Peer Review History
| Original SubmissionAugust 14, 2025 |
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-->PONE-D-25-43400-->-->Validating the 2-Minute Walk Test MCID for Subacute Stroke Patients: A Pakistani Multicenter Cohort Analysis-->-->PLOS ONE Dear Dr. Muteesasira,-->--> 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 Jan 15 2026 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.. 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.. 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.. 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:-->
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 . 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 . 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 . 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, Sohel Ahmed, BPT, MPT, MDMR 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 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. 3. We note that your Data Availability Statement is currently as follows: “All relevant data are within the manuscript and it's supporting information files” Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition). For example, authors should submit the following data: - The values behind the means, standard deviations and other measures reported; - The values used to build graphs; - The points extracted from images for analysis. Authors do not need to submit their entire data set if only a portion of the data was used in the reported study. If your submission does not contain these data, please either upload them as Supporting Information files or deposit them 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. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If data are owned by a third party, please indicate how others may request data access. 4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 5. Please include a caption for figures 2 and 3. 6. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 5 in your text; if accepted, production will need this reference to link the reader to the Table. 7. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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 ********** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes Reviewer #2: No ********** -->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.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.-->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.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: No ********** -->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: Dear Authors I would like to thank the authors for submitting the manuscript entitled “Validating the 2-Minute Walk Test MCID for Subacute Stroke Patients: A Pakistani Multicenter Cohort Analysis.” The study addresses an important gap in stroke rehabilitation research by determining the minimally clinically important difference (MCID) for the 2-Minute Walk Test (2MWT) among subacute stroke patients in a developing country context. The multicenter approach, adequate sample size, and emphasis on patient-centered outcomes are commendable and add value to the literature on functional recovery metrics after stroke.However, to improve its scholarly value and readability, significant revisions are required for the following points : 1-Clarity and Conciseness of Introduction The introduction provides a good rationale for the study but includes several redundant sentences (e.g., repeated statements about neuroplasticity and the need for context-specific tools). Consider streamlining paragraphs to maintain focus on the knowledge gap: Why the 2MWT MCID has not been established for subacute stroke patients, and why this is particularly relevant for Pakistan. 2-Rationale for Anchor Selection The selection of the ABC_Gait subscale (≥10% improvement) as the anchor is appropriate but should be better justified with references supporting its clinical meaningfulness in stroke populations. Please explain why the Global Perceived Effect (GPE) was not used as the primary anchor, given its patient-centered nature. 3-Statistical Analysis Details The manuscript mentions paired t-tests, logistic regression, and ROC analysis, but the criteria for choosing these models and assumptions testing (e.g., normality) are not clearly described. Clarify how missing data (8%) were handled and how multiple imputation may have affected the robustness of the MCID estimates. Indicate the AUC confidence intervals in the Results section and interpret what an AUC of 0.89 means in practical clinical terms. 4-Interpretation of MCID Value The MCID of 33 meters is statistically sound, but the discussion should better contextualize this value: How does it compare to the 6MWT MCID (≈50 m) and other 2MWT MCIDs in neurological conditions? What does a 33-meter improvement represent in functional independence or patient quality of life? Consider adding a short paragraph linking this finding to functional thresholds (e.g., community ambulation, household walking). Subgroup and Sensitivity Analyses The robustness of MCID across subgroups (age, stroke type, robotic vs. manual training) is well presented, but interpretation could be more clinically oriented. For example: explain why MCID differences by age (35 m vs. 31 m) are not statistically significant yet may hold clinical implications for rehabilitation intensity planning. 5-Figures and Tables Figures 1–4 and Tables 3–4 contain valuable data, but legends are overly descriptive and sometimes repetitive. Simplify figure captions to highlight key findings (e.g., “ROC curve showing optimal 33 m cutoff for 2MWT MCID with 87% sensitivity and 82% specificity”). Ensure that all figures are labeled consistently and referenced appropriately in the text. 6-Discussion and Conclusion The discussion effectively summarizes the results but could benefit from a clearer “clinical implications” section, specifying how rehabilitation clinicians in resource-limited settings can use the 33 m MCID threshold for decision-making. The conclusion could be more concise, emphasizing future directions such as validation in chronic stroke and longitudinal functional outcomes. 7-Language and Style The manuscript would benefit from a light language edit to remove redundancies and improve fluency (e.g., avoid repeating “reliable benchmark for assessing mobility improvements” multiple times). Replace informal phrases like “patients such as Ayesha” with more neutral examples or remove for conciseness. 8-Formatting Ensure uniform citation formatting and numbering consistency. Define abbreviations (e.g., ABC_Gait, GPE) at first mention in both abstract and text. I encourage you to revise the manuscript thoroughly in response to the comments above. I look forward to reviewing the improved version Reviewer #2: Thank you for submitting this important and clinically relevant manuscript. The study addresses a meaningful gap by establishing an MCID for the 2-Minute Walk Test in subacute stroke patients within a multicenter LMIC context. The research question is valuable, the methodology is generally sound, and the findings have potential impact for rehabilitation practice. However, the manuscript requires significant revision to improve clarity, structure, and readability. My detailed comments are below. Major Comments 1. Repetition across multiple sections There is substantial duplication of text in the Introduction, Methods, Data Analysis, and Discussion. Several paragraphs appear more than once, and the same concepts are repeated with similar wording. Suggestion: Remove all duplicated content and streamline each section for clarity. 2. Introduction lacks focus and is overly long The Introduction contains multiple narrative threads (e.g., the Ayesha example, global burden statistics, repeated MCID rationale). This affects the flow and dilutes the study objective. Suggestion: Condense the Introduction into four clear paragraphs: Stroke burden and importance of mobility Role and relevance of the 2MWT Lack of MCID evidence, especially in LMICs Precise study aim 3. Methods section needs clearer organization The Methods are too lengthy, and several elements (center selection, interventions, statistical procedures) appear twice. Suggestion: Reorganize under standardized subheadings: Study Design Setting and Centers Participants Interventions Outcome Measures Data Collection Statistical Analysis This will greatly improve readability. 4. Inconsistencies in tables and figures There are repeated figure numbers, tables described more than once, and some figures lacking captions. Suggestion: Ensure each table/figure appears only once and is clearly numbered and labeled. A standard structure could be: Table 1: Centers Table 2: Baseline characteristics Table 3: Pre–post outcomes Table 4: Subgroup MCID Table 5: Comparison with other populations 5. Discussion contains unnecessary repetition The Discussion restates parts of the Introduction and Results and includes multiple general statements. Suggestion: Structure into four concise paragraphs: Key findings Comparison with existing literature Strengths and limitations Implications and future research 6. Language and style issues Some sentences are long, conversational, or informal. Tense usage is inconsistent, and clarity can be improved. Suggestion: Edit for concise, scientific language with consistent past tense. 7. Duplication of ethical and administrative content Funding, competing interests, and ethics approval statements appear in more than one section. Suggestion: Present this information only once in the designated section. Minor Comments Include a STROBE/CONSORT-style flow diagram. Clarify your missing data handling approach. State whether assessors were trained or calibrated for inter-rater reliability. Provide the formula used for sample size calculation. Briefly explain the clinical meaning of the 33-m MCID (e.g., change in gait speed or functional relevance). Overall Recommendation This is a valuable study with strong methodological foundations and clear clinical implications. However, substantial revisions—particularly reducing repetition, reorganizing structure, and tightening the writing—are needed to improve clarity and prepare the manuscript for publication. ********** -->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 published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->..--> Reviewer #1: Yes:Duaa Abualkhair, Division of Physiotherapy , Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine . (www.najah.edu)Duaa Abualkhair, Division of Physiotherapy , Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine . (www.najah.edu)Duaa Abualkhair, Division of Physiotherapy , Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine . (www.najah.edu)Duaa Abualkhair, Division of Physiotherapy , Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine . (www.najah.edu) Reviewer #2: Yes:Michael Selvaraj AlbertMichael Selvaraj AlbertMichael Selvaraj AlbertMichael Selvaraj Albert ********** [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.
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| Revision 1 |
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-->PONE-D-25-43400R1-->-->Validating the 2-minute walk test MCID for subacute stroke patients: A Pakistani multicenter cohort analysis-->-->PLOS One Dear Dr. Muteesasira , 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 Feb 12 2026 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.. 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.. 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.. 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:-->
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 . 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 . 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 . 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, Sohel Ahmed, MPT, MDMR Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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: 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 ********** -->3. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes Reviewer #2: No ********** -->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.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.-->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.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 ********** -->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) ********** -->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 and satisfactorily addressed all previous reviewer concerns. The manuscript is now methodologically sound, clearly written, and makes a valuable contribution to the field. I recommend acceptance in its current form. Reviewer #2: Dear Authors, Thank you for the opportunity to review your manuscript entitled “Validating the 2-Minute Walk Test MCID for Subacute Stroke Patients: A Pakistani Multicenter Cohort Analysis.” The study addresses a clinically meaningful and timely topic in neurorehabilitation, particularly relevant for resource-limited settings. Establishing a minimally clinically important difference (MCID) for the 2-Minute Walk Test (2MWT) in subacute stroke patients is of clear practical value for clinicians and researchers. The multicenter design, relatively large sample size, and use of both anchor-based and distribution-based approaches are notable strengths. However, several methodological, reporting, and presentation issues should be addressed to improve the scientific clarity and overall quality of the manuscript. Major Comments 1. Sample Size Justification o The manuscript reports an initial sample size calculation of n = 431, while the final analyzed sample consists of 150 participants. o The rationale for this discrepancy is insufficiently explained and may raise concerns regarding statistical power. Recommendation: Please clearly clarify whether the calculated sample refers to the screened population or revise the sample size justification using MCID-specific considerations appropriate for anchor-based analyses. 2. Methodological Consistency � There are inconsistencies in the reporting of baseline 2MWT values (e.g., 32.8 m vs. 62.5 m) across sections. � The Methods section mentions “paired t-tests every three months,” which does not align with the reported 6–8 week intervention period. Recommendation: Carefully review and harmonize all numerical data and timelines throughout the manuscript to ensure consistency. 3. Redundancy Across Sections � The importance and robustness of the 33-meter MCID are repeatedly stated in the Introduction, Results, and Discussion. � Several paragraphs reiterate similar interpretations without adding new insights. Recommendation: Streamline the narrative to reduce repetition and improve readability, particularly in the Introduction and Discussion sections. 4. Data Availability Statement � The manuscript contains conflicting statements regarding data accessibility (public availability vs. availability upon request). Recommendation: Please ensure compliance with journal data-sharing policies by providing a single, clear, and accurate data availability statement. 5. Language and Formatting � The manuscript contains numerous typographical errors, formatting artifacts (e.g., tracked changes), and grammatical issues. � These issues detract from the clarity and professionalism of the submission. Recommendation: A thorough language edit is strongly recommended prior to resubmission. Minor Comments 1. Introduction � The Introduction would benefit from a more focused background and avoidance of anecdotal or narrative examples. � Consider sharpening the rationale for selecting the ABC_Gait subscale as the primary anchor. 2. Outcome Measures � Please clarify whether assessors were blinded to baseline measurements and intervention details. 3. Figures and Tables � Some figures appear redundant with tabulated results. � Consider reducing the number of figures to improve conciseness. 4. Discussion � The comparative discussion with other populations (e.g., COPD, MS) is appropriate and informative. � A brief paragraph translating the 33-meter MCID into direct clinical application would further strengthen this section. Conclusion In summary, this study has the potential to make a valuable contribution to the stroke rehabilitation literature. Addressing the points outlined above—particularly those related to sample size justification, data consistency, and manuscript clarity—will significantly enhance the quality and impact of the work. I encourage the authors to revise the manuscript accordingly and look forward to reviewing a revised version. Sincerely, Reviewer ********** -->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 published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->..--> Reviewer #1: Yes:Duaa Abualkhair, Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, PalestineDuaa Abualkhair, Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, PalestineDuaa Abualkhair, Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, PalestineDuaa Abualkhair, Department of Applied and Allied Medical Sciences, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, Palestine Reviewer #2: Yes:Michael Selvaraj AlbertMichael Selvaraj AlbertMichael Selvaraj AlbertMichael Selvaraj Albert ********** [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.
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| Revision 2 |
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-->PONE-D-25-43400R2-->-->Validating the 2-minute walk test MCID for subacute stroke patients: A Pakistani multicenter cohort analysis-->-->PLOS One Dear Dr. Muteesasira, 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 03 2026 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.. 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.. 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.. 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:-->
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 . 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 . 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 . 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, Sohel Ahmed, BPT, MPT, MDMR Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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 #2: 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 #2: Yes ********** -->3. Has the statistical analysis been performed appropriately and rigorously? --> 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.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.-->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.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 #2: 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 #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 #2: Dear Authors, Thank you for the opportunity to review your manuscript. Your study addresses an important and practical question in stroke rehabilitation — establishing the minimally clinically important difference (MCID) for the 2-Minute Walk Test in subacute stroke patients. This is especially valuable for clinicians working in resource-limited settings. The multicenter design and inclusion of 150 participants strengthen the relevance of your findings. While the study is meaningful and promising, a few areas would benefit from clarification and refinement before publication. First, the sample size calculation needs clearer justification. Since the study focuses on MCID estimation using ROC analysis, please explain why the chosen formula was appropriate and whether the final sample of 150 participants provided adequate statistical power. Second, there appears to be an inconsistency in the reported baseline 2MWT values in different sections of the manuscript. Please review and correct this to ensure internal consistency. Third, the choice of a 10% improvement in the ABC_Gait as the anchor requires stronger justification. It would help readers to understand why this threshold was selected and whether it has been validated specifically in subacute stroke populations. Additionally, since rehabilitation interventions varied across centers (robotic vs. manual training), please clarify whether this variability may have influenced the results and whether center effects were considered in the analysis. The section on missing data should also provide more detail, including which variables were imputed and the method used. Some figures, particularly the ROC curve and scatter plot, should be carefully reviewed to ensure they accurately reflect the data and are clearly presented. There is also an inconsistency in the data availability statement that should be aligned with journal policy. Finally, the manuscript would benefit from careful language editing to correct minor grammatical issues and improve overall clarity and flow. Overall, this is a clinically relevant study with practical implications. With clearer explanations and minor revisions, it has strong potential for publication. Best regards. ********** -->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 published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->..--> Reviewer #2: Yes:Dr.Michael Selvaraj ADr.Michael Selvaraj ADr.Michael Selvaraj ADr.Michael Selvaraj A ********** [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.
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| Revision 3 |
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Validating the 2-minute walk test MCID for subacute stroke patients: A Pakistani multicenter cohort analysis PONE-D-25-43400R3 Dear Dr. Edward Muteesasira, 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. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support.... 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, Sohel Ahmed, BPT, MPT, MDMR Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: |
| Formally Accepted |
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PONE-D-25-43400R3 PLOS One Dear Dr. Muteesasira, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Sohel Ahmed Academic Editor PLOS One |
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