-->PONE-D-26-00279-->-->Validation of a portable pressure-tile system for standing and stepping stability assessment in young and older adults-->-->PLOS One

Dear Dr. McGibbon,

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Academic Editor

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

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 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

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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

Reviewer #2: 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: This manuscript presents a validation study of a portable pressure-tile system for assessing balance and stepping stability, using AMTI in-floor force plates as a reference standard and evaluating sensitivity to age-related differences. The authors do a nice job of stating the clinical relevance of this study.

The study design is generally sound, however there are some suggestions to offer to help create a more suitable manuscript for publication.

One of my main concerns is that the authors continue to describe this measurement procedure as being meaningful for detecting falls risk, however the subjects that were included were healthy and likely not generalizable to a falls risk population. The authors should have at least performed a formal screening for falls risk, such that the they can classify the participants falls risk. Line 101 indicates that the authors used the “Get Active Questionnaire” to screen potential volunteers, however they do not elaborate on the contents of this assessment, nor do they discuss what scores would be required in order to qualify for study participation. This should be clarified in resubmission.

I understand that the threshold of measurement accuracy of 5mm was utilized based upon the StepScan, however it is not clear that this can be reasonably extrapolated to the ability to identify clinically relevant differences between those at risk of falls. The authors state the measurement differences ranged from 1-3mm on average. The clinical utility of these differences should be commented on in the discussion.

Line 202 – What type of ICC was utilized?

Reporting:

The authors should include representative Bland–Altman plots and provide a clearer interpretation of limits of agreement in relation to clinically meaningful thresholds.

Reviewer #2: The paper presents a mixed validation approach to evaluate a commercially available portable pressure tile system in terms of measurement accuracy. To this end, a StepScan™ pressure tile system was placed upon in-floor mounted AMTI™ force platforms for simultaneous data acquisition.

The aim is to assess if the stability parameters derived from pressure tiles agree with those derived from the industry “gold standard” (in-floor) force plates. In addition, they analyzed whether these parameters are sufficiently sensitive to detect age-related decline in balance.

The study is well described and the results presented appropriately.

The experimental setup configurations are well described in the text. However, the use of the wooden box to support the StepScan™ pressure tile should be better explained in relation to its interference in obtaining the center of pressure (CoP) on the force platform on which it is supported.

Wouldn't a solid wooden box supported on the force platform distribute the pressure of the footstep over the entire area of the platform, altering the results obtained from the CoP variation?

Could the results be compared in the same way with the force platform on which the StepScan™ is directly supported?

Table 2 presents the characteristics of the participants in the two groups described, including body weight. Based on the standard deviation shown, a reasonable difference in weight can be observed between participants. The authors could include a column with the participants' Body Mass Index, as well as a brief discussion of how this parameter can affect the analysis of the participants' body balance.

The authors first used the abbreviation CoM in the text on line 181, but did not indicate what it stood for (Center of Mass).

Review repeated words in the text, e.g. lines 69 and 252.

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-->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.

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Reviewer #1: No

Reviewer #2: No

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

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Validation of a portable pressure tile system for standing and stepping stability assessment in young and older adults

PONE-D-26-00279R1

Dear Dr. McGibbon,

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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Kind regards,

Valentina Graci, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: 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

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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

Reviewer #2: 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: (No Response)

Reviewer #2: (No Response)

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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

Reviewer #2: No

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