Gait Compensation among Children with Non-Operative Legg–Calvé–Perthes Disease: A Systematic Review

Add information about Methodological quality and risk of bias of the selected papers in the abstract.

Thank you for this suggestion. We have made this clear in the abstract.

I suggest rewritting the Material and  Methods using the Guidelines PRISMA in the method section.

We can assure the review that PRISMA was utilized throughout our research. Our apologize if this was not clear but we hope that the method section is now clearer in the revised version of the manuscript.

Add more information about the PRISMA and the strategy "PICO" in the search strategy.

Once again, thank you for this comment. The information about PRISMA and PICO have been add in the search strategy.

Improve the presentations of the references in the result table.

The presentations of the references in the result table have been improved.

Add a legend at the bottom of the Table to define all abbreviations indicated in the Table.

The legend has been added.

The Discussion is too long. I suggest reducing it. There are repetitions of many statements.

Thank you for this comment. We have reviewed our discussion we also noticed that there are a couple of parts that could be improved. We hope that the revised section has been improved with less unnecessary repetitions.

I suggest addding a paragraph with the limitations of the study at the end of the Discussion section.

Thanks for the comment. to make this clearer to readers we have added a separate limitation section.

The term "Gait Compensation" is used in the title, but the main outcome in this manuscript is joint angle data during gait. I leave the decision to change the title to the author

Thank you for the comment. In this systematic review we investigated all key gait parameters that include temporospatial, kinematic and kinetic parameters. We believe that any compensations in gait would include one or more than gait parameters and joint angles are one of the indictors of gait compensation. We feel that  gait compensation is the appropriate term on this occasion.

Abstract

"The results revealed large variations, and several methodological issues in these studies “. The authors should at least provide an overview of the methodological issues, since it is not possible for the reader to estimate what they are

Thank you for the comment. This has been rewritten to provide a clear information.

Discussion

If the study focuses on kinematic data, there should be a reference to the marker set.

Thank you for this comment. We have highlight this as a limitation of this study.

Only in Table.4 the caption is embedded in the table and is difficult to find. It is recommended that the formatting be standardized.

The legend has been added to the table 4.

I suggest them to use MeSH terms for keyword selection.

Although MeSH terms were considered, the specific term for Perthes did not yield many relevant results in the MeSH database. As a result, to ensure a comprehensive and targeted search, alternative keywords were selected based on expert guidance from a librarian. This strategy was chosen to improve the thoroughness and relevance of the literature search, given the limited results encountered with MeSH terms for this particular topic.

In the method section, it is written in the search strategy section that the search was completed in 2022 and then updated again in 2023. Did the authors extend the date because they could not write the study? Please explain here

This has been rewritten to avoid confusion. The search for literature was conducted in December 2023

Did the researchers make any other statistical evaluation other than the statistical analysis presented in the studies, or was it only the analysis of the scores given by two authors?

It is just the analysis of the scores given by two authors.

In studies evaluating these gait parameters, it may be important to indicate whether the evaluations were performed before physiotherapy. Because with physiotherapy, muscle strength, flexibility and ROM may improve and gait parameters may change.

It is not mention in the included literature where the children with Perthes received physiotherapy or not. This is addressed partly in the limitation section.