{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:33:03Z","timestamp":1777984383299,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/hrbopenres.14101.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000}}],"reference-count":52,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["HRCI-HRB-2022-006"],"award-info":[{"award-number":["HRCI-HRB-2022-006"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]},{"name":"International Organisation of Physiotherapists in Paediatrics"},{"name":"Royal College of Surgeons in Ireland Strategic Academic Recruitment (StAR) programme"}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns3:p>Background Cerebral Palsy (CP) is the largest contributor to childhood physical disability with abnormal gait pattern such as toe walking commonly reported. The International Classification of Functioning (ICF) in disabilities framework outlines three domains to consider when looking at impact of a disability on a child; body\/structure, activity and participation. Activity and participation targeted interventions using Motor Learning Theory (MLT) have shown positive results on walking performance, gross motor skills and upper limb rehabilitation in CP. MLT encompasses multiple concepts that shape our understanding of how motor skills are acquired and developed. This study aims to determine feasibility and acceptability of a novel motor learning-based intervention for lower extremities (MOBILE) targeting walking performance in ambulant children with CP to inform a future randomized controlled trial (RCT). Methods Fourteen ambulant children with CP, aged 6\u201317, with a walking goal will be recruited from community disability services. They will undergo a tailored intensive MOBILE intervention to target walking goals amounting to 30 hours practice in 6 weeks or less. Outcomes will include feasibility of recruitment, adherence, retention and outcome measures, and acceptability of the intervention. Clinical outcome measures will include the Gait Outcomes Assessment List, Six Minute Walk Test, modified Timed Up and Go, Ten metre walk test, Range of Motion and the Child Health Utility instrument. Feasibility outcomes will be reported using descriptive statistics such as percentages and confidence intervals. Discussion Long-term retention of walking improvements in CP following interventions targeting the body\/structure domain of the ICF are reportedly poor. The MOBILE intervention based on its theoretical framework could lead to improvements in walking performance with a possibility of long-term retention and impact on activity and participation. The feasibility of the study design and acceptability of the intervention needs to be investigated to inform a future definitive trial.<\/ns3:p>","DOI":"10.12688\/hrbopenres.14101.2","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:54:08Z","timestamp":1769687648000},"page":"46","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A \"motor learning based intervention for lower extremities (MOBILE)\" to target walking performance in ambulant children with cerebral palsy: A feasibility study."],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4242-4114","authenticated-orcid":false,"given":"Caitr\u00edona","family":"O'Shaughnessy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dereena","family":"Minehane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3768-2132","authenticated-orcid":false,"given":"Jennifer","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7997-4099","authenticated-orcid":false,"given":"Ailish","family":"Malone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1494-1506","DOI":"10.1111\/dmcn.15346","article-title":"Global 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with Cerebral Palsy: a systematic review with meta-analysis.","volume":"20","author":"N Milne","year":"2020","journal-title":"BMC Pediatr."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"1523-1530","DOI":"10.1007\/s00381-022-05548-x","article-title":"Assessment of gait quality and efficiency after undergoing a single-event multilevel surgery in children with Cerebral Palsy presenting an intoeing gait pattern.","volume":"38","author":"G Moisan","year":"2022","journal-title":"Childs Nerv Syst."},{"key":"ref-10","doi-asserted-by":"publisher","DOI":"10.3390\/s23020569","article-title":"AFOs improve stride length and gait velocity but not motor function for most with mild Cerebral Palsy.","volume":"23","author":"H White","year":"2023","journal-title":"Sensors (Basel)."},{"key":"ref-11","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-020-1022-z","article-title":"State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with Cerebral Palsy.","volume":"20","author":"I Novak","year":"2020","journal-title":"Curr Neurol Neurosci Rep."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"339","DOI":"10.3390\/children9030339","article-title":"Recurrence of equinus foot in Cerebral Palsy following its correction\u2014a meta-analysis.","volume":"9","author":"A Horsch","year":"2022","journal-title":"Children (Basel)."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"261-281","DOI":"10.1007\/s40272-019-00344-8","article-title":"Botulinum toxin in the management of children with Cerebral Palsy.","volume":"21","author":"I Multani","year":"2019","journal-title":"Paediatr Drugs."},{"key":"ref-14","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013114.pub2","article-title":"Mechanically assisted walking training for walking, participation, and quality of life in children with Cerebral Palsy.","volume":"11","author":"H Chiu","year":"2020","journal-title":"Cochrane Database Syst 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Contemporary management of motor control problems","author":"F Horak","year":"1991"},{"key":"ref-21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2017-000078","article-title":"Task-specific gross motor skills training for ambulant school-aged children with Cerebral Palsy: a systematic review.","volume":"1","author":"R Toovey","year":"2017","journal-title":"BMJ Paediatr Open."},{"key":"ref-22","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1171224","article-title":"Evidence-based management and motor rehabilitation of Cerebral Palsy children and adolescents: a systematic review.","volume":"14","author":"S Faccioli","year":"2023","journal-title":"Front Neurol."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"5624-5632","DOI":"10.1080\/09638288.2024.2307382","article-title":"Development and content validation of the Upper Limb-Motor Learning Strategy Tool for Cerebral Palsy.","volume":"46","author":"A Taghizadeh","year":"2024","journal-title":"Disabil Rehabil."},{"key":"ref-24","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-023-01291-5","article-title":"Recommendations for progression criteria during external randomised pilot trial design, conduct, analysis and reporting.","volume":"9","author":"K Mellor","year":"2023","journal-title":"Pilot Feasibility Stud."},{"key":"ref-25","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework.","volume":"17","author":"M Sekhon","year":"2017","journal-title":"BMC Health Serv Res."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"200-7","DOI":"10.7326\/0003-4819-158-3-201302050-00583","article-title":"SPIRIT 2013 statement: defining standard protocol items for clinical trials.","volume":"158","author":"A Chan","year":"2013","journal-title":"Ann Intern Med."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"287-291","DOI":"10.1002\/pst.185","article-title":"Sample size of 12 per group rule of thumb for a pilot study.","volume":"4","author":"S Julious","year":"2005","journal-title":"Pharm Stat."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"33-47","DOI":"10.3109\/09593989809070042","article-title":"Motor learning: a practical framework for paediatric physiotherapy.","volume":"14","author":"H Larin","year":"1998","journal-title":"Physiother Theory Pract."},{"key":"ref-29","article-title":"The coordination and regulation of movements","author":"N Bernstein","year":"1967"},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"269-80","DOI":"10.1111\/1440-1630.12666","article-title":"What is the threshold dose of upper limb training for children with Cerebral Palsy to improve function? A systematic review.","volume":"67","author":"M Jackman","year":"2020","journal-title":"Aust Occup Ther J."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"908-16","DOI":"10.3109\/09638280903353422","article-title":"Goal-directed functional therapy: a longitudinal study on gross motor function in children with Cerebral Palsy.","volume":"32","author":"K L\u00f6wing","year":"2010","journal-title":"Disabil Rehabil."},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"S225-S39","DOI":"10.1044\/1092-4388(2008\/018)","article-title":"Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.","volume":"51","author":"J Kleim","year":"2008","journal-title":"J Speech Lang Hear Res."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"222-227","DOI":"10.1080\/17453674.2020.1848154","article-title":"Knee and foot contracture occur earliest in children with Cerebral Palsy: a longitudinal analysis of 2,693 children.","volume":"92","author":"E Cloodt","year":"2021","journal-title":"Acta Orthop."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"1647-56","DOI":"10.1007\/s43465-022-00691-8","article-title":"Analysis of joint power and work during gait in children with and without Cerebral Palsy.","volume":"56","author":"P Hazra","year":"2022","journal-title":"Indian J Orthop."},{"key":"ref-35","doi-asserted-by":"publisher","first-page":"618-23","DOI":"10.1111\/dmcn.13722","article-title":"The Gait Outcomes Assessment List (GOAL): validation of a new assessment of gait function for children with Cerebral Palsy.","volume":"60","author":"P Thomason","year":"2018","journal-title":"Dev Med Child Neurol."},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"370-6","DOI":"10.1111\/j.1469-8749.2008.02048.x","article-title":"Test\u2013retest reliability of the 10\u2010metre fast walk test and 6\u2010minute walk test in ambulatory school\u2010aged children with Cerebral Palsy.","volume":"50","author":"P Thompson","year":"2008","journal-title":"Dev Med Child Neurol."},{"key":"ref-37","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/2794036","article-title":"Minimum Clinically Important Difference of gross motor function and gait endurance in children with motor impairment: a comparison of distribution-based approaches.","volume":"2020","author":"F Storm","year":"2020","journal-title":"Biomed Res Int."},{"key":"ref-38","doi-asserted-by":"publisher","first-page":"71-80","DOI":"10.3233\/PPR-200411","article-title":"Associations between gait kinematics, Gross motor function and physical activity among young people with Cerebral Palsy: a cross sectional study.","volume":"43","author":"J Ryan","year":"2022","journal-title":"Physiother Pract Res."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"518-24","DOI":"10.1017\/s0012162205001027","article-title":"Investigation of the timed \u2018Up & Go\u2019 test in children.","volume":"47","author":"E Williams","year":"2005","journal-title":"Dev Med Child Neurol."},{"key":"ref-40","doi-asserted-by":"publisher","first-page":"482-9","DOI":"10.1111\/dmcn.12325","article-title":"One\u2010minute walk and modified timed up and go tests in children with Cerebral Palsy: performance and minimum clinically important differences.","volume":"56","author":"S Hassani","year":"2014","journal-title":"Dev Med Child Neurol."},{"key":"ref-41","doi-asserted-by":"publisher","first-page":"489-94","DOI":"10.1016\/j.paed.2019.07.013","article-title":"CPIPS: musculoskeletal and hip surveillance for children with Cerebral Palsy.","volume":"29","author":"M Gaston","year":"2019","journal-title":"Paediatrics and Child Health."},{"key":"ref-42","doi-asserted-by":"publisher","first-page":"729-47","DOI":"10.2165\/11599120-000000000-00000","article-title":"Valuation of the child health utility 9D index.","volume":"30","author":"K Stevens","year":"2012","journal-title":"Pharmacoeconomics."},{"key":"ref-43","first-page":"373-4","article-title":"World medical association declaration of Helsinki. Ethical principles for medical research involving human subjects.","volume":"79","year":"2001","journal-title":"Bull World Health Organ."},{"key":"ref-44","article-title":"TIDieR description of MOBILE.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-45","article-title":"MOBILE_protocol description.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-46","article-title":"MOBILE fidelity checklist.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-47","article-title":"Data management plan MOBILE.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-48","article-title":"MOBILE parent information leaflet.pdf","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-49","article-title":"MOBILE consent form V1.2.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-50","article-title":"MOBILE trial case report form V2.docx","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-52","article-title":"Assent Form","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"},{"key":"ref-53","article-title":"SPIRIT checklist for MOBILE study","author":"C O'Shaughnessy","year":"2025","journal-title":"figshare"}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T05:39:09Z","timestamp":1771911549000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":52,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.14101.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/hrbopenres.14101.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.15751.r53254","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.15751.r53173","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.15751.r53173","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/hrbopenres.15751.r53254","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.15751.r53173, Martin Lemay, Universite du Quebec a Montreal, Montreal, Qu\u00e9bec, 30 Jan 2026, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2#referee-response-53173","order":0,"name":"referee-response-53173","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Caitr&iacute;ona O'Shaughnessy<\/b>; \n<i>Posted: 30 Jan 2026<\/i>; \n<b>Thank you for your response and we are happy to further expand on your concerns.<\/b>  In relation to Concern 1:&nbsp;In your response to one of my comments, you mentioned that &quot;This was important as the intervention relies on the participants' ability to problem solve and analyse their own movement patterns.&quot; I would recommend adding more details on this aspect, as it raises concerns that participants may rely on an internal focus of attention, which can be problematic, especially for a movement like walking that requires a certain level of automatization. For example, see this paper: Zorlular R, Akinci M, Elbasan B. Effects of focus of attention on gait parameters and balance performance in children with unilateral cerebral palsy: a randomized controlled trial. Disabil Rehabil. 2026;48(3):829-841.  \n<b>Response:&nbsp;We agree that an internal focus of attention can be problematic if relied upon excessively. While the statement that \u201ca participant\u2019s ability to problem solve and analyse their own movement patterns\u201d could imply that internal focus of attention may be used, this is not the case as planned for this intervention.  As you will see in the first paragraph of the intervention description, we state that the intervention \u201cconsiders factors such as stage of motor skill acquisition, environment, feedback and types of practice\u201d. In the full description of the intervention protocol listed in the extended data https:\/\/doi.org\/10.6084\/m9.figshare.28524788.v1 we provide a full list of the available strategies to be implemented.  Strategies that rely on problem solving and analysing their own movement could include ability to develop one\u2019s own goal, participate in repetitive practice, dual-task practice, imagery practice, self-talk instructions, self-evaluation instructions, bridging settings and external focus of attention, to name a few.  This is a complex intervention that has many options of strategies that can be used depending on the participant\u2019s level of skill acquisition, understanding, ability level and motivation and will be tailored by the interventionist.<\/b>  Concern 2:&nbsp;Concerning the 4th paragraph of the Introduction, while I agree that feedback is important, excessive feedback could be detrimental in some contexts, as participants might become overly reliant on it to perform the task. Therefore, it would be useful to discuss how often feedback will be provided in the intervention. For a detailed discussion on the frequency of feedback in motor learning in children with CP, see: Schoenmaker, J., Houdijk, H., Steenbergen, B., Reinders-Messelink, H. A., &amp; Schoemaker, M. M. (2023). Effectiveness of different extrinsic feedback forms on motor learning in children with cerebral palsy: a systematic review. Disability and Rehabilitation, 45(8), 1271\u20131284.  \n<b>Response:&nbsp; We agree that the balance of feedback is important and have addressed this in detail in the full protocol, appended to this article as extended data https:\/\/doi.org\/10.6084\/m9.figshare.28524788.v1.  Under Principle 3: Type of Feedback, there are 9 different elements that are considered and within these 9 elements there are 33 different strategies that can be implemented as part of this intervention. As described above, this is a complex intervention that will be tailored to the individual based on their stage of skill acquisition and development.  The scope of feedback strategies available allow for different modes of delivery, different frequencies, different timings of delivery, the nature of the feedback and the content which, will be modified and changed as the participant progresses through the study.  Initially they may require error limitation and frequent feedback to ensure success and increase motivation. However, as they progress in their skill development feedback can be reduced, withdrawn or self-feedback encouraged.  Under the frequency element there are options for continuous feedback, faded feedback, summary feedback or bandwidth corrective feedback which can be used when the interventionist determines that this approach best suits that participant\u2019s stage of skill development.  As this is a feasibility trial, it was important to include all available options for motor learning strategies and it is one of the aims of this study that the qualitative analysis of the interventionists reflective diary will provide insight into which strategies were used more frequently and why they were chosen. This will hopefully allow for refinement of the protocol to allow easier training of other interventionists in the future.  In response to both concerns we hope that direction towards the more detailed protocol for the intervention satisfies. Due to space constraints in the main manuscript, it was not possible to provide a full description of all the strategies that could be utilized.<\/b>","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2#referee-comment-3884","order":1,"name":"referee-comment-3884","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15494.r47068, Shoaib Waqas, University of Biological and Applied Sciences, Lahore, 15 May 2025, version 1, 2 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v1#referee-response-47068","order":2,"name":"referee-response-47068","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Caitr&iacute;ona O'Shaughnessy<\/b>; \n<i>Posted: 26 Jan 2026<\/i>; \n<u>Abstract<\/u>  Could you Please include a brief mention of the theoretical framework (Motor Learning Theory) in the abstract for clarity.  \n<b>We agree it is important to mention Motor Learning Theory. We added a brief description that MLT encompasses multiple concepts that shape our understanding of how motor skills are acquired and developed.<\/b>  \n<u>Introduction<\/u>  Clarify the novelty of MOBILE compared to existing MLT interventions (e.g., how it differs from treadmill training or upper-limb MLT approaches).  \n<b>The novelty and need for MOBILE is explained in three main points.<\/b>  \n<b>RAGT and treadmill training, while having one or two elements that are known to influence motor learning, were not designed specifically to target motor learning (Introduction, fourth paragraph).<\/b> \n<b>Upper limb and gross motor MLT approaches do not specifically focus on lower limbs or walking as the target (Introduction, paragraph 5)<\/b> \n<b>There is currently a lack of interventions designed using MLT that specifically target walking as a motor skill (Introduction, final paragraph).<\/b>  Briefly define &quot;feasibility&quot; and &quot;acceptability&quot; as per Sekhon\u2019s framework (cited in methods) to align with objectives.  \n<b>Definitions of feasibility and acceptability have been added to the section preceding the objectives as suggested.<\/b>  \n<u>Methods Intervention:<\/u>  Provide more detail on the &quot;tailored&quot; components (e.g., examples of walking goals or feedback strategies).  \n<b>Three new paragraphs (paragraphs 4-6) have been added to the intervention section providing more detail on the tailored components of the intervention. Some examples of walking goals, feedback strategies and other factors are provided. It has also been added that the intervention therapist will keep a reflective diary throughout which will document how each session developed and why tasks were chosen. This will serve as the basis for developing an instruction manual for other therapists wishing to replicate the intervention.<\/b>  \n<u>Data Analysis:<\/u> Clarify how MCIDs will inform future RCT power calculations (e.g., GOAL as primary outcome).  \n<b>We have expanded the final paragraph of the data analysis subsection to clarify that MCIDs are only being used to estimate a potential effect in the two measures where there are established MCIDs for this population. The GOAL was selected as the primary clinical outcome measure by the PPI advisory group as it was the most meaningful measure to them. There currently are no established MCIDs for the GOAL therefore a power calculation will be done on the data collected for the total GOAL score.<\/b>  \n<u>Discussion<\/u> Expand on how findings will directly inform RCT design (e.g., sample size, intervention refinements).  \n<b>The third and fourth paragraphs of the discussion section have been expanded to provide more detail on how the results will inform an RCT design including (1) potential need for a multi-centre design will be judged on time for recruitment and geographical spread, (2) balance of clinic and home-based programs will be judged on qualitative feedback from interviews and adherence rates and (3) intensity and frequency or other intervention design refinements will be considered based on qualitative analysis from the interviews and feasibility metrics A fifth paragraph has been added to further discuss how the information collected by the interventionist will help to refine the intervention manual. <\/b>  Discuss potential barriers to adherence (e.g., family capacity) and mitigation strategies.  \n<b>The second paragraph of the discussion has been expanded to discuss potential barriers to adherence and mitigating strategies. Briefly, these include participant fatigue or competing demands with school or hobbies, balancing appointments and home programs with other family demands, and physical fatigue or muscle soreness. Rest breaks will be given as needed, appointments will be scheduled to suit families as best possible and home programs will be simple and incorporated into their hobbies or other activities where possible.<\/b>  Mention data anonymization\/storage details (though covered in extended data).  \n<b>Brief mention of anonymisation and storage has been added to the first paragraph of the \u201cdata collection and analysis\u201d subsection, which now explains that anonymised data will be uploaded to a secure SharePoint folder. We also direct readers to our data management plan under extended data.<\/b>  \n<u>Protocol Version Control<\/u> Link version changes to specific limitations (e.g., expanded recruitment to address sample diversity).  \n<b>Linked version change 1.2.1 expansion of recruitment strategy to address more diversity in sample size as suggested. Other changes were due to new evidence emerging or feedback from PPI groups rather than limitations prompting changes.<\/b>  \n<u>Overall Recommendations<\/u>  1. Clarify Novelty: Differentiate MOBILE from existing MLT interventions (e.g., task-specificity for walking vs. upper limb).  \n<b>Addressed above in the introduction.<\/b>  2. Strengthen Feasibility Metrics: Explicitly link recruitment targets (n=14) to progression criteria for RCT (e.g., \u226580% adherence).  \n<b>Specific feasibility metrics for progression were not included for this study as there will likely be many refinements and adjustments to the protocol based on an integrated analysis of the quantitative and qualitative data collected. This is described in an addition to the first line under \u201cFeasibility of Study Design\u201d in the Outcome section of the methodology, It is also added that PPI groups will be involved in the decision-making process around recommendations on progression to RCT.<\/b>  3.&nbsp;Expand Intervention Details: Provide examples of motor learning strategies (e.g., feedback types, task modification).  \n<b>Addressed above in detail.<\/b>  4. Highlight PPI Impact: Show how advisory groups shaped intervention design (e.g., clinic vs. home preference.  \n<b>More detail was added to the PPI paragraph and are highlighted in the comments to reviewer 1.<\/b>","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2#referee-comment-3875","order":3,"name":"referee-comment-3875","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15751.r53254, Christopher J Newman, University of Lausanne, Lausanne, 24 Feb 2026, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/8-46\/v2#referee-response-53254","order":4,"name":"referee-response-53254","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Health Research Board [HRCI-HRB-2022-006].This work was also supported by the Royal College of Surgeons Ireland, Strategic Academic Recruitment (StAR) programme linked with professional doctorate programme of lead researcher and the International Organisation of Physiotherapists in Paediatrics Research Grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}