PONE-D-23-42196Feasibility of the “Preventing functional decline in acutely hospitalized older patients (PREV_FUNC)” study – A three-armed randomized controlled pilot trialPLOS 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

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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: Manuscript PONE-D-23-42196

Feasibility of the “Preventing functional decline in acutely hospitalized older patients” study – A three-armed randomized controlled trial

This manuscript described a randomized controlled trial assessing recruitment and retention rates, intervention compliance, acceptability, and scientific feasibility of 3 different exercise programs for acutely ill older inpatients in geriatric units or clinics of 3 different hospitals in Sweden. The authors highlight that few studies have compared different exercise programs in the acute care setting among older patients.

I think overall this is a well-designed assessment and the authors did a very good job of writing up their findings. One question I have relates to inpatients with mild cognitive impairment (MCI). Other studies have shown that at least 1/3 of older inpatients have some level of cognitive impairment, and that patients with MCI are very limited in terms of physical function and mobility. Have the authors considered the impact of their interventions for patients with MCI? It seems these interventions are helpful for many but not all patients. Also, what happens when a patient develops delirium during hospitalization? How will the authors address this issue in the later RCT? The authors should explain why they are not assessing cognition at baseline using a standardized validated tool such as the Mini-cog. This is important not only for confirming the patient can provide written consent, but also for confirming cognition status. I think this piece of data should be prioritized during recruitment and enrollment for the later RCT and can be used to better understand the results of the study. If it is possible to include some patients with MCI, that would ultimately provide more evidence to present related to this trial. Alternatively, if the exercise programs are not appropriate for patients with MCI that should be clearly articulated and explained.

The first reference was cited twice – reference 1 and reference 3 in the bibliography.

Reviewer #2: This paper reports preliminary results from a feasibility study of in-hospital exercise. The manuscript is clearly written with intervention and analytical details well-documented. The major limitation is the small sample size. However, the authors clarified that the purpose of the study is just to examine the feasibility rather than intervention effectiveness. I only have a few minor suggestions:

1. The study excludes individuals living in nursing homes. It would be helpful if the authors could provide an explanation for this exclusion, given that the intervention is conducted in hospitals.

2. In several instances, the purpose of the study is stated as examining the trends and variance of the outcome measures Does “variance” here actually mean “change” as no variance was reported? If so, please consider revise as the readers may confuse it with the statistical term variance.

3. Considering the small sample size, univariate quantile regression may not have sufficient power. If the intention is to compare the mean or median of the SPPB, I recommend considering non-parametric tests such as the Kruskal-Wallis test.

4. When analyzing the SPPB and Barthel Index, will the sum scores be used? If so, please note that these scores are continuous rather than ordinal. Additionally, ordinal scales are technically a type of categorical variable. I suggest the authors review and clarify the definitions when describing the variables used for analysis.

5. The paper mentions that three participants were lost before the baseline assessment. It would be helpful to provide an explanation for the reasons behind this loss.

6. Although the sample size for each group is small, it is still worth discussing whether the differences in sample characteristics and outcome scores at baseline and after the intervention are statistically significant based on non-parametric tests.

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Reviewer #1: Yes: Christine Loyd

Reviewer #2: No

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Feasibility of the “Preventing functional decline in acutely hospitalized older patients (PREV_FUNC)” study – A three-armed randomized controlled pilot trial

PONE-D-23-42196R1

Dear Dr. Sandberg,

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,

Sascha Köpke

Academic Editor

PLOS ONE

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

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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: Yes

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. 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 comments were adequately addressed. The authors also provided adequate documentation regarding data privacy laws in Sweden.

Reviewer #2: The authors have satisfactorily addressed my previous comments. The current version is good for publication.

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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: Yes: Christine M. Loyd

Reviewer #2: No

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