-->PONE-D-26-10816-->-->Reliability, Usefulness, and Construct Validity of an Instrumented System for Agility and Integrated Motor-Cognitive Assessment in functionally healthy Older Adults-->-->PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

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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: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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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?

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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 is an extremely well-written manuscript. There is a thorough analysis and discussion, assessing different aspects of reliability and validity to paint a well-rounded view of this assessment battery. I had a few minor comments to address:

- Line 84-87: I had to read this sentence multiple times and it was hard to make sense of it. Consider rephrasing and breaking it up into two sentences.

- Line 94: change “stronger” to just “strong,” because it doesn’t appear you are making any comparisons. If you are trying to state that motor-cognitive tests have stronger associations than something else (such as single-task tests), please make that clarification.

- Line 132-133: Please elaborate what you mean by “they familiarized themselves until they felt confident performing them?” Was this just by receiving instruction or did they practice the tests. If they practiced about how many times did they run through this. With the learning effects seen, this may provide some good context/clarity. You could also opt to address this in the discussion.

- Line 190-201: You state that they performed “reactive sidesteps,” but please clarify if they just had to complete one step or multiple. Additionally, was the sidestep(s) reaction time just the initiation of the movement? So, the time from the shape presentation to the first detected movement?

- Figure 3C: I would consider indicating that “ROT” is “red” in English. It took me a while to understand how the word “rot” would apply to the task until I remembered that it may be in German, then I had to look it up.

- Line 296: You italicize the test name for all of the other tests; for consistency, please do that to the task switching test.

- Line 408-414: The formatting of the post-hoc comparisons is hard to follow. Some are on a single line (like line 409) and sone have multiple to a line (like line 410). Please correct this and consider just making it a table.

- All figures are blurry, especially 1, 2, 5, and 6. Please provide better quality images.

Reviewer #2: PONE-D-26-10816

Journal: PLOS One

Date: 2026-04-23

Title: Reliability, Usefulness, and Construct Validity of an Instrumented System for Agility and Integrated Motor-Cognitive Assessment in functionally healthy Older Adults

This manuscript investigates cognitive-motor performance in older adults using SKILLCOURT-based assessments, including lower-extremity tasks targeting executive functions and agility test (Random Star Run) performed with and without an additional visual-cognitive load. Complementary measures of executive functions in a seated condition, as well as physical performance (e.g., TUG and walking speed) under single- and dual-task paradigm, were also evaluated, and their correlations were analyzed. In addition, the study examines reliability and practical utility.

Overall, the manuscript is well designed, clearly written, and presents comprehensive and interesting findings. Nevertheless, several aspects could be further improved to strengthen the work.

Major:

• Please clarify rationale for the statement that “lower correlations with standard cognitive tests are expected due to motor-cognitive interference”, or specify it more precisely. While dual-task paradigms are introduced earlier, the underlying rationale for this hypothesis remains insufficiently explained, The effects of dual-task paradigms on cognitive and physical performance in older adults vary depending on task characteristics, such as postural control demands (e.g., Boisgontier et al., 2013; 10.1016/j.neubiorev.2013.07.014).

• Participant characteristics are presented without stratification by age. However, the reported minimum values for MoCA and handgrip strength suggest that some individuals may not functionally healthy. The authors may therefore with to consider a more cautious characterization of the sample (e.g., “.. in functionally healthy older adults”, as used in the Discussion).

• The agility test on the SKILLCOURT, which primarily reflects physical functions, demonstrated good construct validity, whereas cognitive-motor tests on SKILLCOURT did not. Given the emphasis on cognitive-motor conditions in terms of ecological validity, further discussion and interpretation of these findings are encouraged (e.g., Kwag et al., 2026; 10.1038/s41598-026-44189-x)

• The authors emphasize that the composite score of executive functions within the motor-cognitive tasks demonstrates superior performance, as reflected by higher ICCs across days and greater sensitivity compared to the individual components included in the motor-cognitive test (i.e., SKILLCOURT Test). However, the Stroop SKILLCOURT test appears to show comparable, and in some cases even higher, ICCs (e.g., between days 1-2) relative to the composite score. Moreover, the SKILLCOURT Stroop test demonstrates the best model fit among the motor-cognitive SKILLCOURT measures. It is also noteworthy that performance on traditional executive functions tests (in a seated condition) shows moderately stronger impact on predicting performance on SKILLCOURT Stroop performance than age. It may be helpful for the authors to elaborate on this aspect, as it could further strengthen the interpretation.

Minor:

• The authors are encouraged to use terminology consistently when referring to the Stroop word-colour intereference test. The version incorporated into the physical performance (using lower extremities) is described as reflecting ‘interference control’, whereas the seated version is described as reflecting ‘conflict inhibition’. A more consistent terminology would improve clarity.

• The purity of the Stroop word-colour interference test in the seated condition may warrant further clarification, as this task appears to involve not only inhibitory control but also elements of working memory (i.e., participants must remember the correspondence between colour and keyboard response). If a validation study exists supporting this interpretation, please provide a reference.

• It is unclear why only the cognitive flexibility test in the seated condition differs in task format from the version incorporated into physical performance. In addition, the PC-based cognitive flexibility measure appears to be missing from Table 1.

• Table 2. The term “Number history of falls ..” is unclear. It may be better to specify this as for example “number of individuals who experienced a fall …” or a similar clear formulation.

• No cognitive exclusion criterion was applied except for subjectively reported acute or chronic conditions, despite the cognitive sensitivity of the applied tests (particularly executive functions measures). It might therefore be informative to additionally examine whether results differ in participants with lower MoCA scores (e.g., < 22), which may indicate mild cognitive impairments.

• Please clarify whether predictors were selectively entered into the regression models (enter model). If so, the rationale should be specified; for example, it is unclear why CRT-PC was included in both Random Star Rum and Dual-task agility models (see table 6A).

• Please improve the quality of Fig 6 to enhance clarity and readability.

• Readability would be improved if task names are consistently and clearly distinguished throughout the manuscript as either SKILLCOURT-based or tradition (seated) conditions, particularly in the Results section.

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Reviewer #1: No

Reviewer #2: No

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<p>Reliability, Construct Validity, and Usefulness of an Assessment Device for Agility and Motor-Cognitive Reactive Stepping Performance in Community-dwelling Older Adults

PONE-D-26-10816R1

Dear Dr. Giesche,

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,

Filippo Bertozzi, 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: I Don't Know

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: The authors have responded thoroughly to the reviewer’s comments, and the manuscript has been

substantially improved. I have no further comments.

I believe that the findings presented in this paper make a valuable contribution to the field and

further advance the current body of knowledge.

Thank you.

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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.

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Reviewer #1: No

Reviewer #2: No

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