Multifactorial Causal Analysis of Workplace Musculoskeletal Disorders (WMSDs) and Psychological Stress Among Teaching Professionals for Adult Learners: A Narrative Review

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Thank you very much for inviting me to review(re-review) the manuscript titled “
Multifactorial Causal Analysis of Workplace Musculoskeletal Disorders (WMSDs) and Psychological Stress Among Teaching Professionals for Adult Learners: A Narrative Review.”

1. The revision shows clear effort to address the earlier critique. The title, abstract, and methods are more transparent; figures and tables have been added; and the conceptual framework is logically expanded.
2. Abstract is fine
3. The introduction is fine, and the theoretical framework is properly introduced. However, the research gap statement is still general. Please specify why adult-education teachers differ from K-12 or university faculty.
4. Methods have improved. It would be great to know the reasons for not having a systematic review (as the authors almost included all components of a systematic review).
5. Tables and figures are well made and informative.
6. Discussion: I consider that policy recommendations are generic. Please add concrete examples (e.g., ergonomic assessment programs, teacher-well-being policies).
7. References are updated. Great work. But please recheck again as repeated/incomplete references (e.g., Bezzina et al. 2023 listed twice).

Author Response

Thank you for the comments. We appreciate them.

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

The revised version demonstrates substantial improvement over the original submission. The objectives are now clearly defined, and the theoretical framework is well articulated. Nevertheless, a few points merit further refinement:

1. Provide a more explicit explanation of the review methodology — particularly whether quality appraisal of included studies was conducted.

2. Consider summarizing Table 2 or moving it to an appendix, as its current length interrupts the flow of the text.

3. Clarify the manuscript’s unique contribution — specify what is novel in the proposed multifactorial framework compared with existing models (e.g., STAMP, ERI).

4. Strengthen the “Limitations and Future Directions” section to highlight methodological constraints and the need for empirical validation.

Overall, this version is well improved and suitable for publication after minor revisions.

Author Response

Thank you for all the comments. We appreciate the opportunity to improve the manuscript.

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Good revisions. Wish you all the best.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you very much for inviting me to review the manuscript titled “Multifactorial Causal Analysis of Workplace Musculoskeletal Disorders (WMSDs) and Psychological Stress Among Teaching Professionals for Adult Learners: A Review” The article is interesting and provides some important findings for the research community and policymakers, considering the increasing usage of technologies. However, there are some major concerns for the authors’ consideration.

1. Title is informative. Please, be specific in the title about what kind of review the authors did in this manuscript. It supports the readers to anticipate accordingly.
2. Also, please check the most common terminology used in the majority of publications or the WHO. Work-related MSKL disorders or Workplace.
3. Abstract is exhaustive, and please include only essential contents for the healthcare, MDPI word count for abstract.
4. Abstract: Even though it is not strongly recommended to follow a structured abstract in a narrative review, it must follow the flow of the content. Additionally, in the abstract, methods should be briefly mentioned for transparency. In the current version, it is lacking.
5. The authors made a great effort in making a contextual framework. Highly appreciated. But the research question is still unclear. Could you please specify the research questions or objectives you aim to achieve from this review?
6. Major concern is methods that lack clarity and explanation.
7. Is it narrative, scoping, or systematic? Please be clear and specific.
8. Even though the authors explained some details about methods and search strategies, the authors must clearly include databases used, timeframe, etc, which is absolutely needed for transparency and reproducibility. A summary table of methods and transparency would be more beneficial for the readers.
9. Another table (may be a supplementary one) that applies to each database is also required.
10. Please include a flow diagram that depicts the study selection process, not necessarily the PRISMA (as it is applicable only for systematic review).
11. WMSDs – abbreviations are not followed as per the literature norms.
12. Results: Comprehensive categorisation (human, workplace, organisational, socioeconomic, external stakeholders) is highly appreciated. How can we club the prevalence/factors from developed countries to developing/underdeveloped countries? It would be interesting to subgroup the table according to the WHO regions.
13. In the results table, I can see studies from 2014 also. Please be specific in the timeframe.
14. There are reviews, including a recent systematic review (which is a much higher level of evidence), so what novelty does this review bring to the existing literature?
15. Discussion: Reads as a continuation of results; limited critical analysis
16. No specific policy-related discussion or conclusion, two things: WMSDs prevalent and future research recommendations, and policy changes. These are already known for a long time.
17. In my view, the methods are too much weak, and no novelty. The manuscript requires extensive rework.
18. English quality is fine and understandable.

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript addresses an important and often overlooked population—teaching professionals in adult education—with regard to workplace musculoskeletal disorders (WMSDs) and psychological stress. The conceptual framework is broad and integrates a useful multifactorial perspective.

However, several improvements are recommended:

• Consider adopting a systematic or scoping review methodology to improve transparency and reproducibility (e.g., PRISMA-ScR).

• Reduce redundancies across sections and strive for more concise thematic synthesis.

• Strengthen the critical appraisal of cited studies, particularly regarding study design and evidence strength.

• Clarify whether the proposed framework is purely theoretical or based on data synthesis.

• Improve the language and flow of the manuscript; several sentences are verbose or unclear.

• A final proofread by a native English speaker or professional editor is advised.

Comments on the Quality of English Language

T

The English could be improved to more clearly express the research.
The text contains redundant or poorly formulated statements, an excessive use of passive voice, and issues with coherence and clarity in several paragraphs. Despite the use of technical terminology, the scientific prose requires careful editing.

     

Reviewer 3 Report

Comments and Suggestions for Authors

This manuscript addresses an important and timely issue: musculoskeletal disorders (WMSDs) and psychological stress among teaching professionals, particularly in adult education. The topic is highly relevant to occupational health. However, the manuscript requires major revisions in terms of language, structure, methodology, and focus before it can be considered for publication.

The abstract is significantly longer than MDPI guidelines allow. At approximately 350 words it reads more like an extended introduction than a concise summary. The authors provide long lists of risk factors and repeat the point that WMSDs and stress are bidirectionally linked. An abstract should be limited to around 200–250 words, structured to provide background, objective, methods, key findings, and implications. I strongly recommend that the authors shorten and streamline it, eliminating redundancy and focusing only on the essential elements of their study.

The introduction provides useful background but is highly repetitive. Prevalence figures and risk factors are mentioned multiple times, while the justification for focusing specifically on adult educators is not clearly emphasized until later in the text. Citations are appropriate but are presented descriptively rather than critically, and the relationship between the theoretical models referenced (the biopsychosocial model, Stock’s organisational model, and the Effort–Reward Imbalance model) is not well integrated. The introduction would benefit from a tighter narrative that identifies the precise knowledge gap and establishes the contribution of this review more clearly.

The methods section is the weakest part of the manuscript. The description of the literature search is vague and lacks the transparency required for a systematic or even a scoping review. The authors mention several databases and provide a long list of search terms but do not describe Boolean combinations, timeframes, or inclusion and exclusion criteria. No PRISMA-style flow diagram is included. Without these elements the review reads as a narrative overview, which undermines its scientific rigor. The authors need to decide whether they intend this to be a systematic review or a scoping review and then provide the appropriate methodological detail.

The results and discussion sections are extensive but suffer from redundancy. The manuscript repeatedly emphasizes the bidirectional relationship between WMSDs and stress without offering deeper analytical insights. Table 1 is overloaded with information and resembles raw notes rather than a polished summary; it is too detailed to be reader-friendly and should be streamlined. The conceptual frameworks presented in Figures 3 and 4 are visually complex but are not sufficiently justified in the text. It is unclear whether these frameworks were inductively derived from thematic analysis or deductively constructed from existing models. At present they appear descriptive rather than evidence-based. A more critical synthesis of the literature, assessing the strength of evidence for each risk factor, would improve the value of the review.

The conclusion largely repeats prevalence data and restates the framework without adding new insights. It also fails to provide specific, actionable recommendations for policy and practice. While the authors call for “holistic interventions,” they do not describe what these might look like in practice. Readers would benefit from more concrete proposals, such as ergonomic redesign of classrooms, institutional workload policies, or targeted mental health support for teachers.

There are numerous language and style issues throughout the manuscript. Typos include “Type of the Paper (Article” instead of “Type of the Paper: Review,” “Table 1. 0” instead of “Table 1,” and the repeated use of “et. al.” instead of “et al.”. Headings occasionally break words (for example, “Psycho- logical Stress”), which must be corrected. Grammar errors include subject–verb disagreement such as “psychological stress is presented” when “stress are presented” is correct. Many sentences are overly long and should be broken into shorter units for readability. Terminology is inconsistent, with the authors alternately using WMSDs, MSDs, teaching professionals, teachers, and educators. Consistency is needed.

In addition, the manuscript often relies on older references such as Heinrich (1931) and Reason (1990). While these classic works can provide historical context, they should be clearly framed as such and balanced with stronger recent evidence. Figures should be cited in the text before appearing, and references should be carefully checked for consistency with MDPI style.

In summary, while the manuscript addresses an important issue and has the potential to make a contribution, it requires major revisions in terms of length, clarity, methodological transparency, and critical synthesis. The abstract must be shortened, the introduction streamlined, the methods clarified, the results and discussion refined to reduce redundancy, and the conclusion expanded to include specific recommendations. Comprehensive language editing is also required to correct typos, grammar, and style. Only after these substantial improvements would the manuscript be suitable for publication in Healthcare.

Comments on the Quality of English Language

 

• • “et. al.” should be corrected to “et al.” throughout.

  • “Table 1. 0:” → typo; should be “Table 1:”.

  • Headings contain broken words (e.g., “Psycho- logical Stress”).

    • Subject–verb agreement errors (e.g., “psychological stress is presented” → “stress are presented”).

    • Many overly long sentences should be split for readability.

    • Inconsistent terminology: “WMSDs,” “MSDs,” “teaching professionals,” “teachers,” and “educators” are used interchangeably. These must be standardised.

      • Frequent repetition of prevalence figures (60–70%) and bidirectional relationship.

      • Multiple mentions of COVID-19 pandemic effects without new insights.