PONE-D-22-13269Three Dimensional Analysis of Hip Joint Reaction Force using Q Hip Force (AQHF) Software: Implication as a Diagnostic ToolPLOS ONE

Dear Dr. Farhana,

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Ghulam Md Ashraf, Ph.D.

Academic Editor

PLOS ONE

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #3: Yes

Reviewer #4: 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: Inclusion criteria of Participants should be added.

Assigned Consent Form by each participant should be mentioned in the manuscript.

Ethical Committe number and site should be added to the manuscript.

Limitation section of the study should be added.

Reviewer #2: In this study, the authors designed a software, the Analysis Q Hip Force (AQHF), to analyze the data retrieved from the mathematical equations for calculating the JRF and ground reaction force (GRF) that act on the hip joint during the early part of the stance phase. The paper is very interesting and technically sound.

1) The references is up to date

2) The manuscript is grammatical correct

3) The figures, tables and the statistics are satisfactory.

Major Comments:

1) The authors must write a small section describing the technical characteristics of the AQHF software and the complexity of the functions

2) The authors must analyze advantages and disadvantages compared to other similar software

Reviewer #3: The article is quite interesting trying to calculate the active forces on hip joints that might help in predicting the wear and tear for deviated JRF values. This might help in design of the implant material for a customized fit. With personalized medical devices being the future, this article is an important step towards that. The article is clinically relevant to bring a change and add dimensions to the current therapies for hip pain and gait-associated afflictions. It may be helpful when considering clinical decision-making.

However, I would like the authors to address a few points:

1. The authors mention that the software can predict a healthy gait index with input readings up to 70� elevations. This requires some explanation as to how the software can calculate the extrapolations with precision. Hence, in Section 5, the third point in the material and method section requires a descriptive explanation as to how the Q hip force software synchronizes with the AQHF software to predict the results with significance. An illustration showing this synchronization can be added.

2. In Sections 3.2 and 4, the authors have mentioned an increase in the mean value of male hip JRF compared to the females during walking up four tested elevations. They conclude that this indicates a high degree of micro-motion. Though these results are calculated through software and statistical methods, the percentage of the gait cycle should be mentioned when calculating both ground reaction force and joint reaction force, to affirmatively conclude the results. Hence, the percentage of GRF and JRF must be added in section 3.2 and 4, and should be included in the downstream calculations of the results.

3. In section 2, the authors have discussed the results of two parameters, section 2.1 discusses the effect of gender (Factor B) on 3D hip JRF obtained from AQHF Software, and section 2.2 demonstrates the interaction effect of ramps and gender on the resultant hip JRF. However, no values were provided for the interaction effect of ramp and gender on the resultant GRF. Since both GRF and JRF values are important for prediction and extrapolation of data till 70� elevations, it is mandatory to explain the interaction effect of ramp and gender on GRF as well.

Minor points:

a. Line numbers must be added for ease of reading and tracking.

b. Typographical errors must be corrected.

c. Use uniform format for writing “Tables and Figures”. In some places it is mentioned as fig or figure, and in others as Fig.

Reviewer #4: The strength of the study is the analysis of both JRF and GRF reaction forces for females and males, taking into account the structural differences in both genders. Furthermore, the study is based on the data calculated by actual analysis of the subjects which is used as input data in the Q hip software, with subsequent calculations done through AQHF software. However, some points need to be addressed.

1. The study has used upslope walking instead of level-ground walking. Since the usual walking pattern mostly involves level-ground walking, why is leveled walking not used in the study instead upslope walking is used to calculate the hip joint force. The authors should explain why they have not used ground-level walking.

2. In the introduction section, the authors mention that they have used the motion analysis system which utilizes marker-based motion planes and a force platform to record the kinematic and kinetic gait parameters in a subject-specific investigation method. However, they have not mentioned the frequency at which the data was recorded. Since the analysis depends on the frequency of each data point to obtain kinetic gait parameters, the study requires a clear indication of frequencies for data point calculations.

3. It is evident that the GRF and JRF calculations are used as a final input in the AQHF software, which calculates the actual hip-joint forces. In the results section, the authors have calculated the effect of gender on the hip JRF (section 2.1) and the effect of ramps and gender on the resultant hip JRF (section 2.2). There is no mention of the effect of ramp and gender on the final GRF. This seems to be missing in the study and must be incorporated and discussed.

4. Figure 7 is unclear and should be replaced by a clearer picture.

Minor points:

1. Line numbers can be added for easier readability.

2. Relevant latest references from 2022 can be added (e.g doi: 10.1016/j.gaitpost.2014.06.013).

3. Though some studies have developed prediction models to calculate spinal and joint forces in certain disabilities and amputations, the present study evaluates the forces in normal subjects to identify a healthy walking index. Any derangement from normal forces can be easily identified by the results calculated through the AQHF software. Hence, this study fills a lacuna in synchronizing the research results and its feasible use in clinical settings.

4. The mathematical calculation backed by descriptive statistics with LSD and factorial design provides a rigorous analysis of the subject-based results to be used as input for the software.

5. The study is promising to provide sufficient grounds for further studies that can facilitate the routine use of the AQHF software in clinical settings.

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Reviewer #1: Yes: Asmaa M. Elbandrawy

Reviewer #2: No

Reviewer #3: Yes: M. Dharma Prasad

Reviewer #4: No

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Three Dimensional Analysis of Hip Joint Reaction Force using Q Hip Force (AQHF) Software: Implication as a Diagnostic Tool

PONE-D-22-13269R1

Dear Dr. Farhana,

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.

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Kind regards,

Ghulam Md Ashraf, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #3: Yes

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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

Reviewer #3: Yes

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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: I thank the authors, all recommendations had been done .This is an interesting study and the authors have collected a unique dataset using cutting

edge methodology. The paper is generally well written and structured.

Reviewer #2: The authors have improved and revised the manuscript. It is technically sound and suitable for publication.

Reviewer #3: All questions and comments that I and other reviewers raised and communicated to authors are addressed to my satisfaction.

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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: Yes: Athanasios Alexiou

Reviewer #3: No

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