Review for 10.1186/s12876-024-03533-z (2024)

Title: Impact of exercise on outcomes among Chinese patients with Crohn's disease: A mixed
methods study based on social media and the real world
Version: 1 Date: 02 Oct 2024
Reviewer:  Yuquan Chen
Reviewer's report:
The manuscript titled "Impact of exercise on outcomes among Chinese patients with Crohn's
disease: A mixed methods study based on social media and the real world" addresses a critical
topic given the increasing incidence of Crohn's disease (CD) in East Asia and the lack of
standardized exercise guidelines for Chinese patients. The mixed-methods approach employed
by the authors, combining qualitative data from social media and interviews with quantitative
analysis of patient-reported outcomes, is commendable. However, the manuscript requires
significant revisions to improve its clarity, methodological rigor, and overall presentation of the
findings.
The introduction, while emphasizing the importance of exercise for CD patients, lacks depth in
connecting previous research on Western populations to the current study. It would benefit from
a more detailed discussion of existing exercise interventions and outcomes in CD populations,
providing a clearer rationale for why the study is necessary in the Chinese context. Expanding
this section with a critical analysis of past research would help frame the study’s objectives more
convincingly.
The integration of qualitative and quantitative methods is not well articulated in the manuscript.
There should be a clearer explanation of how the qualitative data, particularly the findings from
social media and patient interviews, informed the quantitative component of the study. A more
explicit discussion of how these two methods complement each other would enhance the study’s
methodological coherence and the strength of its conclusions.
The Latent Dirichlet Allocation (LDA) model used for analyzing social media data is not
sufficiently detailed. The manuscript does not adequately explain how the optimal number of
topics was chosen, nor how the LDA results were validated. Additionally, the coding process for
the qualitative interview data is described briefly, but more information on how the themes were
identified and triangulated with the LDA findings is necessary. Without this, the robustness of
the qualitative analysis is questionable.
In terms of statistical analysis, the manuscript does not discuss how the study ensured sufficient
statistical power for its quantitative findings. There is a lack of clarity on how confounding
factors, such as medication use or disease severity, were controlled in the correlation analysis
between physical activity and patient-reported outcomes. These variables could significantly
influence the results, and their omission from the analysis reduces the study’s validity.
The interpretation of the findings, particularly the correlation between physical activity and
mental health outcomes like depression, appears oversimplified. A more nuanced discussion is
needed, especially regarding cultural factors that may influence exercise behavior in Chinese
patients with CD. The manuscript should explore possible explanations for the observed
correlations and consider alternative hypotheses.
While the authors acknowledge some limitations, the discussion is not comprehensive. The
sample size, particularly for the qualitative interviews, is small, and there is no clear indication
of how data saturation was achieved. Furthermore, the reliance on self-reported data for physical
activity and outcomes introduces potential bias that should be more thoroughly addressed. The
limitations section would benefit from a more transparent discussion of these issues.
Ethical considerations related to the use of social media data are underdeveloped in the
manuscript. While ethical approval for the study is mentioned, there is no detailed explanation of
how participant consent was managed, particularly for the data mined from online platforms. A
clearer ethical framework is needed to ensure that the study’s approach is aligned with accepted
standards for research involving human subjects.
The figures and tables in the manuscript, particularly those related to the LDA analysis, are
difficult to interpret. For example, Table 1 presents representative term clusters from the LDA
model, but these clusters are not explained in sufficient detail. Providing clearer visualizations
or additional explanations would make it easier for readers to understand how the topics relate
to the exercise experiences of CD patients. Improving the quality and clarity of the figures is
essential for enhancing the manuscript’s overall readability and impact.
In conclusion, while this study provides valuable insights into the role of exercise in managing
Crohn's disease, particularly in the Chinese context, substantial revisions are necessary to
improve the clarity and rigor of the research. I recommend a major revision to address the
methodological concerns, enhance the interpretation of the results, and improve the overall
presentation of the manuscript.