PONE-D-24-37984Arm weight effects on dynamic walking stability in individuals with hemiparetic strokePLOS ONE

Dear Dr. Yang,

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.

Both reviewers acknowledge the study's value but raise key concerns. Reviewer #1 requests clarification on the choice of the FSR-based balance evaluation method and the rationale for using a 0.45 kg weight. They also suggest discussing how the weight's position, close to the body's center of mass, may have impacted the results. Reviewer #2 highlights the variability due to the heterogeneous patient group and potential errors in 3D gait analysis. They also note contradictions in the discussion's conclusions and recommend further analysis of factors influencing patients' responses to the weights.

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We look forward to receiving your revised manuscript.

Kind regards,

Jyotindra Narayan

Academic Editor

PLOS 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: Partly

Reviewer #2: Partly

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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: Yes

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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: This study examined the effects of arm weights on dynamic stability during overground walkingin individuals with hemiparetic stroke. The results indicated that arm weights could be a viable addition to rehabilitation programs, potentially enhancing proprioceptive feedback and supporting motor recovery without compromising stability. More explanation of the analysis method is needed before publication.

1) Why did the authors use the FSR-based balance evaluation method among the many dynamic stabiilty measures? For example, MOS could be used (or is simpler), but it is necessary to explain the reasons why this method (FSR) was used, including the advantages of FSR for this study.

2) Please provide any rationale for the mass of the weight (0.45 kg).

3) The reason why the light weight did not have much effect on the balance this time may be due to the position of the weight. Participants carried a weight by his/her hand, but the position of the weight is close to whole body COM, so it may not have much effect on dynamic balance. If the position and length of the weight were different, the dynamic balance would be more affected. This point should be included in the discussion.

Reviewer #2: I have few concerns connected with this paper:

- Patients: the group is very heterogeneous (the authors correctly listed it as one of the limitations). Two factors of this heterogeneity could influence the results of this study: type and duration of the rehabilitation after stroke received of the patients, and the fact that some of them are over 60 years of age – the natural process of aging starts around this age. This can be the reason of the variability of the effect of weight addition among subjects.

- 3D gait analysis is prone to errors due to the marker placement errors and soft tissues artefacts. From the described methodology I presume that some of the markers were placed on the shirts and shorts adding the errors connected with their movement relative to the patients’ body. This fact can be an additional source of the variability of the obtained results.

- In the Discussion section the authors presented a contradictive (to me) conclusions: that there was no effects of the addition of the weights, and that the analysis of the effect in the individual patients showed in some of them their influence. In my opinion these conclusions should be reformulated.

- I wonder if some analysis could be performed to reveal which factors influence the patients’ response to the weights.

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Reviewer #1: No

Reviewer #2: No

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Arm weight effects on dynamic walking stability in individuals with hemiparetic stroke

PONE-D-24-37984R1

Dear Dr. Yang,

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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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,

Jyotindra Narayan

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The reviewers have recommended the manuscript for the publication. Congratulations to the authors for the significant contribution. 

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: 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: Partly

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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: 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

**********

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: Thanks for the revision. The authors responded adequately to my comments and revised the manuscript accordingly.

Reviewer #2: The authors in very nice and detailed way responded to all concerns raised in the previous review. All the introduced changes during the review process are marked in the paper's body, so they are easy to indentify. Still, the study is rather a preliminary one and (low number of subjects, the same weight despite the subjects' variability).

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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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