Review for 10.1186/1471-230X-11-88 (2011)

Reviewer's report
Title:Do gastrointestinal complaints increase the risk for subsequent medically
certified long-term sickness absence? The HUSK study.
Version: 2Date:26 May 2011
Reviewer: Jennifer Schurman
Reviewer's report:
I found this manuscript, “Gastrointestinal complaints and certified long-term
sickness absence in the HUSK study,” much improved with the current revision.
The authors should be commended for undertaking a thoughtful and thorough
revision in response to feedback. There remain a few minor areas for
improvement as outlined below:
Minor Essential Revisions
General
1. The manuscript continues to contain many spelling and grammatical errors. It
will require careful copy-editing prior to any publication.
Background
2. It would be helpful for the authors to specifically state how answering the study
questions will advance clinical practice in the final paragraph of the introduction.
The authors argue in their response to reviewers that they wished to keep the
analyses as is to preserve clinical relevance for primary care physicians, but do
not make this point in the manuscript. It would be helpful in terms of providing a
stronger context for understanding the implications of study results and the
judging the import of this study.
3. The final sentence in the introduction appears misplaced and should be moved
to the method.
Results
4. The authors state that “higher levels of GI complaints were observed” for
several variables in the first line of the results. However, the effect sizes were so
small in several cases that it calls into question the relevance of these findings.
The authors may want to include this caveat in the results and/or discussion to
provide a more accurate assessment of the weight of these variables upon risk
for GI complaints.
5. It would be helpful to state the direction of the associations with gender, level
of education, and smoking with risk for LTSA, as well as to remind the reader that
these were the only 3 variables with sufficiently high effect sizes to warrant
inclusion in the models. This information can only be found in the table and took
some time to piece together. A brief comment on these confounding variables
also may be helpful in the discussion, at least in terms of stating whether these
are consistent with previous findings or not.
6. The authors should be cautious in their language throughout the results, as
they use terms such as “stronger,” “strongest,” and “higher” to describe values for
subpopulations within the sample without empirical basis. In other words, the
authors should perform some type of actual statistical comparison between
groups/values to determine whether these differences are, in fact, statistically
stronger or higher; alternately, they may wish to modify their language to avoid
implied statistical difference when no statistical tests were performed.
7. The authors should include basic statistics for all tests completed, at least in
text form. It would be helpful to the reader to see the values of these
non-significant tests, as well, and it would allow for later inclusion in
meta-analyses or comparison with other samples.
Discussion
8. It was unclear what the authors were referring to in stating that “our results
would suggest that management of the investigation and treatment or underlying
pathology should continue to be augmented by helping the individual manage
their behavior and disability.” Could the authors be more clear about this idea, as
it seems central to the issue of clinical relevance? For example, are they referring
to mental or physical health in using the term “pathology” and do they mean that
investigation as to the cause of the physical symptoms should occur while
simultaneously trying to sure up coping resources and minimizing risk of sickness
absence at first presentation?
9. What is it about GI symptoms that might predict LTSA beyond the variables
accounted for in the current study? Are there ways that the barriers to work
associated with GI symptoms could potentially be investigated and/or
addressed? This relationship over and above anxiety, depression, and other
physical symptoms is an interesting finding and does not get discussed fully.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.