Title: Considerations for multimodal prehabilitation in women with gynaecological cancers: A
scoping review using realist principles
Version: 1 Date: 25 Apr 2022
Reviewer:  Thane Chambers
Reviewer's report:
Thank you for your paper. It was interesting to learn more about prehabilitation for
gynaecological cancer patients. I hope the feedback below will help to make your paper stronger.
ABSTRACT In the methods section you note that social media posts were not included in your
analysis, however I don't see in your paper a specific search for social media posts etc (beyond
perhaps the google web search) so I'm not sure why this needs to be included in the abstract. As
it looks like you were only analyzing research studies, social media posts would probably not
make it through your inclusion/exclusion criteria anyway. Maybe just focus here on what was
included rather than what was excluded?
BACKGROUND I would recommend making a stronger case for doing this review. You state
that little is known about prehabilitation for gynaecological cancer patients and you do mention
that post-operative prehabilitation for abdominal cancer patients exists. But beyond this there
is not a compelling reason offered in your background as to why this study is needed and what
it could offer. Can you add in some more background information about prehabilitation and
its potential benefits? This may compel clinicians who work with gynaecological patients to
continue reading the article. And my inspire patients with gynaecological cancer to push for
this type of intervention. Either in this section or the Methodology section, I would recommend
better explaining the combination of using a scoping review and realist review methods and
what this combination of methods offers to your research questions. As it currently stands, I
found it confusing.
METHODOLOGY Step 1: Define the review scope. This section is confusing. Basically it only
describes your inclusion/exclusion criteria for the included studies. If that's the case, then why
not just describe the inclusion/exclusion criteria. And then add a section about the research
questions being answered by this study. Step 2: Development of Initial Theories. You write the
following, "Initial programme theories derived by the research team to describe a theoretical
relationship between contexts, mechanisms and outcomes underlying delivery and engagement
with prehabilitation in gynaecological cancers." But you do not explain how this was done or
what theories were used in this review. Please provide more information about how these initial
theories were developed, what they were, and how they were used in your analysis. Step 3:
Evidence search. Please provide the dates the searches were conducted, the platforms used for
the databases searched e.g. Ovid MEDLINE. Also, the database Psychinfo is actually named,
PsycINFO. You write in this section, "For completeness, the references of all reviews, guidelines
and generic web resources were manually screened for possible inclusion." This is unclear. I
would be very surprised if you were able to review the references for all studies retrieved by your
search. Should these read instead that the references for included studies were reviewed? For
your searches in the following databases that use controlled vocabularies, MEDLINE, Embase,
CINAHL, Central,  and PsycINFO it seems strange that these controlled vocabularies were
not used in these search strategies. For example, the MeSH term Ovarian Neoplasms should
have been searched for. If the term Ovarian Neoplasms had been exploded in MEDLINE,
it would have also retrieved articles with the following MeSH headings: Luteoma, Meigs
Syndrome, Sertoli-Leydig Cell Tumor, and Thecoma which would have been missed by the
current search strategy. Please provide the bibliographic database fields that were searched (e.g.
title, abstract, subject headings, etc.). In Table 1, the search strategies are listed. For the databases
MEDLINE, Embase, Emcare, CINAHL, AMED, BNI, PsycINFO there are 3 sets of terms
(cancer, gynaecology, prehabilitation), however, it is not shown how these groups of terms were
combined. I'm guessing that was with the Boolean operator AND, but I do not know this. Step 4:
Data Selection and Appraisal On line 144 you state that you used COVIDENCE for screening.
Above on line 89, you write that you used Zotero to manage the citations for this review. It's
totally fine to use both programs, but please clarify how zotero was used. Lines 147-148 Describe
how the CASP tool was used for qualitative studies. I’m curious about the decision to do quality
appraisal and find it puzzling. JBI states Critical appraisal or risk of bias assessment is generally
not recommended in scoping reviews because the aim is to map the available evidence rather
than provide a synthesized and clinically meaningful answer to a question. Peters, M; Marnie,
C.; Tricco, A; Pollock, D; Munn, Z.; Alexander, L.; McInerney, P.; Godfrey, C.M.; Khalil, H.
Updated methodological guidance for the conduct of scoping reviews, JBI Evidence Synthesis:
October 2020 - Volume 18 - Issue 10 - p 2119-2126 doi: 10.11124/JBIES-20-00167. Ramses
guidelines do state that appraisal can be used, but that appraisal method should be explained to
readers. CASP tools measure the methodological rigor of qualitative studies, not sure how this
type of appraisal benefits a study whose questions are about mechanisms. RESULTS Why were
qualitative studies appraised using CASP tool but other studies designs were not? It is stated
that the other studies were not appraised because they were mostly protocols or abstracts. But
still based on the included study designs listed it looks like the CASP tools for cohort studies,
Economic Evaluation Checklist, and possibly the Systematic Review Checklist (if the review
was systematic review) could have been considered. Please specify what type of review was
included (e.g. systematic review). I am very confused about how Research Protocols could be
included in this review. Based on what I know, research protocols describe how studies will be
conducted but they do not have results located within them. I'm having trouble understanding
how protocols would contain data that could be analyzed. Please provide more information about
this decision and what types of data was available that related to your research questions that
could be analyzed.
Because I have so many questions about the methods used in this study, I will refrain from
providing peer review on the discussion and this study's conclusions. I would recommend that
the authors use RAMESES II reporting standards for realist evaluations and explore how this
study fulfilled or doesn't fulfill these standards. Since this is also a scoping review, going through
the same exercise with PRISMA-ScR could be beneficial.