Effects of an aquatic protocol on electromyography activation and strength of lower limb muscles in blind women: A randomized controlled trial

Asma Salari; Mansour Sahebozamani; Abdolhamid Daneshjoo; Mohammad Alimoradi; Mojtaba Iranmanesh; Nicola Relph; Guillermo Mendez-Rebolledo

doi:10.1371/journal.pone.0322395

Peer Review History

Original SubmissionJanuary 30, 2025
30 Jan 2025 Author Response https://doi.org/10.1371/journal.pone.0322395.r001
4 Mar 2025 Decision Letter - Luciana Labanca, Editor PONE-D-25-04750Effects of an aquatic protocol on electromyography activation and strength of lower limb muscles in blind women. A randomized controlled trialPLOS ONE Dear Dr. Relph, 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 Apr 18 2025 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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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [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: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No 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: This, at best, appears to be a pilot effort. There are many analyses in this paper having only 30 observations. The design is inadequately justified. A sample size of 15 per group appears a bit limiting for confident conclusions. The sample size formula (equation 1)was presented but with little detail. The parameters used in the formula ,e.g. means and variance, should be specified. How was the effect size of 0.46 derived from actual past data? Table 4 appears with many p-values or multiple comparisons. Were the p-values adjusted for Bonferroni correction as stated in the protocol supplement? This is not obvious in the manuscript. The authors state that more definitive studies with more time sustainable effects may be needed. They should also include this in the limitations and add that the studies should be larger. Reviewer #2: The current manuscript presents the results on the effects of an aquatic exercise routine on the EMG findings and muscle strength in blind women. Were the baseline EMG indices and muscle strength comparable/randomized between the two groups? The introduction is well prepared but also very redundant. Please remove the unnecessary repetition as it takes away from clarity and conciseness of the text. As an example the last paragraph of the introduction is mostly repeated sentences. The problem of redundancy also affects the discussion. I encourage the authors to make the text more concise and shorten and remove unnecessary content that doesn’t add value to the text. The explanation of the power analysis formula is out of scope for this paper. Mentioning the α and β values, the effect size and the resulting sample size is sufficient. For start and end of the subject recruitment, mentioning month and year is more than enough. ****** 6. 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 ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0322395.r002
Revision 1
11 Mar 2025 Author Response Dear Reviewers, Thank you for your valuable feedback on our manuscript titled " Effects of an aquatic protocol on electromyography activation and strength of lower limb muscles in blind women. A randomized controlled trial " We have carefully addressed your comments and made significant revisions to improve the quality of our work. Below, you will find our detailed responses to each of your suggestions. We appreciate your insights and look forward to your thoughts on the revised manuscript. Best regards, # Reviewer 1 1. This, at best, appears to be a pilot effort. There are many analyses in this paper having only 30 observations. The design is inadequately justified. A sample size of 15 per group appears a bit limiting for confident conclusions. The sample size formula (equation 1)was presented but with little detail. The parameters used in the formula ,e.g. means and variance, should be specified. How was the effect size of 0.46 derived from actual past data? Response: Thank you for your feedback. We have revised the manuscript to provide a clearer justification for the sample size and effect size calculation. The sample size was determined using a 95% confidence level and 80% statistical power, with an effect size of 0.46 based on prior research on aquatic exercise intervention for visually impaired individuals (Salari et al. 2024). This calculation indicated a minimum of 12 participants per group, but to account for potential dropouts, we increased it to 15 per group (n = 30 total) to ensure statistical robustness. The effect size was calculated using Cohen’s d, considering the means and pooled standard deviation of the two groups, following established statistical principles. Additionally, we have strengthened our justification for the study design by emphasizing that this is a single-blind randomized controlled trial (RCT). Randomization was performed using Random.org, ensuring balanced group allocation and minimizing selection bias. We hope this provides more justification for the study design. Salari, A., Sahebozamani, M., Daneshjoo, A., Alimoradi, M., Iranmanesh, M., & Mendez-Rebolledo, G. (2024). Effects of 8 weeks aquatic exercises on balance recovery strategies and center of pressure sways in blind women: A randomized controlled trial. British Journal of Visual Impairment, 0(0), 02646196241281254. https://doi.org/10.1177/02646196241281254 2. Table 4 appears with many p-values or multiple comparisons. Were the p-values adjusted for Bonferroni correction as stated in the protocol supplement? This is not obvious in the manuscript. Response: Thank you for your valuable feedback. We have revised the manuscript to clarify the use of the Bonferroni correction in the post hoc analyses. We hope the revised version meets your expectations. 3. The authors state that more definitive studies with more time sustainable effects may be needed. They should also include this in the limitations and add that the studies should be larger. Response: Thank you for your feedback. In response to your suggestion, we have updated the limitations section to highlight the need for larger studies with extended follow-up periods to assess the sustainability of the observed improvements. Additionally, we have emphasized the importance of investigating the relationship between muscle activation, strength, postural control, and functional outcomes like fall prevention in future research. We hope these revisions address your concerns and improve the manuscript. # Reviewer 2 1. Were the baseline EMG indices and muscle strength comparable/randomized between the two groups? Response: Thank you for your insightful comment. We can confirm that baseline EMG indices and muscle strength were comparable between the two groups. Randomization was conducted to ensure that any potential differences between groups at baseline were minimized. We have clarified this in the revised manuscript to provide more transparency on the randomization process and the baseline measures. 2. The introduction is well prepared but also very redundant. Please remove the unnecessary repetition as it takes away from clarity and conciseness of the text. As an example the last paragraph of the introduction is mostly repeated sentences. The problem of redundancy also affects the discussion. I encourage the authors to make the text more concise and shorten and remove unnecessary content that doesn’t add value to the text. Response: Thank you for your valuable feedback. We have carefully revised the introduction and discussion sections to remove redundancy and improve clarity and conciseness. Specifically, we have shortened the last paragraph of the introduction and streamlined the discussion to eliminate unnecessary repetition while maintaining the key messages of our study. 3. The explanation of the power analysis formula is out of scope for this paper. Mentioning the α and β values, the effect size and the resulting sample size is sufficient. Response: Thank you for your valuable feedback. In response to Reviewer 1’s comments, we revised the sample size and power analysis section for greater clarity. We expanded on the statistical parameters used in the sample size calculation, specifically the effect size (0.46), confidence level (α = 0.05), and statistical power (β = 0.80). The effect size of 0.46 was derived from previous studies, such as Salari et al. (2024), which focused on aquatic exercise interventions in visually impaired individuals, ensuring its relevance to our study. Following Reviewer 1’s suggestion, we simplified the explanation of the power analysis, retaining only the key details necessary for understanding the sample size determination. These adjustments aim to provide transparency and improve the rigor of our study design while keeping the explanation focused and appropriate for the paper’s scope. Salari, A., Sahebozamani, M., Daneshjoo, A., Alimoradi, M., Iranmanesh, M., & Mendez-Rebolledo, G. (2024). Effects of 8 weeks aquatic exercises on balance recovery strategies and center of pressure sways in blind women: A randomized controlled trial. British Journal of Visual Impairment, 0(0), 02646196241281254. https://doi.org/10.1177/02646196241281254 4. For start and end of the subject recruitment, mentioning month and year is more than enough. Response: Thank you for your suggestion. We have revised the manuscript to mention only the month and year for the start and end of subject recruitment. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0322395.r003
21 Mar 2025 Decision Letter - Luciana Labanca, Editor Effects of an aquatic protocol on electromyography activation and strength of lower limb muscles in blind women. A randomized controlled trial PONE-D-25-04750R1 Dear Dr. Relph, 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, Luciana Labanca Academic Editor PLOS ONE Additional Editor Comments (optional): 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 ******** 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: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) ****** 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: (No Response) ****** 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 Response) ****** 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: (No Response) ****** 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 ******** https://doi.org/10.1371/journal.pone.0322395.r004
Formally Accepted
Acceptance Letter - Luciana Labanca, Editor PONE-D-25-04750R1 PLOS ONE Dear Dr. Relph, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. Luciana Labanca Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0322395.r005

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