PONE-D-24-16134Efficacy of virtual reality-based rehabilitation on the upper extremity deficits of stroke patients: A protocol for systematic review and meta-analysisPLOS ONE

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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: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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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: Yes

Reviewer #2: Partly

Reviewer #3: 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: Yes

Reviewer #2: Yes

Reviewer #3: 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: 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 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 manuscript provides a strong rationale for the proposed study, focusing on the efficacy of virtual reality (VR)-based rehabilitation for upper extremity deficits in stroke patients. It addresses a significant and common issue faced by stroke survivors, contributing to the field of neurorehabilitation. The introduction effectively highlights the prevalence and impact of upper extremity deficits post-stroke, and the potential benefits of VR-based rehabilitation. The research question is clearly identified, aiming to synthesize current evidence on the effectiveness of VR interventions, which is a valid academic problem and could significantly enhance clinical practice and rehabilitation strategies.

The protocol is technically sound and planned to lead to meaningful outcomes. The manuscript outlines a systematic approach incorporating randomized controlled trials (RCTs) to assess the effects of VR-based rehabilitation on upper extremity function. The use of comprehensive databases and predefined outcome measures (such as FMUE, BBT, WMFT, and ARAT for primary outcomes, and BI and FIM for secondary outcomes) ensures a structured data collection process. The application of the Cochrane risk of bias tool and planned meta-regression and subgroup analyses add robustness to the methodology. Statistical power analysis is implicit in the extensive data sources and selection criteria, although explicit power analysis details are not provided.

The methodology is feasible and described in sufficient detail to allow replication. The manuscript provides a clear description of the search strategy, inclusion criteria, data extraction, and analysis procedures. The use of independent researchers for study selection and quality assessment ensures objectivity and reproducibility. The detailed explanation of the planned statistical methods, including heterogeneity assessment and evidence quality evaluation, supports the feasibility and robustness of the study design. However, including explicit sample size calculations and more detailed statistical power analysis would strengthen the protocol.

The authors have stated that no datasets were generated or analyzed during the current study and that relevant data will be made available upon study completion. This meets the basic requirement for data availability, but more explicit details on how and where the data will be shared could enhance transparency.

The manuscript is presented in an intelligible fashion and written in standard English. The structure follows a logical flow, and the language is clear and professional. The inclusion of a PRISMA-P checklist ensures adherence to reporting standards, which enhances the clarity and comprehensiveness of the protocol.

The authors might consider addressing potential limitations related to heterogeneity in stroke severity among participants and variations in VR interventions. These factors could impact the generalizability of the findings.

There are no evident ethical concerns regarding the research or publication process. The authors have declared no competing interests and no specific funding, which supports the objectivity of the study.

Overall, the manuscript presents a well-justified, methodologically sound, and feasible protocol for a systematic review and meta-analysis on the efficacy of VR-based rehabilitation for upper extremity deficits in stroke patients. It is suitable for publication.

Reviewer #2: The presented study is a very interesting topic, but there are already two systematic reviews, one from 2018 and another from 2022, with similar maths. In this sense, it is suggested that the authors could reformulate the objective of the study, since the secondary objective will be to understand what is the intensity and duration of the VR intervention to achieve better results in upper limb functionality.

Title should be reformulated to understand the outcome and if it is a systematic review, it is not efficacy but effectiveness what authors want to measure.

The eligibility criteria should be better described (e.g. studies language; search time).

As a protocol of a systematic review with metanalysis submission register could be described.

In PICOS study design the C is not described, what will be compared?

The structure of the abstract and the paper should be similar and following PLOS one submission guidelines. If authors present discussion it should be present in both parts. In this case we have conclusion in the abstract and discussion on the paper. Also it should be Materials and Methods and not Methods and Analysis or just Methods as presented.

Vancouver rules should be followed, reference number is not in a rectangular parentheses.

Reviewer #3: Under the sub topic "Assessment of heterogenicity"

Please correct the tense of the sentences to future tense (from the lines 149-153)

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Reviewer #1: Yes: Ana Isabel Correia Matos de Ferreira Vieira

Reviewer #2: No

Reviewer #3: Yes: Surangika Wadugodapitiya

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Attachments

Attachment

Submitted filename: PONE-D-24-16134.pdf

Effectiveness of virtual reality-based rehabilitation on the upper extremity motor function of stroke patients: A protocol for systematic review and meta-analysis

PONE-D-24-16134R1

Dear Dr. Zhang,

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,

Domiziano Tarantino, MD

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

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: 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

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: Yes

Reviewer #3: 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: After carefully reviewing the revised version of the manuscript, I am satisfied that the authors have adequately addressed the concerns raised in the initial review. The revisions have improved the clarity and overall quality of the paper, and I now consider it to be in a suitable condition for publication. I have no further suggestions or comments.

Reviewer #3: The author answered the comments which I have raised. I accept the revised version of the manuscript

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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: No

Reviewer #3: Yes: Surangika Wadugodapitiya

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