Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The issues studied in this manuscript, as well as the selected data and methods, are basically valid. In addition to the comments from other reviewers, I still have some concerns:

1. This is a public database study, but the number of respondents after screening is too small, with n=612 not being sufficient to draw meaningful encough conclusions. Moreover, it is a cross-sectional study. Please fully discuss this in the Limitation section.
2. The discussion section is not thorough enough, which is why the overall length of the manuscript is relatively short. On the basis of presenting the data analysis results, you should also conduct a thorough comparison and discussion with existing literature.

Author Response

Comment 1. This is a public database study, but the number of respondents after screening is too small, with n = 612 not being sufficient to draw meaningful enough conclusions. Moreover, it is a cross-sectional study. Please fully discuss this in the Limitation section.

Response:
We appreciate the reviewer’s critical observation regarding the sample size and study design. As this is a secondary analysis of the 2022 KNHANES, our analytic sample was restricted to older adults aged ≥65 years with complete data on the key physical, psychological, and lifestyle variables, resulting in 612 participants. We agree that this sample size is modest compared with the full KNHANES dataset and may limit the precision of some estimates, particularly for subgroup analyses.
To address this concern, we have explicitly acknowledged the relatively small analytic sample and the resulting risk of reduced precision and potential type II error in the Limitations section. We also emphasize that the cross-sectional design precludes establishing temporal or causal relationships between the identified risk factors and falls, and that reverse causation (e.g., falls leading to reduced physical activity or work hours) cannot be ruled out. These points have been added to the “Limitations and future directions” subsection.

 

Comment 2. The discussion section is not thorough enough, which is why the overall length of the manuscript is relatively short. On the basis of presenting the data analysis results, you should also conduct a thorough comparison and discussion with existing literature.

Response:
We thank the reviewer for this important comment. In response, we have expanded the Discussion to provide a more detailed comparison of our findings with existing literature. Specifically, we now (1) more fully relate our results on grip strength, diastolic blood pressure, depressive and anxiety symptoms, and physical activity to previous studies on multifactorial fall risk; (2) elaborate on potential biological and behavioral mechanisms linking elevated LDL-cholesterol and reduced weekly working hours with fall risk; and (3) further clarify the unique contribution of this study in identifying LDL-cholesterol and work-related social engagement as underrecognized yet clinically assessable indicators. These additions have increased the depth and length of the Discussion and we hope they address the reviewer’s concern.

Reviewer 2 Report

Comments and Suggestions for Authors

Reveiwer Comment
The article addresses an important and timely topic by examining the physical, psychological, and lifestyle factors that influence fall risk in older adults using a national dataset. The study has valuable potential for public health and clinical applications; however, it requires some fundamental revisions to reach publishability. In general, the original value and purpose of the article should be more clearly stated, and the methods section should be strengthened with details such as ethical approval information, sample size calculation (G*Power), validity and reliability information for the measurement tools used, and normality tests. Results tables should be standardized with abbreviations, units, and statistical test names used. The discussion section should be more comprehensively linked to the literature, biological and behavioral mechanisms should be detailed, and the unique contribution of the study should be more clearly emphasized. The conclusion should include more concrete and guiding recommendations for clinicians and future research. Specific recommendations are as follows.
Revisions
1. Page 2, lines 48-52; However, other potentially important factors—such as depressive symptoms, diastolic blood pressure, LDL cholesterol levels, and weekly working hours—remain relatively underexplored in previous research. Additionally, prior studies have often focused on single risk factors rather than the interplay between multiple factors, limiting the ability to develop comprehensive fall prevention interventions. The introduction section includes information from the literature and should highlight multiple studies in the literature. Citations should be used for all this information. Use without citations in this manner is not consistent with the article writing system.

2. Page 2, lines 63-68; The original value of the study has not been sufficiently clearly established in the text. The purpose of the study should also be stated more clearly and focused. The introduction section should summarize the general characteristics and limitations of similar studies in the existing literature; then, clearly highlight the ways in which this study differs from previous research. In this context, after establishing the original value of the study, the introduction section should be concluded fluently by clearly stating the specific purpose of the study.

3. Page 2, line 70; The "Study Design" section contains insufficient information regarding the ethical aspects of the study. It should state which institution or ethics committee approved the study, the time period during which data collection was conducted, and whether written informed consent was obtained from participants. It should also be clearly stated that the study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Furthermore, the study did not use a checklist or validation form to standardize the data collection process and ensure measurement reliability; the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist should be used. Using such a tool would increase the methodological soundness of the study. These explanations should be detailed under the "Study Design" subheading. Furthermore, the study's mini-design should be described in this section.

4. Page 2, line 74; No G*Power or similar power analysis was reported regarding sample size in the study. The effect size, confidence level, and power value used to calculate sample size should be stated. It should also be clearly stated which scale or assessment tool was used in this calculation, which analysis method was used, and which statistical program was used. The minimum sample size should be explained based on this information, and this explanation should be added to the "Participants" section.

5. Page 2, line 80; The "Variable Selection and Definitions" section remains rather superficial. The measurement and assessment tools used in the study (e.g., PHQ-9, GAD-7, MMSE, physical activity scales, biochemical indicators) should be explained under separate subheadings for each tool, and the validity and reliability information, scoring method, and source reference should be provided for each tool. Furthermore, it should be explained under what conditions and which device or method the measurements were made (e.g., which dynamometer was used to measure grip strength), who conducted the assessments, and over what period of time. Sociodemographic variables should also be categorized and defined; it should be clarified how variables such as age, gender, education, and income level were included in the analysis and in which categories they were evaluated.

6. Page 3, line 124; Ethics committee information is included in the "Data Analysis" section; however, such information should be presented in the study design section. Only the statistical methods used should be described in the "Data Analysis" section. It is also not stated whether the data were assessed for normality before analysis. It should be clearly stated which variables were normally distributed, which tests (e.g., Shapiro–Wilk, Kolmogorov–Smirnov) were used, and whether parametric or non-parametric analyses were preferred based on the distribution. This information will strengthen the validity of the analyses and the interpretability of the results.
7. Page 4, line 163; All abbreviations in Table 1 should be explained in footnotes. To ensure the reader can independently understand the table, the full definition of each abbreviation (e.g., n, mmHg, BMI unit, etc.) should be provided below the table. Furthermore, the unit (e.g., year) for the "age" variable must be given in parentheses. This information should be included in Table 2. In addition, the name of the statistical analysis method used should also be included. 8. Page 6, line 210; “Table 3. Area under the curve (AUC) analysis of predictors for falls in older adults.” The abbreviation AUC should be explained in the text where it is first used, not in the table legend. The abbreviation should be used here.
9. Page 7, line 235; The discussion section is generally consistent but superficial. The findings should be compared more comprehensively with the literature, and the biological and behavioral mechanisms should be explored. The unique contribution of the study (including LDL and work hours variables) should be emphasized more clearly, and more specific conclusions should be drawn. Furthermore, the discussion should be informed by further literature research.
10. The “Conclusion” section summarizes the main findings of the study in general terms but does not offer sufficiently specific implications for clinicians and future research. At the end of the chapter, it should be clearly stated how the findings can be integrated into clinical practice (e.g., fall risk assessment, follow-up, or multidisciplinary intervention planning) and which aspects should be prioritized in future research (e.g., prospective designs, inclusion of environmental factors, further examination of psychosocial variables).

Comments on the Quality of English Language

While the article's overall language is understandable, academic fluency needs improvement. Sentence structures are occasionally repetitive and lengthy. Transitional expressions, particularly in the introduction and discussion sections, should be strengthened to improve text flow; terminology and tenses should be standardized. English spelling, punctuation, and capitalization should be verified.

Author Response

General comment

Reviewer comment (summary)
The article addresses an important topic but needs clearer originality, stronger methods description (ethics, G*Power, validity/reliability, normality), standardized tables, and a more developed discussion and conclusion.

Response
We sincerely thank the reviewer for the thorough and constructive comments. We carefully revised the manuscript to clarify the originality and purpose, strengthen the description of the study design and measurements, standardize the tables, and expand the discussion and conclusion with clearer links to existing literature and practical implications. All changes are highlighted in the revised manuscript, and specific responses to each point are provided below.

 

1. Introduction – statements without citations (Page 2, lines 48–52)

Reviewer comment
Sentences about underexplored factors (depressive symptoms, DBP, LDL, working hours) and focus on single risk factors lack citations.

Response
We agree with the reviewer that these statements should be supported by citations. We have revised this part of the introduction to incorporate additional references that document the limited attention to depressive symptoms, diastolic blood pressure, LDL cholesterol, and weekly working hours in prior fall-risk studies, and the traditional focus on single-domain risk factors. We also clarified that our study addresses these gaps by jointly examining multiple domains within one analytic framework.

 

2. Introduction – originality and purpose not clearly stated (Page 2, lines 63–68)

Reviewer comment
Original value and purpose are not clearly established; need clearer statement of how this study differs from prior work and more focused objective.

Response
Thank you for this helpful suggestion. We have revised the end of the introduction to more explicitly summarize the limitations of existing fall-risk studies and to highlight the originality of our study, including the simultaneous examination of physical, psychological, and lifestyle factors (e.g., LDL-cholesterol and weekly working hours) using nationally representative KNHANES data. We also refined the study aim into a concise and focused statement.

 

3. Study design & ethics, Declaration of Helsinki, STROBE (Page 2, line 70)

Reviewer comment
Ethics information should be in the Study Design section, with IRB details, data collection period, consent, Declaration of Helsinki, and STROBE mention. Mini-design should be described here.

Response
We appreciate this comment. We have expanded the “Study design” section to describe the retrospective cross-sectional design, data collection period, ethical approval, and use of the KNHANES dataset. We also added a separate “Ethical considerations” subsection, moved the IRB information from the Data Analysis section to this new subsection, and explicitly stated that the study complied with the Declaration of Helsinki and adhered to the STROBE reporting guidelines.

 

4. Sample size and G*Power (Page 2, line 74)

Reviewer comment
No G*Power or similar power analysis reported; need effect size, α, power, analysis method, and program, and minimum sample size.

Response
We agree that justifying the sample size improves methodological transparency. Because this study is a retrospective secondary analysis of KNHANES data, we originally included all eligible participants aged ≥65 years without conducting an a priori sample size calculation.

 

5. Variable selection and definitions – instruments, validity, reliability, categories (Page 2, line 80)

Reviewer comment
Section is superficial; each measurement tool (PHQ-9, GAD-7, MMSE, physical activity, biochemical markers) needs its own explanation, validity/reliability, scoring, references, measurement conditions (device, who measured, when), and sociodemographic variable categorization.

Response
We appreciate this detailed suggestion. We have substantially expanded the “Variable selection and definitions” section by organizing variables into physical, psychological, and lifestyle domains. For each standardized instrument (PHQ-9, GAD-7, MMSE) and key measurements (grip strength, physical activity, LDL-cholesterol, blood pressure), we now describe the assessment method, scoring procedures, cut-off values, and relevant validity and reliability information, with supporting references. We also clarified how sociodemographic variables (e.g., age, sex, education, income) were categorized for analysis.

 

6. Data analysis & normality; ethics should not be here (Page 3, line 124)

Reviewer comment
Ethics information should not be in Data analysis; add normality assessment and clarify parametric/non-parametric choices.

Response
We have moved the ethics paragraph from the “Data analysis” section to the new “Ethical considerations” subsection (see response to Comment 3). In the Data analysis section, we now explicitly describe the assessment of normality for continuous variables and clarify the use of independent t-tests and chi-square tests, as well as the rationale for the multivariable logistic regression model.

 

7. Tables – abbreviations, units, and test names (Page 4, line 163)

Reviewer comment
All abbreviations should be explained in footnotes, units specified (e.g., age in years), and names of statistical tests included.

Response
We appreciate the suggestion to improve table clarity. We have revised Tables 1 and 2 so that all abbreviations and measurement units are fully explained in the table footnotes (e.g., years, kg/m², mmHg, mg/dL). We also added a note specifying that independent t-tests were used for continuous variables and χ² tests for categorical variables. This will allow readers to interpret the tables independently of the main text.

 

8. AUC abbreviation (Page 6, line 210)

Reviewer comment
AUC should be spelled out as “area under the curve” at first mention in the text, not only in the table.

Response
We agree. We have revised the first sentence of Section 3.3 to spell out “area under the curve (AUC)” and then used the abbreviation thereafter.

 

9. Discussion – deepen literature linkage, mechanisms, and unique contribution (Page 7, line 235)

Reviewer comment
Discussion is somewhat superficial; needs richer comparison with literature, mechanisms, and clearer emphasis on unique contributions (LDL, work hours).

Response
Thank you for this important suggestion. We have expanded the Discussion to more comprehensively compare our findings with previous studies on fall risk, depressive symptoms, blood pressure, and lipid profiles in older adults. We added more detailed descriptions of potential biological and behavioral mechanisms linking low diastolic blood pressure, elevated LDL-cholesterol, reduced grip strength, and limited weekly working hours with fall risk. We also highlighted more explicitly how our findings contribute new evidence regarding LDL-cholesterol and weekly working hours as underrecognized, yet clinically assessable, predictors of falls in community-dwelling older adults.

 

10. Conclusion – more concrete implications (general & future research)

Reviewer comment
Conclusion is too general; needs clearer implications for clinical practice and priorities for future research.

Response
We agree and have revised the Conclusion to provide more specific recommendations for clinical practice and to outline priorities for future research, including prospective designs and consideration of environmental and psychosocial factors.

 

Comment on English language

Reviewer comment
Language is understandable but academic fluency needs improvement; sentences sometimes long/repetitive; transitions, terminology, and tenses should be standardized.

Response
We appreciate the reviewer’s feedback on language quality. We have carefully revised the manuscript to shorten overly long sentences, reduce repetition, and improve transitions between paragraphs, particularly in the Introduction and Discussion. We also standardized terminology and verb tenses throughout the text. If needed after this revision round.

Reviewer 3 Report

Comments and Suggestions for Authors

I would like to begin by thanking the Editor for the opportunity to review this manuscript entitled “Analysis of physical, psychological, and lifestyle factors affecting falls in older adults: a study based on the Korea National Health and Nutrition Examination Survey (KNHANES)”. The topic is highly relevant and timely, given the global ageing of populations and the growing need to identify modifiable risk factors for falls, a major concern in gerontological nursing and public health.

The study addresses an important gap by integrating physical, psychological, and lifestyle determinants within a single analytical framework, using nationally representative data from the KNHANES. The rationale, overall structure, and clarity of presentation are commendable. The manuscript demonstrates solid analytical work and a valuable contribution to the understanding of multidimensional fall risk factors. With some clarifications and structural improvements, it will be suitable for publication.

 

1. Introduction

The introduction clearly identifies the importance of fall prevention in ageing populations. However, the section begins with a typographical error, as the keywords are duplicated at the start of the text. This should be corrected.

In lines 51–52, the authors claim that previous studies have focused on “single risk factors”, yet no citations are provided to support this assertion. Adding specific references that illustrate this limitation would strengthen the argument.

Between lines 53–62, the text transitions abruptly from conceptual discussion to the implicit formulation of research hypotheses and objectives. This conceptual leap weakens the narrative flow. I recommend that the authors enrich the theoretical grounding of this section to create a smoother and more coherent transition toward the study objective. Strengthening the conceptual density will enhance both the scholarly rigour and the readability of the introduction.

 

2. Materials and Methods

The Materials and Methods section is generally well structured but would benefit from further detail and precision in several aspects:

• A brief contextual description of the Korea National Health and Nutrition Examination Survey (KNHANES) should be added, including its periodicity, sampling method, representativeness, and the main data collection instruments. This contextualisation will help international readers better understand the source and reliability of the dataset.
• The sampling method, though inferable, should be explicitly stated.
• The subsection “Variable selection and definitions” is excessively dense. The clarity and accessibility of this section could be improved by summarising the variables in a table, grouped by type (e.g., physical, psychological, lifestyle). This would improve readability and transparency.
• In “Data analysis”, ethical aspects should be moved to a separate subsection entitled Ethical considerations.
• The statistical description could be more precise. The manuscript states that a “multivariate logistic regression analysis” was performed “to identify factors significantly influencing fall risks”. Conceptually, logistic regression is used to estimate the probability of an event’s occurrence and to identify significant predictors in binary or multiclass classification contexts. The authors should therefore revise the description for methodological accuracy and expansion.

This clarification would reinforce methodological rigour, reproducibility, and transparency.

 

3. Results

The Results section is clearly organised, objective, and generally well presented. However, the text accompanying each subsection is quite dense and could be made more concise. I suggest the authors carefully review whether all the narrative details currently included are necessary, aiming to streamline the presentation.

• Tables 1–2: The column heading “X² or t” should indicate the exact test statistic value, specifying in the table footnote whether it refers to a t-test or a chi-square (χ²) test.
• The results could benefit from clearer alignment between the text and tables, highlighting only the most relevant and statistically significant findings in the text body, while leaving the full numerical detail to the tables.

 

4. Discussion

The Discussion is one of the strongest parts of the manuscript. The authors critically compare their findings with prior literature and provide valuable insight into the multidimensional nature of fall risks among older adults. The inclusion of “Implications for nursing practice” and “Future directions” is particularly appreciated, as these sections add depth and practical relevance to the study.

No major revisions are needed here, although the authors might consider slightly expanding on the implications for interdisciplinary practice, highlighting collaboration between nurses, physiotherapists, and community health professionals in the design of integrated fall-prevention programmes.

 

5. References

The references are generally appropriate and up to date. However, to support a denser conceptual framework in the Introduction, I recommend broadening the literature base to include additional international sources, particularly systematic reviews or meta-analyses that explore multifactorial fall determinants. This will improve the theoretical robustness of the manuscript.

 

 

This manuscript presents an important and well-executed study addressing a significant public health and nursing issue. With the incorporation of the suggested revisions, especially improving conceptual coherence in the introduction, clarifying methodological details, and refining presentation in the results, it will constitute a high-quality contribution to the field of ageing and longevity research.

Author Response

Response to Reviewer

We sincerely thank Reviewer for the thorough and constructive feedback. We have revised the manuscript accordingly. Below we respond point-by-point.

 

1. Introduction – duplicated keywords at the beginning

Reviewer comment

The introduction clearly identifies the importance of fall prevention… However, the section begins with a typographical error, as the keywords are duplicated at the start of the text. This should be corrected.

Response
Thank you for pointing out this formatting error. We have removed the duplicated keyword list at the beginning of the Introduction so that the section now starts directly with the background sentence on falls in older adults.

 

2. Introduction – “single risk factors” statement without citation & conceptual density

Reviewer comment

In lines 51–52, the authors claim that previous studies have focused on “single risk factors”, yet no citations are provided…
Between lines 53–62, the text transitions abruptly… I recommend enriching the theoretical grounding to create a smoother transition toward the study objective.

Response
We agree and have revised the Introduction to (1) add citations supporting the statement that many prior studies examined single or limited risk factors and (2) improve the conceptual flow leading to our study objective.

 

3. Materials and Methods – KNHANES description and sampling method

Reviewer comment

A brief contextual description of KNHANES should be added… including periodicity, sampling method, representativeness, and main data collection instruments. The sampling method, though inferable, should be explicitly stated.

Response
We appreciate this suggestion. We have expanded the Study design and Study population subsections to describe the KNHANES context and sampling.

 

4. Materials and Methods – Variable section too dense; suggestion for table by type

Reviewer comment

The subsection ‘Variable selection and definitions’ is excessively dense… clarity… could be improved by summarising the variables in a table, grouped by type (e.g., physical, psychological, lifestyle).

Response:

Thank you for this helpful suggestion. We agree that clearer organization of the variables is important. However, because the manuscript already contains several tables, we were concerned that adding another detailed summary table would make the presentation overly complex and lengthen the tables section. Instead, we revised the “Variable selection and definitions” subsection by introducing explicit subheadings for each domain (physical, psychological, and lifestyle factors) and reorganizing the text under these subheadings to provide clearer and more structured descriptions of all variables, without adding an additional table.

 

5. Materials and Methods – Ethical considerations separated; logistic regression description

Reviewer comment

In “Data analysis”, ethical aspects should be moved to a separate subsection entitled Ethical considerations. The statistical description could be more precise. The manuscript states that a “multivariate logistic regression analysis” was performed “to identify factors significantly influencing fall risks”… This should be revised for methodological accuracy and expansion.

Response
We have separated the ethical information into a dedicated subsection and refined the description of the logistic regression analysis.

 

6. Results – density and alignment of text with tables

Reviewer comment

The Results section is clearly organised… However, the text is quite dense… consider streamlining… The results could benefit from clearer alignment between the text and tables, highlighting only the most relevant and statistically significant findings in the text body, while leaving the full numerical detail to the tables.

Response
We agree and have streamlined the Results narrative to emphasize key significant associations while referring readers to the tables for full numerical details.

 

7. Results – Tables 1–2 column heading “X² or t”

Reviewer comment

Tables 1–2: The column heading “X² or t” should indicate the exact test statistic value, specifying in the table footnote whether it refers to a t-test or a chi-square (χ²) test.

Response
We have revised the column heading and clarified the test information in the footnotes.

 

8. Discussion – conceptual strength and interdisciplinary practice

Reviewer comment

The Discussion is one of the strongest parts… No major revisions are needed here, although the authors might consider slightly expanding on the implications for interdisciplinary practice, highlighting collaboration between nurses, physiotherapists, and community health professionals…

Response
Thank you for this positive assessment and helpful suggestion. We have expanded the “Implications for nursing practice” subsection to explicitly address interdisciplinary collaboration.

 

9. References – broader international and conceptual literature

Reviewer comment

The references are generally appropriate… I recommend broadening the literature base to include additional international sources, particularly systematic reviews or meta-analyses that explore multifactorial fall determinants.

Response
We agree and have added several international systematic reviews and large-scale epidemiological studies that address multifactorial and multidomain fall determinants in older adults. These references now appear in the Introduction where we discuss established physical predictors and multifactorial fall risk models, thereby strengthening the conceptual framework and global relevance of our work.

Reviewer 4 Report

Comments and Suggestions for Authors

This manuscript describes a multifactorial investigation from falls community dwelling older adults utilizing the KNHANES data set.
The methodology appears sound and the conclusions supported by the data.

The following recommendations were made to enhance clarity of the  presentation.
1.  Recommend deleting table 2 as all of the nonsignificant associations are described in the narrative.
2. Lines 24 and 312 of the manuscript are confusing to the reader.  Consider replacing "meaningful weekly engagement" with "social engagement through work" if appropriate.
3. Lines 30-31 appear out of place.  Perhaps the first portion of the sentence is intended for "keywords"?

Author Response

Response to Reviewer

Response:

We sincerely thank the reviewer for the positive and encouraging evaluation of our study. We appreciate the thoughtful suggestions to improve clarity and presentation. We have carefully considered each comment and revised the manuscript accordingly, as detailed below.

 

Reviewer comment 1:

Recommend deleting table 2 as all of the nonsignificant associations are described in the narrative.

Response:
Thank you for this suggestion. We agree that the presentation of nutritional and biochemical variables should be concise. However, in our dataset some nutritional and biochemical factors, particularly vitamin D intake and LDL-cholesterol levels, showed statistically significant differences between older adults with and without fall experience. Therefore, we decided to retain Table 2 to present these significant findings as well as the non-significant results in a compact and transparent manner.
In line with your recommendation and Reviewer 2’s comment, we have substantially streamlined the corresponding Results text so that only the key significant findings (lower vitamin D intake and higher LDL-cholesterol in the fall group) are described in detail, while the remaining non-significant variables are summarized briefly with a reference to Table 2.

 

Reviewer comment 2:

Lines 24 and 312 of the manuscript are confusing to the reader. Consider replacing "meaningful weekly engagement" with "social engagement through work" if appropriate.

Response:
We appreciate this helpful wording suggestion. To improve clarity, we have replaced the phrase “meaningful weekly engagement” with “social engagement through work” wherever it referred to weekly working hours. Specifically, in the Abstract and in the Discussion section describing lifestyle factors, we now describe weekly working hours as an indicator of “social engagement through work”. We believe this revision more accurately reflects the construct and reduces potential confusion for readers.

 

Reviewer comment 3:

Lines 30–31 appear out of place. Perhaps the first portion of the sentence is intended for “keywords”?

Response:
Thank you for noticing this formatting issue. You are correct that the initial phrase resembled a misplaced keyword list. We have removed this phrase from the beginning of the Introduction so that the section now starts directly with the background sentence on falls in older adults. Keywords are now presented only in the designated “Keywords” section, which we hope will eliminate any confusion.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

If the editor believes that the quality of the manuscript meets the publication standards of JAL, then I have no further comments.

Reviewer 2 Report

Comments and Suggestions for Authors

I thank the reviewers for their careful evaluations and constructive comments. Their detailed feedback enhanced the clarity, methodological accuracy, and overall quality of the manuscript.

Comments on the Quality of English Language

While the article's overall language is understandable, academic fluency needs improvement. Sentence structures are occasionally repetitive and lengthy. Transitional expressions, particularly in the introduction and discussion sections, should be strengthened to improve text flow; terminology and tenses should be standardized. English spelling, punctuation, and capitalization should be verified.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have fully and constructively addressed the points raised in the initial review. The revised manuscript is clearer, more robust, and methodologically sound.