international audience. Consider replacing it with “adult hospital settings involving patients with physical health conditions” for greater clarity. You may consider to include the age range of this population.

- Line 130 – 131: The inclusion criteria are not clearly described and should specify based on the PCC mnemonic. The authors should also clearly state the type of evidence sources (quantitative/ qualitative/ mixed methods studies). I would recommend explicitly defining interprofessional learning (IPL) because some studies may use terms such as interprofessional education (IPE), workplace-based learning or interprofessional training.

- Line 131 – 134: The exclusion criteria should also be clearly described including study design, settings, populations, publication.

- Please clarify whether a quality assessment was undertaken. If not, provide a justification, as quality appraisal is not always required in scoping reviews but should be explicitly addressed.

Results

- I would suggest that the first results subheading focus solely on the characteristics of the included studies. The findings related to facilitators and barriers should be presented under separate subheadings to improve clarity and organization of the results.

- Study selection: Please specify whether studies from other methods (grey literature) in the search strategy. If excluded, provide a rationale for this decision

- Line 187: Please specify the age range and gender of the participants included in the review.

- Line 237: The term “digital team meetings” requires further clarification. Please describe the format of these meetings such as videoconferencing, virtual case discussions or online interprofessional learning session.

Discussion

- Line 360: The authors should consider discussing the potential limitations associated with restricting the search to specific languages and databases. These methodological choices may have excluded relevant evidence and influenced the overall scope and completeness of the review.

Reviewer #2: Comments

I would like to commend the authors for choosing a highly relevant and timely topic. This scoping review addresses a critical gap in health services literature by mapping the facilitators of and barriers to interprofessional learning specifically between nurses and physiotherapists in clinical hospital settings. The manuscript exhibits notable strengths, including a solid methodological foundation built on established scoping review frameworks, strict adherence to PRISMA-ScR guidelines, and proactive prospective protocol registration. The thematic synthesis of organizational conditions, team climates, and structural barriers is logically organized, providing valuable, actionable insights for clinical educators and hospital administrators alike. The manuscript holds clear merit and aligns well with the rigorous scope of PLOS ONE.

Despite these clear strengths, the manuscript requires a few essential revisions before it can be considered suitable for final publication. These recommendations primarily focus on correcting critical journal policy compliance issues, elevating methodological transparency, adding explicit data metrics with illustrative examples in the results, and deepening the overall analytical rigor of the discussion section. To assist the authors in maximizing the scholarly impact and readability of their research, I have outlined the essential revisions below.

1. Methodology and Data Support

•Quality Assessment: The manuscript does not address whether the included studies underwent quality appraisal. While quality assessment is not required for scoping reviews, acknowledging this limitation would enhance transparency.

You can add the following statement: "Consistent with scoping review methodology and the Arksey and O'Malley framework, formal quality assessment of the included studies was not performed. While this is a recognized feature of scoping reviews, readers should interpret the findings with consideration of the varying methodological quality of the primary studies."

•Enhance Transparency: Detail the screening consensus process, clarify if inter-rater reliability metrics (e.g., Cohen's kappa) were calculated, and justify omitting formal quality appraisal and statistical testing given the scoping review design.

•Risk of bias:

The review process involved independent screening by two authors, which is commendable. However, the manuscript could benefit from clearer description of:

How disagreements were resolved during title/abstract screening

Whether inter-rater reliability was calculated

The specific roles of each author in data extraction verification

•Strengthen Evidence and Metrics: Provide concrete examples from primary studies and state the exact study counts ($n$) contributing to each theme in both the Abstract and Results sections.

•Deepen Discussion: The Discussion currently tends to restate findings rather than analyze them in broader context. The connection to Vygotsky and Wenger is appropriate but could be more thoroughly developed. Move beyond descriptive summary by fully integrating Vygotsky’s and Wenger’s frameworks to explain findings, translating them into actionable recommendations for practice, education, and health policy. Briefly compare findings with other scoping reviews or systematic reviews on IPL in other contexts (e.g., primary care, community settings) to highlight what is unique about the hospital clinical practice context.

•The Results section presents findings through aggregated themes (facilitators: 3 themes; barriers: 3 themes) with multiple references per theme. While this is appropriate for scoping reviews, it lacks specific illustrative examples that would help readers understand how these factors manifest in practice.

•Expand the implications section to provide concrete recommendations:

For hospital administrators: specific strategies for creating shared physical spaces, scheduling regular interprofessional meetings, and leadership training.

For educators: how to better prepare students for interprofessional practice and support clinical supervisors.

For policymakers: implications for national guidelines and accreditation requirements.

2. Policy and Data Availability

•Correct Data Statement: Revise the Data Availability Statement to reflect that all underlying data are within Tables 1 and 2, removing inaccurate references to non-existent supporting files.

"All relevant data are within the manuscript and its Supporting Information files."

The authors claim data is in "Supporting Information files", but no such files were actually submitted with the manuscript.

It can be replaced by "All data generated or analyzed during this study are included in this published article (Table 1 and Table 2). No additional Supporting Information files are associated with this manuscript."

•Submit Missing Visuals: Upload the referenced PRISMA flowchart (Figure 1) as a separate, high-resolution image file instead of using a text placeholder.

•Include Mandated Declarations: Add an explicit Ethics Statement to the Methods section clarifying that ethical approval was not required for this secondary review of published literature.

You can add the following statement: "As this study constitutes a scoping review of previously published literature and did not involve human participants, animal subjects, or primary data collection, ethical approval was not required."

•Optimize Documentation: Consider moving full, database-specific search strings and raw extraction quotes into a dedicated Supporting Information file for complete replicability.

3. Language, Formatting, and Presentation

•Several language errors and awkward constructions throughout the manuscript. Inconsistent use of "interprofessional" vs. "inter-professional" (with hyphen) throughout the manuscript. Standardize it.

••Reformat Tables: Table 1 is dense and may be difficult for readers to navigate due to the amount of text in the "Facilitators" and "Barriers" columns. You can split it to tables.

•Verify Citations: Some references do not fully conform to PLOS ONE's reference formatting requirements.

Ref 1: Missing publisher location details

Ref 5: Incomplete journal information

Ref 6, 10: Inconsistent presentation of journal names

Format all references to strictly comply with PLOS ONE’s Vancouver style, ensuring full journal names, correct volume/page numbers, and missing DOIs.

Comments according to section:

Abstract: The abstract is well-structured and follows the standard format (Background, Method, Results, Conclusion).

Suggestions for improvement:

Background: Consider adding:

•One sentence on the importance of IPL for patient outcomes based on existing evidence.

Method: Add brief mention of:

•The databases searched

•Number of studies included (already included in Results)

Results: The results section could be slightly more quantitative:

"The database search yielded 1,973 articles, of which 11 were included. Facilitators included factors supporting socialization (n=X studies), positive team climate (n=X), and organizational conditions (n=X). Barriers included limited structural prerequisites (n=X), restricted interactions (n=X), and non-conducive workplace culture (n=X)."

Conclusion: Currently strong. Consider adding a sentence on the implications for policy or practice.

Introduction: The introduction effectively establishes the rationale for the study, provides relevant background on interprofessional collaboration, and justifies the focus on nurses and physiotherapists.

1.Add a paragraph on the prevalence of hospitalization among older adults and the consequences of functional decline to strengthen the clinical relevance.

2.Briefly acknowledge the existing evidence on barriers and facilitators to interprofessional collaboration more broadly to show this review builds on existing knowledge.

Methods: Strong methodological foundation.

1.Search strategy details: The search string is provided in text, but a table with the full search strategy for each database would be helpful for replicability. Consider adding as Supporting Information.

2.Gray literature: The manuscript does not explain why gray literature was excluded. Adding a brief justification would be helpful.

3.Scoping review vs. systematic review: Briefly justify why a scoping review is appropriate (e.g., to map the available evidence rather than answer a focused clinical question).

Results: Results are presented clearly with appropriate use of tables.

1.Add a brief description of the thematic analysis process in the Methods section (who developed the themes, how consensus was reached).

2.Provide numbers of studies contributing to each theme (quantitative summary) in addition to the references.

Discussion: Discussion connects findings to theory and practice but could be strengthened.

1.Compare findings with previous reviews: Briefly discuss how this review's findings align with or differ from previous reviews on interprofessional education and collaboration.

2.Add a subsection on "Implications for Research":

Need for studies specifically examining nurse-physiotherapist interaction

Need for longitudinal studies examining sustainability of IPL

Need for intervention studies testing specific IPL strategies

3.Add a subsection on "Implications for Education":

How can curricula be adapted to better prepare students for IPL?

What role should clinical supervisors play?

How can university-hospital partnerships be strengthened?

4.Add a subsection on "Implications for Practice":

Concrete recommendations for hospital administrators and ward managers

Specific strategies for overcoming identified barriers

Role of technology in facilitating IPL

Conclusion: Conclusion is appropriate and summarizes key findings.

Suggested Statement: "Hospital organizations and educational institutions must prioritize the development of sustainable IPL structures that transcend individual professionals and persist through staff turnover. Without such commitment, the potential for IPL to improve patient outcomes for older adults will remain unrealized."

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Manuscript Review - Facilitator and Barriers of IPL.docx

Facilitators of and barriers to interprofessional learning between nurses and physiotherapists in hospital-based clinical practice: A scoping review

PONE-D-25-59222R1

Dear Dr. Åhlund,

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,

Suad J Ghaben, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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-->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: Thank you for your feedback and the effort you have put into revising your work. I am pleased to see that you have carefully addressed all the comments and suggestions provided. All the best in your future endeavour.

Reviewer #2: I like to thank authors for their commitment and addressing the reviewer comments and wishing success to them

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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: Yes:  Nurul Hidayah Md Fadzil

Reviewer #2: No

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