Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis

Yikun Yin; Jialin Wang; Qihan Lin; Yinghang Luo; Yongsheng Liu; Junzhi Sun

doi:10.1371/journal.pone.0311355

Peer Review History

Original SubmissionJune 21, 2024
30 Aug 2024 Decision Letter - Renato S. Melo, Editor PONE-D-24-25236Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysisPLOS ONE Dear Dr. Yin, 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 Oct 14 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. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: General Comments: The manuscript, "Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis," presents a comprehensive meta-analysis on the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) in treating Chronic Ankle Instability (CAI). The study is well-structured and includes a thorough search of multiple databases, robust statistical analysis, and a clear presentation of results. Abstract: The abstract effectively summarizes the study's objectives, methods, results, and conclusions. However, it would benefit from a more detailed description of the specific outcomes measured (e.g., specific balance tests and muscle strength assessments). Introduction: The introduction provides a solid background on CAI, its prevalence, and the importance of rehabilitation. It appropriately introduces PNF as a potential intervention and sets the stage for the meta-analysis. The literature cited is relevant and up-to-date. Methods: The methodology section is detailed and transparent. Multiple databases for literature searches enhance the comprehensiveness of the review. The criteria for study inclusion are clear and appropriate. The use of STATA 12 for meta-analysis is standard and acceptable. Specific Comments on Methods: 1. Literature Search: The range of databases searched is commendable. However, including the search terms used in each database for reproducibility might be beneficial. 2. Selection Criteria: The criteria for selecting studies are well-defined. Yet, a flowchart summarizing the selection process would improve clarity. 3. Statistical Analysis: Statistical tests and software are appropriate. The manuscript should briefly justify the selection of STATA 12 and the specific meta-analytic methods used. Results: The results section is comprehensive and clearly presented. The inclusion of both quantitative and qualitative analyses adds depth to the findings. The statistical significance and effect sizes are clearly reported. Specific Comments on Results: 1. Balance Ability: The improvement in balance ability measured by YBT and SEBT is well-documented. Including figures or tables summarizing these results would enhance readability. 2. Muscle Strength: The results related to muscle strength improvements are significant. However, additional details on the specific tests used to measure muscle strength would be helpful. 3. Pain and Questionnaire Scores: The significant improvements in VAS and ankle instability questionnaire scores are notable. It would be beneficial to discuss the clinical relevance of these findings. Discussion: The discussion appropriately interprets the findings, highlighting the clinical implications of PNF in improving balance, muscle strength, and pain in CAI patients. The study's limitations are acknowledged, and suggestions for future research are provided. Specific Comments on Discussion: 1. Interpretation of Results: The discussion effectively relates the results to the broader context of CAI treatment. However, it could benefit from a more in-depth comparison with existing literature. 2. Clinical Implications: The potential for PNF to be integrated into standard CAI rehabilitation protocols is well-argued. Further discussion on the practical implementation of PNF in clinical settings would be useful. 3. Limitations and Future Research: The limitations related to heterogeneity among included studies and potential publication bias are acknowledged. Suggestions for future research could be more specific, particularly regarding the types of studies needed to address current gaps. Conclusion: The conclusion succinctly summarizes the main findings and their implications. It aligns well with the objectives and results of the study. Minor Comments: 1. Grammar and Style: The manuscript is generally well-written. However, a few minor grammatical errors and awkward phrasings should be addressed. 2. Formatting: Ensure consistency in formatting, particularly in headings and subheadings. Including figures and tables within the results section rather than at the end of the manuscript would improve flow. Overall Recommendation: The manuscript is a valuable contribution to the literature on CAI rehabilitation and the use of PNF. It is well-structured, methodologically sound, and clearly presented. With minor revisions to improve clarity and detail in certain sections, it is suitable for publication in PLOS ONE. Suggested Actions: 1. Include a detailed flowchart of the study selection process in the methods section. 2. Provide more specific details on the measurement of outcomes, particularly muscle strength. 3. Enhance the discussion by comparing findings with existing literature and providing more specific suggestions for future research. 4. Address minor grammatical errors and improve formatting consistency Reviewer #2: Congratulations to the authors for the study. This is a systematic review of chronic ankle instability. The data are solid and the results interesting, and the meta-analyses show promising results, justifying its publication. ****** 6. 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Revision 1
9 Sep 2024 Author Response Dear Reviewer We deeply appreciate your valuable comments concerning our manuscript. The suggestions are all very helpful for revision and improvement. We have carefully studied these comments and made related modifications, which we wish could meet with your approval. The modified content has been marked yellow in the text. 1. Include a detailed flowchart of the study selection process in the methods section. Thank you for this suggestion. Revisions have been made to the manuscript. 2.2 Literature Inclusion、Exclusion Criteria and Outcome Indicator According to the PICOS principle, the inclusion、exclusion criteria and outcome indicator for the literature are as follows (See Table 1): Table 1. PICOS framework Parameter Inclusion criteria Exclusion criteria P (population) Adults (>18yrs) population from chronic ankle instability： 1) Subjects had at least one history of ankle sprain in the past 12 months, causing pain and swelling, and the time to lose normal function within 1 day or more 2) The affected ankle of subjects felt "soft leg", and/or repeatedly sprains and/or "un-stable" Non-chronic ankle instability population, ankle surgery history, and animal research I (intervention) Proprioceptive neuromuscular facilitation(PNF), either alone or in conjunction with other measures Non-clinical trials and studies without intervention designs C(comparison) Any alternative treatment includes standard care, placebo, or no treatment O (outcomes) Functional scales、Balance tests、visual analog scale、Muscle strength、Joint Position Sense、Range of Motion Studies from which data is not extracted or original data are inaccessible S (Setting) Language of Publication: Articles published in Chinese or English. Non-Chinese/English documents; non-original research, such as reviews Note: Functional scales including the Ankle Joint Functional Assessment Tool Questionnaire (AJFAI) and the Cumberland Ankle Instability Tool (CAIT); Balance tests include the Star Excursion Balance Test (SEBT) in directions: Anterior (ANT), Anterolateral (ALAT), Anteromedial (AMED), Medial (MED), Posterior (POST), Lateral (LAT), Posterolateral (PLAT), and Posteromedial (PMED), as well as the Y Balance Test (YBT); Visual Analog Scale for Pain (VAS); Muscle strength assessments covering relative peak torque during Plantar flexion, Dorsiflexion, Inversion, and Eversion; Inversion Joint Position Sense; and Ankle Dorsiflexion Range of Motion (DFROM). 2. Provide more specific details on the measurement of outcomes, particularly muscle strength. Thank you for this suggestion. Revisions have been made to the manuscript. 3.4 Effect of PNF on Muscle Strength Muscle strength was assessed using both an isokinetic dynamometer and an isometric handheld dynamometer. The former was used to measure the relative peak torque of the muscles [40], whereas the latter evaluated the maximum peak force [14]. Higher values of relative peak torque and maximum peak force indicate greater muscle strength. Since the units of measurement for the two methods differ, the standardized mean difference (SMD) was chosen for data synthesis. 3. Enhance the discussion by comparing findings with existing literature and providing more specific suggestions for future research. Thank you for this suggestion. Revisions have been made to the manuscript. In the second, third, fourth, and fifth paragraphs of the discussion, the comparison between the research results and the existing literature is added. Second paragraph: The results suggest that PNF techniques can improve lower limb postural control, aligning with previous findings [23, 38] Third paragraph: Compared to other interventions, PNF training also involves additional sensory stimuli (tactile, visual, or verbal) to better facilitate neuromuscular responses and enhance the subject's neural control of the muscles[58]. Fourth paragraph: PNF can alleviate pain, help patients avoid discomfort during movement and daily activities, improve joint function and quality of life, and reduce the risk of secondary injuries. Fifth paragraph: A meta-analysis conducted by AKASAKI H et al. [64] on the effects of PNF on joint position sense showed that PNF did not provide significant advantages, which is consistent with the results of this study. In the article's conclusion, suggestions provided by future research are added. In clinical treatment, PNF training is recommended for improving pain, balance ability, and muscle strength in patients with CAI. However, additional therapeutic approaches should be incorporated if patients with CAI experience significant mobility limitations. For future research directions, we propose the following: (1) To optimize research protocols and experimental designs by using PNF as the sole variable in the experimental group, and including other interventions, either without PNF or with sham PNF, in the control group to determine the combined effects of PNF and other interventions; (2) To increase the sample size and conduct medium- and long-term follow-ups on CAI patients treated with PNF to assess whether the improvements are sustained over time; (3) To further conduct high-quality randomized clinical trials in clinical settings to provide more evidence-based support for clinical application. 4. Address minor grammatical errors and improve formatting consistency Thank you for this suggestion. Revisions have been made to the manuscript. The manuscript has been checked and revised. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0311355.r002
18 Sep 2024 Decision Letter - Renato S. Melo, Editor Effect of proprioceptive neuromuscular facilitation on patients with chronic ankle instability: A systematic review and meta-analysis PONE-D-24-25236R1 Dear Dr. Wang 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Renato S. Melo, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0311355.r003
Formally Accepted
29 Dec 2024 Acceptance Letter - Renato S. Melo, Editor PONE-D-24-25236R1 PLOS ONE Dear Dr. Wang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Renato S. Melo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0311355.r004

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