Dear Dr. Reddy,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Renato S. Melo, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

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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?

Reviewer #1: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This study was aimed to investigate the associations between postural and kinesthetic awareness and both static balance performance and weight-bearing asymmetry in individuals with chronic stroke. This study highlights the independent and moderate contributions of postural and kinesthetic awareness to postural control and symmetry in chronic stroke, supporting their integration into rehabilitation protocols to enhance balance and functional stability. Overall, the study is interesting, however there are some clarifications needed.

Comment#1

Keywords, please edit Keywords and write them based on the MeSH terms.

Comment#2

Introduction, please provide explanations for reliability/validity of CoP parameters assessed in this study.

Reviewer #2: Overall, the topic is clinically relevant, and the manuscript is well written with detailed methodology. The focus on sensory-perceptual contributors to balance after stroke fills a gap in the literature.

However, the manuscript requires substantial revision before it is suitable for publication in PLOS ONE.

1. Conceptual clarity of "postural awareness" is insufficient:

The PAS used in this study primarily measures postural habits and awareness, but its validity in chronic stroke populations has not been established. This limitation needs to be acknowledged more clearly. Additionally, the introduction should better differentiate the constructs of body awareness, proprioception, and verticality perception, as these terms represent distinct sensory-perceptual domains that are currently used interchangeably in the manuscript.

2. Several methodological details lack clarity and transparency:

Important procedural elements are missing or insufficiently described. It is unclear how many patients were screened or excluded, and no flow of recruitment is provided. The rationale for assessing joint position sense at only one angle (15° plantarflexion) should be justified, as most proprioception protocols include multiple angles for reliability. Blinding of assessors is not mentioned, raising concerns about performance bias. These omissions reduce the reproducibility and transparency of the study.

3. The statistical approach requires strengthening:

Although the authors state that normality assumptions were confirmed, several balance variables (e.g., sway area, sway velocity) are typically skewed, and supporting plots or supplementary materials are needed. Multicollinearity should be assessed by reporting VIF values. Furthermore, the regression models include only PAS and JPS error, without adjustment for major confounders such as age, Berg Balance Scale, FMA-LE, or time since stroke. Excluding these established predictors may inflate observed associations.

4. Interpretation of findings overstates causality:

The manuscript frequently uses causal language such as stating that awareness measures "contribute to" or "predict" better balance despite the cross-sectional design. These interpretations exceed what can be inferred from the analysis. The authors should revise the language throughout to reflect associations, not causal effects, and should avoid implying that improving awareness would directly improve balance without longitudinal or interventional evidence.

5. Inconsistencies and inaccuracies appear in the Results section:

The Results state that "no significant differences were found across groups", but this is a single-group study with no comparison groups. This sentence appears to be carried over from another manuscript format and needs revision. Clear, concise reporting of the sample characteristics and analytic findings is recommended to avoid confusion.

6. Rationale for measuring only static balance and using the two-scale WBA method needs elaboration:

The focus on static balance alone is not sufficiently justified, especially given that dynamic balance and functional mobility are more clinically relevant for stroke rehabilitation. The authors should explain why only quiet-standing COP metrics were chosen. Similarly, weight-bearing asymmetry was measured using the two-scale method, which has moderate reliability compared to stabilometric measures; therefore, a rationale for selecting this method should be added.

7. Figures are missing and required for review

Although figure captions are included in the manuscript, the figures themselves were not provided. For completeness, clarity, and proper evaluation of the statistical results, the figures must be included in the submission.

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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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[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.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Relationship Between Postural and Kinesthetic Awareness, Static Balance, and Weight-Bearing Asymmetry in Individuals with Chronic Stroke: A Cross-Sectional Study.

PONE-D-25-45987R1

Dear Dr. Reddy,

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,

Renato S. Melo, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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??>

Reviewer #1: Yes

Reviewer #2: Yes

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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

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: All comments have been well documented and the manuscript is appropriate for publication in this journal.

Reviewer #2: I have reviewed the revised manuscript and confirm that the authors have addressed the concern raised in my previous review. I verified the changes in both the manuscript and response document.

Thank you.

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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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