The Impact of the COVID-19 Pandemic on Outdoor Physical Activities for People with Disabilities, including the Risks for Psychophysical Well-Being

Round 1

Reviewer 1 Report

This study sought to determine the impact of COVID-19 on outdoor activity and physical and mental health in persons with disabilities.  The researchers recruited an adequate sample size for this population.  The use of surveys is appropriate for the research question.  The results demonstrate the negative impact of COVID-19 on physical activity and the psychosocial well-being of athletes with disabilities. 

 

  

Introduction

Line 51 – Just an impact on sport?  What about other indoor activities that are not sport-related?

The introduction needs to identify the population of interest sooner.  This will clarify the background information and who this information is relevant to. 

 The Introduction should be expanded.  Currently, the background does not provide sufficient rationale for the study.  More information regarding athletes with disabilities and their activity levels, barriers, psychosocial health needs to be included in the introduction. 

 The introduction is somewhat confusing as the authors discuss outdoor physical activity and then mention sport and athletes.  Outdoor physical activity has a context of general outdoor leisure and is a broad term.  If the authors are referring to outdoor sport that needs to be clearly stated.  The authors should be consistent with their use of OPA and sport as they may have different contexts for different readers.

 What sports were the athletes competing in?  Were these outdoor sports?  This information needs to be included to determine the relevance of outdoor physical activity to these athletes. 

 Were they in season during the study?  would benefit – it is also unclear if this study is about regular outdoor activities or outdoor sport?

 

Methods

Please provide more detail on the individuals with disabilities.  Were these only physical disabilities or did the athletes also have intellectual or cognitive disabilities?

Line 95 – could some of these sports also be practiced indoors?  Were all of the athletes in their season during the survey?  How could the timing of their season impact the results?

Line 96 – please elaborate on the google modules to determine the impact of COVID-19.  Is there a reference? Was it used in a similar population?

Line 105 – is this survey validated in persons with disabilities?

Line 129 – was the survey only sent to the athletes one time or did they receive reminders to complete the survey. 

 

Results

Line 145 – please define amateur and competitive.

Table 2.  Were all of the variables significant? 

Figures 1 and 2.  Please provide some additional information in the methods regarding the physical and mental dimensions.  What factors made up these dimensions? These figures and the related text do not provide enough information to interpret these data. 

 

Discussion

Overall the discussion provides an explanation of the results and the authors do a good job at bringing in previous literature to explain the results. 

The authors do need to be cautious about assumptions from these limited data.  The inclusion of the section on resilience of the athletes does not line up with the results.  Additionally, the strategy tactics may not be practical especially during the pandemic. 

The conclusion is a nice, concise statement of the findings of this paper. 

Author Response

Dear Sir,

thank You for Your precious comments, which certainly will improve the quality of our paper.

 

Introduction

Line 51 - As we wrote in the introduction, the pandemic led to changes in many aspects of daily life, including various indoor activities, but our research focuses on outdoor physical activity for disabled people.

We welcomed the suggestion of a better description of our study population in the introduction.

We expanded the introduction with the information required.

Despite the OPA is a broad term, we tried to describe the impact of the pandemic on general OPA, also highlighting the impact on the outdoor sports, both competitive and amateur. This was just a descriptive analysis, as we stated in the text.

We preferred to describe the types of outdoor sports practiced by our sample in materials and methods section: soccer, tennis, running, outdoor athletics, handbike, horse riding, skating. Sportpeople were not in season during data collection, but they were all in season when the pandemic begun.

 

Methods

As we reported in the text: “It was mandatory to respect the following criteria: presence of sensorial and/or motor disability, membership in professional sports associations for people with disabilities, regular OPA in the two years preceding the pandemic, ability to understand and to express informed consent.”

Certainly, some of these sports could be practiced indoors, however the restrictions prevented any type of sporting activity, except for that carried out at home, which in the case of our athletes was certainly not practicable according to the characteristics of each sporting practice mentioned. Athletes were not in season during data collection. The timing of their season could not impact the results since the restrictions were yet present at that moment.

With the term “impact of Covid” we intended the effects of the pandemic of the sport habits of our sample. Since it was an emergency condition, all the studies about it were conducted in a quick and methodological weak way.

The peculiar characteristics of the athletes involved and the exceptional nature of the period made it impossible to use existing questionnaires; therefore, as mentioned, we used the model of other surveys dedicated to sports practice.

After sending the survey, some of the athletes who participated were solicited once.

 

Results

We defined these concepts as You required.

According to the indications of all the reviewers, we provided to delete the figures 1 and 2 and to integrate the related section. With regard to table 2, we think that all the variables could contribute to draw a scenario of the investigated situation.

 

Discussion

As we already stated in the text, this paper has a descriptive approach only, therefore it does not allow for general conclusions to be drawn. However, the intention was precisely to highlight an urgency for a fragile category such as people with disabilities. Mentioning resilience serves to signal a tool that this category is called upon to resort to for failures in the healthcare systems. Furthermore, we know that the strategies proposed by us are potentially fallacious, but they are the only ones possible in an emergency condition in which doing nothing equals exacerbating the problem.

 

Finally, we made an extended linguistic revision by a mother tongue University professor expert in scientific English.

 

Best regards

Reviewer 2 Report

Thanks for inviting me to review this manuscript. I believe this is a very important topic. Although in its nature this paper is rather descriptive and therefore some may question its scientific soundness, I can still see its value. Please consider the following comments:

1.        Since the paper focuses on athletes with disabilities only but there are no “athletes” in the title. I suggest the authors add a few sentences in the introduction section about the transferability of their empirical findings. And how could our understanding of people with disabilities during the pandemic be fostered by this study. For example, consider this, “although disabled athletes may have very different needs for outdoor physical activities than other people with disabilities (e.g., Berger, 2008), they have faced similar difficulties during the pandemic.”

2.        I found that a qualitative study may better serve your research objectives (for example another study about the impact of Covid on people with disabilities, Epstein et al., 2021). Why did you choose an open-ended questionnaire and some very basic statistical analyses? Please explain it in the methodology section. And more results about how they answer to those questions are strongly recommended (in the result section).

3.        In the discussion section, you may jump a little bit out of your study and connect it with a wider set of literature. Therefore, I would like to see additional discussions about how Covid has influenced other disadvantaged populations differently. For example, rural-urban migrants in China could not conduct outdoor physical activities as usual because they have been further discriminated against and marginalised during the pandemic (Liu et al., 2022). Older people persisted in conducting outdoor activities because they have no other means to interact with other people (Liu et al., 2021). Did athletes with disabilities have different needs they have to fulfil by going outside? Would insufficient access to outdoor activities have very negative impacts on their mental and physical wellbeing?

Reference

Berger, R. J. (2008). Disability and the dedicated wheelchair athlete: Beyond the “supercrip” critique. Journal of Contemporary Ethnography, 37(6), 647-678.

Epstein, S., Campanile, J., Cerilli, C., Gajwani, P., Varadaraj, V., & Swenor, B. K. (2021). New obstacles and widening gaps: A qualitative study of the effects of the COVID-19 pandemic on US adults with disabilities. Disability and Health Journal, 14(3), 101103.

Liu, Q., Liu, Y., Zhang, C., An, Z., & Zhao, P. (2021). Elderly mobility during the COVID-19 pandemic: A qualitative exploration in Kunming, China. Journal of transport geography, 96, 103176.

Liu, Q., Liu, Z., Kang, T., Zhu, L., & Zhao, P. (2022). Transport inequities through the lens of environmental racism: rural-urban migrants under Covid-19. Transport policy, 122, 26-38.

 

 

Author Response

Dear Sir,

thank You for Your comments, which certainly will improve the quality of our paper.

1. We worked on the introduction as suggested
2. As proposed, we evaluated the study design of Epstein et al. Our choice fell on simple questions to get a descriptive overview of the situation. At the basis of our study, there is the intention of describing an important social problem, for which particularly complex scientific research was not required, we rather wanted to photograph an urgent condition of a fragile category. For this reason, we preferred an open-ended questionnaire and simple statistical analyses. In the text we have frequently remarked on the purely descriptive nature of our analysis.
3. Thanks for the advice, it allowed us to broaden our discussion topic by including information on other fragile categories.

 Best regards

Reviewer 3 Report

Comments for author File: Comments.pdf

Author Response

Dear Sir,

thank You for Your comments, which certainly will improve the quality of our paper.

We corrected the abstract making it more concise, as You requested.

According to the Journal editorial rules we can not formally divide the introduction into two parts. Nevertheless, we integrated the introduction as You requested. In this sense, there are not many articles with the exact same issue of our paper, however the closest ones have been cited and mentioned within the text.

We also integrated the last part of the introduction describing the structure of the paper, as You required.

We deleted the boxplots, as You required.

We know that the methodology of the study is weak, but as we have explained this is a purely descriptive study aimed at signalling a social and health emergency that affects people with disabilities and to draw the attention of the scientific community to this category of fragile people.

 

Best regards

Reviewer 4 Report

Dear authors, the paper is well prepared, but some improvements should be made in the conclusion part, please specify the contributions of the paper, add the practical importance/applications of the findings, provide suggestions for future studies and specify the ways to minimize/avoid the worsening of physical and mental dimensions. 

Author Response

Dear Reviewer,

thank You for Your precious comments, that we welcome.

We integrated the conclusion part on the basis of Your useful suggestions.

 

Best regards

Round 2

Reviewer 1 Report

Thank you for your responses to my comments/suggestions.  In the future, please include the reviewer comment along with the response to document the changes made. 

Introduction - the terminology is still unclear - outdoor physical activity is very different from outdoor sport.  If it is sport, that must be clear and appropriate terminology must be made. 

What rationale is there that the pandemic would impact those with disability differently than able-bodied athletes?  Addition of this rationale would be helpful.

Methods - The actual surveys that the authors generated the current survey from must be identified including which components were used and whether these items were validated.  It is unclear if the authors are looking at just sport activity/training or activity in general.  These are very different constructs and it is unclear what questions were asked.

Results - This is a very specific population with a relatively low sample size.  The figures repeat the data presented in the results section and are superfluous. 

Discussion - The authors overstate the conclusions.  The statements appear to address the general population but in reality are specific to the population assessed. 

Author Response

Dear Reviewer,

Thank You so much for Your reply.

We really appreciate Your effort to lead us in improving the quality of our paper.

So, we will try to give an answer to all Your questions, modifying the article accordingly where possible.

Q1: Introduction - the terminology is still unclear - outdoor physical activity is very different from outdoor sport.  If it is sport, that must be clear and appropriate terminology must be made.

A1: According to Your request, we modified the introduction, taking advantage also to make it leaner and more linear.  In this sense it is necessary to stress a concept. We understand and agree with the distinction between outdoor physical activities and outdoor sports, which you highlight, but we have to consider that this distinction is blurred and subtle for people with disabilities, especially when they practice outdoor sports at an amateur level. This difference was even more subtle during the Covid period, when sport competitive events were suspended and in fact trainings for those who practiced outdoor sports were the only occasions of the day in which they were allowed to leave the house; therefore these individual sports were the only form of outdoor physical activity. It must also be said that often, even in normal conditions, as it is well known, for people with disabilities outdoor sport represents the only real form of outdoor physical activity, given the intrinsic limitations of their condition. Nevertheless, we tried to correct some definitions to avoid confusion for the readers.

Q2: What rationale is there that the pandemic would impact those with disability differently than able-bodied athletes?  Addition of this rationale would be helpful.

A2: As we already said in A1, the baseline of physical activity and sport practicing for people with disabilities is worse than those of able bodies people; it is a fact well known and demonstrated in the literature, including the one cited, therefore it was reasonable to think that the limitations due to the pandemic aggravated an already precarious situation. However, we revised the introduction also in the light of this Your comment.

Q3: Methods - The actual surveys that the authors generated the current survey from must be identified including which components were used and whether these items were validated.  It is unclear if the authors are looking at just sport activity/training or activity in general.  These are very different constructs and it is unclear what questions were asked.

A3: the reference is to sports training and the information collected is illustrated in a more complete way in the results section. In any case, to comply with Your request we inserted the term training in a more specific way. With regard to the survey, we borrowed the model of the studies mentioned since we also had to adapt the methods of data collection to the restrictions caused by the pandemic, which has also irreparably influenced research in all fields.

Q4: Results - This is a very specific population with a relatively low sample size.  The figures repeat the data presented in the results section and are superfluous.

A4: We agree that the figures were superfluous, which is why we had already removed them from the paper.

Q5: Discussion - The authors overstate the conclusions.  The statements appear to address the general population but in reality are specific to the population assessed.

A5: We tried to revise some parts of the discussion to further specify the study population and the purely descriptive nature of the study itself.

English has been further reviewed by a mother tongue University Professor.

 

Thank You in advance for Your further consideration and attention.

Best regards

Reviewer 2 Report

I am satisfied with the current manuscript. Thanks for sharing.

Author Response

Dear Reviewer,

thank You so much for Your kind reply.

 

Best regards

Reviewer 3 Report

 Dear authors,

Thank you for the changes that you have realised on your paper.

In my opinion the paper is still not adequate to agree with the publication. Unfortunately, a descriptive study is not enough from a methodologically point of view for an impact factor journal.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer,

thank You for the commitment and attention you dedicated to our paper.

We understand your reply, however we will try to further improve our paper in the light of Your valuable comments.

 

Best regards

Round 3

Reviewer 1 Report

Thank you for your edits and response to my comments. 

 Introduction - Please consider using "People First Language." Terms such as disabled people   are inappropriate and may be considered offensive to the individuals.  

I am still not clear on how athletes' activities differentiates from leisure physical activity and what exactly the authors are attempting to investigate. 

Methods - Was the time of year considered and whether the time of the survey coincided with the athletes' seasons?  

The construct validity of the surveys must be presented to determine whether the surveys were appropriate for the population as well as provide accurate data. 

Results - Are there descriptive categories that align with the SF-12 Dimension scores.  I understand the values decreased but I do not have a sense of what that means.

Discussion - The limitation of the small sample size severely limits the findings and conclusions. 

Author Response

Dear Reviewer,

Thank you for your further comments.

We really appreciate the time you dedicated to our paper and your efforts to improve the quality of  this article.

Q1:  Introduction - Please consider using "People First Language." Terms such as disabled people   are inappropriate and may be considered offensive to the individuals.  

A1: Thank you for pointing out this concern. We changed these inappropriate terms, as you required.

Q2: I am still not clear on how athletes' activities differentiates from leisure physical activity and what exactly the authors are attempting to investigate. 

A2: We simply tried to understand how the pandemic affected the outdoor physical activity and the outdoor sporting activities for people with disability. As it is well known, the difference between this activities became superfluous during the pandemic due to the lockdowns and restrictions, especially for this fragile category. However, this important aspect is still not investigated in literature. So, we aimed to investigate this limitations for people with disabilities in all their outdoor physical activities, with particular regard to outdoor sporting activities.

Q3: Methods - Was the time of year considered and whether the time of the survey coincided with the athletes' seasons?  

A3: As we reported, we considered as a turning point the date 11^th March 2020, when in Italy the pandemic was officially declared. A comparison between the year before and the year after 11^th March is useful to understand the impact of the pandemic, and it is intuitive that the athletes’ season was underway at that moment, but then all the activities were seriously limited at least until March 2022.

Q4: The construct validity of the surveys must be presented to determine whether the surveys were appropriate for the population as well as provide accurate data. 

A4: As we stated, the survey was developed according to other online surveys used for researches during the pandemic. In fact, this period of emergency also forced researchers to adapt to restrictions and limitations, having to use new and sometimes poorly validated methods to investigate the radical socio-economic and health changes linked to Covid-19.

Q5:Results - Are there descriptive categories that align with the SF-12 Dimension scores.  I understand the values decreased but I do not have a sense of what that means.

A5: Although the results are only descriptive, we think that a generic description of the physical and mental dimension of the recruited subjects helps to describe the difficulties encountered by people with disabilities due to the pandemic.

Q6: Discussion - The limitation of the small sample size severely limits the findings and conclusions. 

A6: We agree with your comment, this is the reason why we openly stated and described this limitations in the discussion section and within the all text.

 

Best regards

Reviewer 3 Report

There are no other comments.

Author Response

Dear Sir,

thank you for the time you dedicated to our paper and for your precious comments.

We provided a further English style revision.

Best regards