The Impact of Harvesting Height on Farmers’ Musculoskeletal Tissue

The sample size is quite small; please remember that MSD are a common complaint in the general population: for example, some studies have shown that up to 23% of the world's adults suffer from chronic low back pain. In other words, minimum sample size would be: 1.96*1.96*(1-0.23)*0.23/(0.05*0.05) = 3,8416*0.77*0.23/0.0025 = 272 participants. Your study would be, therefore, severely underpowered at least for back pain, but similar considerations could be made for other districts. Clearly, in this stage of development you cannot extend your sample, but you could address this potential shortcoming in a more appropriate way by reporting the calculations for sample size and explaining in a specifically designed limits section how this sample has potentially impaired your calculation.

Thanks for the comment. We have mentioned this study’s limitations in the statistical analysis methods and research limitations sections at the end of the article. Although this study met the criteria for a large sample size after grouping by harvesting height, there is still room for improvement. Therefore, we used a more rigorous confidence level for our analysis. Moreover, we adopted a more conservative approach in the discussion. The description was revised in Lines 217-221, 380-383.

several questionnaires for MSD do exists, some of them have been extensively validated across the world, but I had some problems in obtaining the original instrument from your study; please add an English translation as supplementary material and provide some information about internal reliability and consistence (e.g. through calculation of Cronbach's alpha).

Thanks for the comment. The overall questionnaire’s cronbach’s alpha was 0.714. Additionally, among the main question groups, the healthy life question group had an alpha coefficient of 0.894; the MSDs severity question group had an alpha coefficient of 0.825. The entire questionnaire’s cronbach’s alpha coefficient exceeded 0.7, and the key question group’s alpha coefficient exceeded 0.8, which should demonstrate this study’s questionnaire’s reliability.

After we adjusted to match this study need, we submitted it to experts and scholars in agricultural and occupational safety and health for review to ensure the validity of the questionnaire.

The questionnaire English translation form had been added as supplementary material.

Table 1 suggests that some differences affects the main groups of vegetables collectors. Please provide some analyses at least of the distribution of categorical variables in order to better appreciate the multivariable analyses you've also performed.

Thanks for the comment. We have followed the reviewer’s suggestion and added the sample sizes of different crops to Table 1. The description was revised in Lines 240 (Table1).

please stress whether participating (or not participating) into your study could have led to some stigma to the individuals included (or not included) in the eventual population.

Thanks for the comment. Following the reviewer’s comment, this study adds an explanation of how it implements research ethics. It emphasizes the anonymity of this study; the informed consent and voluntary participation of the research participants; and the exclusion of any possible harm to their physical, mental, or reputational well-being. The description was revised in Lines 146-150.

The final section of the discussion (i.e. row 356 onwards) is quite unclear in terms of English phrasing. Please double check.

Thanks for the comment. Based on the reviewer’s comment, this study revises the descriptions of these paragraphs to make the words more precise and the argumentation smoother. The description was revised in Lines 373-396.

The overall quality of the English text is, from my point of view, quite acceptable. I had some difficulties in following the flow of the phrasing in the section from row 356 onwards, and the double checking of the main text could improve its status.

Thanks for the comment. Based on the reviewer’s comment, this study revises the descriptions of these paragraphs to make the words more precise and the argumentation smoother. Besides that, we also double checked the main text to improve the description of these paragraphs. The description was revised in Lines 373-396.

The text is neat. But the study is not clearly described and does not motivate the reader to finish reading.

Thanks for the comment. This study adjusted the description method based on the reviewer’s suggestion, and under the premise of maintaining academic rigor, it will present more arguments focusing on the research topic, to enhance the readers’ interest.

The theme is original but has been developed in the past.

Thanks for the comment. This study has read relevant studies through a literature review. However, most of the previous studies focused on a single category of crops, and there were few studies that compared farmers who plant different types of crops. In the past, the analysis of differences in agricultural injuries or diseases was mostly done through different research projects. This study is relatively rare in comparing them in the same study. Moreover, different countries have different prevalent types and methods of agricultural work. This study targets Taiwan’s agriculture, which has the advantage of localization and can better reflect the characteristics of Taiwan’s agricultural operations.

The introduction suffices for the matter. The description of inclusion and exclusion criteria is not clear. Also, in detail the demographic data of the sample. The measurements and the method followed are clear.

Thanks for the comment. Based on the reviewer’s suggestion, this study enhanced the explanation of the inclusion and exclusion criteria for the sample. Moreover, all the demographic data collected in the questionnaire were shown in Table 1. The description was revised in Lines 134-144.

Necessary normality checks have not been performed on the sample. The results and discussion are consistent with how the study was conducted. The limitations of the research are adequately described.

Thanks for the comment. This study applied the Shapiro-Wilk test and examined the kurtosis and skewness of the sample distribution to verify that the sample did not follow a normal distribution. Based on these results, this study used the Kruskal-Wallis test (one type of median test) instead of one-way ANOVA to test the severity of MSD in different body parts. The description was revised in Lines 206-210.

Why is informed consent not in the language of research? Are you sure all participants knew English?

Thanks for the comment. This study provided the farmers with informed consent in Chinese. However, in response to the editor’s requirements, an English version is also provided for the reviewers. We apologize for any misunderstanding caused and also emphasized that in the description. The description was revised in Lines 147.

References 6, 12, 17, 20, 35, 40, 42 need correction.

Thanks for the comment. We have revised the citation format of the references according to the journal’s requirements.

L51-57, Because these statements were presented in the Introduction section, the appropriate references should be cited.

Thanks for the comment. We have added citations to the relevant description in certain sections, as you suggested. The description was revised in Lines 52-58.

L59-61, Similarly, please cite the references.

Thanks for the comment. We have added citations to the relevant description in certain sections, as you suggested. The description was revised in Lines 61.

L73, the dot was duplicate.

Thanks for the comment. We have revised and corrected the error you mentioned in L77. The description was revised in Lines 77.

L80-82, When reporting “Through a literature review, this study hypothesized that one of the key factors causing the variation in the probability and severity of MSDs in different crops is the harvesting height”, I do not think that the description was rationally. The authors did not provide the sufficient evidence that harvesting height was important based on the aforementioned literature review. However, to our knowledge, the working height is generally a significant factor in postures adopted by the workers, regardless of the work types.

Thanks for the comment. We agreed what reviewer said that the working height is generally a significant factor in postures adopted by the workers, regardless of the work types. However, as the literature cited in this study indicated, fruit farmers who had higher harvesting heights tended to use worse postures for their work, or needed to maintain uncomfortable postures for longer periods of time. And this was exactly why they used more improper postures, or kept improper postures for longer, which led to increased severity of MSDs in certain body areas.

L159, If possible, one or several photographs to illustrate the workers’ postures may be helpful to understand the reality of the harvesting tasks by the readers.

Thanks for the comment. This study mainly conducted a questionnaire survey, so we did not take photos or ask the participants to provide them. Therefore, we are unable to provide photos that illustrate the relevant harvesting postures at the moment. However, we will keep the reviewer’s suggestion in mind. In future related research, we will try to take enough photos to assist explanations, as long as it complies with the research ethics and the participants agree.

L180, when reporting “MSDs affecting areas are usually divided into nine areas in the related study: the neck, shoulder, elbow, wrist/hand, upper back, lower back, knees, hip/thighs, and ankle/feet [36]”, please specify it if an NMQ method was employed in the survey.

Thanks for the comment. We apologize for causing confusion to the reviewer. The meaning of this paragraph is that, based on previous related studies, MSDs were divided into 9 body areas for evaluation or diagnosis. Therefore, this study followed this division method to separate different areas and assess their severity. This study has revised the wording of this paragraph to avoid further possible misunderstandings. The description was revised in Lines 192-196.

L190-200, these paragraphs are somewhat fragmental. Please merge them into a complete paragraph.

Thanks for the comment. Based on the reviewer’s comment, this study revises the description of these paragraphs to make it more systematic and integrated. The description was revised in Lines 203-216.

In table 2, all abbreviations should be noted by the full-spelled name. Generally, the tables and figures in the report should have their completeness. Please check all tables in the manuscript.

Thanks for the comment. Based on the reviewer’s reminder, this study has verified the abbreviations and indicated the full names in parentheses or footnotes at the end of the tables, and reviewed all the tables in the manuscripts. The description was revised in Lines 240 (Table1), 267 (Table2), and 295 (Table3).

L356, Another limitation of the study is that all the disturbs are self- reported and did not have real diagnosis. This can lead to overreporting for example.

Thanks for the comment. As the viewer pointed out, one of the limitations of this study is that it mainly relied on participants’ self-reports, and the reports were not about specific diseases, but symptoms. Therefore, there is a significant difference between participants’ self-reports and the diagnoses of professional doctors. We have tried to emphasize this point as much as possible in the research discussion, especially in the section on limitations. The viewer also reminded us again that we will review and revise the discussion of this study, and use a more conservative approach to discuss the research findings. The description was revised in Lines 374-380.

L381, When saying “Those who can maintain a standing posture, but with arm movements falling between the shoulders and waist, have a relatively lower MSDs incidence rate. This can be considered a relatively appropriate and safe working” in the Conclusion section, this may be insufficient for a typical MSDs study. If possible, please mention about how to improve the relatively dangerous tasks, not only to know what kind of tasks are dangerous.

Thanks for the comment. This study has supplied a potential way to improve relatively dangerous tasks in the conclusion. The description was revised in Lines 404-410.