PONE-D-25-19949Remote physical function testing in older adults: a mixed methods study exploring test reliability, feasibility, and perceptions of participants and assessors.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: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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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

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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

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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:  The present manuscript describes an investigation into the reliability of remote physical function tests, repeated three times, in older adults. The data provide quantitative scores of reliability along with a qualitative description of key enablers and barriers for remote testing from the participant and assessor view point.

Overall, this is a well written manuscript with a clear focus that will add to the evidence base around remote assessment of physical function of older adults, however there are some key issues that need to be addressed before publication can be recommended.

Please note, I returned the answer ‘I don’t know’ to the Review Question ‘Has the statistical analysis been performed appropriately and rigorously?’ specifically because more information is required regarding the ICC model used. The overall approach of using ICC to assess reliability in this context appears sound to me.

Reviewer’s comments:

Introduction:

Lines 64-66: A slightly pernickety point but given the literature available and described in the rest of the paragraph, it is probably not appropriate to say that understanding of the validity of remote vs in-person testing is particularly limited anymore- validity in this context is becoming reasonably well established now.

More rationale could be provided on the choice of functional tests, and this might inform a discussion point on which tests could be dropped from such a remote functional testing battery in future iterations, particularly in the context of the barriers related to set up etc.

Methods:

Line 158: ‘all participants had access to these items at home’ is really a result that should be reported in the feasibility section not methods.

Lines 188-195: were the single leg balance tests attempted for a maximum duration with no time cap?

Lines 297-298: please specify which ICC model was used, see 10.1016/j.jcm.2016.02.012 for further details and rationale for the importance of this.

Statistical analysis: to give a complete picture of the data, the data presented in Table 1 could be compared by repeated measures ANOVA / GLM to see if there were differences in the mean scores of each test across time.

Results:

Line 333: were reasons for drop-out provided, and could these be considered in the context of feasibility? On reading the qualitative results, were these drop-outs after receiving instructions for room set up? If so, this is an important consideration for feasibility?

Line 339: Weekly MVPA seems high for this age group- is that worth mentioning in the discussion?

Lines 348-352: this feels like it is missing written results giving an objective summary of the key data in the tables and figures. Given the data is quite dry and there is a lot of it, highlighting the headlines that are later discussed is all that is needed. For readability, these written results might be best broken up to proceed the respective table or figure.

Table 2: the negative ICC value might be indicating that there is a problem with the data, or the ICC model used is not appropriate. If these have been checked, then generally a negative ICC should not be meaningfully interpreted as the within-group variance is greater than the between-group variance, which contradicts one of the assumptions needed for ICC calculation.

Figure 1: should each panel be individually labelled and referred to in the figure legend? Also, for ease of interpretation, the axis formatting for test 1 vs test 2, and test 2 vs test 3, should be the same- this is different for 30-STS, FSST, and SPPB scores.

Figure 2: axis alignment is a bit off for some of the panels

Layout of Qualitative Results section: it might be a quirk of the submission process, but readability would be improved if the written results for given assessment of feasibility preceded the corresponding table of quotes, i.e., summary of participant’s enablers followed by table of participant’s enabler quotes, then summary of assessor’s enablers followed by table of assessor’s enabler quotes.

Discussion:

- Given the interview was after third assessment only, is there risk of recency bias, for example when considering technical difficulty? After three sessions, technical issues of the first session may be downplayed.

- Possibly linking back to a comment on the introduction regarding rationale for inclusion of each test, providing pragmatic suggestions for how these data might inform future implementation (alluded to in lines 585-587) would be an interesting and useful addition to the manuscript.

- A limitation that ought to be mentioned was that no comparison of reliability between assessors was made, though that would have required a larger sample size and different ICC model.

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Reviewer #1: No

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Remote physical function testing in older adults: a mixed methods study exploring test reliability, feasibility, and perceptions of participants and assessors.

PONE-D-25-19949R1

Dear Dr. Jackson J Fyfe,

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.

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Kind regards,

Jindong Chang, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #1:

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

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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

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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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

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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

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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: The authors have thoroughly addressed all my comments, the additional text is clear and adds further insight to 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 #1: No

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