Physical Activity, Well-Being, and the Needs of Canadians with Disabilities during the COVID-19 Pandemic

Round 1

Reviewer 1 Report

The manuscript on physical activity, well-being and the needs of Canadians with disabilities is well-written and relevant, particularly given the high risk in people with disabilities to develop inactive lifestyles, and particularly in periods of lock down. Furthermore, the authors used the results of the study to inform policy makers. However, I have the following concerns:

·       Authors used the IPAQ questionnaire and state that this questionnaire was validated (paragraph 4 ‘Strength and limitations’ line 380). Furthermore, in line 325 authors imply that, in contrast to the 2001 data which were not based on a valid measure of PA, the current study is based on a valid questionnaire. Although the IPAQ has indeed been validated in healthy people and groups of disabled persons, to my opinion, the IPAQ has not been validated in people with SCI. Authors do not provide references regarding validity of the IPAQ in people with SCI, they only refer to a study in which this questionnaire was used in people with SCI. If no validation study is available on IPAQ in people with SCI, authors should reformulate their statements concerning validity of this questionnaire in this population.

·       Authors aimed to  assess the impact of the COVID-19 pandemic on physical activity in people with a disability. No pre-morbid information was available on physical activity levels. Therefore, participants were asked whether and how the pandemic had impacted their physical activity level (no change, negative change, positive change). Why did authors not also ask participants about the estimated magnitude of the change?

·       The study had a longitudinal design. However, if I understood it well, authors did not use the longitudinal data on the relationship between physical activity and health (physical and mental); whereas these data are available in 216 participants. Why did they only report the correlations for the 2 iterations separately?

·       If I understood it well, no information is available on whether the participants had suffered from COVID-19 themselves. Is that correct, and if yes, why did authors not focus on that aspect? How may this have affected their conclusions?  

·       Unmet needs were evaluated with pre-defined needs. Why did authors not also include an open question on (unmet) needs?  

·       Findings of the study (iteration 1) were presented to policy makers which resulted in allowance for recreation facilities to re-open that supported physical therapy for people with disabilities. However, no differences in physical activity levels were found between the two iterations. Can authors comment on that? 

Author Response

Thank you for your feedback and time taken to review our manuscript. Please see the attached response in whichwWe have addressed your concerns on a point-by-point basis.

Author Response File: Author Response.doc

Reviewer 2 Report

Thank you for the opportunity to review this manuscript on physical activity and well-being of Canadians with disabilities during the COVID-19 pandemic. This study is a cohort study with two measurements, using self-report questionnaires within a large group of people with disabilities.  The aim of the study is to investigate physical and mental wellbeing, as well as intra-individual changes over time, during the pandemic and explore the needs of people with disabilities. This is an important topic and this research contributes to more knowledge on the health and well-being, as well as the needs during and beyond the pandemic.

I have some questions and suggestions. The most important limitation of this study is that data before the start of the pandemic is lacking. Results refer to perceived impact and to physical and mental health during the pandemic. More caution is needed in the conclusions and implications, preventing the reader from interpreting the results as causal effects.

 

Abstract

1.       Could you be more precise about which results represent change over time?

2.       The conclusion does not fit to the research questions.

 

Introduction

3.       Could you define more precisely the population = people with disabilities?

4.       The introduction lacks literature on physical and mental health of people with disabilities, independently of the effect of a pandemic or lockdown. Also literature on the comparison with abled people is lacking.

Method

5.       What was the rationale for the two timeframes? Why was December 19^th used as new time frame?

6.       For the people that participated at both iterations, what was the average time between both iterations?

7.       page 3 line 125: link to OSF gives an error

8.       What is known about the internal consistency and construct validity of the measures used? More information on psychometric properties is needed, especially for using these measures with people with a disability.

 

Results

9.       It is unclear to me how figure 1A and 1B should be read. What does the variation on x-as means, or the surface of this figure? Some explanation is needed.

10.   What does the asterisk means in 1B?

11.   in paragraph 3.4 inter and intra-individual differences were both described. Please check the words that were used to describe both type of differences (lower vs decreased vs worst). Prevent the reader from interpreting the results as longitudinal effects.

12.   paragraph 3.5 starts with the conclusion in stead of describing the data. Other high percentages may also be relevant to describe, precisely because it is one of the research questions to describe the needs.

13.   page 8 line 289: which percentages were compared in this chi-square test?

 

Discussion

14.   Page 8 line 307 “As hypothesized, the majority of respondents perceived that the pandemic had a negative impact on their PA habits”. A baseline measure (before pandemic) is lacking, and conclusions about the impact of the pandemic rely on perceived impact (in retrospect). Also in the next sentence, conclusions for mental health were based on one item.  This should be mentioned in the limitations section.

15.   page 8 line 308 – a comparison is made with a proportion of Canadians with disabilities reporting this earlier in the pandemic. I believe that this conclusion should be tested, or if not, not can be reported in the discussion as a conclusion

16.   page 9 line 312: Is it a validated measure, also for this population? See also page 10 line 380.

17.   PROMIS: it is a limitation that there are no norms for people with disabilities; the norms that were used were based on able-bodied adults measured during non-pandemic times. So, what does the comparison with the norms exactly implies?

18.   The group that participated at iteration 2 was less heterogenous on ethnicity, this should also be reported in the limitations

19.   Perceived impact of the pandemic on mental health is measured by 1 question. No information is given on validity or reliability of this measure. This should be described as limitation.

20.   the correlation between MVPA and mental health was almost doubled at iteration 2 compared to iteration 1. Could the authors give some explanation for this? Is it a time effect or a group effect?

 

Typo’s and language use

1.       page 2 line 85 “disabilities”

2.       page 4 line169-174: long sentence, not easy to read

3.       page 10, line 398 no should be not

Author Response

Thank you for your feedback and time taken to review our manuscript. We have addressed your comments on a point-by-point basis in the attached response and tracked changes within the manuscript.

Author Response File: Author Response.doc

Round 2

Reviewer 2 Report

Thanks to the authors for their reply to my suggestions. Most of them were solved and thoroughly processed. I have some minor points.

1.       Abstract: I don’t understand why the authors addes the phrase ‘compared to pre-pandemic’. I would suggest to delete this, because the study did not include a measurement before the pandemic.

2.       page 2 line 75: typo ‘js’

3.       page 2 line 91-95: the authors summarize the research question. In the first question the impact on PA levels is mentioned, but the impact on mental health levels is lacking.

4.       Results: 3.2 subhead should be ‘perceived impact of the pandemic’, because physical activity and mental heath were described in the paragraph

5.       Figure 1

a.       Thanks for the explanation of the violin graphs. It would be helpful to add this to the notes “A and B represent violin graphs indicating the number of responses for each t-scores

b.      Because C and D were described at page 7 and A and B at page 8 it would be more logic when C and D were presented first (A = C, B = D)

c.       please check the adds to the text: ‘inidicates’ in notes of Figure 1.

6.       I asked the authors to explain the rationale for the two timeframes. Why was December 19th used as new time frame? The answer of the authors is clear, but it would be relevant to include this also in the manuscript. For example in paragraph 2.2.

Author Response

Please see attached point-by-point response.

Thank you for your time and input.

Author Response File: Author Response.doc