Variation in Daily Wheelchair Mobility Metrics of Persons with Spinal Cord Injury: The Need for Individual Monitoring

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This article investigates the variability in wheelchair mobility metrics (WCMM) among 19 participants with spinal cord injuries (SCI). The study utilizes inertial measurement units (IMUs) to measure daily wheelchair mobility in real-life settings, focusing on variables such as distance covered, number of pushes, turns, and inclines. The study aims to emphasize the importance of individualized monitoring to enhance clinical decision-making and shoulder health outcomes. However, the paper has some limitations that need to be addressed to strengthen its findings and improve its clarity.

1. In Line 14, “Since comprehensive data is limited, this study aimed to implement..." here replace "is" with "are" because "data" is plural.

2. In the introduction section, the authors should include some recent literature addressing WCMM methods and IMUs to provide a fuller picture of the current state of research.

3. In Line 57, the abbreviation of IMU would be “inertial measurement units” rather than “inertial magnetic units”.

4. In the materials and methods section, the selection of 19 participants is adequately explained. While the limitations of the sample size are mentioned later, the authors should give a brief explanation why this specific number was chosen (e.g., due to sensor limitations or complexity of data collection).

5. The inclusion and exclusion criteria are clearly outlined, but the exclusion of participants with shoulder problems may reduce the clinical relevance, as MWUs with SCI often experience shoulder issues. Consider discussing this in the limitations section.

6. The methodology provides detailed descriptions of how data were collected using inertial measurement units (IMUs). However, a potential limitation is the use of only two sensors, which might not capture all aspects of wheelchair propulsion. Please add an explanatory detail to clarify this.

7. The duration of the real-life measurements (2 to 9.2 hours) could be a limitation. Therefore, the normalization of WCMM data to an 8-hour period is justified, but it may not fully capture the variability in daily wheelchair use. The author should explain how this choice affects the interpretation of the results, especially for participants with shorter recording periods.

8. In Line 96, 105, 153 and 241, no apostrophe is needed for "IMUs" because it is plural, not possessive.

9. In the result section, the figures and tables are informative but some of the figures are difficult to interpret without additional explanation. Add interpretation of the data with more explicit comparisons between participants especially for Figure 1(a)-(f) rather than just reporting the values.

10. The authors can provide a more straightforward legend that summarizes key findings for each figure.

11. In Line 315-316, "Week and weekend days" is repetitive; "weekdays and weekends" sounds more natural, so correct the sentence as “Data collection should include weekdays and weekends to get the full overview”.

12. In future directions or conclusion section, the authors could add some lines emphasizing on the potential for technological advancements in IMU sensors and data analysis to further enhance individualized monitoring.

Comments on the Quality of English Language: Minor improvement needed.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

he manuscript presents a thorough investigation into wheelchair mobility metrics (WCMM) for individuals with spinal cord injuries (SCI) using inertial measurement units (IMUs). It addresses a crucial area of research, emphasizing the need for personalized data to inform clinical decisions and enhance patient outcomes. The study provides valuable insights into the daily variations in wheelchair use, offering potential applications for improving the quality of life for SCI patients. While the manuscript is well-structured and presents meaningful findings, a few areas need further clarification and enhancement to strengthen its overall impact.

1.While the study highlights the importance of individualized monitoring, it would be beneficial to emphasize how the WCMM approach improves upon existing methods of assessing wheelchair use. Specifically, how does the use of dual IMUs and the proposed metrics address limitations of prior studies focused on activity levels or energy expenditure? A clearer articulation of this would help readers better appreciate the innovation in this study.

2.The paper relies heavily on data derived from IMUs. It would enhance the manuscript’s rigor to provide more details on the assumptions used in IMU calibration, data synchronization, and the process for normalizing data to an 8-hour period. Additionally, considering that data collection durations varied significantly, what impact might this variability have on the accuracy of the results?

3.The manuscript does acknowledge certain limitations, such as the variation in recording durations. However, a deeper discussion of how these limitations might impact the generalizability of the findings to broader SCI populations would be valuable. For instance, could the active lifestyle of participants skew the data in terms of daily mobility metrics?

4.The study mentions potential clinical applications of the findings, but it could benefit from specific examples. How might the insights gained from this study translate into practical strategies for clinicians? For example, in what scenarios would clinicians adjust a patient's activity based on WCMM data? More concrete examples would enhance the manuscript’s relevance to applied settings.

5.While the manuscript references some related studies, a more comprehensive comparison with existing data on wheelchair mobility metrics would strengthen its depth. For instance, how do the study’s findings regarding the number of daily turns or distance covered compare with previous work by Togni et al.? A detailed comparison table could help highlight these differences and reinforce the study's contributions.

6.The authors propose future research, including larger samples and extended monitoring periods. It would be useful to expand on this by providing specific suggestions for improving the measurement accuracy or addressing the current limitations. Additionally, is there any plan to validate the IMU-based metrics with other measurement methods, such as GPS or video tracking, to enhance the reliability of the results?

Author Response

Please see attachment 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for your responce.I got all necessary answer, so I agree to publish your research.  I wish you all the best in the future！