Experiences of Individuals Living with Spinal Cord Injuries (SCI) and Acquired Brain Injuries (ABI) during the COVID-19 Pandemic

Round 1

Reviewer 1 Report

1.- Change secondary objectives to secondary objective in abstract, because you only have one secondary objective

2.- How complicated was to carry out your study when applying the online surveys, since your work is precisely about exploring the use of virtual services designed to know the impact of pandemic on psychological wellbeing, physical health, quality of life, and delivery of care in persons living with SCI and ABI.

3.- Were all participants able to answer the questionnaire on their own or were they assisted by their caregivers?

4.- I suggest to mention in the abstract the 5 themes identified regarding COVID-19 and recovery.

5.- Did you evaluate the degree of stress, depression and anxiety in the participants? this to determine how much the mood of the patients influenced their responses.

6.- At what point in the pandemic were the surveys applied? at the beginning, in the middle or at the end of the pandemic?

7.- What were the main psychological stressors that you found in your population?

Author Response

1.- Change secondary objectives to secondary objective in abstract, because you only have one secondary objective - Done

2.- How complicated was to carry out your study when applying the online surveys, since your work is precisely about exploring the use of virtual services designed to know the impact of pandemic on psychological wellbeing, physical health, quality of life, and delivery of care in persons living with SCI and ABI. - Added statement in lines 600-602

3.- Were all participants able to answer the questionnaire on their own or were they assisted by their caregivers? - Addressed in lines 134-135

4.- I suggest to mention in the abstract the 5 themes identified regarding COVID-19 and recovery. - Fixed to include the general concepts of the 5 themes in abstract, but the titles of themes are revealed later

5.- Did you evaluate the degree of stress, depression and anxiety in the participants? this to determine how much the mood of the patients influenced their responses. - We did not use any other outcome measures or validated scales for anxiety / depression / stress for the interview. Anxiety and depression scales (e.g. PHQ-9, GAD-7) were used in the initial online survey in the study but we did not evaluate these in the thematic analysis of the interviews. 

6.- At what point in the pandemic were the surveys applied? at the beginning, in the middle or at the end of the pandemic? - I added the dates in which each interview was conducted in the demographics table (Table 1).

7.- What were the main psychological stressors that you found in your population? - The unpredictability re: the COVID pandemic, unpredictability re: their health condition, limited access to healthcare, and in-person contact with healthcare providers during COVID (e.g. PSW, attendant services) remained the most prominent stressors. 

Reviewer 2 Report

Thank you for your important article and research, please find line by line feedback below.

In the introduction, consider adjusting the general statement in lines 39-41 on the measures taken in the pandemic, consider discussing the measures taken in the specific areas the participants were in to provide more context. If there was uniform adoption or not both in policy but also socially, could impact affects on participants.

Stroke is explicitly named in the introduction but then none of the participants were identified as having experienced a stroke. If stroke was included as a type of ABI, please explain that in the introduction for readers who are not as familiar with that topic.

The introduction seems a bit disjointed, please consider revising the introduction for better flow and set up of the objectives of the study. It seems like the introduction could be the first two sentences in the first paragraph added to the second paragraph and that may be a more focused introduction.  

Line 46- I would recommend ‘outcomes’ instead of ‘consequences’ as consequences gives an impression that it is due to the individuals shortcomings/fault that they are experiencing those things.

Line 46-48- please add citations that support the statement on motor and cognitive functioning of individuals with SCI, ABI, and have had a stroke.

Line 70-72- please add in citations that point to the scientific and grey literature that is emerging.

Line 147-148- This sentence is confusing, please consider revising for clarity.

Lines 157-159- Please consider revising this sentence for clarity

Consider including count information in the results section. How many participants commented upon each theme/subtheme? This can help show how universal a theme was. Instead of using ‘some participants’ say how many participants that was.

Consider drawing on additional literature in the discussion, even if this literature pulls from studies outside of the covid time but that speak to outcomes, those could be useful comparisons in this manuscript.

Citation 5- capitalize the journal name

Citation 11- capitalize the journal name

Citation 15- capitalize the journal name

Citation 18- capitalize the journal name

Author Response

In the introduction, consider adjusting the general statement in lines 39-41 on the measures taken in the pandemic, consider discussing the measures taken in the specific areas the participants were in to provide more context. If there was uniform adoption or not both in policy but also socially, could impact affects on participants. Added more detail on specific pandemic measures relevant to the interview participants in lines 40-43.

Stroke is explicitly named in the introduction but then none of the participants were identified as having experienced a stroke. If stroke was included as a type of ABI, please explain that in the introduction for readers who are not as familiar with that topic. As the interview participants did not end up having a stroke diagnosis, I removed statements regarding stroke in the introduction. The participants were gathered from an initial pool of individuals with a diagnosis of SCI, ABI, or stroke, thus this information remained in the methods section.

The introduction seems a bit disjointed, please consider revising the introduction for better flow and set up of the objectives of the study. It seems like the introduction could be the first two sentences in the first paragraph added to the second paragraph and that may be a more focused introduction.  Revised the introduction for better flow

Line 46- I would recommend ‘outcomes’ instead of ‘consequences’ as consequences gives an impression that it is due to the individuals shortcomings/fault that they are experiencing those things. Done

Line 46-48- please add citations that support the statement on motor and cognitive functioning of individuals with SCI, ABI, and have had a stroke. Done, citations 4-6

Line 70-72- please add in citations that point to the scientific and grey literature that is emerging. Done, citations 1, 7-10

Line 147-148- This sentence is confusing, please consider revising for clarity. Done

Lines 157-159- Please consider revising this sentence for clarity Done

Consider including count information in the results section. How many participants commented upon each theme/subtheme? This can help show how universal a theme was. Instead of using ‘some participants’ say how many participants that was. Done

Consider drawing on additional literature in the discussion, even if this literature pulls from studies outside of the covid time but that speak to outcomes, those could be useful comparisons in this manuscript. Added supporting citations throughout discussion

Citation 5- capitalize the journal name Done

Citation 11- capitalize the journal name Done

Citation 15- capitalize the journal name Done

Citation 18- capitalize the journal name Done