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. 2023 Oct 9;18(10):e0292487. doi: 10.1371/journal.pone.0292487

Force plate methodologies applied to injury profiling and rehabilitation in sport: A scoping review protocol

Francisco Javier Robles-Palazón 1,2, Paul Comfort 1,3, Nicholas J Ripley 1, Lee Herrington 1, Christopher Bramah 1, John J McMahon 1,*
Editor: Chris Connaboy4
PMCID: PMC10561863  PMID: 37812631

Abstract

Musculoskeletal injuries are a common health problem among sporting populations. Such injuries come with a high financial burden to the involved organisations and can have a detrimental impact on the career attainment of injured individuals. Force plates are now a common tool available to sport and exercise science and medicine professionals to enable them to profile injury risk predisposition and modulate the rehabilitation process within sporting environments. This is because contemporary force plate technology is portable and affordable and often comes with software that enables the automatic and immediate feedback of test variables to key stakeholders. However, to our knowledge, to date, there has been no comprehensive review of the scientific literature pertaining to clinical applications of force plate technology. Therefore, this article presents a protocol and a methodological framework to perform a scoping review to identify and map the available scientific literature in which force plates have been applied to the injury profiling and rehabilitation of athletes. The specific aims of the scoping review are 1) to identify and describe the force plate tests, methodologies, and metrics used to screen for injury risk and guide the return of injured athletes to full-time training and competition, 2) to identify potential trends and/or differences by participants’ age, sex, and/or level of performance in tests, methodologies, and metrics selected, and 3) to identify key gaps in the existing evidence base and new questions that should be addressed in future research. The global aim of the scoping review is to improve practitioner decision-making around force plate test and variable selection when applied to the injury prevention and rehabilitation of sporting populations.

1. Introduction

Musculoskeletal injuries are a common health problem among sporting populations [1–4]. It has been proposed that a professional soccer team might expect around two musculoskeletal injuries per player every competitive season [5,6]. Likewise, three out of four elite athletes competing in athletics have reported at least one injury over a year of follow-up [4]. But the high incidence of injuries is not limited to adult professional sports. It has been estimated that around 40–60% of youth athletes participating in such popular team and individual sports as soccer, basketball, or athletics might suffer an injury over a typical competitive season as well [4,7,8]. As a result, musculoskeletal injuries are having an increased impact on sport participation, and may also require long rehabilitation processes [2]. The periods of absence may compromise athletes’ skill maintenance and acquisition, which may then negatively influence their future performance [9–11]. These injury incidents will also lead to significant financial costs to sport clubs and governments worldwide [10,12]. In fact, an average English Premier League team might lose approximately £45 million per season due to injury-related decrements in performance [12]. Therefore, there is a clear necessity to develop and implement measures aimed at identifying those at risk from and reducing the number and severity of musculoskeletal injuries derived from participation in sports.

The implementation of appropriate training programs has shown to decrease the rate of injuries and their recurrences in athletes [13,14]. To be highly effective, training program designs must be targeted to each athlete’s individual needs through the identification of specific predisposing factors [15]. The use of objective screening tools that allow sport and medicine professionals to profile injury risk predisposition and modulate the rehabilitation process may be considered key to the design of tailored preventive measures. Toward this effort, devices such as force plates, with the capability to measure and provide feedback about an athlete’s force production characteristics [16], maximal strength [17], balance [18], running [19], and jumping and landing forces [26], have been developed. These devices are becoming increasingly utilised in applied environments such as sports [20,21] due to the advent of affordable, commercially available force plate systems that have been validated against industry gold standard systems [22–24] and well-established criterion data analyses procedures [25]. No longer, therefore, are most force plate tests being conducted via laboratory-grade systems located within a traditional research environment (e.g., University laboratories). In fact, millions of force plate tests are being conducted by practitioners each year, with this number likely to rise thanks to the quickness, portability, and valuable information that the modern force plate systems can provide practitioners without the requirement for additional technology, such as motion capture systems.

However, the increasingly frequent use of force plates also presents a challenge. On the one hand, the possibility of this equipment to conduct a large variety of assessments has led to many tests being proposed; a recent review has identified up to nine different tests to assess injury risk via jump assessments conducted with force plates [26]. However, in this review only prospective studies were analysed, so even more tests would be expected when considering other study designs [26]. On the other hand, while the high sampling frequencies generated by force plates (typically 1000 Hz) have allowed force-time metrics to be potentially highly sensitive to changes in the neuromuscular status of an individual, they have also presented a large amount of data and number of force-time metrics to choose from [27]. For example, for a countermovement jump (considered one of the simplest jump tests and one that can be pertinent to injury screening and rehabilitation [28]), more than one hundred different variables can be obtained immediately via commercial force plate software [29]. Many automatically generated force plate variables are duplicative or similar and so cluster analyses have been applied in a few recent studies to help practitioners identify relevant countermovement jump variables in an injury screening context [30,31].

The multitude of force plate tests and metrics, and sporting populations, that have been studied to date have created controversy and inconsistency within the scientific literature that makes synthesis of the findings difficult for a practitioner. Therefore, the existence of a review would help to improve practitioner decision-making around force plate test and variable selection in relation to injury prevention purposes. After a preliminary search, no published or in-progress scoping or systematic reviews were identified on this topic, so here we present a protocol for a scoping review where we will provide a descriptive overview of the currently utilised force plate methodologies with athletes. In this protocol, we pre-define the objectives, methods, and reporting of our upcoming scoping review.

1.1. Aim

To establish the current evidence base underpinning the use of force plates to assess injury risk and return to sport purposes in competitive athletes.

1.2. Objectives

  • To identify and describe the force plate tests, methodologies, and metrics used to screen athletes for injury risk.

  • To identify and describe the force plate tests, methodologies, and metrics used to guide the return of injured athletes to full-time training and competition.

  • To identify potential trends and/or differences by participants’ age, sex, and/or level of performance in tests, methodologies, and metrics selected.

  • To identify key gaps in the existing evidence base and new questions that should be addressed in future research.

2. Methodology

The framework proposed by the Joanna Briggs Institute (JBI) will be followed to conduct this scoping review [32,33]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) [34] statement has been used to develop and report this protocol (S1 File). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) [35] along with the specific extension for Scoping Reviews (PRISMA-ScR) [36] will be used to guide the reporting of the full scoping review findings (S2 File).

As proposed by the JBI framework, the inclusion criteria will follow the elements of population, concept, and context [33]. A brief overview of all the eligibility criteria with their rationale can be found in S3 File.

2.1. Inclusion criteria

2.1.1. Participants

The participants of interest for this review will be athletes, competing in either individual or team sports. No limitation by participants’ age, sex, and/or level of performance will be applied. Due to the different injury profiles and demands of sports for these populations [37,38], which will probably result in the use of force plates with different objectives, studies on recreational athletes and paralympic athletes will be excluded from this review. To consider a study sample as “recreational athletes”, the classification framework proposed by Mckay et al. [39] will be used (i.e., tier 1: those who meet World Health Organization minimum activity guidelines and/or participate in multiple sports/forms of activity, but do not train and compete regularly).

2.1.2. Concept

Force plate methodologies applied to assess the injury profiling or rehabilitation process of athletes will be reviewed. For the purpose of this review, an injury will be defined as any musculoskeletal damage, involving bones, muscles, ligaments, tendons, joints and associated tissues [40], derived from sport participation. No exclusion will be made based on the type of injury (e.g., primary and secondary injuries), as long as the study population is athletes (i.e., not former athletes) and, in those cases where the participants are injured, they are undergoing rehabilitation at the time of data collection. Illnesses and other non-musculoskeletal damages will also not be considered. Tests and metrics identified might require a single or multiple force plates to screen the athlete. Although studies integrating complementary technology (e.g., three-dimensional motion analysis systems) will not be excluded, only the metrics extracted exclusively from data collected via force plates will be recorded. Those metrics derived from the combination of data obtained through different technologies (e.g., joint moments) will be beyond the scope of this review. The tests will be grouped into generic (i.e., used for multiple injury diagnoses) or injury-specific (e.g., knee injuries), upper body or lower body, unilateral or bilateral, single joint or multiple joints, and dynamic or isometric assessments. All this information will help guide practitioners and clinicians when choosing the most appropriate test and methodology.

2.1.3. Context

The context of this scoping review will be settings where athletes undergo physical assessments to evaluate their health status and where force plate methodologies are used to screen participants for injury risk (pre-injury event) and/or status of the rehabilitation process (post-injury). Any test applied during primary, secondary and/or tertiary injury prevention strategies will be identified and recorded. It should be noted that, in studies focused on primary injury prevention, a measure of the injury occurrence (i.e., prevalence and/or incidence) in the assessed cohort should be reported among the primary outcomes. Thus, those studies assessing the effect of an intervention (e.g., FIFA 11+) on athletes’ physical performance measures (e.g., strength, balance) as well as those focused on proxy indicators of injury risk (e.g., knee valgus), with no report of injuries, will be excluded. As previously mentioned, studies involving injured athletes will be considered as long as the athletes are still symptomatic and undergoing their rehabilitation process; those involving athletes who have already completed the post-injury return-to-sport rehabilitation will then be excluded. Since the objective is to report on the methodologies used to guide practitioners’ decision making based on the physical condition of athletes, studies evaluating the effect of protective equipment (e.g., knee brace, ankle taping) will not be considered either.

2.2. Sources

This review will consider any type of quantitative study designs, including randomised controlled trials, non-randomised controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, and cross-sectional studies. Included studies will have to report their results in a paper published in a peer-reviewed journal. Literature reviews, conference abstracts, editorial commentaries, pre-prints, and letters to the editor will be excluded to avoid duplication of data.

2.3. Search strategy

A systematic search will be conducted in the databases MEDLINE/PubMed, Scopus, and Web of Science. In addition, a complementary search of the reference lists of included articles and a Google Scholar search will be also performed. This will be do through a backward (manually searching the reference list of a journal article) and forward (scanning a list of articles that had cited a given paper since it was published) citation tracking [41]. When additional studies that meet the inclusion criteria are identified, they will be included in the final pool of studies. Relevant search terms will be used to construct Boolean search strategies in the different databases. An example of the initial search strategy that will be implemented in the MEDLINE/PubMed database can be found in Table 1. Studies published in English or Spanish will be considered for inclusion in this review. No date restrictions will be applied.

Table 1. Example of search strategy used in PubMed.

Source Search strategy
PubMed
(“force plat*”) AND (injur*[tiab] OR injur*[MeSH Terms] OR pain[tiab] OR pain[MeSH Terms] OR dysfunction[tiab] OR dysfunction[MeSH Terms] OR impairment[tiab] OR impairment[MeSH Terms] OR instability[tiab] OR instability[MeSH Terms] OR musculoskeletal[tiab] OR musculoskeletal[MeSH Terms] OR muscle[tiab] OR muscle[MeSH Terms] OR muscular[tiab] OR muscular[MeSH Terms] OR ligament[tiab] OR ligament[MeSH Terms] OR tendon[tiab] OR tendon[MeSH Terms] OR bone[tiab] OR bone[MeSH Terms] OR cartilage[tiab] OR cartilage[MeSH Terms] OR meniscus[tiab] OR meniscus[MeSH Terms]) AND (rehab*[tiab] OR rehab*[MeSH Terms] OR physio*[tiab] OR physio*[MeSH Terms] OR return*[tiab] OR return*[MeSH Terms] OR treatment*[tiab] OR treatment*[MeSH Terms] OR reconstruct*[tiab] OR reconstruct*[MeSH Terms] OR prevent*[tiab] OR prevent*[MeSH Terms] OR reduc*[tiab] OR reduc*[MeSH Terms] OR predict*[tiab] OR predict*[MeSH Terms] OR profil*[tiab] OR profil*[MeSH Terms] OR screen*[tiab] OR screen*[MeSH Terms] OR risk[tiab] OR risk[MeSH Terms]) AND (athlet*[tiab] OR athlet*[MeSH Terms] OR sport*[tiab] OR sport*[MeSH Terms] OR player*[tiab] OR player*[MeSH Terms])
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Two authors, independently, will carry out the selection of studies to be included in the scoping review [42]. To do this, a two-step search strategy will be used: first, studies will be screened based on title and abstract; second, the full text of the studies identified after the initial screening will be reviewed to identify those studies that meet all the inclusion criteria. A study will be excluded immediately when it failed to meet any of the eligibility criteria. Disagreements will be solved by consensus after consulting a third author. The entire study selection process will be carried out through Covidence (covidence.org), which will help to protect the integrity of the systematic review process and minimise bias [43]. The systematic search and study selection process will be regularly updated to identify new papers released during the development and writing of the review. To maximise the currency of our research, the last update will be carried out immediately after we have the first draft of the manuscript completed.

2.4. Extraction of results

A codebook will be designed to standardise the record of each study in order to maximise the objectivity of the data collection. The data collection form will be also pilot tested for usability and reliability by coding three to five randomly selected studies before the coding of the rest of the studies is started. Subsequently, each of the studies included in our review will be codified by two different authors. The moderator variables of the eligible studies will be coded and grouped into 3 categories: (1) general study descriptors (e.g., study design, year of publication, context, injury type/s); (2) study population (e.g., number of participants, age, sex, level of performance); and (3) force plate assessment characteristics. Force plate assessment characteristics reviewed will include test, instructions, number or time of registered trials, rest between trials, and metrics used. Other force plate characteristics, such as brand, model, sampling rate, filters, or software, will be also recorded. When necessary, the authors of the included studies will be contacted by email to provide clarifications. In any case, the codebook and data collection form might be adjusted during the review process if other potential variables of interest are identified. For example, additional characteristics considered worthy of study may be included during the review process, or variables that yield minimal information may be excluded. Data extraction will also be performed using the Covidence software.

2.5. Quality assessment

The methodological quality of the studies included in this review will be assessed in two ways: on the one hand, the reproducibility of the methodologies using force plates will be analysed by means of different variables included during the data extraction process (e.g., brand, model, sampling rate, filters applied); on the other hand, the quality of the research conducted will be assessed by means of a modified version of the Mixed-Methods Appraisal Tool (MMAT) 2018 [44] as well as by means of a modified version of the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 model [45]. The MMAT has been used for the assessment of the quality of studies included in previous scoping reviews, and its comprehensiveness, usefulness, and reliability has been widely demonstrated [46]. For the purposes of our scoping review, only those categories of the appraisal tool focused on quantitative studies (i.e., categories 2, 3, and 4) will be applied. The methodological quality for each included study will be described using the corresponding MMAT criteria, and where appropriate, an overall quality score will be calculated. The OCEBM will be used to determine level of evidence for each study. Based on the studies’ exclusion criteria, the levels 1a, 2a, 3a (systematic reviews), and 5 (opinion-based papers) will be excluded in this case. The quality assessments will be also conducted by two independent authors, and any discrepancies during this process will be settled by consensus after consultation with a third author.

2.6. Presentation of results

All the tests identified will be summarised in a table presenting what (metrics), when (screening for injury risk or return to sport purposes), where (type of sport), how (range of sets, repetitions and/or time; metrics), and how much (frequency) are used in the literature reviewed. Additionally, a brief description of the tests and metrics will be provided. The information provided in this review should not only aid sport and exercise science and medicine researchers and practitioners in making informed decisions when applying force plate methods to the injury profiling and return to sport processes of athletes (sport or tactical), but also force plate manufacturers and technical developers in understanding which are the main applications of this equipment on a scientific and practical level to date.

3. Discussion

The high injury rates shown in male and female, youth and adult, and elite and sub-elite athletes [1–4,7,8] combined with the large opportunities offered by force plates for injury screening and rehabilitation in applied environments justify the development of this scoping review. The current protocol outlines the specific objectives, methodology, and reporting of the planned review, which will help increase transparency, and reduce duplication and publication bias [33]. Two researchers performing the entire process of search, selection, and extraction of data independently will also increase the accuracy of the data recorded and reduce errors associated with this process. Despite these strengths, we acknowledge that the restriction by language (including only studies written in English and Spanish) and publication type (only studies published in peer-reviewed journals) will be a limitation of our scoping review. However, we also consider that these restrictions will facilitate the completion of our work and thus enable the results to reach sport and exercise coaches and clinicians sooner, and they will not have a major impact on the conclusions drawn in our review.

Supporting information

S1 File. Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) checklist.

(DOC)

Click here for additional data file. (83KB, doc)
S2 File. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

(DOCX)

Click here for additional data file. (118.7KB, docx)
S3 File. Inclusion/Exclusion criteria for literature search.

(DOCX)

Click here for additional data file. (16.9KB, docx)

Data Availability

All relevant data from this study will be made available upon study completion.

Funding Statement

This study was financially supported by the Spanish Ministry of Universities via the European Union–NextGenerationEU in the form of a Margarita Sala Postdoctoral Fellowship (UMU/R-1500/2021) awarded to FJR-P. No additional external funding was received for this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Decision Letter 0

Chris Connaboy

3 May 2023

PONE-D-23-07414Force plate methodologies applied to the injury profiling and rehabilitation of sport and tactical athletes: a scoping review protocolPLOS ONE

Dear Dr. McMahon,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Both reviewers have recognized the quality of the written work submitted. However, both  have pointed out several major areas of concern regarding necessary methodological omissions, which if addressed/included would vastly improve the quality of the work presented. Justification is required for both the need for the scoping review and the protocol itself, highlighting their importance to the 'field', and adhering to reporting standards for review document/papers.

==============================

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FJRP was supported by a Margarita Salas postdoctoral fellowship (UMU/R-1500/2021) given by the Spanish Ministry of Universities and funded by the European Union–NextGenerationEU. The funders did not and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

  

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[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Partly

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Efforts to prevent musculoskeletal injuries and improve clinical recovery outcomes remain significant challenges for healthcare providers. More recently, portable force plates have provided new scientific capabilities to potentially identify athletes at risk for sustaining an injury or evaluate functional performance following recovery. Currently, as the authors describe, there has yet to be scoping review of the relevant literature describing the methodologies of force plates among both sport and tactical (law enforcement, first responder/paramedic, etc.) to be used for identifying both injury profiling (injury risk) and rehabilitation (recovery progression). Overall, the manuscript is well-written and the supporting documents (supplementary Tables 1-3) are correctly identified in the current submission. However, significant limitations in the methodological approach leave the scoping review too broad which would significantly reduce the overall scientific impact of resultant findings. The topic is appropriate for PLOS One but requires significant improvements before further consideration.

In short, the authors propose to review any peer reviewed article (written in English or Spanish) examining at least one force plate outcome among sport and tactical athletes that may be related to injury onset (risk of injury) or physical recovery (injury rehabilitation) by including prospective and retrospective cohort (including randomized and non-randomized), cross-sectional, and case-control studies. Because of including a broad population (sport and tactical athletes) and potential outcomes (any force pate measurement outcome) associated with multiple contexts (Injury profiling and injury rehabilitation), there is considerable likelihood of a high number of irrelevant articles to fulfill the aim of this study. Additionally, just because both sport (recreational and competitive) and tactical athletes experience musculoskeletal injuries during training and/or fulfilling job duties, the authors need to improve their justification why force plate measurement applications can equally apply to both populations. Injury is also not clearly defined in the protocol, which would greatly affect the potential number of studies and refine the focus of the current protocol. As currently written, potential articles would include studies measuring proxy indicators of injury risk (e.g., knee valgus during squat) without measuring injury occurrence itself (for most cross-sectional studies). If the current protocol plans to conduct a scoping review of this breadth, then the Methods section should clarify these considerations.

In summary, there is a need for a scoping review to aggregate the relevant literature examining force plate methodologies used for injury profiling and to inform injury recovery, but the protocol as currently written is too broad and needs further refinement to ensure that resultant articles clearly align with the study objectives.

Title:

The title is directional and clearly conveys the manuscript. No additional comment.

Abstract

The abstract is succinct and appropriately describes the study protocol.

Introduction

In the first paragraph of the Introduction, please provide examples of injury risk among tactical populations. Currently, the introduction pertains to athletes and U.S. army, can you provide examples for law enforcement, fire and rescue, paramedics, or EMTs? Since tactical populations are also a focal point of the scoping review, the rationale to support the need for these populations would be beneficial.

Line 76-78: Please provide a citation for each of the potential outcomes that have been developed from force plates, including “an athlete’s force production characteristics (CITE), maximal strength (CITE), balance (CITE), running (CITE), and jumping and landing forces (CITE).

Methods

2.1.1. Please clarify if indicators or markers of injury predisposition will be included (I assume the author team does not intend to include these studies). This can present many studies that screened healthy athletes that underwent force plate measurement that was not included with any injury.

2.1.1. Line 150: Will all participants derive from organized sporting groups, and not include recreational athletes? In line 50, ‘level of performance’ implies competitive levels (e.g., high school vs college or amateur vs advanced) within a particular organized sport. I am not certain if recreational athletes are intended in the current review. If so, this may present a limitation due to varying injury exposure levels among recreational athletes compared to those actively participating in a competitive season. Can you please clarify and provide the rationale whether you will include these recreational athletes?

For included articles, will data be extracted in duplicate, or will only 1 reviewer extract data and 2nd reviewer confirm that extracted information is correct?

Given the anticipated breadth of articles that will apply to the search criteria with minimal exclusionary criteria, it would be important to identify if (or when) an update to the literature search will occur. Please clarify your planned approach to address either 1 or multiple literature searches.

Line 203: I believe ‘any’ should be referred to ‘all’ eligibility criteria. Please review and correct if necessary.

Line 209: Among the categories, 1) general study descriptors, 2) study population, 3) force plate assessment characteristics, only force place characteristics are further clarified (e.g., instructions, number of trials, rest between trials, etc.). Can you please describe the general study descriptors and study population?

Line 221: Recommend rephrasing ‘where’ to ‘who’ when describing sport or tactical athletes.

Reviewer #2: The following manuscript proposes a comprehensive scoping review on force plate testing methodology and their use for injury risk identification, prevention, and rehabilitation. There is a need for this review as force plate use as a means to assess athletes (sporting and tactical) has become very popular and extends beyond the laboratory now. Additionally, the proliferation of commercial force plate companies has resulted in the over saturation of information regarding their use making it difficult for the practitioners to navigate the optimal use strategies. I commend the authors for taking on this topic as I think it is much needed in the sports medicine field. However, I have several concerns regarding this proposed protocol.

Firstly, the protocol appears to be a little too ambitious given the limited exclusion criteria. Including athletic and tactical populations and investigations of any study design will result in a large number of studies in the final report which is a lot to undertake for a single review. I would suggest delimiting to only athletics or tactical populations since there are valid arguments that these populations have very different mechanical exposures. Additionally, it is unclear why lower quality study designs would be included in this review. One of the current issues with this topic is the high number of cross-sectional studies that link a force plate assessment to injury prediction without direct evidence.

Secondly, I was surprised to see no methods listed to discern publication quality, risk of bias, etc. There are many validated tools available to objectively appraise the literature being reviewed and would help identify the state of the science regarding force plates and musculoskeletal injuries (objective 3). Furthermore, this would help identify limitations and gaps in the science that need to be addressed with future work (objective 4). Would suggest reviewing some protocols published in the journal ‘systematic reviews’ and the standards for a Cochrane review to get ideas to create a more novel and rigorous protocol for this scoping review.

Lastly, my biggest issue is it is not clear why this scoping review protocol should be published on its own separate from the actual scoping review itself. The introduction does a fine job justifying the need for this scoping review (which I agree a review on this topic is needed). However, from what is presented in the manuscript, this protocol is not using any novel methods to appraise the literature nor is it the most thorough protocol I’ve seen. The questions being asked are large in scope, but it is missing key rigors of objectivity that would set it apart (e.g., study quality assessment, risk of bias tools, etc). If there is a valid reason for the publishing of the protocol on its own, then it has not been adequately conveyed (this case needs to be made in the introduction).

Comments for specific sections below.

Abstract:

Line 33: Change ‘systematic review’ to just ‘review’ since you go on to propose a scoping review.

Line 50: Remove ‘systematic review’ from keywords since this is technically not a systematic review

Introduction:

While I think the rationale for why a scoping review is necessary is acceptable, the introduction provides no strong rationale as to why the literature needs a manuscript describing the methods of a proposed scoping review. What necessitates the need for knowing the methodological rigor (which would be described in the methods section of the scoping review anyways)? What is novel about your methodological approach to the scoping review? What gaps or limitations in the literature are these novel methods addressing? These are the types of questions that need to be addressed/discussed in the introduction for a protocol paper.

Specific comments below:

Line 72: phrase ‘allow sport and exercise science and medicine professionals’ is clunky, rephrase to improve readability.

Lines 78-90: Most of the information is redundant. Only need to discuss the low cost and accessibility of force plates one time.

Lines 108-116: This paragraph is somewhat misleading as it implies that a scoping review was performed, not the proposal of a methodological framework for a potential scoping review.

Aim/Objectives: These are very ambitious and will result in a very large number of papers for the final analysis (even after screening papers out)

Methodology:

2.1.1 Participants:

Why no age or level of performance exclusion criteria? You are including both sport and tactical populations, but excluding paralympic athletes due to ‘different injury profiles and demands of sports for this populations’; does that mean you consider injury profiles of traditional athletes and tactical athletes analogous? Do you think injury profiles, exposure and sports demands are similar between adolescent recreational athletes (e.g., high school varsity basketball) and even division I collegiate basketball players?

2.1.2 Concept:

Line 158: are you only considering primary injuries or secondary musculoskeletal injuries as well such as osteoarthritis?

2.2 Sources:

This is a very broad range of studies to include which will drastically increase the number of manuscripts you will be reviewing. Do you believe that quasi-experimental, case-control, and cross-sectional studies will provide valid evidence for a force plate and its associated test’s prognostic capability? I would argue it would not and will further muddy interpretations interfering with the objective to provide a use guide for practitioners.

2.3 Search strategy:

If going to include tactical athlete populations would suggest searching DTIC as well since much of their work won’t be published in journals indexed in Medline.

Between what years is the search being conducted?

Line 199-201: Need to have a specific statements or questions for both levels of screening that is reported to show how you identified if study was included or excluded. Would suggest using at minimum three levels (i.e., title only screening, abstract and full text).

Discussion:

Line 233-236: This is true that it will increase transparency, but all this information would be presented in the actual review as well.

Line 236: Only two individuals screening for a review this size might take a long time, especially during the stages of data extraction.

Line 240: I wouldn’t consider only reviewing peer-reviewed literature as a weakness for this review since there is also a lot of misinformation on force plate injury screening protocols (especially from commercial sector just trying to sell their force plate and software platform).

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Reviewer #1: No

Reviewer #2: No

**********

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PLoS One. 2023 Oct 9;18(10):e0292487. doi: 10.1371/journal.pone.0292487.r002

Author response to Decision Letter 0

19 Jul 2023

Dear editor and reviewers,

Thank you very much for your comments. We appreciate your valuable feedback and feel that your comments have contributed to an improved protocol. Furthermore, we have been forced to reflect and have learnt a lot from the reviewers´ suggestions and comments, which will definitely help to improve the quality of our scoping review as well. Below, we have addressed all your comments point by point in green. In addition, you can find the changes in the main manuscript highlighted with track changes.

Reviewer #1:

Efforts to prevent musculoskeletal injuries and improve clinical recovery outcomes remain significant challenges for healthcare providers. More recently, portable force plates have provided new scientific capabilities to potentially identify athletes at risk for sustaining an injury or evaluate functional performance following recovery. Currently, as the authors describe, there has yet to be scoping review of the relevant literature describing the methodologies of force plates among both sport and tactical (law enforcement, first responder/paramedic, etc.) to be used for identifying both injury profiling (injury risk) and rehabilitation (recovery progression). Overall, the manuscript is well-written and the supporting documents (supplementary Tables 1-3) are correctly identified in the current submission. However, significant limitations in the methodological approach leave the scoping review too broad which would significantly reduce the overall scientific impact of resultant findings. The topic is appropriate for PLOS One but requires significant improvements before further consideration.

In short, the authors propose to review any peer reviewed article (written in English or Spanish) examining at least one force plate outcome among sport and tactical athletes that may be related to injury onset (risk of injury) or physical recovery (injury rehabilitation) by including prospective and retrospective cohort (including randomized and non-randomized), cross-sectional, and case-control studies. Because of including a broad population (sport and tactical athletes) and potential outcomes (any force pate measurement outcome) associated with multiple contexts (Injury profiling and injury rehabilitation), there is considerable likelihood of a high number of irrelevant articles to fulfill the aim of this study. Additionally, just because both sport (recreational and competitive) and tactical athletes experience musculoskeletal injuries during training and/or fulfilling job duties, the authors need to improve their justification why force plate measurement applications can equally apply to both populations. Injury is also not clearly defined in the protocol, which would greatly affect the potential number of studies and refine the focus of the current protocol. As currently written, potential articles would include studies measuring proxy indicators of injury risk (e.g., knee valgus during squat) without measuring injury occurrence itself (for most cross-sectional studies). If the current protocol plans to conduct a scoping review of this breadth, then the Methods section should clarify these considerations. In summary, there is a need for a scoping review to aggregate the relevant literature examining force plate methodologies used for injury profiling and to inform injury recovery, but the protocol as currently written is too broad and needs further refinement to ensure that resultant articles clearly align with the study objectives.

Thank you very much for reviewing our manuscript. We are really grateful for your work and agree with many of the points you made. In fact, considering the question raised about the breadth of the intended review, we have decided to focus our study population on athletes competing in individual and team sports exclusively (excluding tactical athletes and recreational athletes). In addition, we have clarified in the context of the study that only those papers that include injury occurrence outcomes and/or involve injured athletes at the time of the study will be considered. Thus, those investigations that analyse performance measures and/or proxy indicators of injury risk (e.g., knee valgus during squat) without measuring injury occurrence itself will be excluded. Thanks to these modifications, we believe that the review will provide more accurate and relevant results for practitioners, while reducing the timeframe for its development and dissemination of results.

Below, we respond in detail to the specific comments made for some of the sections of the protocol.

Title:

The title is directional and clearly conveys the manuscript. No additional comment.

Thank you for the comment. We have kept the same title, with the only modification being the deletion of the term “tactical” since the focus of the review has been changed to sports athletes.

Abstract

The abstract is succinct and appropriately describes the study protocol.

Thank you. As for the title, only those parts relating to tactical athletes have been removed.

Introduction

In the first paragraph of the Introduction, please provide examples of injury risk among tactical populations. Currently, the introduction pertains to athletes and U.S. army, can you provide examples for law enforcement, fire and rescue, paramedics, or EMTs? Since tactical populations are also a focal point of the scoping review, the rationale to support the need for these populations would be beneficial.

As tactical athletes are no longer a focal point of our scoping review, the information related to this population has been removed from this paragraph. Contrarily, we have included some examples of injury risk among different athletes, to highlight the importance of reducing them across diverse sports, ages and levels of play. The following are examples of some of the new sentences included:

Likewise, three out of four elite athletes competing in athletics have reported at least one injury over a year of follow-up (4). But the high incidence of injuries is not limited to adult professional sports. It has been estimated that around 40-60% of youth athletes participating in such popular team and individual sports as soccer, basketball, or athletics might suffer an injury over a typical competitive season as well (4,7,8).

Line 76-78: Please provide a citation for each of the potential outcomes that have been developed from force plates, including “an athlete’s force production characteristics (CITE), maximal strength (CITE), balance (CITE), running (CITE), and jumping and landing forces (CITE).

Thank you for this comment. We have added citations to support these common applications of force plates in line with your suggestion.

Methods

2.1.1. Please clarify if indicators or markers of injury predisposition will be included (I assume the author team does not intend to include these studies). This can present many studies that screened healthy athletes that underwent force plate measurement that was not included with any injury.

Thank you for this comment. This has been clarified in the section “2.1.3. Context”.

2.1.1. Line 150: Will all participants derive from organized sporting groups, and not include recreational athletes? In line 50, ‘level of performance’ implies competitive levels (e.g., high school vs college or amateur vs advanced) within a particular organized sport. I am not certain if recreational athletes are intended in the current review. If so, this may present a limitation due to varying injury exposure levels among recreational athletes compared to those actively participating in a competitive season. Can you please clarify and provide the rationale whether you will include these recreational athletes?

Thank you for this comment. As the reviewer indicates, it would be very difficult to compare recreational vs. competitive athletes because of the differences in injury exposure levels so, in our review, we will only include athletes participating in an organised sport. Thus, recreational athletes (i.e., those who meet World Health Organization minimum activity guidelines and/or participate in multiple sports/forms of activity, but do not train and compete regularly [McKay et al., 2022]) will be excluded. This has been detailed in the main text of the protocol, and also in the Supplementary File 3 where inclusion and exclusion criteria are summarised.

For included articles, will data be extracted in duplicate, or will only 1 reviewer extract data and 2nd reviewer confirm that extracted information is correct?

Study characteristics and force plate outcome data will be coded in duplicate by two reviewers to reduce both the risk of making mistakes and the possibility that data selection/extraction is influenced by a single person’s biases (Peters et al., 2015; Peters et al., 2020). To maximise the objectivity of the coding, a codebook and a data collection form will be designed to standardise the record of each study. The data collection form will be pilot tested for usability and reliability by coding three to five randomly selected studies before the coding of the rest of the studies is started. In any case, unavoidable disagreements during the final codification process of included studies will be solved through consensus or by consulting a third author. This information has been added to the “2.4. Extraction of results” section of the protocol.

Given the anticipated breadth of articles that will apply to the search criteria with minimal exclusionary criteria, it would be important to identify if (or when) an update to the literature search will occur. Please clarify your planned approach to address either 1 or multiple literature searches.

As the reviewer indicates, the breadth of articles included for review in our research may delay the process of performing, writing, and publishing our scoping review. We are aware of that and, although we will make important efforts to have the final report as soon as possible, this is the reason why we have planned to regularly update the search, with the last update being just when we have the first draft of the scoping review manuscript completed. To do that, we will conduct all the study selection (and also data extraction) through Covidence (covidence.org), a software for managing systematic reviews which will de-duplicate files upon import new references. This will help us to identify new papers that have recently been published as well as to maximise the currency of our review. All this information has been added to the protocol as follows:

The entire study selection process will be carried out through Covidence (covidence.org), which will help to protect the integrity of the systematic review process and minimise bias (43). The systematic search and study selection process will be regularly updated to identify new papers released during the development and writing of the review. To maximise the currency of our research, the last update will be carried out immediately after we have the first draft of the manuscript completed.

Line 203: I believe ‘any’ should be referred to ‘all’ eligibility criteria. Please review and correct if necessary.

If a study does not meet one of the criteria, it will be excluded. This is why we think that “any” would be more appropriate here.

Line 209: Among the categories, 1) general study descriptors, 2) study population, 3) force plate assessment characteristics, only force place characteristics are further clarified (e.g., instructions, number of trials, rest between trials, etc.). Can you please describe the general study descriptors and study population?

We have included some examples for general study descriptors and study population characteristics as suggested.

Line 221: Recommend rephrasing ‘where’ to ‘who’ when describing sport or tactical athletes.

We have changed "athletes" to "type of sport", so we have kept "where".

References used in responses to Reviewer 1:

McKay AKA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey VL, et al. Defining training and performance caliber: a participant classification framework. Int J Sports Physiol Perform. 2022;17(2):317–31.

Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. JBI Evid Implement. 2015;13(3):141–6.

Peters MDJ, Godfrey CM, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020.

Reviewer #2:

The following manuscript proposes a comprehensive scoping review on force plate testing methodology and their use for injury risk identification, prevention, and rehabilitation. There is a need for this review as force plate use as a means to assess athletes (sporting and tactical) has become very popular and extends beyond the laboratory now. Additionally, the proliferation of commercial force plate companies has resulted in the over saturation of information regarding their use making it difficult for the practitioners to navigate the optimal use strategies. I commend the authors for taking on this topic as I think it is much needed in the sports medicine field. However, I have several concerns regarding this proposed protocol.

Firstly, the protocol appears to be a little too ambitious given the limited exclusion criteria. Including athletic and tactical populations and investigations of any study design will result in a large number of studies in the final report which is a lot to undertake for a single review. I would suggest delimiting to only athletics or tactical populations since there are valid arguments that these populations have very different mechanical exposures. Additionally, it is unclear why lower quality study designs would be included in this review. One of the current issues with this topic is the high number of cross-sectional studies that link a force plate assessment to injury prediction without direct evidence.

Secondly, I was surprised to see no methods listed to discern publication quality, risk of bias, etc. There are many validated tools available to objectively appraise the literature being reviewed and would help identify the state of the science regarding force plates and musculoskeletal injuries (objective 3). Furthermore, this would help identify limitations and gaps in the science that need to be addressed with future work (objective 4). Would suggest reviewing some protocols published in the journal ‘systematic reviews’ and the standards for a Cochrane review to get ideas to create a more novel and rigorous protocol for this scoping review.

Lastly, my biggest issue is it is not clear why this scoping review protocol should be published on its own separate from the actual scoping review itself. The introduction does a fine job justifying the need for this scoping review (which I agree a review on this topic is needed). However, from what is presented in the manuscript, this protocol is not using any novel methods to appraise the literature nor is it the most thorough protocol I’ve seen. The questions being asked are large in scope, but it is missing key rigors of objectivity that would set it apart (e.g., study quality assessment, risk of bias tools, etc). If there is a valid reason for the publishing of the protocol on its own, then it has not been adequately conveyed (this case needs to be made in the introduction).

Thank you very much for reviewing our manuscript. We are really grateful for your work and consider that some of your suggestions have made us improve the proposed protocol. In fact, in line with your first comment, we have limited the study population in our review to sport athletes only. Following your second comment, we have also selected two scales/methods to assess the quality of the studies included in our review. Finally, and with regard to your last comment, the publication of an a priori protocol has been described as an important step to increase the transparency and quality of the review results since it allows reviewers and readers to understand changes done during the development of the review, and authors to explain the needs for changes in case they have been made (Peters et al., 2015; Peters et al., 2020). Therefore, we believe that its publication separately from the final review is justified.

Below, we respond in detail to the specific comments made for some of the sections of the protocol.

Abstract:

Line 33: Change ‘systematic review’ to just ‘review’ since you go on to propose a scoping review.

Done.

Line 50: Remove ‘systematic review’ from keywords since this is technically not a systematic review

Done.

Introduction:

While I think the rationale for why a scoping review is necessary is acceptable, the introduction provides no strong rationale as to why the literature needs a manuscript describing the methods of a proposed scoping review. What necessitates the need for knowing the methodological rigor (which would be described in the methods section of the scoping review anyways)? What is novel about your methodological approach to the scoping review? What gaps or limitations in the literature are these novel methods addressing? These are the types of questions that need to be addressed/discussed in the introduction for a protocol paper.

As for clinical trials, there is increasing evidence of the existence of publication bias for reviews (Silagy et al., 2002; Tricco et al., 2009). The existence of an a priori protocol helps increase the rigour and trustworthiness of these studies for several reasons: (1) it allows reviewers to plan carefully and thereby anticipate potential problems; (2) it allows reviewers to explicitly document what is planned before they start their review, enabling others to compare the protocol and the completed review to replicate review methods if desired, and to judge the validity of planned methods; (3) it prevents arbitrary decision making with respect to inclusion criteria and extraction of data; and (4) it may reduce duplication of efforts and enhance collaboration (Shamseer et al., 2015). Therefore, the development of a protocol is important in itself, as it pre-defines the objectives, methods, and reporting of the review and allows for transparency of the process, limiting the occurrence of reporting bias (Peters et al., 2015; Peters et al., 2020).

While the prospective registration of planned systematic reviews in some popular databases such as PROSPERO may contribute to making this a priori plan visible, scoping reviews are not eligible for registration in this database (https://www.crd.york.ac.uk/prospero/). The publication of their comprehensive protocols in scientific journals may be, therefore, a good option to overcome this issue, promoting the best practice (i.e., conduct of the review in accordance with a fully developed protocol, and reporting in line with the PRISMA guidelines) in the conduct and reporting of scoping reviews (The PLoS Medicine Editors, 2011).

Taking all this into account, we have made some modifications in the introduction to specify that this is a protocol for conducting a scoping review, and the benefits derived from the publication of an a priori protocol have been discussed later in the discussion, as the reviewer suggested. However, we do not believe that it is necessary to extend the explanation of why a protocol is necessary when it is within the quality criteria for conducting a scoping review.

Line 72: phrase ‘allow sport and exercise science and medicine professionals’ is clunky, rephrase to improve readability.

Done.

Lines 78-90: Most of the information is redundant. Only need to discuss the low cost and accessibility of force plates one time.

This part has been modified as suggested:

These devices are becoming increasingly utilised in applied environments such as sports (20,21) due to the advent of affordable, commercially available force plate systems that have been validated against industry gold standard systems (22–24) and well-established criterion data analyses procedures (25). No longer, therefore, are most force plate tests being conducted via laboratory-grade systems located within a traditional research environment (e.g., University laboratories). In fact, millions of force plate tests are being conducted by practitioners each year, with this number likely to rise thanks to the quickness, portability, and valuable information that the modern force plate systems can provide practitioners without the requirement for additional technology, such as motion capture systems.

Lines 108-116: This paragraph is somewhat misleading as it implies that a scoping review was performed, not the proposal of a methodological framework for a potential scoping review.

This paragraph has been slightly modified as suggested:

Therefore, the existence of a review would help to improve practitioner decision-making around force plate test and variable selection in relation to injury prevention purposes. After a preliminary search, no published or in-progress scoping or systematic reviews was identified on this topic, so here we present a protocol for a scoping review where we will provide a descriptive overview of the currently utilised force plate methodologies with athletes. In this protocol, we pre-define the objectives, methods, and reporting of our upcoming scoping review.

Aim/Objectives: These are very ambitious and will result in a very large number of papers for the final analysis (even after screening papers out)

As tactical athletes are no longer a focal point in our review, the breadth of articles to be considered for inclusion will be reduced. Likewise, we think that the slight amendments we have done to the injury definition and inclusion criteria will also limit the number of papers to be included in the final analysis.

Methodology:

2.1.1 Participants: Why no age or level of performance exclusion criteria? You are including both sport and tactical populations, but excluding paralympic athletes due to ‘different injury profiles and demands of sports for this populations’; does that mean you consider injury profiles of traditional athletes and tactical athletes analogous? Do you think injury profiles, exposure and sports demands are similar between adolescent recreational athletes (e.g., high school varsity basketball) and even division I collegiate basketball players?

Following reviewers’ suggestions according to the scope of our review, we have limited the target population to sports athletes, so tactical populations will be excluded. Regarding sports athletes, we agree with the reviewer that those participating in organised sports (i.e., athletes involved in competitive events) and those doing recreational sports would probably present differences in injury profiles, sport demands and injury exposure levels, which will make them not comparable. Therefore, only athletes participating in organised sports will be considered. To consider a study sample as “recreational athletes” (and thus, exclude the study) the classification framework proposed by Mckay et al. (2022) will be used. We have specified this in the main text of the protocol and also in the Supplementary File 3. However, no additional restrictions (by age or level of performance) will be applied as we would like to provide an overview of the tests and metrics most typically used for each of these categories.

2.1.2 Concept: Line 158: are you only considering primary injuries or secondary musculoskeletal injuries as well such as osteoarthritis?

Thank you for this comment. We have clarified this in the text as follows:

No exclusion will be made based on the type of injury (e.g., primary and secondary injuries), as long as the study population is athletes (i.e., not former athletes) and, in those cases where the participants are injured, they are undergoing rehabilitation at the time of data collection.

2.2 Sources: This is a very broad range of studies to include which will drastically increase the number of manuscripts you will be reviewing. Do you believe that quasi-experimental, case-control, and cross-sectional studies will provide valid evidence for a force plate and its associated test’s prognostic capability? I would argue it would not and will further muddy interpretations interfering with the objective to provide a use guide for practitioners.

Thank you for your comment. We believe that the inclusion of all types of study design can help us to have a better overview of the tests and metrics that have been proposed to assess the risk of injury and make decisions during the athlete's rehabilitation process. This will not only help us discuss whether the reporting of the tests and metrics among studies is adequate and reproducible, but also to show the quality of the published evidence in this regard by categorising the papers according to the OCEBM levels of evidence 2009.

2.3 Search strategy: If going to include tactical athlete populations would suggest searching DTIC as well since much of their work won’t be published in journals indexed in Medline.

As explained in previous responses, tactical athletes have been removed from the scope of our review.

Between what years is the search being conducted?

No restrictions will be applied in terms of data publication, so all studies published before the last update of the search strategy will be considered. The last update will be carried out once we have the first draft completed to identify papers recently published and thus, to maximise the currency of our review.

Line 199-201: Need to have a specific statements or questions for both levels of screening that is reported to show how you identified if study was included or excluded. Would suggest using at minimum three levels (i.e., title only screening, abstract and full text).

We will conduct all the study selection (and also data extraction) through Covidence (covidence.org), a software for managing systematic reviews. This software follows the last update of the PRISMA guidelines, which differentiates a two-step process for study selection: (1) title and abstract screening and (2) full-text assessment. This information has been added to the corresponding section of the protocol.

Discussion:

Line 233-236: This is true that it will increase transparency, but all this information would be presented in the actual review as well.

Please, see the reasons previously stated to publish an a priori protocol. We think it is a fundamental task to improve the quality of the evidence provided.

Line 236: Only two individuals screening for a review this size might take a long time, especially during the stages of data extraction.

In our research group, we have two individuals with previous experience in the development of systematics reviews and meta-analysis which will be working full-time on the proposed review. They will make important efforts to have the data extraction as soon as possible; however, we are aware of the potential delay from the beginning of the process to the completion of the first draft. This is the reason why we have planned to regularly update the search, with the last one done once we have the first version of the manuscript completed to maximise the currency of our work.

Line 240: I wouldn’t consider only reviewing peer-reviewed literature as a weakness for this review since there is also a lot of misinformation on force plate injury screening protocols (especially from commercial sector just trying to sell their force plate and software platform).

We understand what the reviewer says and we partially agree with that. But it is also true that, in social and health research, an important body of first-level grey literature (in terms of Adams et al. 2017) exists in practitioner journals, books and reports from public and private institutions. This first grey level contains literature produced by authors with high-expertise and published with a high degree of explicit and transparent criteria. Therefore, we consider that the exclusion of these non-peer-reviewed reports should be acknowledged among the limitations of our planned review.

References used in responses to Reviewer 2:

Adams RJ, Smart P, Huff AS. Shades of grey: guidelines for working with the grey literature in systematic reviews for management and organizational studies. International Journal of Management Reviews 2017;19:432–54

McKay AKA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey VL, et al. Defining training and performance caliber: a participant classification framework. Int J Sports Physiol Perform. 2022;17(2):317–31.

Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. JBI Evid Implement. 2015;13(3):141–6.

Peters MDJ, Godfrey CM, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020.

Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L. A. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;349.

Silagy CA, Middleton P, Hopewell S. Publishing protocols of systematic reviews: Comparing what was done to what was planned. JAMA 2002;287:2831–2834.

The PLoS Medicine Editors. Best Practice in Systematic Reviews: The Importance of Protocols and Registration. PLoS Med 2011;8(2):e1001009. https://doi.org/10.1371/journal.pmed.1001009

Tricco AC, Pham B, Brehaut J, Tetroe J, Cappelli M. An international survey indicated that unpublished systematic reviews exist. J Clin Epidemiol 2009;62:617–623.

Attachment

Submitted filename: 00. Reviewer Comments.docx

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Decision Letter 1

Chris Connaboy

21 Sep 2023

Force plate methodologies applied to the injury profiling and rehabilitation in sport: a scoping review protocol

PONE-D-23-07414R1

Dear Dr. McMahon,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #2: Yes

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Reviewer #1: The authors have done a commendable job of addressing my concerns and the revised manuscript is much improved. I do not have further suggestions and believe it is ready for publication. Best of luck with the review.

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**********

Acceptance letter

Chris Connaboy

29 Sep 2023

PONE-D-23-07414R1

Force plate methodologies applied to injury profiling and rehabilitation in sport: a scoping review protocol

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) checklist.

    (DOC)

    Click here for additional data file. (83KB, doc)
    S2 File. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

    (DOCX)

    Click here for additional data file. (118.7KB, docx)
    S3 File. Inclusion/Exclusion criteria for literature search.

    (DOCX)

    Click here for additional data file. (16.9KB, docx)
    Attachment

    Submitted filename: 00. Reviewer Comments.docx

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    Data Availability Statement

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