Coping with the COVID-19 Pandemic Using Internet Connected Assistive Devices: Global Online Survey

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents a global online survey of Persons With Disabilities (PWD) and Persons Without Disabilities (PWOD) coping with COVID lockdown restrictions by using internet-connected technology.

While the topic is interesting and the manuscript is generally well-written, its scientific contribution is limited, as it primarily reports survey results.

The originality is affected because similar studies have already been published (e.g., “Impact of COVID-19 lockdown on IADL functioning for people with disabilities using internet-connected assistive devices: Global online survey”, “Impact of COVID-19 on people with physical disabilities”, “Examining the effects of the COVID-19 pandemic on community engagement for people with mobility disabilities”, “The COVID-19 pandemic and people with disability”, “A scoping review of barriers and facilitators affecting the lives of people with disabilities during COVID-19” and “Evaluation of the impact of the first wave of COVID-19 and associated lockdown restrictions on persons with disabilities in 14 states of India”). Therefore, the main question addressed in this manuscript is not completely novel.

The following improvements should be considered:

- Authors should include information about the steps taken to validate the survey by also using other reliability statistics (for example, Cronbach’s alpha).

- The methodological data limitations and how they may affect the interpretation of the obtained results should also be discussed.

- The methodological steps should be improved by comparing results across countries, time points and with control groups.

- Authors should identify potential confounding factors that might influence the online survey results.

- The experimental data would benefit from the incorporation of other advanced statistical analyses (example: regression, subgroup comparisons) to strengthen the findings.

Since the authors state that “The results of this study provide important pilot data to conduct further research for improving everyday functioning for both PWD and PWOD during pandemics and global health emergencies.”, including a case study within this manuscript would also strengthen its originality contribution.

While the references are generally appropriate, their formatting requires correction. Additionally, the reference title should also be moved to the next page.

The Acknowledgements section and the Disability Language/Terminology Positionality Statement are missing.

I can't recommend this manuscript, in its current form, for publication, given the limitations already mentioned, as well as the lack of a significant scientific contribution and originality.

Author Response

This manuscript presents a global online survey of Persons With Disabilities (PWD) and Persons Without Disabilities (PWOD) coping with COVID lockdown restrictions by using internet-connected technology. 

While the topic is interesting and the manuscript is generally well-written, its scientific contribution is limited, as it primarily reports survey results. 

RESPONSE: Thank you for your comment. We have made an effort to specifically point out the unique contribution of our research and this manuscript.   

The originality is affected because similar studies have already been published (e.g., “Impact of COVID-19 lockdown on IADL functioning for people with disabilities using internet-connected assistive devices: Global online survey”, “Impact of COVID-19 on people with physical disabilities”, “Examining the effects of the COVID-19 pandemic on community engagement for people with mobility disabilities”, “The COVID-19 pandemic and people with disability”, “A scoping review of barriers and facilitators affecting the lives of people with disabilities during COVID-19” and “Evaluation of the impact of the first wave of COVID-19 and associated lockdown restrictions on persons with disabilities in 14 states of India”). Therefore, the main question addressed in this manuscript is not completely novel. 

RESPONSE: Existing studies in the literature only describe how people with disabilities have been disproportionately marginalized due to the pandemic. However, the COPING study is the first study on a global scale to assess the everyday functioning of people with disabilities using a self-report outcome instrument that has been specifically designed and validated for assessing satisfaction with performing IADLs for people with disabilities using iCAD. Addintional policy implications have been added to the discussion section. 

 

The following improvements should be considered: 

- Authors should include information about the steps taken to validate the survey by also using other reliability statistics (for example, Cronbach’s alpha). 

RESPONSE: We have included the estimates of reliability and internal consistency for EISA version 1.0 in the manuscript.  

- The methodological data limitations and how they may affect the interpretation of the obtained results should also be discussed. 

- The methodological steps should be improved by comparing results across countries, time points and with control groups. 

RESPONSE: This survey was a one time cross sectional survey that represented individuals from 32 countries. Our group sizes, especially for individuals with disabilities, were too small to compare data across countries. Considering the logistics of administering the global survey over internet, repeating the survey over multiple time points was not feasible. We, however, relied on the participants’ recall of their limitations before and during the pandemic.  We have added this limitation to the “Limitations” section under discussion.  

 

- Authors should identify potential confounding factors that might influence the online survey results. 

RESPONSE: We have already identified and accounted for age and gender as confounding factors in the statistical analyses. We have identified other potential confounding factors in the Limitations section of the manuscript.  

 

- The experimental data would benefit from the incorporation of other advanced statistical analyses (example: regression, subgroup comparisons) to strengthen the findings. 

RESPONSE: Because of smaller and uneven cell sizes, building a regression model was not feasible from these data.   

 

Since the authors state that “The results of this study provide important pilot data to conduct further research for improving everyday functioning for both PWD and PWOD during pandemics and global health emergencies.”, including a case study within this manuscript would also strengthen its originality contribution. 

RESPONSE: This global survey was conducted as a onetime cross-sectional retrospective survey. The discussion section of the manuscript is updated to describe how PWD were disproportionately marginalized compared to PWOD. Adding a case study would be beyond the scope of this manuscript since we did not specifically collect in-depth information on individual scenarios beyond the scope and objectives of the survey questions. 

 

While the references are generally appropriate, their formatting requires correction. Additionally, the reference title should also be moved to the next page. 

The Acknowledgements section and the Disability Language/Terminology Positionality Statement are missing. 

I can't recommend this manuscript, in its current form, for publication, given the limitations already mentioned, as well as the lack of a significant scientific contribution and originality. 

RESPONSE: We have addressed these issues.  

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript provides a valuable analysis of how people with disabilities used Internet-connected assistive devices (iCADs) to perform instrumental activities of daily living (IADLs) before and during the COVID-19 pandemic. The large sample of 700 participants across 32 countries offers meaningful insights into global disparities in accessibility and digital independence.

To further strengthen this important contribution, I would like to offer three constructive suggestions:

1. Strengthening Theoretical and Practical Implications
   The manuscript would benefit from more explicit connections to established frameworks such as universal design and digital inclusion theory. Integrating these perspectives could deepen the conceptual grounding of the findings. Furthermore, expanding the discussion on implications for welfare and public health policy would enhance the practical relevance of the study.
2. Enhancing Methodological Transparency
   Because the study relies on snowball sampling and online-only data collection, the generalizability of the findings is inherently limited. Addressing potential selection biases and acknowledging barriers to technology access (e.g., device availability, digital literacy, language) would improve methodological clarity and strengthen the credibility of the work.
3. Addressing Data Skew and Global Context
   Although the limitations section acknowledges the concentration of respondents from English-speaking regions, this issue warrants deeper discussion. As this is a global online survey, referencing international frameworks such as the Convention on the Rights of Persons with Disabilities (CRPD) and reflecting on environmental and cultural diversity—particularly in non–English-speaking and low- and middle-income countries—would strengthen the global relevance of the manuscript.

Overall, this study makes an important contribution to understanding the role of assistive technologies during a global crisis. I recommend acceptance pending revisions.

Author Response

This manuscript provides a valuable analysis of how people with disabilities used Internet-connected assistive devices (iCADs) to perform instrumental activities of daily living (IADLs) before and during the COVID-19 pandemic. The large sample of 700 participants across 32 countries offers meaningful insights into global disparities in accessibility and digital independence. 

To further strengthen this important contribution, I would like to offer three constructive suggestions: 

1. Strengthening Theoretical and Practical Implications 
   The manuscript would benefit from more explicit connections to established frameworks such as universal design and digital inclusion theory. Integrating these perspectives could deepen the conceptual grounding of the findings. Furthermore, expanding the discussion on implications for welfare and public health policy would enhance the practical relevance of the study. 

RESPONSE: These comments have been addressed in the " Implications for Research and Practice " section  

 

1. Enhancing Methodological Transparency 
   Because the study relies on snowball sampling and online-only data collection, the generalizability of the findings is inherently limited. Addressing potential selection biases and acknowledging barriers to technology access (e.g., device availability, digital literacy, language) would improve methodological clarity and strengthen the credibility of the work. 

RESPONSE: Thank you for suggesting these potential confounding factors. We have identified these under limitations section of the manuscript.  

 

1. Addressing Data Skew and Global Context 
   Although the limitations section acknowledges the concentration of respondents from English-speaking regions, this issue warrants deeper discussion. As this is a global online survey, referencing international frameworks such as the Convention on the Rights of Persons with Disabilities (CRPD) and reflecting on environmental and cultural diversity—particularly in non–English-speaking and low- and middle-income countries—would strengthen the global relevance of the manuscript. 

Overall, this study makes an important contribution to understanding the role of assistive technologies during a global crisis. I recommend acceptance pending revisions. 

RESPONSE: These suggestions have been addressed in the discussion and  implications section  

Reviewer 3 Report

Comments and Suggestions for Authors

First, I would like to thank the Authors for the opportunity to review this manuscript. The study addresses an important and timely topic - the role of internet-connected assistive devices (iCAD) in performing instrumental activities of daily living (IADL) among people with disabilities (PWD) during the COVID-19 pandemic. Despite the relevance of this issue, there are several areas of the manuscript that require clarification or additional data. Below, I present my critical comments.

1. Abstract: It should have a clear and explicit structure: Introduction, Aim, Materials and Methods, Conclusions. Please add information about the standardized questionnaires that were used. The abstract also lacks a conclusions section.
2. Introduction: The current section on the pandemic is very long and does not always lead directly to research on IADL and iCAD. Many sentences are overly lengthy, which reduces readability and makes it difficult to follow the narrative. The introduction should lead to the research gap, yet for about half of the section it remains a general description of ICT and the pandemic. The pandemic context is broad but too narrative and fragmented - it can be shortened while retaining the elements that directly connect to the study aims.
3. Introduction: The global data on the number of mobile connections are interesting, but they do not demonstrate a link to disability.
4. Introduction, line 123: Some citations are incorrectly formatted, e.g., (11) instead of [11].
5. Line 151: There are unnecessary bolded first letters in the text.
6. After stating the study aim, please include the research hypotheses or research questions.
7. Please clarify whether the authors defined any exclusion criteria.
8. Please report Cronbach’s alpha values for the standardized scales used in the study.
9. I noticed that “gender” is used in the manuscript when referring to participants’ biological characteristics. In scientific and clinical research contexts, “sex” is generally preferred to denote biological differences, whereas “gender” refers to social and cultural roles. For clarity and scientific accuracy, I recommend using “sex” consistently throughout the manuscript when describing biological variables.

Author Response

First, I would like to thank the Authors for the opportunity to review this manuscript. The study addresses an important and timely topic - the role of internet-connected assistive devices (iCAD) in performing instrumental activities of daily living (IADL) among people with disabilities (PWD) during the COVID-19 pandemic. Despite the relevance of this issue, there are several areas of the manuscript that require clarification or additional data. Below, I present my critical comments. 

1. Abstract: It should have a clear and explicit structure: Introduction, Aim, Materials and Methods, Conclusions. Please add information about the standardized questionnaires that were used. The abstract also lacks a conclusions section. 

RESPOSNE: These issues were addressed in the manuscript 

1. Introduction: The current section on the pandemic is very long and does not always lead directly to research on IADL and iCAD. Many sentences are overly lengthy, which reduces readability and makes it difficult to follow the narrative. The introduction should lead to the research gap, yet for about half of the section it remains a general description of ICT and the pandemic. The pandemic context is broad but too narrative and fragmented - it can be shortened while retaining the elements that directly connect to the study aims. 

RESPONSE: The introduction section has been streamlined and description of pandemic is shortened.  

 

1. Introduction: The global data on the number of mobile connections are interesting, but they do not demonstrate a link to disability. 

RESPONSE: The global data on mobile connections indicates the ubiquity of this technology in everyday functioning. As has been highlighted in the introduction using mobile technology is no longer a luxury but a necessity for everyday functioning for all individuals including people with disabilities.   

1. Introduction, line 123: Some citations are incorrectly formatted, e.g., (11) instead of [11]. 

1. Line 151: There are unnecessary bolded first letters in the text. 

RESPONSE: These issues were fixed  

1. After stating the study aim, please include the research hypotheses or research questions. 

RESPONSE: We have added anticipated hypotheses to the main objectives of the study 

1. Please clarify whether the authors defined any exclusion criteria. 

RESPONSE: The study did not have any exclusion criteria.  

1. Please report Cronbach’s alpha values for the standardized scales used in the study. 

RESPONSE: These values were included in the manuscript 

1. I noticed that “gender” is used in the manuscript when referring to participants’ biological characteristics. In scientific and clinical research contexts, “sex” is generally preferred to denote biological differences, whereas “gender” refers to social and cultural roles. For clarity and scientific accuracy, I recommend using “sex” consistently throughout the manuscript when describing biological variables. 

RESPONSE: The authors would like to retain gender as marker for male and female sex as this is a more accepted terminology in contemporary rehabilitation research.  

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have sincerely and clearly explained their point of view and improved the manuscript according to some of my recommendations.
I still consider that it primarily reports survey results, but I accept that the manuscript could, eventually, be included for publication if the Editor agrees.

Author Response

Comments: The authors have sincerely and clearly explained their point of view and improved the manuscript according to some of my recommendations.
I still consider that it primarily reports survey results, but I accept that the manuscript could, eventually, be included for publication if the Editor agrees.

Response: We are extremely grateful to the reviewers for their insightful suggestions and pointers for improving the manuscript. We have identified the limitations of the study and included few policy implications of the survey results. We sincerely believe that this research survey will encourage similar surveys targeted towards individuals with disabilities.  

Reviewer 3 Report

Comments and Suggestions for Authors

I have no further comments. Thank you for responding to the reviewers’ comments and making the requested revisions.

Author Response

We are extremely grateful to the reviewers for their insightful suggestions and pointers for improving the manuscript.