Title: Considerations for multimodal prehabilitation in women with gynaecological cancers: A
scoping review using realist principles
Version: 1 Date: 04 May 2022
Reviewer's report:
Thank you for the effort in promoting women’s health. Overall, the paper is well-written and
there are some problems that need to clarify.
Abstract
1. In the Background, why focus on gynaecological cancer patients? Here lacks some transition
to gynaecological cancer patients.
Methodology
2. Page 4, line 91: Five key steps for what? For a scoping review or some other?
3. Page 5, line 97: In your eligibility criteria, you need to mention that abstracts and protocols
will be included with reasons.
4. Page 7, line 146 and line 147: “Other study designs were not formally appraised for quality,
as the majority were abstracts or protocols only.” Are these designs included or excluded? If not
appraise quality, how to make sure that the abstract and protocols qualify to make a conclusion?
Results
5. Page 12, line 275: Please provide the definition of the intended and unintended outcomes in
advance and mention what are their corresponding outcomes.
6. Page 12, line 284: “Only a few published studies reported the outcomes of their prehabilitation
programme.” Do published studies include interventional studies and protocols? This is
confusing since you mention previously “Interventional studies and protocols included a wide
variety of outcomes”.
7. Page 13, line 293: Please mention what is the study before introducing their specific results,
e.g. ”none of the six smokers stopped smoking during the pre-operative period.”
8. Page 13, line 305: Please follow the sequence (key components, skills and contexts) to
describe the corresponding results. How to differentiate key components and the most acceptable
activities?
9. Page 14, line 330: “Key mechanisms and contexts underpinning engagement with
prehabilitation can be summarised by five overarching themes.” How these themes are formed?
10. Page 14, line 334: the heading “The acceptability of prehabilitation by patients”, is confusing
for the results listed under this heading. It seems that the results can be classified as acceptable
components in the prehabilitation programme by patients. The acceptability here does not match
the contents very well. You need to first define what the acceptability of prehabilitation by
patients is. Not only acceptability, but you also need to explain or define what will be included
in the five questions you intend to answer, or some key terms in your five questions for readers
to understand.
11. Page 15, line 357: “As for the interventional trials, two studies intend to assess acceptability
and or satisfaction of the programme through exit interviews/questionnaires (25,28).” What is
the acceptability of interventions in these trials?
12. Page 16, line 362: “treatment-related outcomes and cancer-related outcomes (39,39,41,42)”.
Something wrong here with your citations.
13. Page 17, line 401: “Another important accessibility issue relates to ethnic and socio-
economic diversity”. Where does this judgment come from? Please cite relevant references.
Discussion
14. Please discuss following your aims or the five questions you intend to answer. After the
review, you can also try to provide your definition of prehabilitation in gynaecological cancer
patients after your work.
15. Page 18, line 422 and 423: “We were already aware that there are no published
trials for prehabilitation within gynaecological cancer.” Since there are no published trials
for prehabilitation within gynaecological cancer, why not include a unimodal intervention
programme?
16. Page 19, line 447: “One study presented a working prehabilitation model for women
undergoing surgery”. What about the other study that uses theory (citation 26)?