Musculoskeletal Acute and Chronic Pain Surveyed among Construction Workers in Wisconsin, United States: A Pilot Study

Round 1

Reviewer 1 Report

I appreciate the opportunity to build on the review of the article "Musculoskeletal Acute and Chronic Pain Surveyed among Construction Workers in the Upper Midwestern United States". In my opinion, the research presents some problems:

1- What is the representativeness of a sample of 23 workers for the economic sector such as civil construction? I believe that no conclusion can be drawn from such a small sample.

2- Work physical exertion and BMI are two factors that are already known to contribute to WMSD symptoms... Is this the main finding of the article? Unfortunately, the degree of originality of the research is very low. Not to mention that the BMI p-value was not lower than 0.05 in any of the models presented.

3- There is no way to know which logistic regression model was used... Was it an ordinal, binary or other model? Is it recommended to use regression models for such small samples? I believe that using regression models requires using samples much larger than 23.

4- How were the factors that contribute to the symptoms of WMSDs chosen? Recent studies (Bispo et al., 2022, for example) show that there are multiple risk factors for WRMDs, not only individual, but also biomechanical, psychosocial and organizational factors. This article verified the influence of very few factors, generating models with very few risk factors.

5- The literature also says that the relationship between risk factors and WMSDs is complex (Bodin et al., 2020, de Souza et al., 2021, for example), with factors contributing directly and indirectly to WMSDs. Therefore, regression models are not the most appropriate methods to relate such risk variables and WMSD symptoms.

6- There is no measure of validity or reliability in the data collected. Likert scales are used in the article as direct measurement methods without any method that generates scores or perceptions in a valid, accurate and reliable way. All research findings lose strength and credibility in the face of such methodological flaws.

References

Bispo, L.G.M. Bispo, C.F. Moreno, G.H. de Oliveira Silva, N.L.B. de Albuquerque, J.M.N. da Silva. Risk factors for work-related musculoskeletal disorders: A study in the inner regions of Alagoas and Bahia. Saf. Sci., 153 (2022), p. 105804. https://doi.org/10.1016/j.ssci.2022.105804

Bodin, J., R. Garlantézec, N. Costet, A. Descatha, J.F. Viel, Y. Roquelaure. Shoulder pain among male industrial workers: validation of a conceptual model in two independent French working populations. Appl. Ergon., 85 (2020). https://doi.org/10.1016/j.apergo.2020.103075

de Souza, D.S.F, J.M.N., da Silva, J.V.O., Santos, M.S.B., Alcântara, M.G.L., Torres. Influence of risk factors associated with musculoskeletal disorders on an inner population of northeastern Brazil. International Journal of Industrial Ergonomics, Volume 86, 2021, 103198. https://doi.org/10.1016/j.ergon.2021.103198.

Author Response

"Please see the attachment." 

Author Response File: Author Response.pdf

Reviewer 2 Report

This paper addresses the problem of occupational risks involved while working in construction sector, due to the high physical demand in daily work. I appreciate the authors for contributing to this topic and its relevance. Before publishing the recommendation, I want the authors to clarify few points:

Please ensure to use MeSH (National Library of Medicine's vocabulary thesaurus) keywords for indexers and search engines to find this article.

“…we identified three construction worksites in the states of…” – Please elaborate more about the type of construction activities you focused. It will help readers understand the way in which these people work.

Risk of small sample size may have underlying distributions heavy-tailed or have extreme skewness. How do the inferences drawn from 23 construction workers represent a large population? Is this a pilot study for any longitudinal work?

In other words, what restricted you to go for more participants?

Explain how you determine sample size?

How many people were patients cured because of some musculoskeletal disorders?

Do they miss work as a result of pain?

Do you check in their medical history if they suffer from musculoskeletal disorders or only based on workers' claims that they have pain/symptoms? It is of huge importance.

“…trades/occupations were carpenter, laborer, framing, and brick mason…” – this study got only 23 participants; Need more clarification on why the workers were classified in three occupations and then taken as a whole in logistic regression?

Why did not conduct for each of the occupations separately so that the readers can see some comparisons about work-related acute and chronic musculoskeletal pain between the three occupations?

What is the minimum reasonable sample size for the logistic regression?

Please include the results of Hosmer-Lemeshow goodness-of-fit test and an Omnibus Test of Model in the respective regression tables.

Although the level of English is very good, a slight linguistic correction would be useful.

Author Response

"Please see the attachment."

Author Response File: Author Response.pdf

Reviewer 3 Report

The study contain the information about the musculoskeletal disorders among construction workers. The findings are of some interest but there are some literary and methodological issues as pointed out below: 1. The construction work (especially manual work) depends upon several factors such as type of posture, body part utilized (single or multiple body part), type of operation (manual or mechanical), education background of workers, complexity of the operation, heat effect, etc.? I think these factors need to be reflected in literature and discussion section of the paper appropriately.

2. Sampling strategy needs some more description. Also, I feel a pictorial view including the numbers (total, inclusion and exclusion) must give a better overview to the reader. 3. The questionnaire was developed from various sources and one thing that stands out is the issue of psychometric properties of the questionnaire such as reliability and validity of the items used in the questionnaire. 4. The results are of some interest but the authors could elaborate further on the practical implications of their findings (especially related to physical activity related consequences) in the discussion section.

Author Response

"Please see the attachment."

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

I appreciate the authors' responses.

Unfortunately, I don't think that an unrepresentative sample can generate enough reliable information to be published in a Journal of this magnitude and scientific impact. I believe that the contribution of the article is much more of a technical nature than a scientific one.

The fact that the sample was made up of construction workers from Wisconsin does not make any significant scientific contribution. The working conditions and occupational risk factors studied in this article (with Wisconsin construction workers) are similar to the factors and risks experienced by workers from geographically close regions already studied. And if there are differences, the article did not seek to assess. Assessing the risks of MSDs that have already been extensively studied.

The sample is small and the effects are overestimated. Unfortunately, the models do not have much scientific value. Authors should increase the sample size before drawing scientific conclusions.

Furthermore, the proposed models are overly simple and inappropriate for drawing conclusions and building strategies for a complex disease such as MSDs.

Given the above, I would recommend the article for a Journal with less scientific weight and greater focus on technical aspects.

Author Response

Please see the attachment - Thank you.

Author Response File: Author Response.pdf

Reviewer 2 Report

One criterion for article acceptance by the reviewer while assessing a revised manuscript is the extent to which the re-work is integrated with the previous comments. Most of my previously raised comments have not been incorporated satisfactorily into the manuscript:

1.      Upon considering a previously raise concern, the authors have now used the phrase ‘pilot study’ in their author response, but not in the manuscript. Why should it not be in the paper title, if the survey is a pilot survey?

2.      Now, if you have done this initial small-scale test (pilot study) for ‘future larger confirmatory studies’, what are your plans for conducting a full-scale research project?

3.      What was the longer purpose of conducting a pilot study? After the successful completion of this pilot study, how the finding from the pilot will help in your full-scale research project?

4.      Author(s) cleverly included a study limitation of ‘relatively small sample size’, and other important things that this study fails to answer. The author(s) should discuss how can their data be beneficial in spite of the small sample size.

A lot of re-work is needed from the authors. Due to the low sample size, the statistical inferences drawn may not be true for the actual population.

Author Response

Please see the attachment - Thank you!

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

I am grateful for the authors' response to the points highlighted by this reviewer.

Unfortunately, I still consider that the article has serious methodological problems and unreliable results. The regression model does not consider several factors that can contribute to WMSDs. And it presents results of factors already known by previous studies. In fact, regression models can be used for inference purposes, as long as the sample is carefully selected, ensuring that the parameters estimated for the sample are similar to the population parameters, and this is not guaranteed in this article. Nor can I identify points of relevance and originality in the article.

I hope I'm not being overly strict in my assessment. However, this is my position in the face of similar articles that I have read and written on the subject.

Reviewer 2 Report

I have no further comments!