PONE-D-23-41381Comparative efficacy of robot-assisted therapy associated with other different interventions on upper limb rehabilitation after stroke: a protocol for a network meta-analysisPLOS ONE

Dear Dr. Hu,

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.

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Roberto Di Marco, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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: 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

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The protocol focuses on a hot topic and the results may have a significant impact on clinical practice.

I have however some major concerns on clinical and methodological concepts.

From a clinical point of view, the authors neglect the major concept of "opportunity window" for recovery, which would strongly bias results. I suggest either they focus on the first 3/6 months after the event, or conduct a separate analysis for the early/late subacute and chronic phase. Similarly, the the authors pool together very different types of brain lesions, ranging from SH to intracranial hemorrhage and hemorrhagic/ischemic stroke. They need to refocus the etiology to be consistent with the planned title.

Primary outcome measures are heterogeneous. The authors just report a few among the most commonly used scales for body integrity and function (see ICF), but they need to report all the outcome measures (primary and secondary) which they plan to include.

The authors need also to provide a clear list of the associated interventions they plan to include: for example, they briefly mention NIBS. In this case, they should detail which NIBS (rTMS, tDCS, tACS?) and possibly the protocol they will consider. The same holds true for other interventions, with a report of dosing and intensity. This may push up heterogeneity - the authors will need to discuss how they plan to manage this.

From a methodological point of view, the authors do not mention how they will deal with direct, indirect and mixed comparisons, as well as assess inconsistencies.

I would also suggest attaching as supplementary the data extraction form.

A thorough revision by a native speaker is mandatory

Reviewer #2: The manuscript "Comparative efficacy of robot-assisted therapy associated with other different interventions on upper limb rehabilitation after stroke: a protocol for a network meta-analysis" is a protocol-type article with the objective of developing a network meta-analysis, which aims to contribute to determining suitable auxiliary interventions for robot-assisted therapy.

[1. Introduction

The text of the manuscript is very well written, easy to read and understand. The authors contextualize the problem well. However, the authors stated that there is no research comparing which rehabilitation program combined with robot-assisted therapy has the best effect. This is a very strong statement, especially given the large number of research published every day. Therefore, I recommend that authors inform in the introduction how they arrived at this information or improve the text in this section.

[2] Methodology

In the statistical analysis section, the authors need to better justify the techniques to be used, as the selection criteria are not clear.

The authors also did not inform whether they will make the analyzed data available, this is important, as it guarantees the reproducibility of the research.

[3] Discussion

The authors made the following statement: "To date, no studies have explored which rehabilitation programs are most effective in combination with robot-assisted therapy," but they do not say how they reached this conclusion. I recommend that the authors inform how they reached this conclusion or improve the text.

The discussion is redundant, as some parts have already been highlighted very well in the introduction. My recommendation is that the authors discuss the importance of their study and how it can be used, for example, in the formulation of public health policies.

General information

The justification for the research is well defined, but the authors need to make their research questions clearer.

Authors need to describe where all data underlying the results will be made available when the study is completed.

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Reviewer #1: No

Reviewer #2: Yes: Ricardo Valentim

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Comparative efficacy of robot-assisted therapy associated with other different interventions on upper limb rehabilitation after stroke: a protocol for a network meta-analysis

PONE-D-23-41381R1

Dear Dr. Hu,

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,

Roberto Di Marco, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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

**********

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: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The authors managed to improve the manuscript in relation to the points recommended by the reviewer. Therefore, for my part there is nothing more to recommend.

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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 #2: Yes: Ricardo Valentim

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