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Congratulations, I'm happy to recommend this paper be accepted for publication in PeerJ.
[# PeerJ Staff Note - this decision was reviewed and approved by Michelle Ploughman, a PeerJ Section Editor covering this Section #]
Comments have been addressed. I have no further comments for this manuscript.
Comments have been addressed. I have no further comments for this manuscript.
Comments have been addressed. I have no further comments for this manuscript.
Apologies for the delay in response. Please see the attached review comments from our expert reviewer.
This is an interesting and straightforward study on the creation and validation of a DT exercise program that looks to improve balance and gait speed in the older adult population. I would like to commend the author(s) for focusing on a sample that is often difficult to do research on. Delphi studies are very important in our quest to improve the balance and gait speed of older adults. However, there are some issues that I think should first be addressed so that they can meaningfully contribute to the body of knowledge on DT exercise programs for older adults.
The main change in the experimental design would be to condense Figures1-5 into a figure and include either a Table or Figure on what exactly entails the DT program to really show your audience how this DT program is different from all the rest and how it shows the impact it has for improving balance and gait speed for the older adult population.
The research question is well addressed and relevant. It is also well defined and meaning full to the older adult population. Well done on examining an area that has been underdeveloped and bringing to fruition an area that will make a significant impact. I look forward to seeing the DT program put into practice. The paper is well laid out, with just some minor comments in the attachment in regards to being concise and clear in certain areas.
The paper is well defined with valid findings from the Delphi study documented.
See attached the PDF of the manuscript with further comments and edits.
The two reviewers and I both see some merit in the study but also a number of areas that require considerable provisions prior to this being more strongly considered for publication in PeerJ. Please look to address these constructive criticisms of the two reviewers before resubmitting your manuscript.
[# PeerJ Staff Note: Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. #]
General comment (originality, scientific accuracy, strengths and/or weaknesses): Thank you for the opportunity to review the present paper. The topic is interesting and the paper is well written however some minor changes are required.
Originality and strengths: the a Delphi study creating and validating a DT exercise program for older adults to improve balance and gait speed has not been studied before.
Major corrections (main criticisms): Figures are very low quality, also could you not include the results from L265-273 into the figures rather than as text as its very hard to follow with so many exercise being spoken about. There is also some inconsistency with reporting in this paragraph with some exercises missing (N = X).
discussion needed to intertwine your study results into this section, needs to be made stronger. Also missing paragraph on balance - you have emphasis on gait speed but missing the importance in discussion here.
Introduction should be improved
Table 1 should be supplementary and figure 1 needs to be clearer in terms of the text provided - hard to read the figure have to zoom in significantly to understand what is going on but I can not make out what the actual % are within the figure/.
Minor corrections (page, paragraph, line where the author must make the corrections):
abstract
L37: either re-write to keep in results section or keep as is and move to methods section.
introduction
L57: error with reference - requires fixing
L65: more detail required at the end of that sentence as you go into detail about motor deficits but no on cognitive alterations
L70: in reference to "them" what do you specifically mean here?
L76: provide more than one reference to strengthen this
L80; you need to pick a term and be consistent throughout, sometimes you say older adult, older person or ageing patient. pick one.
L92: references required for your statement
L102-103: repeats what you have stated above on L92-93/
L113: missing full stop
materials and methods
L117: consistency of term again noted here - pick one and keep it
L123: how long did the process take?
L158: best to avoid starting with K - rewrite sentence
L168-174 captions required with calculation
L181: was it anonymous to research team or just the participants to other participants? clarify
L195:"them" explain and be specific here in what you are referring to
L197: which was when ... what happened to stop the rounds.
L200: state what all 11 exercises are
L205-206: provide more clarification are you just taking about the exercises or the Delphi rounds?
L211: be very clear which response equaled which Likert scale number
statistical analysis
L225: how were rounds analysed?
L226; version of Excel?
L232: you have already used acronym for Q1 and Q3 so can be used here rather than full spelling
results
L246: extra space needs to be removed
L253: did any experts drop out? how many experts did you start with?
L290: replace or with and
L293: space required between paragraphs
L308: emphasis point which should be made in intro as well
L317: how have all these conditions been taken into account?
L326: remove 'prioritization' after fixed
L333: include reference for statement
L339-346; missing the link to cognitive impairment again -this really needs to be linked into the discussion but is missing
L338: space between paragraphs missing
L356: space between paragraphs missing
L356-363: merge paragraphs together
L380-382: different wording to L107-109 - consistency issue again here
please refer to above
please refer to above
English language should be revised thorughout the manuscript for minor errors (Examples: "work on physical activities" Line 74; "Training activities such as for gait" Line 98).
"physical activity" and "exercise" are used indistinctly thorughout the text, however, they are not synonyms. Authors are advised to check the terms and make the neccessary corrections.
Background and justification of the study: The background and justification of the study need revising for better structuring the information and addressing how cognitive function declines with ageing, the link between cognition and motor disturbances, and the mechanisms by which dual-task training might exceed the benefits of single task training.
Examples that can be found in the attached pdf provided:
Additional information on cognitive decline and the link between cognitive impairment with gait and balance would be helpful to understand the importance of including not only physical but also cognitive training in older adults (Lines 64-65).
The term dual-task needs further explanation and justification, including why it is relevant in this population (Lines 75-88).
The research question is relevant and meaningful for older adult populations. Overall, the methodology seems appropiate, however, further details on the physical and cognitive aspects of the intervention would be advisable.
No information has been given regarding the cognitive functions addressed through DT training thoughout the text and why those specific cognitive tasks were selected. In addition, information regarding whether the difficulty level of cognitive tasks could be adjusted. Authors are encouraged to include this information in the manuscript.
The authors state the following "divided into five levels that progressively increase in difficulty" (Lines 201-202). Does difficulty come from the type of exercises, the type of prioritization, or both? Authors are advised to specify how task difficulty progression has been designed.
The authors state the following: "For progress at each level, the older people must be able to perform the previous level safely and without an increased risk of falling" (Lines 206-207).This is an important aspect of the intervention. Authors are encouraged to include more detailed and as objective as possible criteria for exercise completion to progress to more complex exercises.
Information on the target population should be given, since it would need adapting for individuals with different levels of physical impairment (Line 209).
The authors state the following: "training in a single task condition is insufficient to improve functional walking (Silsupadol et al., 2009)"(Line 213).To date there is not enough evidence to make categorical affirmations regarding single and dual-task training for DT improvement. Therefore, other terms such as "might", or "it has been suggested" are preferable.
The authors state the following: "in both intervention groups" (Line 336). However, the characteristics of the groups have not been described (controls, a certain intervention...).
If the effectiveness of the DT intervention was demonstrated to improve gait and balance to a greater extent than with physical training, a protocolized DT intervention could be relevant to improve functionality and reduce the risk of falling in older adult populations.
The conclusions are appropiate.
The manuscript provides with a promising intervention to improve functionality and reduce the risk of falling in older adults. The methodology to validate the program seems adequate. However, the introduction needs revising to improve the rationales of the study by including more information regarding the link between cognitive and motor disturbances and how dual-task training may be more effective than physical training alone, including previous relevant studies.
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