Neck Functional Status Assessment Using Virtual Reality Simulation of Daily Activities

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Authors have choose am important global helath concern on musculoskeletal disorders. Overall problem assesment is well organised and identification of problems are good enough, however authors should have concerned few more points to increase the reading pleasure as follows,

1. Introduction needs to more elloborate with higher number of references.
2. Need to list country wise data as you addressed towards global population,inlcuding gender and age wise data.
3. Data sets on the IMUs, and CROM devices need to be given as per statistics.
4. In line 53, authors described as several instruments and methodologies are used to quantity cervical impariment, need the list with refernce which is more imporant to testimony your statement.
5. Similarlay need to add reference for line 54.
6. Add reference for line 104-105.
7. Significant and need to introduce VR environment needs more justification with refernces and real-time clinical trails data.
8. Is it possible to add one more table value to show the corrected p-values for each spectral band from statsticals test assessment age wise which may show the usability data across age, as you have displayed SUS yielded overall score for the average.
9. Besides, the score level suggested by authors falls under any ethical guidelines or other such, if so kindly quote the reference (line no.345-346).
10. As suggested by authors in line no.412-413, quantification data is missing and needs to be addressed in near future.

Author Response

 "Please see the attachment."

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper presents a novel and well-executed study investigating neck functional assessment using a virtual reality (VR) simulation of an apple-picking task. The approach is innovative, providing a more ecologically valid alternative to conventional Cervical Range of Motion (CROM) evaluations by capturing dynamic head kinematics during simulated daily activities.

Strengths: 

+The VR task design is thoughtful and well-aligned with daily living scenarios, increasing ecological validity.

+The use of spectral content to describe movement variability and control adds a novel dimension to the analysis.

+The comparison between healthy and chronic pain groups is statistically supported and meaningful.

Areas to improve: 

-The spectral analysis and statistical testing are clearly described, but some readers may find the level of technical detail dense. Consider summarizing key steps in the main text and moving extended math or figures to supplementary materials if allowed.

-While the task simulates daily movement, its adaptability for more impaired populations (e.g., elderly, post-surgical) could be briefly addressed.

-Some figures (e.g., spectral plots) may benefit from larger labels or simplified captions to enhance clarity.

 

Author Response

 "Please see the attachment."

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Please note the following:

• The rationale for choosing apple picking as the simulated functional task in VR should be explained.
– It is necessary to understand how this activity reflects natural neck movements in everyday life.
• The operation of the HTC Vive Pro Eye™ system used to record head kinetics should be clearly described.
– It is necessary to understand what types of data are collected, at what frequency, and how they are subsequently processed.
• The data processing method in MATLAB™ should be detailed, including the spectrogram generation algorithms.
– A full explanation of the STFT parameters used (Hamming window, overlaps, thresholds, etc.) is required.
• It should be clarified why spectral analysis was chosen instead of other methods of motion analysis (e.g., amplitude, instantaneous velocity).
– It is important to justify the advantages of frequency analysis in the functional context of cervical pain.
• The selection of the frequency bands analyzed ([0–0.1] Hz, [0.1–0.5] Hz, [0.5–5] Hz) and their relevance for voluntary and involuntary movements will be explained.
– This delimitation must be related to the typologies of human movement and neuromuscular control.
• The statistical testing procedure used will be presented in detail, including the normality test, Mann-Whitney U/t-Student tests and FDR correction.
– It is essential to understand how the validity of the results was ensured in the context of multiple analyses.
• The elimination of the first 30 seconds from the spectrographic analysis and the impact of this decision on the results will be justified.
– These seconds will be correlated with the accommodation phase and non-functional initiation movements.
• The implementation of the virtual reality scenario will be detailed, including the positioning of the apples, interaction with the environment and the instructions provided.
– These details are crucial to understanding the standardization and repeatability of the task.
• The method of recording “stored apple” events will be explained and how these moments are marked in spectrograms.
– It is important to understand how to correlate discrete events with continuous movement data.
• The significance of the obtained SUS score (84.21 ± 9.49) will be detailed and its implications for the potential clinical and home use of the system will be discussed.
– The criteria for evaluating and interpreting SUS scores will be discussed.
• The main limitation of the study – the lack of measurement of compensatory trunk movements – will be analyzed and how it could be remedied in a future study.
– A realistic technical solution for separately recording trunk rotation will be proposed.
• The choice of an observational, cross-sectional design will be justified and how it affects the interpretation of causality of the results.
• The inclusion and exclusion criteria for participants will be explained and how they ensure sample homogeneity and validity.
• The use of the pain self-report method (VAS) and the threshold of ≥4 for inclusion in the symptomatic group will be justified.

Author Response

 "Please see the attachment."

Author Response File: Author Response.pdf