The Role of Textured Material in Supporting Perceptual-Motor Functions
Identifieur interne : 002265 ( Pmc/Curation ); précédent : 002264; suivant : 002266The Role of Textured Material in Supporting Perceptual-Motor Functions
Auteurs : Dominic Orth [France, Australie] ; Keith Davids [Australie, Finlande] ; Jon Wheat [Royaume-Uni] ; Ludovic Seifert [France] ; Jarmo Liukkonen [Finlande] ; Timo Jaakkola [Finlande] ; Derek Ashford [Royaume-Uni] ; Graham Kerr [Australie]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
Simple deformation of the skin surface with textured materials can improve human perceptual-motor performance. The implications of these findings are inexpensive, adaptable and easily integrated clothing, equipment and tools for improving perceptual-motor functionality. However, some clarification is needed because mixed results have been reported in the literature, highlighting positive, absent and/or negative effects of added texture on measures of perceptual-motor performance. Therefore the aim of this study was to evaluate the efficacy of textured materials for enhancing perceptual-motor functionality. The systematic review uncovered two variables suitable for sub-group analysis within and between studies: participant age (groupings were 18–51 years and 64.7–79.4 years) and experimental task (upright balance and walking). Evaluation of studies that observed texture effects during upright balance tasks, uncovered two additional candidate sub-groups for future work: vision (eyes open and eyes closed) and stability (stable and unstable). Meta-analysis (random effects) revealed that young participants improve performance by a small to moderate amount in upright balance tasks with added texture (SMD = 0.28, 95%CI = 0.46–0.09, Z = 2.99, P = 0.001; Tau2 = 0.02; Chi2 = 9.87, df = 6, P = 0.13; I2 = 39.22). Significant heterogeneity was found in, the overall effect of texture: Tau2 = 0.13; Chi2 = 130.71, df = 26, P<0.0001; I2 = 85.98%, pooled samples in upright balance tasks: Tau2 = 0.09; Chi2 = 101.57, df = 13, P<0.001; I2 = 72.67%, and in elderly in upright balance tasks: Tau2 = 0.16; Chi2 = 39.42, df = 5, P<0.001; I2 = 83.05%. No effect was shown for walking tasks: Tau2 = 0.00; Chi2 = 3.45, df = 4, P = 0.27, I2 = 22.99%. Data provides unequivocal support for utilizing textured materials in young healthy populations for improving perceptual-motor performance. Future research is needed in young healthy populations under conditions where visual and proprioceptive information is challenged, as in high-speed movements, or where use of equipment mediates the performer-environment interaction or where dysfunctional information sources ‘compete’ for attention. In elderly and ailing populations data suggests further research is required to better understand contexts where texture can facilitate improved perceptual-motor performance.
Url:
DOI: 10.1371/journal.pone.0060349
PubMed: 23565232
PubMed Central: 3615024
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EA 3832, Faculty of Sports Sciences, University of Rouen, Rouen, Haute-Normandie, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre d’Etude des Transformations des Activités Physiques et Sportives (CETAPS) - EA 3832, Faculty of Sports Sciences, University of Rouen, Rouen, Haute-Normandie</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland</wicri:regionArea></affiliation></author><author><name sortKey="Davids, Keith" sort="Davids, Keith" uniqKey="Davids K" first="Keith" last="Davids">Keith Davids</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland, Finland</addr-line></nlm:aff><country xml:lang="fr">Finlande</country><wicri:regionArea>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland</wicri:regionArea></affiliation></author><author><name sortKey="Wheat, Jon" sort="Wheat, Jon" uniqKey="Wheat J" first="Jon" last="Wheat">Jon Wheat</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, South Yorkshire, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, South Yorkshire</wicri:regionArea></affiliation></author><author><name sortKey="Seifert, Ludovic" sort="Seifert, Ludovic" uniqKey="Seifert L" first="Ludovic" last="Seifert">Ludovic Seifert</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Centre d’Etude des Transformations des Activités Physiques et Sportives (CETAPS) - EA 3832, Faculty of Sports Sciences, University of Rouen, Rouen, Haute-Normandie, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre d’Etude des Transformations des Activités Physiques et Sportives (CETAPS) - EA 3832, Faculty of Sports Sciences, University of Rouen, Rouen, Haute-Normandie</wicri:regionArea></affiliation></author><author><name sortKey="Liukkonen, Jarmo" sort="Liukkonen, Jarmo" uniqKey="Liukkonen J" first="Jarmo" last="Liukkonen">Jarmo Liukkonen</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland, Finland</addr-line></nlm:aff><country xml:lang="fr">Finlande</country><wicri:regionArea>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland</wicri:regionArea></affiliation></author><author><name sortKey="Jaakkola, Timo" sort="Jaakkola, Timo" uniqKey="Jaakkola T" first="Timo" last="Jaakkola">Timo Jaakkola</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland, Finland</addr-line></nlm:aff><country xml:lang="fr">Finlande</country><wicri:regionArea>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland</wicri:regionArea></affiliation></author><author><name sortKey="Ashford, Derek" sort="Ashford, Derek" uniqKey="Ashford D" first="Derek" last="Ashford">Derek Ashford</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Institute for Biophysical and Clinical Research into Human Movement, The Manchester Metropolitan University, Alsager, North West England, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute for Biophysical and Clinical Research into Human Movement, The Manchester Metropolitan University, Alsager, North West England</wicri:regionArea></affiliation></author><author><name sortKey="Kerr, Graham" sort="Kerr, Graham" uniqKey="Kerr G" first="Graham" last="Kerr">Graham Kerr</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Movement Neuroscience Program, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Movement Neuroscience Program, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Simple deformation of the skin surface with textured materials can improve human perceptual-motor performance. The implications of these findings are inexpensive, adaptable and easily integrated clothing, equipment and tools for improving perceptual-motor functionality. However, some clarification is needed because mixed results have been reported in the literature, highlighting positive, absent and/or negative effects of added texture on measures of perceptual-motor performance. Therefore the aim of this study was to evaluate the efficacy of textured materials for enhancing perceptual-motor functionality. The systematic review uncovered two variables suitable for sub-group analysis within and between studies: participant age (groupings were 18–51 years and 64.7–79.4 years) and experimental task (upright balance and walking). Evaluation of studies that observed texture effects during upright balance tasks, uncovered two additional candidate sub-groups for future work: vision (eyes open and eyes closed) and stability (stable and unstable). Meta-analysis (random effects) revealed that young participants improve performance by a small to moderate amount in upright balance tasks with added texture (SMD = 0.28, 95%CI = 0.46–0.09, Z = 2.99, P = 0.001; Tau<sup>2</sup> = 0.02; Chi<sup>2</sup> = 9.87, df = 6, P = 0.13; I<sup>2</sup> = 39.22). Significant heterogeneity was found in, the overall effect of texture: Tau<sup>2</sup> = 0.13; Chi<sup>2</sup> = 130.71, df = 26, P<0.0001; I<sup>2</sup> = 85.98%, pooled samples in upright balance tasks: Tau<sup>2</sup> = 0.09; Chi<sup>2</sup> = 101.57, df = 13, P<0.001; I<sup>2</sup> = 72.67%, and in elderly in upright balance tasks: Tau<sup>2</sup> = 0.16; Chi<sup>2</sup> = 39.42, df = 5, P<0.001; I<sup>2</sup> = 83.05%. No effect was shown for walking tasks: Tau<sup>2</sup> = 0.00; Chi<sup>2</sup> = 3.45, df = 4, P = 0.27, I<sup>2</sup> = 22.99%. Data provides unequivocal support for utilizing textured materials in young healthy populations for improving perceptual-motor performance. Future research is needed in young healthy populations under conditions where visual and proprioceptive information is challenged, as in high-speed movements, or where use of equipment mediates the performer-environment interaction or where dysfunctional information sources ‘compete’ for attention. In elderly and ailing populations data suggests further research is required to better understand contexts where texture can facilitate improved perceptual-motor performance.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Watanabe, I" uniqKey="Watanabe I">I Watanabe</name></author><author><name sortKey="Okubo, J" uniqKey="Okubo J">J Okubo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Palluel, E" uniqKey="Palluel E">E Palluel</name></author><author><name sortKey="Nougier, V" uniqKey="Nougier V">V Nougier</name></author><author><name sortKey="Olivier, I" uniqKey="Olivier I">I Olivier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Palluel, E" uniqKey="Palluel E">E Palluel</name></author><author><name sortKey="Nougier, V" uniqKey="Nougier V">V Nougier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Preszner Domjan, A" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23565232</article-id><article-id pub-id-type="pmc">3615024</article-id><article-id pub-id-type="publisher-id">PONE-D-12-40139</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0060349</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology</subject><subj-group><subject>Biotechnology</subject><subj-group><subject>Bioengineering</subject><subj-group><subject>Medical Devices</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Engineering</subject><subj-group><subject>Bioengineering</subject><subj-group><subject>Medical Devices</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Clinical Research Design</subject><subj-group><subject>Meta-Analyses</subject><subject>Systematic Reviews</subject></subj-group></subj-group><subj-group><subject>Drugs and Devices</subject><subj-group><subject>Medical Devices</subject></subj-group></subj-group><subj-group><subject>Mental Health</subject><subj-group><subject>Psychology</subject><subj-group><subject>Behavior</subject><subj-group><subject>Adjustment (Psychology)</subject><subject>Human Performance</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Social and Behavioral Sciences</subject><subj-group><subject>Psychology</subject><subj-group><subject>Behavior</subject><subj-group><subject>Adjustment (Psychology)</subject><subject>Human Performance</subject></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>The Role of Textured Material in Supporting Perceptual-Motor Functions</article-title><alt-title alt-title-type="running-head">Texture Effects on Perceptual-Motor Functions</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Orth</surname><given-names>Dominic</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Davids</surname><given-names>Keith</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wheat</surname><given-names>Jon</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seifert</surname><given-names>Ludovic</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Liukkonen</surname><given-names>Jarmo</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jaakkola</surname><given-names>Timo</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ashford</surname><given-names>Derek</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kerr</surname><given-names>Graham</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Centre d’Etude des Transformations des Activités Physiques et Sportives (CETAPS) - EA 3832, Faculty of Sports Sciences, University of Rouen, Rouen, Haute-Normandie, France</addr-line></aff><aff id="aff2"><label>2</label><addr-line>School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></aff><aff id="aff3"><label>3</label><addr-line>FiDiPro Programme, Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Central Finland, Finland</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, South Yorkshire, United Kingdom</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Institute for Biophysical and Clinical Research into Human Movement, The Manchester Metropolitan University, Alsager, North West England, United Kingdom</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Movement Neuroscience Program, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Martinez</surname><given-names>Luis M.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>CSIC-Univ Miguel Hernandez, Spain</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>d.orth@qut.edu.au</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: DO KD JW LS JL TJ GK. Analyzed the data: DO DA. Contributed reagents/materials/analysis tools: JL TJ. Wrote the paper: DO KD.</p></fn></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>2</day><month>4</month><year>2013</year></pub-date><volume>8</volume><issue>4</issue><elocation-id>e60349</elocation-id><history><date date-type="received"><day>15</day><month>12</month><year>2012</year></date><date date-type="accepted"><day>26</day><month>2</month><year>2013</year></date></history><permissions><copyright-year>2013</copyright-year><copyright-holder>Orth et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><p>Simple deformation of the skin surface with textured materials can improve human perceptual-motor performance. The implications of these findings are inexpensive, adaptable and easily integrated clothing, equipment and tools for improving perceptual-motor functionality. However, some clarification is needed because mixed results have been reported in the literature, highlighting positive, absent and/or negative effects of added texture on measures of perceptual-motor performance. Therefore the aim of this study was to evaluate the efficacy of textured materials for enhancing perceptual-motor functionality. The systematic review uncovered two variables suitable for sub-group analysis within and between studies: participant age (groupings were 18–51 years and 64.7–79.4 years) and experimental task (upright balance and walking). Evaluation of studies that observed texture effects during upright balance tasks, uncovered two additional candidate sub-groups for future work: vision (eyes open and eyes closed) and stability (stable and unstable). Meta-analysis (random effects) revealed that young participants improve performance by a small to moderate amount in upright balance tasks with added texture (SMD = 0.28, 95%CI = 0.46–0.09, Z = 2.99, P = 0.001; Tau<sup>2</sup> = 0.02; Chi<sup>2</sup> = 9.87, df = 6, P = 0.13; I<sup>2</sup> = 39.22). Significant heterogeneity was found in, the overall effect of texture: Tau<sup>2</sup> = 0.13; Chi<sup>2</sup> = 130.71, df = 26, P<0.0001; I<sup>2</sup> = 85.98%, pooled samples in upright balance tasks: Tau<sup>2</sup> = 0.09; Chi<sup>2</sup> = 101.57, df = 13, P<0.001; I<sup>2</sup> = 72.67%, and in elderly in upright balance tasks: Tau<sup>2</sup> = 0.16; Chi<sup>2</sup> = 39.42, df = 5, P<0.001; I<sup>2</sup> = 83.05%. No effect was shown for walking tasks: Tau<sup>2</sup> = 0.00; Chi<sup>2</sup> = 3.45, df = 4, P = 0.27, I<sup>2</sup> = 22.99%. Data provides unequivocal support for utilizing textured materials in young healthy populations for improving perceptual-motor performance. Future research is needed in young healthy populations under conditions where visual and proprioceptive information is challenged, as in high-speed movements, or where use of equipment mediates the performer-environment interaction or where dysfunctional information sources ‘compete’ for attention. In elderly and ailing populations data suggests further research is required to better understand contexts where texture can facilitate improved perceptual-motor performance.</p></abstract><funding-group><funding-statement>The lead author would like to thank and acknowledge the support the Faculty of Sport and Health Science, University of Jyväskylä, Finland, whose funding facilitated preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="14"></page-count></counts></article-meta></front><body><sec id="s1"><title>Introduction</title><p>The somatosensory system in humans includes many sensory components such as plantar cutaneous mechanoreceptors, joint receptors and muscle receptors. Previous research has shown that the stimulation of sensory receptors in the skin via simple mechanical deformation of the surface by added texture (e.g., addition of nodules and protuberances on the surface of a shoe insole or a standing area) can improve perceptual-motor system functionality in upright balance <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>. These findings have since been replicated, under similar experimental task constraints, in a number of other samples of healthy, young participants <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>–<xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>. The morphology of textured surfaces used in previous work has been defined by a huge parameter space including variables such as nodule height, shape, material, area and packing density. Research has evaluated the efficacy of added texture that passively deforms the plantar surface of the foot in a variety of populations (elderly <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>–<xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> and those with ailment <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>–<xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>) and under a range of perceptual-motor task constraints, including upright balance <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>–<xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, walking <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>–<xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> and joint position discrimination <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>.</p><sec id="s1a"><title>Somatosensory Regulation of Movement and Effects of Stimulating Cutaneous Receptors with Added Texture</title><p>The somatosensory system has functionally distinct and interacting roles in the nervous system <xref ref-type="bibr" rid="pone.0060349-Gardner1">[25]</xref>. Structurally it pervades both central and peripheral regions through which it functions to convey information to the brain from the skin <xref ref-type="bibr" rid="pone.0060349-Simoneau1">[26]</xref>, <xref ref-type="bibr" rid="pone.0060349-Gutierrez1">[27]</xref> and musculoskeletal <xref ref-type="bibr" rid="pone.0060349-Kavounoudias1">[28]</xref> system regarding weight bearing activities and the relative positioning of body parts <xref ref-type="bibr" rid="pone.0060349-Gardner1">[25]</xref>. Information, much of which is induced by movement <xref ref-type="bibr" rid="pone.0060349-Medell1">[29]</xref>, <xref ref-type="bibr" rid="pone.0060349-Mackey1">[30]</xref>, ascends to the brain via somatosensory tracts <xref ref-type="bibr" rid="pone.0060349-Gardner1">[25]</xref> where it may be perceived or integrated with visual and vestibular inputs <xref ref-type="bibr" rid="pone.0060349-Maurer1">[31]</xref> at sub-conscious <xref ref-type="bibr" rid="pone.0060349-Hongo1">[32]</xref>, <xref ref-type="bibr" rid="pone.0060349-Fallon1">[33]</xref> and conscious <xref ref-type="bibr" rid="pone.0060349-Wolpert1">[34]</xref>–<xref ref-type="bibr" rid="pone.0060349-Teasdale1">[36]</xref> levels. These multilevel interactions <xref ref-type="bibr" rid="pone.0060349-Peterka1">[37]</xref> between the somatosensory and other nervous system sub-components reflect its complex role in supporting action <xref ref-type="bibr" rid="pone.0060349-Matyas1">[38]</xref>–<xref ref-type="bibr" rid="pone.0060349-Maki2">[40]</xref>.</p><p>Previous research has reported that textured materials can influence somatosensory system functioning during mechanical interactions with specialized cutaneous receptors <xref ref-type="bibr" rid="pone.0060349-Kennedy1">[41]</xref>. Cutaneous end organ afferents are specialized to be preferentially sensitive to specific spatio-temporal scales of mechanical energy <xref ref-type="bibr" rid="pone.0060349-Kennedy1">[41]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse2">[42]</xref>, meaning that acceleration, velocity and intensity of action can be discriminated. It appears that all of these characteristics might be stimulated by added texture <xref ref-type="bibr" rid="pone.0060349-Kennedy1">[41]</xref>.</p><p>Research to date has sought to ascertain effects on perceptual-motor performance of added texture at the plantar surface of the foot sole under various task constraints (i.e. static and dynamic balancing). Varied effects have been observed in studies which have added texture to articulation surfaces and determining the contexts in which textured materials provide the greatest benefits for perceptual-motor functionality is clearly an important research task. This is especially the case in populations, such as those with ageing <xref ref-type="bibr" rid="pone.0060349-Perry2">[43]</xref> or diseased nervous systems and those with a high falls risk <xref ref-type="bibr" rid="pone.0060349-Lord1">[44]</xref>, where individual and social benefits are palpable (for reviews see <xref ref-type="bibr" rid="pone.0060349-Maki2">[40]</xref>, <xref ref-type="bibr" rid="pone.0060349-Alfuth1">[45]</xref>–<xref ref-type="bibr" rid="pone.0060349-Maki3">[48]</xref>). Evidence suggests that textured material can ameliorate reduced perceptual-motor system functionality related to ageing <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, disease <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, and previous injury <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, and that observed benefits are not lost over extended time scales due to habituation to stimuli <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>.</p></sec><sec id="s1b"><title>Textured Material Interventions</title><p>In contrast to growing evidence of improved perceptual-motor performance with added texture, a significant body of work has also shown no significant effects of texture on perceptual-motor performance in postural sway <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> and walking tasks <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>. Some studies have reported that textured material effects seem to be dependent on the combined influences of two or more sample- or task-related independent variables - such as age, vision or task stability - suggesting that the relationship between added textured and task performance is somewhat complex.</p><p>Additionally, despite early work revealing that structural characteristics of texture (i.e. nodule density) can affect the scale of postural sway in upright balance <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, characteristics of textured materials (i.e. internodule distance, width, height, shape, uniformity, hardness, compound type) and related equipment (shoes, insoles, orthotics, socks etc) have varied widely across studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, and in some cases have gone unreported <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref> or uncontrolled <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>. It is possible, therefore, that inconsistencies in outcomes across studies may be due to variations in treatments, age, health status and experimental task designs reported across studies <xref ref-type="bibr" rid="pone.0060349-Maki2">[40]</xref>, <xref ref-type="bibr" rid="pone.0060349-Alfuth1">[45]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hijmans1">[47]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki3">[48]</xref>.</p><p>The primary aim of this paper is to investigate how added texture has influenced perceptual-motor performance in the different populations studied in previous work. Additionally, we sought to evaluate whether variations in methodology and sample characteristics might have influenced reported effects on perceptual-motor performance by process of systematic review and meta-analysis.</p><p>To the best of our knowledge this is the first meta-analysis on the effects of textured materials on measures of perceptual-motor performance. Previous reviews related to somatosensoty facilitation have typically had alternative foci, such as evaluating overall footwear design features <xref ref-type="bibr" rid="pone.0060349-Maki2">[40]</xref>, <xref ref-type="bibr" rid="pone.0060349-Alfuth1">[45]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hijmans1">[47]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki3">[48]</xref> (e.g., insole hardness, tread characteristics etc.) or the use tapes or joint support for injury prevention <xref ref-type="bibr" rid="pone.0060349-Cheung1">[49]</xref>, <xref ref-type="bibr" rid="pone.0060349-Williams1">[50]</xref>. Given that reviews that have discussed textured materials provide support for their utility, it was anticipated we would confirm that perceptual-motor performance is improved by added texture. Results, although context dependent, were largely favourable and open a number of future research pathways.</p></sec></sec><sec sec-type="methods" id="s2"><title>Methods</title><sec id="s2a"><title>Search Strategy</title><p>We searched MEDLINE and EMBASE for published primary sources. Ten keywords related to textured material were pooled (via Boolean operation “OR”) and combined (via Boolean operation “AND”) with twenty similarly pooled keywords related to perceptual-motor system functionality. Results were limited to human participants and each database was searched from their earliest available record up to August 2012. We also undertook a related articles search on Google Scholar and carefully scrutinized cited articles and reference lists of all included studies. Articles were restricted to those written in English.</p></sec><sec id="s2b"><title>Inclusion Criteria</title><p>No restrictions were made on study design, comparison group or participant sample. For inclusion in the review, studies were required to have involved human participants experiencing treatments with a localized textured material intervention (whose nodules or indenting structures could be described) during performance of a perceptual or perceptual-motor task during which observations were recorded. Textured materials that utilized a power source, such as a vibration-inducing mechanism were excluded, as were interventions where the textured material in some way restricted the range of motion in underlying structures. The former studies involved complex technologies with a mechanism that has been described as stochastic resonance, requiring random signal oscillations utilising a power-source <xref ref-type="bibr" rid="pone.0060349-Priplata1">[51]</xref>. The latter studies were excluded because restricting the range of motion of body joints might have modified the strategic actions of participants. Finally, studies using adhesive tapes, where no measurable nodules or indenting structures were present, were also excluded. Secondary criteria were developed for inclusion in the meta-analysis. In addition to the primary criteria (required for inclusion in review, see <xref ref-type="supplementary-material" rid="pone.0060349.s001">Table S1</xref>), studies were required to report sample sizes as well as means and standard deviations (or derivatives) of perceptual-motor performance responses whilst interacting with textured materials and under control conditions without added texture (either dependent or independent groups).</p></sec><sec id="s2c"><title>Selection of Studies</title><p>Two authors independently selected trials for inclusion. Titles and abstracts of publications obtained with the search methodology were screened and all studies classified as relevant were retrieved. We utilized a standardized form to select studies eligible for inclusion in the review and/or meta-analysis. Disagreement was resolved by consensus amongst the authors.</p></sec><sec id="s2d"><title>Data Extraction and Management</title><p>Data were extracted independently by the lead author and a research assistant using a customized form. This was used to extract relevant data on experimental design, sample characteristics, interventions (including detailed characteristics of texture intervention) and controls, movement task characteristics, independent variables and levels, outcome measures and equipment, and comparisons and interaction effects (see <xref ref-type="supplementary-material" rid="pone.0060349.s001">Table S1</xref>). There was no blinding of information on lead author or journal outlet at this stage.</p></sec><sec id="s2e"><title>Measures of Treatment Effect</title><p>For each study, unbiased (Hedges’ <italic>g</italic>) standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous outcomes <xref ref-type="bibr" rid="pone.0060349-Morris1">[52]</xref>. Effect size estimates for texture compared to no-texture conditions in each study were standardized using the control group standard deviation in dependent group designs <xref ref-type="bibr" rid="pone.0060349-Looney1">[53]</xref> and the pooled standard deviations in independent group designs <xref ref-type="bibr" rid="pone.0060349-Hedges1">[54]</xref>. The synthesized (by average) <xref ref-type="bibr" rid="pone.0060349-Becker1">[55]</xref> effect size estimates were, in the first instance, used to calculate the unbiased SMD <xref ref-type="bibr" rid="pone.0060349-Morris1">[52]</xref>, which were then used to calculate the unbiased variance estimates with equations specialized for variations due to dependent <xref ref-type="bibr" rid="pone.0060349-Morris1">[52]</xref> and independent <xref ref-type="bibr" rid="pone.0060349-Hedges1">[54]</xref> study designs. One study involving repeated measures provided data enough to determine rho values on dependent measures <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>. The rho estimates were then averaged together and used for subsequent calculation of all estimates for the unbiased effect size variances <xref ref-type="bibr" rid="pone.0060349-Morris1">[52]</xref>. There were a small number of cases where mean and standard deviation data were deemed unsuitable because of difficulty in interpreting the appropriate direction of the effect <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Bartold1">[20]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> or were unobtainable <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, in which case they were excluded from consideration for meta-analysis to avoid contamination. Significance for testing the null (no effect) was set at the one-tailed P<0.05 in favour of texture and utilized the Z-test method <xref ref-type="bibr" rid="pone.0060349-Borenstein1">[56]</xref>.</p></sec><sec id="s2f"><title>Risk of Bias</title><p>For all studies, methodological quality was assessed independently by the lead author and a research assistant using the Cochrane risk-of–bias tool <xref ref-type="bibr" rid="pone.0060349-1">[57]</xref>. Each study was graded on the following domains: sequence generation, performance blinding (participants and personal), assessment bias (detection bias) and for incomplete outcome data (attrition bias). For each study, the domains were determined based on the published study report and judged by the assessors as to their risk of bias. They were assigned the label ‘low’ if criteria for a low risk of bias were met, or ‘high’ if criteria for a high risk of bias were met. If there was insufficient detail to determine either a ‘low’ or ‘high’ risk of bias, then risk of bias was deemed ‘unclear’ for that domain. Disagreements between independent assessors (two authors) regarding risk of bias for domains were resolved by consensus.</p></sec><sec id="s2g"><title>Subgroup Analysis</title><p>Differences in study samples and task constraints were anticipated as potential sources of heterogeneity and considered for subgroup analysis. Points of clear differentiation in task constraints were discerned in study details through process of systematic review (<xref ref-type="supplementary-material" rid="pone.0060349.s001">Table S1</xref>). Different populations were identified by applying MEDLINE age group criteria (all child: 0–18 years (yrs), adult: 19–44 yrs, middle aged: 45–64 yrs, and elderly: 65 yrs and over).</p></sec></sec><sec id="s3"><title>Results</title><p><xref ref-type="fig" rid="pone-0060349-g001">Figure 1</xref> summarises the search strategy and selection process based on included and excluded studies.</p><fig id="pone-0060349-g001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g001</object-id><label>Figure 1</label><caption><title>Summary of the search strategy and selection process based on included and excluded studies.</title></caption><graphic xlink:href="pone.0060349.g001"></graphic></fig><sec id="s3a"><title>Included Studies</title><p>Individual characteristics of included studies are summarised in <xref ref-type="supplementary-material" rid="pone.0060349.s001">Table S1</xref>. There were 23 eligible studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, comprising 21 published peer reviewed research articles and two published conference proceedings <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>. Of the excluded studies, notably one was a special issue <xref ref-type="bibr" rid="pone.0060349-Bartold1">[20]</xref> reporting additional findings on a previously published sample <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> and, therefore, not included in our analysis. Details of sample characteristics of included studies are summarized in <xref ref-type="table" rid="pone-0060349-t001">Table 1</xref> and show that two distinct age groupings were identified (young from 18 <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref> to 51.1 <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> yrs and, elderly, from 64.7 <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref> to 79.4 yrs <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>) which could be further characterized by the presence of ailment (with or without). Hence four distinct groups were identified within <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> and between studies: young healthy <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, young with ailment <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, elderly healthy <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, and elderly with ailment <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>.</p><table-wrap id="pone-0060349-t001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.t001</object-id><label>Table 1</label><caption><title>Sample Characteristics.</title></caption><alternatives><graphic id="pone-0060349-t001-1" xlink:href="pone.0060349.t001"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1">Ailment</td><td align="left" rowspan="1" colspan="1">Age</td><td align="left" rowspan="1" colspan="1">N</td><td align="left" rowspan="1" colspan="1">M</td><td align="left" rowspan="1" colspan="1">F</td><td align="left" rowspan="1" colspan="1">Age</td><td align="left" rowspan="1" colspan="1">SD</td><td align="left" rowspan="1" colspan="1">Max</td><td align="left" rowspan="1" colspan="1">Min</td><td align="left" rowspan="1" colspan="1">Note</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold>No</bold></td><td align="left" rowspan="1" colspan="1"><bold>Young</bold></td><td align="left" rowspan="1" colspan="1">330</td><td align="left" rowspan="1" colspan="1">166</td><td align="left" rowspan="1" colspan="1">164</td><td align="left" rowspan="1" colspan="1">27.1</td><td align="left" rowspan="1" colspan="1">4.6</td><td align="left" rowspan="1" colspan="1">51.1 <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref></td><td align="left" rowspan="1" colspan="1">18 <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><bold>Elderly</bold></td><td align="left" rowspan="1" colspan="1">247</td><td align="left" rowspan="1" colspan="1">97</td><td align="left" rowspan="1" colspan="1">150</td><td align="left" rowspan="1" colspan="1">71.7</td><td align="left" rowspan="1" colspan="1">5.6</td><td align="left" rowspan="1" colspan="1">79.4 <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref></td><td align="left" rowspan="1" colspan="1">64.7 <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Yes</bold></td><td align="left" rowspan="1" colspan="1"><bold>Young</bold></td><td align="left" rowspan="1" colspan="1">80</td><td align="left" rowspan="1" colspan="1">26</td><td align="left" rowspan="1" colspan="1">54</td><td align="left" rowspan="1" colspan="1">37.4</td><td align="left" rowspan="1" colspan="1">6.6</td><td align="left" rowspan="1" colspan="1">49 <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref></td><td align="left" rowspan="1" colspan="1">21.5 <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref></td><td align="left" rowspan="1" colspan="1">MS <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, CAI <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"><bold>Elderly</bold></td><td align="left" rowspan="1" colspan="1">86</td><td align="left" rowspan="1" colspan="1">42</td><td align="left" rowspan="1" colspan="1">44</td><td align="left" rowspan="1" colspan="1">71.1</td><td align="left" rowspan="1" colspan="1">6.2</td><td align="left" rowspan="1" colspan="1">79 <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref></td><td align="left" rowspan="1" colspan="1">65.4 <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref></td><td align="left" rowspan="1" colspan="1">PD <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, PI <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, FH <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref></td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt101"><label></label><p><bold>CAI = </bold>Chronic ankle instability; <bold>F = </bold>female; <bold>FH</bold> = falls history; <bold>M = </bold>male; <bold>MS = </bold>Multiple Sclerosis; <bold>N = </bold>sample size; <bold>PD = </bold>Parkinson’s disease; <bold>PI</bold> = plantar insensitivity; <bold>SD = </bold>standard deviation.</p></fn></table-wrap-foot></table-wrap><p>The MEDLINE age grouping criteria was departed from in a number of respects. Firstly the adult and middle-aged divisions were grouped to form a ‘young’ group. This was done because only two studies <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, involved participant samples whose mean age fell within the middle-aged group classification according to MEDLINE age grouping criteria. Secondly, a 13.6 yr gap separated the young and elderly age groups and was considered large enough to distinguish between the age groupings, despite the fact that, technically, the by average youngest elderly sample <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref> of 64.7 yrs fell inside the cut off for middle-aged classification criteria. It was reasonable therefore to summarize this sample as part of the elderly group. Finally only two studies reported samples of athletes <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, which involved a total of 29 female participants with a mean age of 21 yrs. These athlete participants, due to their small number, were incorporated into the young and healthy subgroup summarised in <xref ref-type="table" rid="pone-0060349-t001">Table 1</xref>.</p><p>Five studies <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> were designed with age (young versus (vs.) elderly) as an independent variable, whilst two studies utilized the presence or absence of an ailment as an independent variable <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>. The average sample size was 23 with the largest study based on 80 participants <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>. Twenty-two studies (n = 11 repeated measures, and n = 11 mixed model designs) incorporated at least one textured-intervention group and a no-texture control group. Only one study was observational in that it measured participant’s behaviours with no control group or condition for comparison <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>. Only five studies used a pre-post test protocol where texture conditions were measured on both occasions <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>. One of these studies involved a five-minute between measures period <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>. The time between tests in the remaining studies ranged from 14 to 84 days <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>. One study was unique in that it used a pre-post test design but the first test was always the control condition (no texture). After five minutes a follow-up test with added texture was undertaken and then two additional follow ups under control conditions were then carried out with 5 minutes of either walking or standing between tests <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>.</p></sec><sec id="s3b"><title>Risk of Bias</title><p>There was a risk of bias across all 23 studies as summarised in <xref ref-type="fig" rid="pone-0060349-g002">Figure 2</xref>. There was a high risk of selection bias in four studies in administering the treatment: three failed to address whether a randomization procedure was in place <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, and one reported that no randomization occurred <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>. Four studies had a low risk of bias, reporting acceptable methods of randomization <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, whilst in the remaining 15 studies the methods of randomization were not reported and received an uncertain risk of bias rating. In both blinding categories (performance and detection), there were high risks of bias across all studies with the exception of two studies that included a sham insole condition <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> and were subsequently rated a low risk of performance bias.</p><fig id="pone-0060349-g002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g002</object-id><label>Figure 2</label><caption><title>Risk of bias summary.</title></caption><graphic xlink:href="pone.0060349.g002"></graphic></fig><p>A single study was rated at a high risk of reporting bias because it failed to report outcomes on dependent variables described <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>. The remaining studies were rated at an unclear risk of attrition bias for not reporting methods for handling participant drop out and/or not providing methods allowing judgment of whether the pre-planned dependent variables were reported.</p></sec><sec id="s3c"><title>Details of Intervention</title><p>Twenty-two studies applied texture to some part of the plantar surface of the foot <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>–<xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, and one study was unique in adding texture, in a uniform arrangement, to the right index finger tip <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>. Sixteen of the studies that applied texture to the feet did so to the entire plantar surface <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>–<xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, three of which were in a non-uniform pattern <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>. Five studies applied texture to select aspects of the plantar surface (all with a uniform structure). Three of these studies applied it only to the perimeter of the plantar surface <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, one study involved a condition where texture was applied to the middle third of the plantar surface <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> and one applied it longitudinally to the medial third of the plantar surface <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>. Two studies did not report enough information to determine the extent and consistency of the textured material applied to the foot surface <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>.</p><p>The majority of studies used a textured insole in shoes worn by participants (n = 14 <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>–<xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>). Of the remaining nine, five studies applied the texture to a standing surface <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, two studies used a textured sandal <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, one study glued gravel to the inside of a sock <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, and another study used adhesive tape to fix a flexible tube to the border of the plantar surfaces <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>. The texture in all non-insole studies made direct contact with the participants’ skin surface (i.e. no intervening material was included between the texture and skin surface although, the studies involving textured sandals did not explicitly report this <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>).</p><p>Of the insole studies, 12 inserted the insole into a pair of shoes <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>–<xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>. Of these shod studies, five controlled for shoe type <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, four used the participants’ personal shoes <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, and three did not report whether the shoes were controlled or personal <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>. Five reported using socks <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, four of which reportedly controlled the type of sock worn between the in-shoe textured insole and skin <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>. Three studies did not report use of socks but, very likely, involved the participants’ personal socks, given that the textured in-shoe insoles were worn by participants for a time period in the range of 14 to 84 days <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>. There were two studies involving shoes that did not report whether or not socks were used <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref> and only two studies involving shoes reported not to have used socks (i.e. textured insoles were in direct contact with the skin) <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>. The two studies involving insoles that did not use shoes had unique intervention characteristics. One study observed participants standing directly onto textured insoles positioned on the surface of a force platform <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref> (i.e. as a textured insole surface), whilst one study used an adhesive wrapping over the insoles and foot, recording participant performance whilst walking with direct contact with the insoles <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>.</p><p>Of the studies that applied texture to a surface, four studies applied texture over a force platform that participants stood on whilst performing an upright balance task <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, and one study applied texture to a surface positioned at hip height that participants touched with their right index finger during an upright balance task <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>.</p><p>Seventeen studies used a single texture type <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>–<xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, five examined two different types <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, and a single study compared three types <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>. A range of materials (rubber/foam/plastic <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>–<xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, sandpaper <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, gravel <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, leather <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref> and metal <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>) and shapes (points/spikes <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>–<xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, rounding <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, semicircles <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, grooves <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> or ridges <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>) were described. The majority of studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>–<xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>–<xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref> also reported measures of the structural characteristics of texture applied (including internodule distance/density <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>–<xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, height <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref> and/or width/diameter <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>–<xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>), as summarized in <xref ref-type="table" rid="pone-0060349-t002">Table 2</xref>, in descending order of nodule magnitude.</p><table-wrap id="pone-0060349-t002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.t002</object-id><label>Table 2</label><caption><title>Texture Dimensions and Characteristics.</title></caption><alternatives><graphic id="pone-0060349-t002-2" xlink:href="pone.0060349.t002"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1">Study</td><td align="left" rowspan="1" colspan="1">Density (n/cm<sup>2</sup>)</td><td align="left" rowspan="1" colspan="1">Dist. (mm)</td><td align="left" rowspan="1" colspan="1">Height (mm)</td><td align="left" rowspan="1" colspan="1">Width (mm)</td><td align="left" rowspan="1" colspan="1">Shape or material</td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Hatton et al., 2011) <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">2.5</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">point</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Preszner-Domjan et al., 2012) <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref></td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">spike</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Waddington et al., 2000) <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref></td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Waddington et al., 2003) <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref></td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(McKeon et al., 2012) <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref></td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Hatton et al., 2011) <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">semicircle</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Palluel et al., 2008) <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref></td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">spike</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Palluel et al., 2009) <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref></td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">spike</td></tr><tr><td align="left" rowspan="1" colspan="1">(Nurse et al., 2005) <xref ref-type="bibr" rid="pone.0060349-Gardner1">[25]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">semicircle</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Watanabe & Okubo 1981) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">10</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1">(Ritchie et al., 2011) <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Watanabe & Okubo 1981) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Watanabe & Okubo 1981) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref> c.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">20</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Corbin et al., 2007) <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">2.5</td><td align="left" rowspan="1" colspan="1">5.5</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Qui et al., 2012) <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">3.1</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">round</td></tr><tr><td align="left" rowspan="1" colspan="1">(Chen et al., 1995) <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">5.5</td><td align="left" rowspan="1" colspan="1">gravel</td></tr><tr><td align="left" rowspan="1" colspan="1">(Chen et al., 1995) <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">2.5</td><td align="left" rowspan="1" colspan="1">gravel</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Maki et al., 1999) <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref></td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">ridge</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Jenkins et al., 2009) <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref></td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">ridge</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Perry et al., 2008) <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref></td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">ridge</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Tremblay et al., 2004) <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref></td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">2.7</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">2.5</td><td align="left" rowspan="1" colspan="1">groove</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Kelleher et al., 2010) <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref></td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">na</td><td align="left" rowspan="1" colspan="1">0.2</td><td align="left" rowspan="1" colspan="1">sandpaper</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Hatton et al., 2009) <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">point</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Hatton et al., 2009) <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">circle</td></tr><tr><td align="left" rowspan="1" colspan="1">(Wilson et al., 2008) <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">point</td></tr><tr><td align="left" rowspan="1" colspan="1">(Wilson et al., 2008) <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">circle</td></tr><tr><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="nt102">*</xref>(Hartmann et al., 2010) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">leather</td></tr><tr><td align="left" rowspan="1" colspan="1">(Dixon et al., 2012) <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref> a.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td></tr><tr><td align="left" rowspan="1" colspan="1">(Dixon et al., 2012) <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref> b.</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td></tr><tr><td align="left" rowspan="1" colspan="1">(Hatton et al., 2012) <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref></td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td><td align="left" rowspan="1" colspan="1">nr</td></tr><tr><td align="left" rowspan="1" colspan="1">Average</td><td align="left" rowspan="1" colspan="1">3.83</td><td align="left" rowspan="1" colspan="1">9.40</td><td align="left" rowspan="1" colspan="1">3.58</td><td align="left" rowspan="1" colspan="1">3.29</td><td align="left" rowspan="1" colspan="1"></td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt102"><label>*</label><p> = studies selected for meta-analysis, <bold>Dist.</bold> = Distance <bold>n/cm<sup>2</sup></bold> = nodules per centimetre squared.</p></fn></table-wrap-foot></table-wrap><p>Of the seven studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> that used texture as an independent variable (having at least two texture modifications), significant differences in performance measures were reported in a single study <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref> (two additional studies described differences <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>). It should be emphasized that only Watanabe and Okubo <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref> and Chen et al. <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> altered packing density and the remaining studies altered the pattern of the surface texture. Of note also is that Qiu et al. <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref> manipulated the hardness (soft vs. hard) of a textured insole and found significant interactions with performance effects favouring the soft insole condition, under more unstable foam surface standing conditions for elderly participants however, favoured hard insoles for young participants (eyes open and eyes closed).</p></sec><sec id="s3d"><title>Summary Effects of Texture</title><p>The Forrest plot summarizing the effects of textures clearly suggests a trend toward improved perceptual-motor performance and shows a range of strong <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, moderate to strong <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, small to moderate <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, absent <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>–<xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref> and adverse <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref> effects (<xref ref-type="fig" rid="pone-0060349-g003">Figure 3</xref>). However, analysis revealed significant heterogeneity across the effect sizes (<xref ref-type="fig" rid="pone-0060349-g003">Figure 3</xref>) and identified a very large outlier <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>. After removal, heterogeneity was still confirmed, suggesting that there were potentially significant influences by subgroups, either at population, task or experimental control level. Finally, except in the case of Watanabe and Okubo <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, the data suggested no clear trend when ordered by descending order of nodule density.</p><fig id="pone-0060349-g003" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g003</object-id><label>Figure 3</label><caption><title>Forrest plot summary of the effect of textured material on perceptual-motor performance.</title><p><bold>CI</bold> = confidence interval; <bold>eld.</bold> = elderly group; <bold>PD</bold> = Parkinson’s disease; <bold>IV</bold> = inverse variance; <bold>random</bold> = randomized; <bold>SMD</bold> = standardized mean difference; <bold>Wt</bold> = weight. Notes: within groups vs baseline and between <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> groups vs baseline. The first dashed line from the top includes groups where the internodue distance was known and are in order starting with the smallest to largest internodule disatance. The remaining studies do not report details regarding internodule distance and are in order of how much information was aviliable regarding the texture material characteristics.</p></caption><graphic xlink:href="pone.0060349.g003"></graphic></fig></sec><sec id="s3e"><title>Details of Performance Outcomes</title><p>Prior to undertaking the meta-analysis, it was anticipated that task factors might play a role in the variability across studies. Hence, the following sections describe the interventions at a level of detail that uncovers task related features inherent to the strategies for observing perceptual-motor behaviour employed across studies.</p><p>Twelve studies recorded centre of pressure excursions <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>–<xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> with an average extent time of 28.4 s, (minimum 10 s <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, maximum 60 s <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>). All studies of this type used a force platform and reported a variety of measures: area covered (mm<sup>2</sup>) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, excursion length (mm) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, excursion velocity (mm/s) <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, anterior-posterior (mm) <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, root mean square <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, Hz <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, time to boundary (s) <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref> and/or medial-lateral (mm <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, root mean square <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, Hz <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, time to boundary (s) <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>) sway parameters. Three studies measured surface electromyography of lower limb muscles <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>. One study also measured ground reaction forces, frequency and distance of stepping actions induced by perturbations during an upright balance task <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>. Furthermore, one study took measures of finger-tip force <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, and one took measures of tibial nerve discharge <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>. In studies that utilized the standing balance paradigm, five independent variables were identified including: vision (eyes open <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>, <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>–<xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, eyes closed <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>), follow up (pre vs. post conditions <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>), and surface (all involved a hard surface condition but only three involved a foam surface condition <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>). One study used perturbation methods including intermittent and continuous destabilization of the support surface and a dual task <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, and one study manipulated breathing <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref> (normal vs. held breath).</p><p>Ten studies observed effects of added texture during walking <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, with one study including a sub-condition that involved running gait <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, which was also unique in using a treadmill. The majority of studies sought participants to walk at a self-preferred pace, with only two studies requiring a set pace be met (5.4 <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, 6 <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref> and 13 km/hr <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>). The average reported distance that participants were required to walk was 12.0 m (minimum distance = 6.1 m, maximum = 24 m). Locomotion was typically observed on level and hard surfaces with the exception of two studies <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> that modified the surface slope <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> and compliance <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>. A variety of gait parameters were reported including spatiotemporal (walking velocity (m/s) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, cadence (steps/minute) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, stride/step length (m) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, distance to base of support (m) <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, support duration (s) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref> and step length variability (mm) <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>), kinematic (midfoot-tibial angle <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> and hip/knee/ankle absolute angles <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>), kinetic (ground reaction force <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref> and knee/ankle joint torque <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref> or foot sole pressure distribution <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>) characteristics. Four studies <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> utilized an instrumented walkway to record spatiotemporal features of gait, two used a multiple camera array <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> and one used triaxial accelerometers <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>. All four studies to report lower limb segment kinematics utilized a multi-camera array <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, and kinetic data were collected using camera and force plate technology <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>. The single study to report pressure distribution patterns utilized a pressure-measuring insole <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>. Finally, lower limb electromyography data were collected across four studies <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>.</p><p>Four task-related independent variables were identified in studies requiring bipedal locomotion task performance; time (pre, post) <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, surface (hard <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, compliant <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, slope/uneven <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>), cognitive load (neutral <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, dual task <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>) and movement patterning (walking <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref>, running <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>).</p><p>Two studies were unique in utilizing a psychophysical paradigm to assess texture on perception (absolute judgment) of five different joint positions of ankle inversion <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>.</p></sec><sec id="s3f"><title>Stability in Upright Balance Tasks</title><p>Twelve studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>–<xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref> focused on postural stability in upright balance tasks. Eight of these studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref> reported significant reductions interpreted as improvements in postural sway parameters with added texture and two studies reported changes consistent with an adverse effect for texture <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>. Main effects for texture were reported in six studies <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, and interactions were reported across seven studies for vision <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>, age <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, time <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, surface hardness <xref ref-type="bibr" rid="pone.0060349-PresznerDomjan1">[4]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, number of supporting legs <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref> and resting task requirements <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>.</p></sec><sec id="s3g"><title>Performance in Bipedal Locomotion Tasks</title><p>Ten studies <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> reported outcomes on measures recorded during performance of bipedal locomotion tasks. Six of these studies <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>–<xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> reported significant changes in performance measures (vs. control) that were interpreted as beneficial. Main effects were reported in five studies, and interactions were reported in one study <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref> for trial, gait cycle phase and ailment.</p><sec id="s3g1"><title>Summary effects of task</title><p>Across the included studies, two clearly distinguishable perceptual-motor task vehicles for evaluating the effects of texture on motor performance were upright balance and walking. We analysed the effect size estimates of each study involving either an upright balance or walking task and found significant heterogeneity in the pooled effect sizes of the upright balance conditions (<xref ref-type="fig" rid="pone-0060349-g004">Figure 4</xref>). Conversely, significant homogeneity was found in the pooled effect sizes of the walking conditions (<xref ref-type="fig" rid="pone-0060349-g004">Figure 4</xref>), which, nonetheless, showed no effects in favour of or against texture. Furthermore, the overall pooled effect sizes also showed significant heterogeneity.</p><fig id="pone-0060349-g004" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g004</object-id><label>Figure 4</label><caption><title>Forrest plot summary of textured material effects on perceptual-motor performance in upright balance or walking tasks.</title><p>CI = confidence interval; eld. = elderly group; PD = Parkinson’s disease; IV = inverse variance; random = randomized; SMD = standardized mean difference; Wt = weight. Note: within groups vs baseline and between <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> groups vs baseline.</p></caption><graphic xlink:href="pone.0060349.g004"></graphic></fig><p>The walking group sample characteristics may have underpinned the homogeneity in summary effects. Of the four, three studies <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> involved elderly participants (n = 176) with an average age of 70.6 yrs (range = 79.4–65.1 yrs), one of which involved a subgroup with Parkinson’s disease <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>. Another study involved participants who had been diagnosed with plantar insensitivity <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>. The fourth study was of a group of 14 middle-aged adults (average 41.8 yrs) diagnosed with both multiple sclerosis (MS) and plantar insensitivity <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>. In contrast, the upright balance effect size summary included both young <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>–<xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref> (n = 181, 25.1 yrs) and elderly <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> (n = 145, 70.5 yrs) participant samples and also had one study that involved a group with chronic ankle instability <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>. To determine whether sample characteristics were related to heterogeneity, we subsequently undertook a subgroup analysis of age utilizing only the upright balance data from healthy participants (<xref ref-type="fig" rid="pone-0060349-g005">Figure 5</xref>).</p><fig id="pone-0060349-g005" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g005</object-id><label>Figure 5</label><caption><title>Forrest plot summary of textured material effects on perceptual-motor performance in upright balance tasks – age grouped.</title><p>CI = confidence interval; IV = inverse variance; random = randomized; SMD = standardized mean difference; Wt = weight. Note: within groups vs baseline.</p></caption><graphic xlink:href="pone.0060349.g005"></graphic></fig></sec><sec id="s3g2"><title>Summary effects of age, vision and stability in upright balance tasks</title><p>Homogeneity was found in the young subgroup in addition to significant small to moderate subgroup effects in favour of texture for improved perceptual-motor performance (SDM = 0.28, <xref ref-type="fig" rid="pone-0060349-g005">Figure 5</xref>). In contrast, however, the elderly subgroup analysis showed significant heterogeneity suggesting that task or experimental design-related factors were influencing levels of variability across effect sizes (<xref ref-type="fig" rid="pone-0060349-g005">Figure 5</xref>).</p><p>To highlight variations in task design variables we next calculated summary effect sizes for different levels of vision (eyes open and eyes closed) and stability (stable and unstable) for each subpopulation (young and old), the results of which are sumarised in <xref ref-type="fig" rid="pone-0060349-g006">Figure 6</xref>. Whilst, it was not feasable because of the small number of studies comprising subgroups, this qualitative analysis may provide a platform for organising studies as more findings are published. For young participants, two conditions, eyes closed by stable and eyes closed by unstable, revealed pooled effect size estimates that appear meaningful (SMD = 0.20 and 0.55 repectively). Furthermore, for elderly participants, on the other hand, three conditions, eyes open by unstable, eyes closed by stable and eyes closed by unstable, displayed pooled effect size estimates that suggest meaningful values (SMD = 0.60, 0.30 and 0.36 respectively).</p><fig id="pone-0060349-g006" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journal.pone.0060349.g006</object-id><label>Figure 6</label><caption><title>Pooled summary effect sizes in upright balance tasks grouped by ‘common’ experimental design constraints.</title><p>CI = confidence interval; IV = inverse variance; random = randomized; SMD = standardized mean difference.</p></caption><graphic xlink:href="pone.0060349.g006"></graphic></fig></sec></sec><sec id="s3h"><title>Follow-Up</title><p>Six studies utilized a pre-post test design <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>. Three studies <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> reported significant improvements in performance measures with added texture (vs. control). Perry et al. <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> required an experimental group of participants to wear textured inserts for 12 weeks. However, they showed that in the experimental group, performance measures, whilst significantly better in the pre-test, were not significantly different (vs. control) in the post-test. Intriguingly, this was because performance under the no-texture condition increased to levels similar to the with-texture condition. Also in this study, during the 12-week period, 12 participants reported falling events, nine of which were in the control group. Palluel et al. <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref> and Palluel and Nougier <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref> observed young and elderly participants under eyes closed and double limb support conditions, with both reporting an overall significant reduction in centre of pressure sway area (vs. control) regardless of age. Palluel et al. <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref> reported a significant interaction for age and resting task. Similar reductions in centre of pressure sway area were reported for older and younger participants after five minutes of <italic>standing stationary</italic> and <italic>walking</italic> between postural sway tests, respectively. Palluel and Nougier <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref> replicated these findings reporting that standing between sessions was more beneficial for elderly participants and walking more beneficial for young participants. However, this study differed in that during rest periods - involving standing still or walking - participants wore the textured material.</p></sec></sec><sec id="s4"><title>Discussion</title><sec id="s4a"><title>Using Texture for Improved Perceptual-motor Performance</title><sec id="s4a1"><title>Material characteristics</title><p>The purpose of introducing texture is to enhance the sensory input from regions of indentation. The proposed mechanism for the effects involves an increase in the rate of discharge from stimulated groups of cutaneous receptors. Indentation or stretch at sufficient intensity provides information about characteristics of the material, such as roughness, spatial resolution and orientation. However, it needs to be resolved whether greater quantities or amplitudes (depth) of indentations caused a greater number of receptors to fire and at higher rates <xref ref-type="bibr" rid="pone.0060349-Hatton3">[16]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kennedy1">[41]</xref>, the data clearly suggests the relationship is not so simple. Additionally, because characteristics such as shape, contouring or hardness might influence the degree of deformation of skin receptors, it is reasonable to expect that these factors too would influence receptor stimulation to some degree <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>. The data presented in this review showed that whilst texture enhanced perceptual-motor functionality, effects were dependent on contextual factors such as individual, environmental and/or task constraints and were strong enough to distort any systematic effects of packing density previously shown by Watanabe and Okubo <xref ref-type="bibr" rid="pone.0060349-Watanabe1">[1]</xref>.</p></sec><sec id="s4a2"><title>Upright balance and age</title><p>Regulation of the centre of mass enables people to maintain upright posture and is believed to be a key factor for falls risk in elderly participants <xref ref-type="bibr" rid="pone.0060349-Lord2">[58]</xref>. Because ageing negatively effects structural (e.g. receptor morphology) and functional (e.g. nerve condition velocity) components of the somatosensory system, texture is introduced on the basis that it can stimulate peripheral receptors that are otherwise not being stimulated <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>. Indeed, older adults have been observed to have increased muscle activity in leg muscles, suggesting a reliance on conscious strategies for postural stability <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref>, <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>, a conclusion supported by observations of more deterministic patterns of postural sway in older adults by other research groups <xref ref-type="bibr" rid="pone.0060349-Riley1">[59]</xref>, <xref ref-type="bibr" rid="pone.0060349-Seigle1">[60]</xref>.</p><p>It is clear that further research in elderly populations is required, for instance studies by Qiu et al. <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, Tremblay et al. <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> and Maki et al. <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref> comprised the only efforts to evaluate effects of texture on upright balance under unstable postural conditions. Certainly the moderate to large summary effect sizes in favour of texture (0.52) shown in the study by Qiu et al. <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref> warrant further evaluation. This is especially the case given the design differences between the studies of Qiu et al. <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref> (who used foam to induce instability with texture added at foot sole) and Maki et al. <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref> (where perturbations were induced by moving the platform and including a dual task), and Tremblay et al. <xref ref-type="bibr" rid="pone.0060349-Tremblay1">[12]</xref> (who used foam to induce instability, but the finger tip was the point of texture contact as opposed to the foot sole in Qiu et al. <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>).</p><p>Nonetheless, the data unequivocally show that during upright balance tasks, the largest and most reliable effects in favour of added textured material were observed in young, healthy individuals (0.28). Furthermore, these favourable effects were strongest under conditions where reliance on somatosenory system information was exacerbated by removal of visual information (0.55). Therefore, textured material effects, here, support the notion that interaction with texture improves body awareness and specifically the spatial representation of the pressure distribution at the foot sole <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>. It may be for instance that an external focus of attention was implicitly supported, a combination previously associated with improved perceptual performance <xref ref-type="bibr" rid="pone.0060349-Chiviacowsky1">[61]</xref>.</p><p>These findings are also in line with data reported by Waddington and Adams <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>. In two studies, young athletes wearing socks and shoes with textured inserts were able to discriminate between five different joint positions with success equivalent to barefoot conditions. Their sensory discrimination performance was significantly better than when wearing shoes with no added insoles and socks.</p><p>However, it should be noted that there exist potentially separate mechanisms to explain why young participants display enhanced joint position discrimination, which might be considered a mainly sensory detection problem, as opposed to a coupled, perceptual-motor problem, as in the case of postural regulation. Furthermore, the mechanisms for these reported somatosensory facilitation effects remain unknown <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Welch1">[62]</xref> and were a question beyond the scope of the current study.</p></sec><sec id="s4a3"><title>Walking</title><p>Alteration to sensory inputs at the foot sole have been clearly shown in movement kinetics and kinematics across studies in this review <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-Dixon1">[13]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-Chen1">[19]</xref>, <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref>, <xref ref-type="bibr" rid="pone.0060349-Ritchie1">[22]</xref> with the exception of data from Wilson et al. <xref ref-type="bibr" rid="pone.0060349-Wilson1">[18]</xref>. The collective weight of these findings support the notion that sensory feedback from cutaneous receptors in the foot sole is involved in determining movement strategies during walking <xref ref-type="bibr" rid="pone.0060349-Nurse1">[21]</xref> or during recovery actions such as stepping to recover balance <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>.</p><p>Taken in conjunction with the results of the meta-analysis, however, some doubts emerge on the efficacy of added texture in healthy elderly participants with only one study demonstrating any meaningful effect <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, which was not in favour of an intervention. Furthermore, there remains doubt about which direction changes in outcome measures, such as walking speed, reflect a functional improvement. For instance, in healthy young participants, typically increases in gait variables such as walking velocity, cadence and step length are interpreted to the functional direction of effect. Contrary to these observations, however, a number of studies reported reductions in gait variables <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, but were nonetheless interpreted as functional changes on the basis that the participants were either elderly <xref ref-type="bibr" rid="pone.0060349-Hatton2">[9]</xref> or diagnosed with MS <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref> and hence, reflected and increased level of caution.</p></sec></sec><sec id="s4b"><title>Long Term Usage</title><p>Textured materials appear to be utilized continuously by participants in that, after their removal, performance deteriorates back to baseline levels <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>. Intriguingly, in the study by Perry et al. <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> measures taken during walking over a series of uneven platforms showed that, after 12 weeks of resistance training, performance began to converge between the group that wore textured insoles for the 12 week period and the group that did not. Perceptual-motor stability has been observed previously in muscles that underwent four weeks of resistance training. Improvements in measures of coordination stability were observed (compared to muscles or participants that did not undergo training) <xref ref-type="bibr" rid="pone.0060349-Carroll1">[63]</xref>. The suggestion then, is that stability in perceptual-motor performance may be facilitated through textured material, and/or resistance training programs.</p></sec><sec id="s4c"><title>Advantages and Disadvantages for Using Textured Materials</title><p>The principal advantage of using textured materials appears to involve facilitating the tighter regulation and control of spatial and temporal characteristics of the centre of mass over an individual’s base of support. Improvements in the ability to detect information changes, such as changes in balance <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Hatton1">[7]</xref> or the positioning of a limb <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref>, might help prevent falls <xref ref-type="bibr" rid="pone.0060349-Hartmann1">[8]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> and injuries <xref ref-type="bibr" rid="pone.0060349-Waddington1">[23]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref> or facilitate the perception of useful information, supporting adaptive regulation of movement <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>.</p><p>There appear to be no disadvantages regarding use of textured materials that cannot be overcome and preclude their utilization. There are, however, two concerns raised in the literature that warrant consideration in future research, product development or application: comfort <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>, <xref ref-type="bibr" rid="pone.0060349-Waddington2">[24]</xref> and time course of sensory re-calibration <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>.</p><p>Comfort is an important research, design and clinical issue. It is recommended that future work be guided by the nature of environmental and task-related constraints that will determine how textured materials will be interacted with. To exemplify, the design needs of a textured surface for an athlete who might perform repetitive and forceful contacts with a textured surface will be different to those of an elderly individual undertaking daily activities or of a patient with peripheral neuropathy who may have ulcers and wounds on the foot surface <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>. Some studies have reported participant discomfort with the use of textured materials <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, whilst, one 12 week study reported no occurrences of discomfort associated with textured material use. To ameliorate discomfort, design strategies can include utilizing soft insole material <xref ref-type="bibr" rid="pone.0060349-Qiu1">[5]</xref>, strategically placing texture <xref ref-type="bibr" rid="pone.0060349-Maki1">[6]</xref>, <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref> or utilizing customized devices such as orthotic insoles <xref ref-type="bibr" rid="pone.0060349-Corbin1">[17]</xref>.</p><p>With regards to sensory re-calibration, a number of experimental and clinically relevant recommendations can be provided. There is some evidence that a short period of exposure (through sustained contact or activity) is important in order that improvements in performance with added texture might take effect [five minutes of contact or four trials can be recommended, 2,10]. In addition, when participants remove insoles, there is evidence that performance deteriorates for a short period of time <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>. These phenomena are believed to reflect a short term process of sensory re-calibration <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, and hence it is recommended that in future research, and in applied settings, that users are allowed a period of at least five minutes pre- and post-usage in order to benefit from the textured material, and to re-adapt in cases of it’s withdrawal. It should also be noted that concerns for potential long term habituation (i.e. an adjustment in the resting sensory detection threshold) with added texture appear to be unfounded, with long term studies suggesting no such effects <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>.</p><p>Furthermore, there appear to be interactions with disease factors that are currently not fully understood <xref ref-type="bibr" rid="pone.0060349-Jenkins1">[10]</xref>, <xref ref-type="bibr" rid="pone.0060349-Kelleher1">[14]</xref>, <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>. McKeon et al. <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref> found that performance in individuals with chronic ankle instability reduced performance with added texture in a single limb stance task (vs. control). Although, in this study no time was provided for participants to become accustomed to the texture, the findings suggest that, in the presence of chronic ankle instability, performance is reduced <xref ref-type="bibr" rid="pone.0060349-McKeon1">[15]</xref>. Hence, future research is needed to determine whether this is an acute or long term effect in such individuals.</p></sec><sec id="s4d"><title>Limitations and Future Study</title><p>This study undertook a comprehensive search of relevant databases and meticulously assessed supplementary materials. We acknowledge however, that the gray literature (material not formally published) may contain other relevant studies subsequently overlooked. Additionally, no study had a registered protocol and hence accurate assessment of reporting bias was constrained. Finally there were a number of outcomes where summary values were extracted from graphs and although minimization involved two independent reviewers undertaking this, with inconsistencies resolved through third party consensus, the data extracted this way reflects an estimation of treatment effect.</p><p>The findings of this systematic review suggest a number of fruitful avenues for future research. There is unequivocal evidence that young, healthy individuals improve perceptual-motor performance with added texture. Furthermore the increased stability in perceptual-motor performance for young participants with short term exposure <xref ref-type="bibr" rid="pone.0060349-Palluel1">[2]</xref>, <xref ref-type="bibr" rid="pone.0060349-Palluel2">[3]</xref>, taken together with data showing maintenance of performance over long time scales in elderly participants <xref ref-type="bibr" rid="pone.0060349-Perry1">[11]</xref>, provides reasonable evidence that texture is robust to habituation and exploited on-line. It is likely that distinct populations, such as developing elite athletes or young children over the age of eight yrs <xref ref-type="bibr" rid="pone.0060349-Gori1">[64]</xref>, might also respond to added textured material in contexts to enhance somatosensory perception during learning and development <xref ref-type="bibr" rid="pone.0060349-Woollacott1">[65]</xref>. Additionally, added texture is likely to be valuable in performance of highly constrained movements where visual perception of information is challenging <xref ref-type="bibr" rid="pone.0060349-Elliot1">[66]</xref>, such as in high speed interceptive actions (e.g. kicking, batting, catching etc.), or in the presence of exercise induced fatigue <xref ref-type="bibr" rid="pone.0060349-Pinsault1">[67]</xref>–<xref ref-type="bibr" rid="pone.0060349-Vuillerme1">[69]</xref>. Should findings confirm, for example, that with textured insoles, kicking performance improves, then this observation would open the way for examining the functional utility of textured inner garments or texture applied to important objects and surfaces in performance environments. It is also entirely possible that extended time scale benefits of textured material could reveal themselves under transfer and retention tests, or in injury occurrence rates. Furthermore, there may also be an opportunity to combine textured materials with biofeedback techniques currently emerging as a useful method for providing augmented feedback for improving perceptual-motor performance <xref ref-type="bibr" rid="pone.0060349-Baudry1">[70]</xref>, <xref ref-type="bibr" rid="pone.0060349-Vuillerme2">[71]</xref>. These various research opportunities are yet to be explored in the extant literature.</p><p>Current research efforts have only just begun to explore the role of added texture in populations with perceptual-motor deficits, and indeed there is clear scope for future research in this area. For example, it needs to be understood whether, in clinical groups (e.g. diabetic peripheral neuropathy, Parkinson’s disease or MS), textured materials might provide potentially stronger benefits than in healthy populations. Whilst there is clear supportive evidence across a number of studies, further research with larger sample sizes and under conditions that require reliance on cutaneous inputs is required. Furthermore, the risk-of-bias assessment revealed that there was bias for blinding across studies. Whilst it is acknowledged that it is often difficult to allocate resources necessary to blind assessors or include sham conditions to control for potential placebo effects, future studies should begin to address this issue to improve the quality of work in this area. As a final point, the review uncovered a void of research into the utility of texture in other settings such as work environments, military or hospitals. Adding texture to surfaces or tools may well facilitate improved performance behaviours in these contexts.</p></sec><sec id="s4e"><title>Conclusion</title><p>Utilizing methods derived from systematic review and meta-analysis <xref ref-type="bibr" rid="pone.0060349-Moher1">[72]</xref> (see <xref ref-type="supplementary-material" rid="pone.0060349.s002">ChecklistS1</xref>), this study provided clear evidence for the role of textured material in improving perceptual-motor functionality in young healthy individuals and serves as a strong basis for future research with such individuals. Textured material is also likely to be robust to habituation effects and research to evaluate whether it may improve learning will be an important research step. Also discussed is the likelihood that texture materials should improve performance under constraints where high movement speeds reduce opportunity for visual perception, such as in elite sport contexts, but which as yet requires confirmation. Finally, future research with larger sample sizes and more effective experimental control is also clearly required in elderly and clinical populations due to ongoing variability across effect size estimates.</p></sec></sec><sec sec-type="supplementary-material" id="s5"><title>Supporting Information</title><supplementary-material content-type="local-data" id="pone.0060349.s001"><label>Table S1</label><caption><p><bold>Study Characteristics.</bold></p><p>(DOCX)</p></caption><media xlink:href="pone.0060349.s001.docx" mimetype="application" mime-subtype="msword"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material><supplementary-material content-type="local-data" id="pone.0060349.s002"><label>Checklist S1</label><caption><p><bold>PRISMA 2009 Checklist.</bold></p><p>(DOC)</p></caption><media xlink:href="pone.0060349.s002.doc" mimetype="application" mime-subtype="msword"><caption><p>Click here for additional data 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