The Effect of Muscle Stretching on Joint Position Sense in Active Young and Elderly Adults: A Comparative Study

Round 1

Reviewer 1 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

1. the material and method section should be placed before the results 

2. In the material and method, please describe the cognitive status of the elderly

3. Results should be further detailed to see differences by age, physical performance if considered 

4. Was the weight of the patients taken into account? Is any factor such as sarcopenia assessed?

5. In the Discussions, the ideas from the results of paragraphs 162-178 are repeated.

7. Easily updated bibliography with meta-analyses on the topic 

Ex Borges, M. O., Medeiros, D. M., Minotto, B. B., & Lima, C. S. (2017). Comparison of static stretching and proprioceptive neuromuscular facilitation on hamstring flexibility: systematic review and meta-analysis. European Journal of Physiotherapy, 20(1), 12–19. https://doi.org/10.1080/21679169.2017.1347708

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

1. the material and method section should be placed before the results.

• We followed the general guidelines provided by the journal for the placement of the Material and Methods section.

 

2. In the material and method, please describe the cognitive status of the elderly

• We have added the information in line 298 (highlighted in green).

 

3. Results should be further detailed to see differences by age, physical performance if considered.

• We understand that the Results section may seem short. However, because we formulated specific questions and hypotheses in advance, we aimed to present the results clearly and concisely. Figure 1 shows the age-specific comparison of absolute errors (AE) and in the text (line 147-149) the AE values are described for the age groups. In addition, in the discussion section (line 289-292; highlighted in green), we have added the point on physical performance for future studies.

 

4. Was the weight of the patients taken into account? Is any factor such as sarcopenia assessed?

• We did not assess sarcopenia in our study but plan to integrate this factor in future research. Our analysis indicates no significant differences between the two age groups, suggesting that sarcopenia is unlikely to explain our results. Body weight was not included in the statistical analysis. However, given that participants in both age groups had similar sporting backgrounds and comparable Body Mass Index (BMI) values, we believe that body weight did not influence the outcomes. This consideration will be included in future studies. Thank you for your valuable input! We have now included the BMI in the participant description (lines 296; highlighted in green).

 

5. In the Discussions, the ideas from the results of paragraphs 162-178 are repeated.

• In order to give the discussion a structure and to make it easier to follow this section, we have summarized the aims, hypotheses and key findings in the first paragraph.

 

6. Easily updated bibliography with meta-analyses on the topic.

• We have added the recommended literature in the Materials and Methods section (line 330; highlighted in green).

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

The reviewed paper is good contribution to the anatomy and physiology of locomotor system and contain new findings valuable also for the physiotherapy. The work was well organized and written, but some less important editorial remarks were indicated in text. I appreciate the wide and deep knowledge of authors about the role of proprioreceptors and nervous system in the locomotor system control. The study indicates and discusses the problems arising from findings in this field of knowledge. The results allows for forming the new approaches, which can be taken under consideration in further studies. Introduction gives good view on general subject of investigation. Material and methods – methods are clearly described; Discussion is well written and drive us to the conclusions. I suggest to revise carefully the whole text, my remarks are indicated in pdf file. I suggest to accept this work after minor revision.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

1. I suggest to revise carefully the whole text, my remarks are indicated in pdf file. I suggest to accept this work after minor revision.

• Thank you for your valuable feedback and the comments in the text! We have carefully revised the text and the whole manuscript has been proofread by a native English speaker.

Round 2

Reviewer 1 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

I agree with the changes made by the authors according to the recommendations. It would be ideal to add more data in the results section.

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

1. I agree with the changes made by the authors according to the recommendations. It would be ideal to add more data in the results section.

• Yes, we agree that additional data for the presentation of results would be ideal. However, we can only refer to our last statement that we have presented the results consistently in terms of the research question and hypothesis testing. We will take your valuable comments into account in further studies, as we mentioned in the discussion. With the initial results from the present study, further studies will be planned.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The type of stretching used should be specified and the importance of using one type or another should be made clear in the introduction section, as not all of them provide the same benefits/adaptations (why were these types of stretches used?).

It would be of interest to provide data from control groups (both young and old) and that the experimental groups, instead of performing recreational activities, should take into account strength training. In this way it would be possible to check both the effect of the passage of time as well as the variable of the specificity of strength exercise, as mentioned in the introduction (the introduction should be consistent in relation to the methodology).

Material and methods are after the introduction. Put in place.

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

The type of stretching used should be specified and the importance of using one type or another should be made clear in the introduction section, as not all of them provide the same benefits/adaptations (why were these types of stretches used?).

• We have specified the stretching regimen above Figure 2 and have highlighted this section in yellow for clarity.

It would be of interest to provide data from control groups (both young and old) and that the experimental groups, instead of performing recreational activities, should take into account strength training. In this way it would be possible to check both the effect of the passage of time as well as the variable of the specificity of strength exercise, as mentioned in the introduction (the introduction should be consistent in relation to the methodology).

• This is an excellent point, and we will incorporate this suggestion into future studies. Thank you for your valuable feedback!

Material and methods are after the introduction. Put in place.

• We followed the general guidelines provided by the journal for the placement of the Material and Methods section.

Reviewer 2 Report

Comments and Suggestions for Authors

The rviewed manuscript brings the important information about the himan locomotor system physiology and function changing with age. The ROM and JPS plays important role in modern studies and the results o later can influence not only the mobility of humans, but the quality of life and recovery process after serious injuries and orthopaedic interventions. The Introduction is well written and gives reader sufficient background. Even that very long I want to stress that I apreciate the wide knowledge and  sicentific skills of authors. Maybe sone of this information can be moved to the Discussion, it is only suggestion. In my opinion the chapter Introduction shall be finished with the aim of the study definition.

The Material and methods are carefully and clearly described.

The Results shall be better elaborated. The cahpter is very short and has only one figure. Some text form Discussion can be moved to the Resutlks chapter (see pdf file) and summarized in discusion only.

Discussion chapter is well written, bot see the above written remark.

I sugesst to accept the manuscript after the minor revision.

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

The rviewed manuscript brings the important information about the himan locomotor system physiology and function changing with age. The ROM and JPS plays important role in modern studies and the results o later can influence not only the mobility of humans, but the quality of life and recovery process after serious injuries and orthopaedic interventions. The Introduction is well written and gives reader sufficient background. Even that very long I want to stress that I apreciate the wide knowledge and  sicentific skills of authors. Maybe sone of this information can be moved to the Discussion, it is only suggestion. In my opinion the chapter Introduction shall be finished with the aim of the study definition.

• We have moved some information from the Introduction to the Discussion section and highlighted the revised paragraph in yellow. Additionally, we have rephrased the last sentence of the Introduction to clearly define the aim of the study.

The Results shall be better elaborated. The cahpter is very short and has only one figure. Some text form Discussion can be moved to the Resutlks chapter (see pdf file) and summarized in discusion only.

• We have extended the Results section below Figure 1 and highlighted the new text in yellow. We understand that the Results section may seem very short. However, because we formulated a specific question and hypotheses in advance, we aimed to present the results clearly and concisely.

Discussion chapter is well written, bot see the above written remark.

• We have moved some information from the Introduction to the Discussion section and highlighted the revised paragraph in yellow. Additionally, we have transferred some information from the Discussion to the Results section.

Reviewer 3 Report

Comments and Suggestions for Authors

The introduction is too long and there is more of a discussion section

The material and method are noted in section 4 after the results

The results are very few and unconvincing

There are no conclusions

The bibliography must be updated with newer works

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

The introduction is too long and there is more of a discussion section

• We have moved some information from the Introduction to the Discussion section and highlighted the revised paragraph in yellow.

The material and method are noted in section 4 after the results

• We followed the general guidelines provided by the journal for the placement of the Material and Methods section.

The results are very few and unconvincing

• We have extended the Results section below Figure 1 and highlighted the new text in yellow. We understand that the Results section may seem short. However, because we formulated specific questions and hypotheses in advance, we aimed to present the results clearly and concisely.

There are no conclusions

• We have added a Conclusion section (5. Conclusion).

The bibliography must be updated with newer works

• Through our literature search, we found that there is currently limited literature on the topic of stretching and JPS in old age or in comparison with old age. We have included the most recent literature available on this topic. The results of our literature search are currently being prepared for publication.

Reviewer 4 Report

Comments and Suggestions for Authors

Very interesting study on the relationship between the effects of hamstring stretching and proprioception of the knee joint. A non-randomised controlled experimental analytical study comparing the effect between two non-homogeneous groups such as young people and adults of around 65 years of age, both groups are not comparable given the different physiological changes in relation to age and although they describe in detail the effects of sarcopenia and other effects on the muscle, the study population are active hockey athletes, which added to the low number of participants, 15 in each group, does not allow generalising the effect in the general population only in terms of the effect of age. Nor do they indicate the sex or the existence of pathologies or drugs that could influence the results, as well as the level of physical activity, hours of training sessions per week.

Author Response

Dear Reviewer, thank you very much for taking the time to review this manuscript and your valuable feedback!

Very interesting study on the relationship between the effects of hamstring stretching and proprioception of the knee joint. A non-randomised controlled experimental analytical study comparing the effect between two non-homogeneous groups such as young people and adults of around 65 years of age, both groups are not comparable given the different physiological changes in relation to age and although they describe in detail the effects of sarcopenia and other effects on the muscle, the study population are active hockey athletes, which added to the low number of participants, 15 in each group, does not allow generalising the effect in the general population only in terms of the effect of age. Nor do they indicate the sex or the existence of pathologies or drugs that could influence the results, as well as the level of physical activity, hours of training sessions per week.

• We believe there has been a misunderstanding here. In our study, we compared active young and older individuals. The comparative study with roller hockey players was intended to illustrate that active hockey players have better JPS compared to non-hockey players, a finding which could be extrapolated to our experimental groups. Since our participants consisted solely of active individuals, it would be valuable for future studies to investigate the extent to which JPS is more pronounced in active versus non-active older individuals.