Dear Dr. Lannin:Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE's publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised by both reviewers during the review process.Please submit your revised manuscript by November 14th. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Alessandra Solari, M.D.

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

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We will update your Data Availability statement on your behalf to reflect the information you provide.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a systematic review evaluates the quality of measures, and of related psychometric studies, assessing activity and/or participation in adults with upper limb spasticity. A second aim is to explore differences in the quality of the tools for adults with a neurological impairment but without upper limb spasticity.

The subject is interesting and deserves to be investigated. The procedure is well explained and the methodology used to determine the overall quality of the evidence (modified COSMIN GRADE) adequate. There are two major concerns which limit the interpretation of results:

-The second aim stated in the introduction (“differences in psychometric properties for the identified measurement tools for adults with a neurological impairment but without upper limb spasticity will be defined”) is not so clear. Plus, it is hard to reach considering the neurological conditions listed in the inclusion criteria in the Methods, as all these conditions are associated with spasticity (≥ 90% diagnosis of a following neurological condition; Stroke, Multiple Sclerosis, Cerebral Palsy, Traumatic Brain Injury, Anoxia). To define differences in psychometric properties for the identified measurement tools it would be better to include diseases that do not involve spasticity (e.g. Parkinson’s disease or neuromuscular disorders).

-The rationale for inclusion of the 10 metre walk test is not clear. As the authors state, “the 10 metre walk test (10MWT) is a common measure of gait speed. Tools evaluating walking speed are relevant as involuntary and/or impaired arm movements can impact on balance and walking abilities when considering upper limb activity performance.”

Walking speed may correlate with arm movements in neurological diseases involving upper together with lower limbs. As the inclusion criteria did not require spare lower limb function such correlation may be found just because upper limb impairment is associated with lower limb impairment, which does not make the 10 meter test a good measure of upper limb function. The sentence should be modified and the need for including the 10 meter test revised critically and properly justified since the screening phase.

Minor:

-In “Now in 2019, such evidence is available” the year should be updated or removed. It is not clear why the availability in 2019 of a list of measures as in reference [6] (Ashford and Turner-Stokes, 2013) prompted a literature search up to 2016. It is like the study has been started in 2017, so “now in 2019” may be a little confusing.

The meaning of the sentence “a second reviewer screened a random 25% sample against inclusion criteria” should be better clarified as it is not clear what were the purpose and the result of 25% sample screening.

Reviewer #2: The paper reports the results of a survey inquiring psychometric properties of upper limb tools assessing upper limb performances in neurological subjects.

Results highlight moderate confidence level in measurement property in 8 out of 30 selected tools. They also highlight the need of investigating psychometric properties of upper limb assessment tools in neurological subjects with upper limb spasticity.

TITLE

The title is appropriate.

INTRODUCTION

I would add a brief paragraph on the relevant literature summarizing findings from published systematic reviews on upper limb assessment tools.

The aim of this study was “to firstly critically appraise and summarize the quality of the psychometric properties of previously identified upper limb activity “. However authors included tools assessing other domains (e.g. the 10MWT). I agree that the 10MWT can be used as a proxy to assess ‘real-life’ activities however its inclusion in this paper reduces readability. I would recommend to remove these tools from the analyses.

Authors should also provide a rationale for the inclusion of tools mesuring upper limb and activity and participation in real-life activities

Methods.

It is unclear why authors only selected tools published by Ashford and Turner-Stokes. This paper has been published in 2013. A wide range of new tools has potentially been excluded (e.g.Box and Block Test). Authors included the Arm Activity Measure (ArmA) as a newly developed measure. Following this reasoning other tools should be added.

Additionally, I do not understand why inclusion-exclusion criteria list “Undergoing rehabilitation”. I think this has greatly reduced number of collected papers. A clear example is the nine hole peg test. Authors reported less than 10 papers on psychometric properties of this tools that has been extensively studied in MS and other conditions.

Data Analysis

Please add the Terwee’s quality criteria for measurement properties and provide a guide (categorization rules) to quantify the strength of the correlation (“very weak,” 0.20-0.39 “weak,”…).

Results

95% of studies included post stroke participants. I think It is best to remove findings from conditions other than stroke. Likewise a very limited number of papers reported psychometric properties of several tools I think they can be removed from analysis.

In table 2 replace “While sample” with “Whole sample”, column name “Sample” can be misleading.

It would also be useful adding an extra data on Minimal clinically important difference.

Overall I’m concerned about the number of studies included for each tool. For instance, authors reported 5 studies inquiring NHPT psychometric properties for stroke survivors. Similarly they reported only 5 studies including patients with multiple sclerosis. A review published in 2014 reported at least 14 papers investigating psychometric properties of this outcome measure in MS.

Discussion should be better elaborated. Clinical implications should be included guiding clinicians in the choice of the best assessment tool. For example, coming back to the NHPT the most relevant problem in the clinical use of this tool for stroke survivors is the presence of floor effect. This makes NHPT a second line tool to assess upper limb in this condition. The reverse is true for ARAT in MS population.

Comparisons between patient reported outcome and performance scale should also be considered.

Finally, this paper reports findings on scales inquiring upper limb performances and scales on activity and participation the relationship between these two sets of instruments should be discussed. Are there activity and participation scales better representing upper limb impairments in real life activities than others? Are these scales better correlated with scales inquiring upper limb function. Are correlations with these scales better for Patients reported outcomes than functional scales?

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-15560R1

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation – A systematic review.

PLOS ONE

Dear Dr. Lannin,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 31 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Alessandra Solari, M.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All comments have been addressed with the exception of the request on the timed walk test. Not only I had required to modify the sentence but also that the need for including the 10 meter test had to be revised critically and properly justified since the screening phase. I have also noticed that my fellow reviewer asked to address the issue of the 10 meter test. The indicated sentence has been modified, but it seems that no other action was taken in the paper towards the critical revision and proper justification, besides a response to reviewer "Given our sampling frame for selection of assessments to include in this systematic review was drawn from the 2013 published systematic review of measurement tools reported in upper limb studies of spasticity management, and we published our protocol apriori, we respectfully cannot remove 10MWT from our screening".

Reviewer #2: I have read all changes. It seems that authors did not change the manuscript according to reviewers’ suggestions.

The 10MWT has not been removed from the paper. Authors have added this sentence “The 10 metre walk test .... on lower limb activity performance as involuntary and/or impaired arm movements may impact on balance and walking ability”. First, they did not provide references supporting this statement, second disentangling the effect of UL spasticity on gait using TMWT is, at least, challenging.

In addition authors did not removed or added other conditions

I understand the protocol was developed years ago and the importance to comply with the published study protocol.

However these two constrains made the paper less informative:

Psychometric properties of measures in adults with and without spasticity are unclear, and lack of methodological consistence makes decisions between measures difficult.

Additionally, several tools widely used to assesses UL are not reported especially for pathologies different from stroke.

In my opinion these caveats make difficult to “compare the psychometric properties of a wide range of assessment tools and different pathologies”.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation – A systematic review.

PONE-D-20-15560R2

Dear Dr. Lannin,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Alessandra Solari, M.D.

Academic Editor

PLOS ONE