Title: Considerations for multimodal prehabilitation in women with gynaecological cancers: A
scoping review using realist principles
Version: 3 Date: 31 May 2022
Reviewer:  Thane Chambers
Reviewer's report:
Thank you very much for your  responses to the previous peer review comments. I am happy
to report that the version I reviewed is much clearer. I hope that the following suggestions can
help to continue to improve it:
INTRODUCTION:
On lines 88-89, you wrote: Scoping reviews are particularly relevant for examining the extent,
range and nature of the evidence on a topic and for summarising findings from a heterogeneous
body of knowledge (14).
I would recommend incorporating this into the introduction in a better way. Currently it reads
like this sentence has just been added in without much thought. Some coherence with the rest
of the introduction would help.
METHODOLOGY:
On lines 94-96, you wrote:
Realist synthesis seeks to identify what contexts and mechanisms lead to particular outcomes,
thus helping to explain how and why interventions may or may not work (16). And then on lines
98-102, you wrote:
This review follows the Joanna Briggs Institute (JBI) guidelines for scoping reviews (17),
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping
Reviews (PRISMA-ScR) checklist (14) and also fulfils the Realist And Meta-narrative Evidence
Syntheses - Evolving Standards (RAMSES) publication standards for realist syntheses (15).
I guess I'm still confused. Is this study a scoping review OR is it a realist synthesis? I thought,
based on my readings of your responses to the peer reviewer comments, that you were now
doing a scoping review, but using realist principles to look at mechanisms and context. As it
currently reads, it sounds like you’re still doing a scoping review and realist synthesis. And this
is what caused much confusion in the previous version of this paper. Is this still the case? If so,
the confusion for me remains. Maybe in this section, it would make things easier for the reader
if you could better explain what aspects of the realist review you are using in this scoping review
and justify it clearly. Maybe referencing other studies that have combined scoping reviews and
realist syntheses and provide us with information about what was gained by this combination
would serve as a rationale for this decision?
METHODOLOGY Step 3 Search strategy
Thank you for clarifying your search strategy. I now see that many of the included databases were
searched via the National Health Service’s Healthcare Database (HDAS). Just a small point of
contention (which I realize may be unfair), because reviews should allow for replication using a
database that is only available in the UK (I believe) and has now been discontinued may not have
been the best plan. Because you state that duplicates were removed using that tool, I'm  assuming
that you searched multiple databases at one time. I found some information that if you're
searching HDAS using multiple databases then you are not able to use the controlled vocabulary
within that database. I found this information here: https://www.wuth.nhs.uk/media/18790/3-
hdas-full-user-guide.pdf
Can you please clarify if that was the case. I note in the Supplementary Tables that Table 1
includes a search strategy for the various databases and that Table 2 includes a list of keywords
and subject headings from various databases, but these subject headings do not seem to appear in
the search strategy itself. Is it possible to create a search strategy that displays the actual queries
that were run? Also, I strongly note that in my previous peer review I recommended that you
supply information about which database fields were searched. Although you indicate that this
has been done, if you look at Supplementary Table 1: Search strategies used for each repository
this data still is not present. Similarly, there are no boolean operators to describe how each search
concept was combined. This too was recommended in my previous peer review report, and the
response was that the information is now in the Supplementary Table. I still do not see it there.
I strongly recommend that you refer to the PRISMA for Searching checklist which calls for
you to include the search strategies for each database and information source, copied and pasted
exactly as run. It is available here https://osf.io/y765x/
DISCUSSION
The following comment is about this paragraph located on lines 529-533:
Qualitative studies included in this review have focussed primarily on Caucasian cohorts (38–
42).  Although the incidence of gynaecological cancers is greater amongst white women in the
UK (56), there is evidence of increasing incidence and mortality related to endometrial cancer
in black women (56).  This points to a need to ensure that future studies reflect the multi-
ethnic population and shed light on the factors which influence engagement with prehabilitation
amongst ethnic minorities.
You have capitalized Caucasian and keep the term black  in lower case. Please refer to this article
which provides guidance on this topic. Flanagin A, Frey T, Christiansen SL, AMA Manual of
Style Committee. Updated Guidance on the Reporting of Race and Ethnicity in Medical and
Science Journals. JAMA. 2021;326(7):621–627. doi:10.1001/jama.2021.13304
Also note strongly that Black is not an ethnicity so you should definitely  rewrite the last sentence
in this paragraph.