Review for 10.1186/s12876-025-04059-8 (2025)

Title: Clinical Application of pre-rehabilitation concept on comfort colonoscopy in Chinese
elderly patients: a randomised controlled trial
Version: 0 Date: 22 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction explains the importance of bowel preparation and its challenges, it could
briefly mention current strategies or interventions for improving bowel preparation quality and
patient comfort in colonoscopy. This would help to position the pre-rehabilitation approach
within the landscape of existing practices.
-While the challenges associated with elderly patients are mentioned, further elaboration on
how age-related factors such as frailty, polypharmacy, and cognitive decline might affect
the preparation process would help deepen the understanding of why elderly patients are at
heightened risk for poor bowel preparation.
-While the methods section describes how patients were separated into pre-rehabilitation and
control groups after matching for confounding factors, it does not mention randomization.
Randomizing participants into groups would reduce the risk of selection bias and increase the
study's internal validity. Additionally, if possible, blinding of participants or outcome assessors
could further reduce bias, particularly when measuring patient satisfaction and adverse effects.
-The psychological counseling component of the pre-rehabilitation intervention is described
briefly, but it would be helpful to specify the content or structure of the counseling sessions.
For instance, how long were the counseling sessions? What key topics were addressed (e.g.,
anxiety reduction, education on the colonoscopy process)? More detail would help clarify how
this component of the intervention could impact patient outcomes.
-While adverse effects are monitored during and up to 48 hours after the colonoscopy, a
longer follow-up period could be valuable to assess any delayed complications or longer-
term outcomes. Given that elderly patients may experience delayed reactions or complications,
extending the monitoring period could offer a fuller picture of the intervention's safety profile.
-Although the pre-rehabilitation group receives psychological counseling, the control group only
receives standard bowel preparation. It might be worthwhile to offer some psychological support
to the control group as well, to control for potential confounding effects of counseling. This
would help determine whether the improvements observed in the pre-rehabilitation group are due
to the nutritional aspect alone or the combination of both components (nutrition + psychological
counseling).
-Although the discussion acknowledges the limitations of the study, it could benefit from more
detailed reflection on potential confounding factors that could have influenced the outcomes.
For instance, while the study compares the pre-rehabilitation and control groups, the absence of
randomization and blinding could lead to bias in patient selection or outcome reporting. A more
explicit discussion of how these biases might affect the results would provide more transparency.
-The discussion highlights the lack of long-term data and suggests that future studies should
assess the long-term prognosis of patients in the pre-rehabilitation group. While this is a valid
point, it would be helpful to elaborate on the types of long-term outcomes that could be assessed,
such as recurrence of polyps or the long-term benefits of pre-rehabilitation on overall health
and well-being.
-While the discussion explains the benefit of psychological counseling in reducing anxiety, it
could delve deeper into the specifics of the counseling interventions. For example, how much
time was spent on psychological counseling, and what content was provided? Did the counseling
focus on stress reduction techniques, education about the colonoscopy process, or other aspects?
Clarifying these details could provide insights into which elements of the counseling were most
effective.