PONE-D-21-04117

Factors associated with low back pain among construction workers in Nepal: A cross-sectional study

PLOS ONE

Dear Dr. Adhikari,

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 Apr 24 2021 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Pranil Man Singh Pradhan

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

2.We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.  

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following:

• The name of the colleague or the details of the professional service that edited your manuscript
• A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)
• A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

3. In your Methods section, please provide a justification for the sample size used in your study, including any relevant power calculations (if applicable).

[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: 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: No

**********

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 manuscript addresses the factors associated with low back pain among construction workers. The manuscript is well written and structured. The title and abstract are appropriate for the content of the paper. All the data are well understood. Furthermore, the manuscript is well constructed but the introduction needs to be revised but the analysis is well performed.

Reviewer #2: a. In abstract: CLBP – short form has been used abruptly without prior mention

b. Reference pattern in 49-56 lines are (?). It is abruptly starting from 21? And it starts directly from sentence line 64?

c. Line 103- why DASS was used? Nothing mentioned in objectives about it.

d. Line 113- why mentioned abruptly about CLBP. Nowhere has been ever talked about these types. Never mentioned in introduction clearly except abruptly mentioned once.

e. Line 140- define others (you have those answers for others… mentioned here )

f. Line 198- what do you mean by age limitation? As you have had exclusion criteria for age.

g. Results: Line 197- why did you assess 456 when they did not meet the criteria? Explain sample size calculation

h. Please explain the enrollment process of the study participants clearly.

i. Who are others in Ethnicity? Correct it

What do you mean? (J-m)

j. Family Size 5 (4, 6)

k. Dependent family members 3 (2, 4)

l. Monthly income (participant) N.Rs.25000 (20000, 25250)

m. Monthly family income N.Rs. 45000 (30000, 55000)

n. Age at joining construction industry (year): it carries great value so it would be best if you could show table of age joining for below 18 years because 127 is a good number.

o. Table 4: amazing that age is not the predictor of LBP .Maybe you should try regrouping the age. Generally age is the predictor.

p. It was difficult to understand difference between LBP and CLBP in your study. Please elaborate.

q. Line 401- Health seeking behavior for low back pain was very poor among construction workers. As nowhere in your study you have mentioned the pain score so you cannot make this statement. Pain scale would have been better to be used and explore grades of LBP. I think this study need this to make your study more valid.

r. You have so many factors included in tables. Please make it smart including only needy variables. Many variables are unnecessarily shown. You have too many unnecessary variables which are not needed for this study and have no direct connections. So for this article those variables are not needed.

s.

t. Chronic back pain has good connection with Depression. Here mostly you have used LBP not CLBP. So you should use this cautiously when needed.

u. No variables which show real relations with LBP such as “working posture”, times of bending, pushing, pulling, dragging, carrying and holding are not in this study. So as topic suggests “the factors associated” is not supported in real.

v. LBP is also strongly associated with the bed quality where workers sleep. No variables related to it show a bias too.

**********

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: Dr.Nikita Bhattarai

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: Plos article.pdf

Factors associated with low back pain among construction workers in Nepal: A cross-sectional study

PONE-D-21-04117R1

Dear Dr. Adhikari,

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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Pranil Man Singh Pradhan

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

**********

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

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

**********

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

**********

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: (No Response)

Reviewer #2: i have seen the artcile with abstract and it is final from my side.

Background: Low back pain (LBP) is the commonest cause of disability throughout the

world. This study aimed to determine the prevalence and factors associated with LBP

among the construction workers in Nepal.

Methods: A community-based cross-sectional study was conducted among the

construction workers working in Banepa and Panauti municipalities of Kavre district,

from September 2019 to February 2020. Data was collected purposively by face-toface interview from 402 eligible participants from the both municipalities using semistructured questionnaire. Mobile-based data collection was done using KoboCollect.

Data were exported to and analysed using R-programming software (R-3.6.2).

Univariate and multivariate logistic regressions were performed. All tests were two

tailed and performed at 95% confidence interval (CI).

Result: One-year prevalence of LBP among construction workers were 52.0% (95%CI:

47.0-57.0). The higher odds of LBP was reported among females [adjusted odds ratio

(aOR) =2.42; 95%CI: 1.12-5.23], those living below poverty-line (aOR=2.35; 95%CI:

1.32-4.19), participants with more than five years of work experience (aOR=1.66;

95%CI: 1.01-2.73) and those with intermediate sleep quality (aOR=2.06; CI: 1.03-

4.11). About 80.0% of construction workers with LBP never seek healthcare services

due to: a) time constraints (90.9%), b) financial constraints (18.1%) and c) fear of

losing wages on seeking healthcare services (40.9%). The majority of the participants

(94.8% among those without LBP and 72.3% among those with LBP) did nothing to

prevent or manage LBP.

Conclusion: The prevalence of LBP in the past one year was high among construction

workers where majority of workers never did anything to prevent or manage LBP.

Therefore, the public health professionals should set up the health promotion,

education, and interventions aimed at increasing awareness on preventive techniques

and predisposing factors of LBP.

**********

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: Nikita Bhattarai

Reviewer #2: No