Title: The relationship between sleep quality, neck pain, shoulder pain and disability, physical
activity, and health perception among middle-aged women : a cross-sectional study
Version: 2 Date: 26 Mar 2022
Reviewer's report:
The article entitled “The relationship between sleep quality and neck pain, shoulder pain and
disability, physical activity, and health perception among middle-aged women: a cross-sectional
study”. This is a great article, however some correction it essencial to considere the publication.
I provide some comments to improve the manuscript.
Abstract
Line 29-33: In the excerpt located at the conclusion of the abstract: “To improve the sleep
quality in middle-aged women, healthcare workers should take into consideration the subjects’
symptoms, such as pain, in accordance to their health. Perceived difficulty of one’s work
and their health can affect sleep quality; hence, it is necessary to develop health intervention
strategy to provide health management, emotional support, and social support for the purpose
of improving daily sleep quality”.
I suggest that the conclusion of the study be placed first and the suggestion for professionals
after, like: “Perceived difficulty of one’s work and their health can affect sleep quality; hence,
it is necessary to develop health intervention strategy to provide health management, emotional
support, and social support for the purpose of improving daily sleep quality. To improve the sleep
quality in middle-aged women, healthcare workers should take into consideration the subjects’
symptoms, such as pain, in accordance to their health”.
Line 29: The authors conclude that “to improve the sleep quality of middle-aged women,
healthcare providers should consider symptoms as pain in line with health. ” However, as a
conclusion, I believe that this statement did not point any direction. The simple fact that health
professionals consider other symptoms, such as those that the authors exemplified, does not
guarantee that there will be an improvement in sleep quality. I suggest that the authors review
this exposed conclusion.
Line 34. I suggest adding “neck pain” to the Key-words.
Background
Line 40-42: “(...) physically demanding work are at a higher risk of developing disabilities
than those with a lower level of physically demanding work.5,6 Physically demanding (...). ”
In this excerpt the authors use “physically demanding work” repeatedly, which makes reading
expensive. I suggest that authors build more fluid sentences with fewer repetitions of words in
the same paragraph.
Line 45-47: “It was found that neck or shoulder pain and disability can affect the degree of
physical exertion at one’s current job while also interfering with the sleep quality. ” What
reference is this information about? I suggest that the authors reference the sentence.
Line 55-56: “In middle-aged women, metabolism, estrogen level, and physiological functions
all gradually decrease with the onset of menopause. ” What reference is used to base these
statements? I suggest including. And the authors address metabolism in their background,
however it is not an outcome of the study, nor is the study sample suitable for the age at which
menopause occurs.
Methods:
Why did the authors set the age between 35 and 64 years? Is there any reference that at this age
the prevalence of shoulder and neck pain is higher in women?
Where was the sample recruited?
The authors could insert a flowchart of the sample selection criteria, showing how many
participants were screened, how many were excluded and how many were selected for the study.
Statistical analysis the authors mention that they used multiple regression analysis with the
stepwise model to determine the degree of effect for each participant. How did the authors define
the covariates? What criterion is used?
What was the base model of the variables and the final model? Authors could write which are
the independent variables and the dependent variables.
Results
I recommend that authors enter the confidence interval in Table 4.
Discussion
Line 220: “This study aims to provide fundamental information for nursing interventions (...).
” Do the authors agree that not only nursing, but other health professionals, such as physical
therapists, physical educators and clinicians can benefit from the results obtained in this study?
In this sense, I suggest that the authors readjust the opening sentence of the discussion.
Conclusion
Line 310: The conclusion is too extensive. Please, summarize the main findings.
Line 311-313: “This study identified the correlation between sleep quality and neck pain,
shoulder pain and disability, physical activity and health perception and looked at factors that
affect sleep quality.” In the concluding session, the authors reformulated the proposal of the
bidding study on the findings, which is not appropriate in this section. I suggest that the authors
aim at the study clearly and directly.