Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey study

Ingela Marklund; Brynjar Fure; Maria Klässbo; Per Liv; Britt-Marie Stålnacke; Xiaolei Hu

doi:10.1371/journal.pone.0323290

Peer Review History

Original SubmissionNovember 28, 2024
28 Nov 2024 Author Response https://doi.org/10.1371/journal.pone.0323290.r001
20 Dec 2024 Decision Letter - Redoy Ranjan, Editor PONE-D-24-53802Post-stroke health-related quality of life after lower-extremity constraint-induced movement therapy - A cross-sectional surveyPLOS ONE Dear Dr. marklund, 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. ACADEMIC EDITOR: Thank you for submitting your manuscript to the Plos One. After a critical external peer review by experts in the field, I found that this manuscript has merit but needs to fully meet journal publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript addressing the concerns the reviewers raised, specifically regarding study methodology and the clarity of your presentation. Please see the attached reviewer comments and details below. Please submit your revised manuscript by Feb 03 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. 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We look forward to receiving your revised manuscript. Kind regards, Dr Redoy Ranjan, MBBS, MRCSEd, Ch.M., MS (CV&TS), FACS Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 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 2. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. We will update your Data Availability statement on your behalf to reflect the information you provide. [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: No Reviewer #3: Yes Reviewer #4: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: 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: No Reviewer #3: Yes Reviewer #4: 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 Reviewer #3: Yes Reviewer #4: 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: The manuscript is well detailed and the methods used is explicit . it is written in standard English as well. can the topic be revised to "A cross-sectional evaluation of post-stroke health-related quality of life following lower-extremity 4 constraint-induced mobility therapy" Reviewer #2: Please add MeSH related keywords. "who had experienced a stroke and had previously participated in LE-CIMT" The methodology is not clear. Why do you name the study as cross-sectional? pre and post-procedure results should have been compared. Some data were collected retrospectively. Reviewer #3: The lack of pre-intervention HRQoL data prevents direct comparisons to baseline levels. Potential selection bias due to non-respondents , should be discussed further.Explore additional interventions that complement LE-CIMT, such as cognitive and psychosocial support. Include qualitative assessments to better understand the lived experiences of post-stroke patients undergoing LE-CIMT. Highlight specific recommendations for integrating LE-CIMT into post-stroke rehabilitation protocols. Emphasise the need for longitudinal studies to confirm the long-term impact of LE-CIMT. Reviewer #4: Please see the attach for specific comments.THese comments should be shared with the author. I responded partly for question 1 as some of their conclusions are overstated in the discussion given that this is an observational survey study. ****** 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 Reviewer #3: Yes: Irma Ruslina Defi Reviewer #4: 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. Attachments Attachment Submitted filename: LE-CIMT.docx https://doi.org/10.1371/journal.pone.0323290.r002
Revision 1
29 Jan 2025 Author Response Dear Editor To the best of our ability, we have followed the PLOS ONE's style requirements and the figures has now been checked by PACE. The ethical and legal restrictions on sharing our data set, has now been explained in detail. The data cannot be shared publicly because it contains sensitive personal data on a relatively small number of individuals from a specified and local area which also can be used to identify people, e.g. age, sex, time since stroke onset, time since treatment with LE-CIMT, affected side, their living conditions and physical functioning. According to the ethical approvals, by the Swedish Ethical Review Authority, from 2013, and 2020, data access is currently limited to participating researchers. Researchers may request deidentified data from the data owner, County Council of Västerbotten (Region Västerbotten) fou.datauttag@regionvasterbotten.se or contact the corresponding author for guidance. Access may require an approved application from the Swedish Ethical Review Authority (https://etikprovningsmyndigheten.se). Reviewer #1: The manuscript is well detailed and the methods used is explicit . it is written in standard English as well. Thanks can the topic be revised to "A cross-sectional evaluation of post-stroke health-related quality of life following lower-extremity 4 constraint-induced mobility therapy" The topic is now revised. Reviewer #2: Please add MeSH related keywords. In the PLOS one manuscript body formatting guidelines there is no information about MESH-related keywords at all. If it is ok with keyword I would like to add them. "who had experienced a stroke and had previously participated in LE-CIMT" The methodology is not clear. Action taken. The sentence is clarified. Why do you name the study as cross-sectional? Thank you for bringing this to our attention. The topic is now revised and also the method section. pre and post-procedure results should have been compared. I agree, but it was not possible under my time as a PhD-student. I started my PhD-period in 2020 and the intervention with LE-CIMT ended 2018. I had only possibilities to collect post- intervention data of RAND-36. Some data were collected retrospectively. Yes, their previously results on 6MWT were collected retrospectively. The sentence is now clarified in the method section. Reviewer #3: The lack of pre-intervention HRQoL data prevents direct comparisons to baseline levels. Yes I agree, there is a lack and in forthcoming studies pre-intervention data should be included. Potential selection bias due to non-respondents , should be discussed further. Action taken. I have now further developed the discussion around selection bias and non-responders Explore additional interventions that complement LE-CIMT, such as cognitive and psychosocial support. Action taken. I have now further developed the discussion about additional interventions. Include qualitative assessments to better understand the lived experiences of post-stroke patients undergoing LE-CIMT. I agree, and a qualitative study were performed earlier. ”I got knowledge of myself and my prospects for leading an easier life”: Stroke patients’ experience of training with lower-limb CIMT. https://www.tandfonline.com/doi/full/10.3109/14038190903141048 Highlight specific recommendations for integrating LE-CIMT into post-stroke rehabilitation protocols. Action taken. The discussion section has been revised. Emphasise the need for longitudinal studies to confirm the long-term impact of LE-CIMT. Action taken. The discussion section has been revised. Reviewer #4: Please see the attach for specific comments. These comments should be shared with the author. See table below, I have answered all the questions in the attached file I responded partly for question 1 as some of their conclusions are overstated in the discussion given that this is an observational survey study. Action taken. The discussion section has been revised. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0323290.r003
20 Feb 2025 Decision Letter - Redoy Ranjan, Editor PONE-D-24-53802R1Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey studyPLOS ONE Dear Dr. marklund, 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. ============================== ACADEMIC EDITOR: After a critical external peer review by the experts, I recommended a minor revision to improve the paper's clarity and presentation based on the reviewers' concerns. Please see the attached reviewer comments below. ============================== Please submit your revised manuscript by Apr 06 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. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Dr Redoy Ranjan, MBBS, MRCSEd, Ch.M., MS (CV&TS), FACS Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. 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. 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: (No Response) Reviewer #3: All comments have been addressed Reviewer #4: 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: Yes Reviewer #2: (No Response) Reviewer #3: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: (No Response) Reviewer #3: Yes Reviewer #4: 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 Response) Reviewer #3: Yes Reviewer #4: 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 #1: Yes Reviewer #2: (No Response) Reviewer #3: Yes Reviewer #4: 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: (No Response) Reviewer #2: Re-review of the manuscript: Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey study Comments: Some of the queries are not addressed properly. Reviewer #3: The manuscript is well-structured and contributes valuable knowledge to post-stroke rehabilitation. Minor refinements in the discussion and methodological transparency would further strengthen its impact. I recommend acceptance with minor revisions. Suggestion: 1. Consider discussing how LE-CIMT compares to other gait rehabilitation strategies in improving HRQoL. 2. Discussing why some HRQoL domains were not significantly different from the general population could enhance interpretation. Reviewer #4: Thank you for the corrections. I did notice some typos in the new manuscript, in particular the discussion which should be corrected. ****** 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 Reviewer #3: Yes: Irma Ruslina DEFI Reviewer #4: 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.0323290.r004
Revision 2
14 Mar 2025 Author Response Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. 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. Thanks for bringing this to our attention. I have gone through the reference list and where the DOI has been missing I have inserted the PMID instead. One reference Acarös Candan S, Livanelioglu A. Efficacy of modified constraint-induced movement therapy for lower extremity in patients with stroke: Strength and quality of life outcomes. Turk J Physiother Rehabil 2019;30(1):23-32. https://doi.org/10.21653/tfrd.406349. Has been replaced, I can´t find that the article has been retracted but the article is not searchable with PubMed so I chose to replace it anyway. Reviewer #1: (No Response) Reviewer #2: Re-review of the manuscript: Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey study Comments: Some of the queries are not addressed properly. I am sorry, can you clarify which queries who are not addressed properly? Reviewer #3: The manuscript is well-structured and contributes valuable knowledge to post-stroke rehabilitation. Minor refinements in the discussion and methodological transparency would further strengthen its impact. I recommend acceptance with minor revisions. Suggestion: 1. Consider discussing how LE-CIMT compares to other gait rehabilitation strategies in improving HRQoL. Thanks, action taken. I have now further developed the discussion around how LE-CIMT improving HRQoL compares to other gait rehabilitations strategies 2. Discussing why some HRQoL domains were not significantly different from the general population could enhance interpretation. Thanks, action taken. I have now further developed the discussion around the domains who were not significantly different from the general population. Reviewer #4: Thank you for the corrections. I did notice some typos in the new manuscript, in particular the discussion which should be corrected. Thanks, I hope I found and correct all the typos you had notice Attachments Attachment Submitted filename: Response to Reviewers2.docx https://doi.org/10.1371/journal.pone.0323290.r005
6 Apr 2025 Decision Letter - Redoy Ranjan, Editor Post-stroke health-related quality of life following lower-extremity constraint-induced movement therapy - An observational survey study PONE-D-24-53802R2 Dear Dr. marklund, 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, Dr Redoy Ranjan, MBBS, MRCSEd, Ch.M., MS (CV&TS), FACS Academic Editor PLOS ONE Additional Editor Comments (optional): Review Comments to the Author Reviewer #3: The author has successfully addressed and accommodated all the comments I provided. I believe the revisions are sufficient and have adequately improved the manuscript. No further concerns remain from my side. Reviewer #4: All comments have been addressed and is ready for submission by the journal. Typos have been corrected. https://doi.org/10.1371/journal.pone.0323290.r006
Formally Accepted
Acceptance Letter - Redoy Ranjan, Editor PONE-D-24-53802R2 PLOS ONE Dear Dr. marklund, 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. Redoy Ranjan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0323290.r007

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