PONE-D-23-30683Activities of daily living, self-efficacy and musculoskeletal fitness are compromised in children with developmental coordination disorderPLOS ONE

Dear Dr. Farhat,

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Mohamed Rafik N. Qureshi, Ph.D.

Academic Editor

PLOS ONE

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Additional Editor Comments:

To comply with PLSO ONE's quality standards, the manuscript entitled "Activities of daily living, self-efficacy, and musculoskeletal fitness are compromised in children with developmental coordination disorder" needs to be modified. The necessary data file may be uploaded along with the questionnaires used.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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: No

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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: The aim of the study is to determine musculoskeletal fitness level, the level of activities of daily living in children (ADL) as reported by their parent and self-efficacy as reported by the children with moderate and severe DCD and compare that to typically developing children (TD). Overall, the paper reads very well, is well conducted, and includes a large group of children with DCD meeting all diagnostic criteria. That physical fitness, ADL and self-efficacy are compromised in DCD has been reported in previous studies, although not in an African country, and not related to different levels of motor impairment. However, the relation between the three concepts has hardly been research before. I would recommend to focus more on this relation in the introduction. At present, the introduction mainly focusses on compromised physical fitness and poor-self efficacy. Research question 2 needs more justification than presently given, as the need to study ADL is hardly mentioned in the introduction. The same holds for research question 4: why is it important to study the relationship between these concepts? And what kind of relationship do you expect based on theory/previous research? The impact of the paper would increase if those 2 research questions are more thoroughly introduced.

Title/abstract: I would suggest to include the relationship between the different concepts in the title and abstract.

Introduction: see above: rationale for research questions 2 and 4 is lacking.

- Line 92: ‘needed sports’ � ‘needed for sports’

Methods:

- Line 122-123: The DCDDailyQ and CSAPPA were translated into the Arabic language. Was the backward-forward translation method applied?

- Line 126: was the CSAPPA individually administered to the children? Please explain in the text.

- Line 141: ‘parental questonnaire’. This questionnaire has not been mentioned before. What kind of questionnaire was used?

- Line 147: how many children were selected by teachers, and how many met the diagnostic criteria for DCD?

- DCDDaily and CSAPPA: please add that only Dutch/Canadian norms were available for these instruments.

- Line 198-199: “Non-parametric correlations were calculated for the TD and DCD groups, separately”. Please add between which variables correlations were calculated

- Considering the number of post-hoc tests: was a Bonferoni correction applied?

Results:

- Line 205: “The descriptive statistics revealed that sex was equally distributed between TD and DCD groups (p=0.275)”. Did you also check whether sex was equally distributed between the two DCD groups? At first glance it seems that far more girls than boys were in the sDCD group compared to the mDCD group.

- Table 1: Height: please present two figures after the full stop.

- Table 2: please add measurement units for the PERFIT subtests. Please add in column 3 what the p-values represent (difference between TD and DCD groups?). I was confused by the label BMI, please explain.

- The DCDDailyQ is written in different ways throughout the text (DCD-DAILY-Q; DCDDaily-Q). In the papers by Van der Linde, the author of the questionnaire, it is called the DCDDaily-Q.

- Line 299: “Data also suggest that the CwDCD did not estimate their adequacy correct” This is not what the data reveal. Children with CwDCD rated their adequacy comparable to the TD group. This does not have to mean that it is incorrect. Young children may not be able to reflect on their own performance. The same statement also occurs in the discussion. Please reflect on this.

Discussion:

- Lines 305-317: I miss a summary of the relation between the PERF-FIT and the questionnaires, where some interesting relations were reveled for the DCD group between Participation/predilection and power/agility and motor skills.

- Lines 318 and following: I miss a reference to the review of Rivilis (Rivilis I, Hay J, Cairney J, Klentrou P, Liu J, Faught BE. Physical activity and fitness in children with developmental coordination disorder: a systematic review. Res Dev Disabil. 2011 May-Jun;32(3):894-910. doi: 10.1016/j.ridd.2011.01.017. PMID: 21310588.)

- Line 323: “Flexibility was assessed using the sit-and-reach test, which measures the flexibility of hamstrings and lower back, and not overall joint flexibility [26]”. This sentence should be added to the methods section, where information about the sit-andreach is scarce.

- Line 325: “We recommend using goniometry of the most important joints, to get valid information about the level of hyper- or hypomobility [27]”. This comment comes out of the blue, as hyper- or hypomobility is not discussed before.

- Line 327: What I miss in the discussion about BMI is the fact that the BMI levels of the children in the present study are still within the normal range. The text know reads as if the children with DCD are overweight, which is not the case.

- Line 342: “Our data suggest that children’s motivation to participate in leisure sports is significantly influenced by their level of skill in motor performance”. This is too bold, as no causal directions were tested. Children with DCD indicated to be less motivated to participate in leisure sports. This may be due to their lower level of motor skill.

- Line 345-347: “In fact, in both groups the highest correlation between predilection to physical activity and participation was seen for the fitness scale of the PERF-FIT and not for the motor skill item series.” Do you have an explanation? Maybe because predilection to physical activity is related to leisure sports, which require fitness?

- I miss a discussion about the differences between TD and DCD groups regarding ADL and CSAPPA data, and how they relate to previous studies. You refer to Noordstar and Volman, but not in relation to your own findings.

- Line 396: “This study showed that components of health-related fitness are not attainable for individuals with low motor competence”. I disagree. Your study shows that children with DCD have lower fitness levels, not that health-related fitness levels are not attainable. I do hope that these children can improve with training.

- I miss in the discussion a remark about the different boys-girls ratios in the mDCD and sDCD groups and how this may (or not) have affected your results.

Reviewer #2: Title of the paper: Activities of daily living, self-efficacy and musculoskeletal fitness are compromised in children with developmental coordination disorder

Developmental co-ordination disorder (DCD) is leading to reduced physical co-ordination and increased risk towards health problems. The paper determines the musculoskeletal fitness level in children with moderate and severe DCD and compare that to typically developing children (TD). It also finds the level of activities of daily living (ADL) as reported by their parent and self-efficacy as reported by the children. The study compares TD children (n=105) and children with DCD (n=109; 45 moderate DCD and 64 severe DCD) of Tunisian students aged between 7 and 10 years of age. The DCD Daily-Questionnaire and Children’s Self-perceptions of Adequacy in and Predilection for Physical Activity Questionnaire were used to determine ADL and adequacy towards physical activity, respectively. The PERF-FIT was used to measure musculoskeletal fitness levels.

Comments:

1) “Activities of daily living, self-efficacy and musculoskeletal fitness are compromised in children with developmental coordination disorder” may be changed to “Activities of daily living, self-efficacy and musculoskeletal comparison among the children with developmental coordination disorder”

2) Please refer to:” In total 214 children participated in the study: 105 TDC and 109 CwDCD. How the sample size was determined is unclear. Sample size selection may be verified using Lwanga and Lemeshow (1990).

Lwanga, S.K., Lemeshow, S. and World Health Organization, 1991. Sample size determination in health studies: a practical manual. World Health Organization.

3) Author may provide flow diagram research methodology steps for sample recruitment and follow up for more clarity.

4) The legend shown below Table 1 may be changed, M-DCD may be changed to m-DCD, similarly S-DCD may be changed to s-DCD to make uniform in throughout the manuscript.

5) Table 2 may be properly formatted to identify the heading of Power and Agility, Motor item series, and Flexibility

6) In Table 2 The heading F may be F-value, legend and last column entry "all sign" may be "all significant" since "all sign" has misleading meaning, similarly "TD-DCD sign" may be "TD-DCD significant"

7) Table 3 first column suitable heading may be provided for instance. Test description. The dF2,211 may be added at the table bottom. The degree of freedom (DF) may be used throughout the manuscript.

8) Table 4 first two columns may be suitably named as DCD types and Statical parameters respectively.

9) Notes below the Tables may be suitable changed to small font size or maybe in italics. All notes must be below adjoining the Table.

10) Some typos may be checked for instance "table 3" should be 'Table 3", "Table 4. gives..." should be “Table 4, gives..." "...and predilection of the children. (Table 5)." should be "...and predilection of the children (Please refer Table 5)." "by Larsen et al. [29]" should be "by Larsen et al. [29]."

11) Table header for Table 5 may be suitable changed. The values of Spearman's rho are shown in the last three columns, The first two columns must be suitable named.

12) Table header for first two columns of Table 6 may be suitable added.

13) Asper Jelsma et al. (2013), ‘In general the motor performance and joint mobility are not related, in DCD.” Hence recommending the use of goniometry may be disjoint here.

Jelsma, L.D., Geuze, R.H., Klerks, M.H., Niemeijer, A.S. and Smits-Engelsman, B.C., 2013. The relationship between joint mobility and motor performance in children with and without the diagnosis of developmental coordination disorder. BMC pediatrics, 13, pp.1-8.

14) Some recommendations put forward by Mandich et al., (2001) as " Skill acquisition through evidence-based practices, Interventions leading to functional outcomes etc. may also be discussed.

Mandich, A.D., Polatajko, H.J., Macnab, J.J. and Miller, L.T., 2001. Treatment of children with developmental coordination disorder: What is the evidence?. Physical & occupational therapy in pediatrics, 20(2-3), pp.51-68.

15) Some similar studies related to PERF-FIT, DCD may be compared with the present studies:

• Smits-Engelsman, B., Neto, J.L.C., Draghi, T.T.G., Rohr, L.A. and Jelsma, D., 2020. Construct validity of the PERF-FIT, a test of motor skill-related fitness for children in low resource areas. Research in developmental disabilities, 102, p.103663.

• Girish S, Raja K, Kamath A. Prevalence of developmental coordination disorder among mainstream school children in India. Journal of pediatric rehabilitation medicine. 2016 Jan 1;9(2):107-16.

• Montes-Montes, R., Delgado-Lobete, L., Pereira, J., Schoemaker, M.M., Santos-del-Riego, S. and Pousada, T., 2020. Identifying children with developmental coordination disorder via parental questionnaires. Spanish reference norms for the DCDDaily-Q-ES and correlation with the DCDQ-ES. International Journal of Environmental Research and Public Health, 17(2), p.555.

• van der Linde, B.W., van Netten, J.J., Otten, B., Postema, K., Geuze, R.H. and Schoemaker, M.M., 2013. Development and psychometric properties of the DCDDaily: a new test for clinical assessment of capacity in activities of daily living in children with developmental coordination disorder. Clinical Rehabilitation, 27(9), pp.834-844.

Data availability:

16) As authors all relevant data are within the manuscript and its Supporting Information files. However. no data file is uploaded. Authors also need to upload DCD Daily-Questionnaire and Children’s Self-perceptions of Adequacy in and Predilection for Physical Activity Questionnaire.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-30683R1Activities of daily living, self-efficacy and musculoskeletal fitness and the interrelation in children with moderate and severe Developmental Coordination DisorderPLOS ONE

Dear Dr. Farhat,

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 11 2024 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 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Mohamed Rafik N. Qureshi, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The manuscript entitled "Activities of daily living, self-efficacy and musculoskeletal fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder" has been modified as per the reviewer's suggestions. The manuscript may further be revised as per the reviewer's remarks. The authors have not made all the data available, except a 'Group Comparison TD DCD PLos one.sav'.

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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: 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

**********

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

Reviewer #1: Yes

Reviewer #2: 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: No

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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: No

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: The authors responded in a satisfactory way to my comments. Some typo's/ clarifications are still needed:

Abstract:

Slow motor learning was associated with lower perceived enjoyment in physical education in the moderate DCD group, and with lower perceived adequacy in physical education in the severe DCD group.

Children with DCD participate and enjoy physical activity less than their peers. This combination of lower participation, lower predilection to physical activity ….

Introduction:

Line 87: “Our current study extends on Cairney’s work [15], who reported that children with DCD had lower levels of generalized than TD children. “ A word is missing after generalized.

Methods:

Line 182: “In total 137 children were selected by teachers, and 141 children met the diagnostic criteria for DCD.” Typo? 141 is more than 137.

Line 213: “The level of the feet is used as zero, so that if children do not reach their toes the values is negative and if the past their toes positive.” Change into: the value is negative; if they reach past their toes.

Line 226: “Norms are available based a Dutch and Spanish sample.” Change into: based upon

Line 248: “Non-parametric correlations were calculated for activities of daily living (DCDDaily-Q), self-efficacy CSAPPA) and musculoskeletal fitness (PERF-FIT) the TD and DCD groups, separately.” Change into: were calculated between

Line 264: “Fig 2. Percentage per the BMI classification” Change into: Percentage per BMI classification.

Discussion:

Line 416:” In the severe DCD group, the highest association with the time to learn skills emerged with perceived adequacy in physical education” Please add: the longer it took them to learn motor skills, the lower their perceived adequacy in physical education.

Line 467:” Moreover, for the DCDDaily-Q participation the highest correlation was also found with Power and agility.” Please add direction: children who participated more had better scores for power and agility?

Reviewer #2: 1) ‘Materials and Methods Study Design or Procedure’ may be changed to under section ‘Materials and Methods Study Design Procedure’

2) There are some typos may be corrected for instance:

a) components; should be components:

b) ‘not feel adequate in physical fitness tasks, such’ should be ‘not feel adequate for physical fitness tasks such’

c) ‘who lack musculoskeletal fitness prerequisites needed sports should be ‘who lack the musculoskeletal fitness prerequisites needed for sports’

d) To make the picture complete, reports what parent see should be To make the picture complete, reports of what parents see

e) ‘ life and perspective of the child’ should be ‘life and the perspective of the child’

f) ‘Diagnostic and Statistical Manual of mental disorders,’ should be ‘Diagnostic and Statistical Manual of Mental Disorders,’

g) ‘Sit-and-reach test was added as measure of flexibility.’ should be ‘A sit-and-reach test was added as a measure of flexibility.’

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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

**********

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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-23-30683R2Activities of daily living, self-efficacy and musculoskeletal fitness and the interrelation in children with moderate and severe Developmental Coordination DisorderPLOS ONE

Dear Dr. Farhat,

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 Feb 26 2024 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 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Mohamed Rafik N. Qureshi, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments :

The manuscript entitled"Activities of daily living, self-efficacy and musculoskeletal fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder

' needs modification as per the reviewers' comments.

[Note: HTML markup is below. Please do not edit.]

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 #2: (No Response)

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 #2: Yes

Reviewer #3: Partly

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

Reviewer #2: Yes

Reviewer #3: Yes

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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 #2: (No Response)

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 #2: (No Response)

Reviewer #3: No

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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 #2: Authors have modified the manuscript as per the reviewers' comments.

However, the manuscript is not free from typos, hence needs careful reading and editing. Some of the typos are listed below:

'To determine musculoskeletal fitness level ..' should be 'To determine musculoskeletal fitness levels ..'

'Lastly, the relation physical fitness, ..' should be 'Lastly, the relation of physical fitness, ..'

'Key words' should be 'Keywords'

'By definition, CwDCD have ..' should be 'By definition, CwDCD has ..'

'CwDCD face evident motor difficulties ..' should be 'CwDCD faces evident motor difficulties ..'

'on the mastering these skills.. ' should be 'on mastering these skills... '

'...that CwDCD participate less in physical activities ...' should be '...that CwDCD participates less in physical activities ...'

'...on their observation on the playground...' should be '...on their observations on the playground...'

'...they did not estimate their adequacy correct. ' should be 't....hey did not estimate their adequacy correctly. '

Reviewer #3: OVERALL

•The overall review of the document is positive, highlighting its elaborate and well-conducted nature. The depth of the study design, ethical considerations, recruitment process, translation methods, and assessment procedures is commendable.

GENERAL

•The study's objective focuses on musculoskeletal fitness in DCD and its association with the level of ADL perceived by parents and self-efficacy as perceived by children. To enhance clarity and better align with the study's objective, it is recommended to consistently use the term "musculoskeletal fitness" throughout the document. This will help avoid potential ambiguity associated with broader terms like "health-related fitness" and "motor skill-related fitness."

•Additionally, consider providing a clear operational definition of the term "musculoskeletal fitness" within the document. This adjustment ensures that the terminology aligns precisely with the study's focus and minimizes the risk of confusion among readers.

•Throughout the entire document, there is room for improvement in the use of English

SPECIFIC

1.INTRODUCTION

The introduction offers a thorough background on DCD. To enhance its effectiveness and improve reader comprehension, it is suggested to refine the introduction emphasizing on particular aspects of musculoskeletal fitness and its correlation with activities of daily living (ADL) and self-efficacy, coupled with a more explicit differentiation from prior studies

2.MATERIALS & METHODS

•Study design and procedure: Provides a clear understanding of the ethical considerations, recruitment process, translation methods, and assessment procedures

•Participants:

oThe statement regarding the identification of children with a motor coordination problem by parents or teachers (Criterion B) does not explicitly align with the DSM-5 criteria for the diagnosis of DCD. To strengthen this aspect, consider revising the statement to explicitly state how the motor coordination difficulties identified by parents or teachers, as per Criterion B, specifically impact activities of daily living or academic performance. This clarification will ensure a closer alignment with the diagnostic criteria for DCD.

oIf the acerating criteria D is solely reliant on parent interviews without involvement of specialist, it is essential to acknowledge this as a limitation of the study. Additionally discuss how this limitation might impact the overall validity.

oIf the global prevalence of DCD is estimated to be 5%, & the study identified 141 out of 167 with DCD, it does indeed raise questions about the potential overestimation. In light of this discrepancy, it is crucial for the study to thoroughly discuss and address the reasons behind the higher-than-expected prevalence in the sample. Consider examining the sensitivity and specificity of the diagnostic tools used, potential biases in the identification process, or any other factors that might have contributed to the observed prevalence. Additionally, discuss how this overestimation might impact the generalizability of the study's findings and the validity of the prevalence rates reported.

•Measurement: The measurements in the study are indeed well-explained, and their psychometric properties are clearly demonstrated. However, the evaluation of cultural sensitivity, particularly pertaining to the items in the Movement Assessment Battery for Children, Second Edition (MABC-2), is not explicitly addressed. It would be beneficial for the study to include a discussion or statement regarding the cultural sensitivity of MABC-2 items

•Statistical analysis: While all the tests were deemed suitable, there is a need for clarification regarding the particular non-parametric correlation method applied in the study concerning DCDDaily-Q, CSAPPA, and PERF-FIT.

•Results: The results have been comprehensively and effectively documented. However, there is a need for clarification regarding the specific non-parametric test used in Table 5

•Discussion: The document features a comprehensive discussion. However, potential confusion among readers may arise due to the use of terms like "health-related" and "musculoskeletal" fitness. Therefore, it is recommended to revise the wording for clarity, and addressing the limitation of the study is advised

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

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Reviewer #2: No

Reviewer #3: Yes: Srilatha Girish

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Activities of daily living, self-efficacy and motor skill related fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder

PONE-D-23-30683R3

Dear Dr. Farhat,

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,

Mohamed Rafik N. Qureshi, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for the updated version.

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 #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 #2: Yes

Reviewer #3: Yes

**********

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

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 #2: Yes

Reviewer #3: 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 #2: (No Response)

Reviewer #3: 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 #2: The paper titled "Activities of daily living, self-efficacy and motor skill related fitness and the interrelation in children with moderate and severe Developmental Coordination Disorder" has been amended as per the comments.

Reviewer #3: (No Response)

**********

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 #2: No

Reviewer #3: Yes: Srilatha Girish

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