The PREPARE Study: Acceptability and Feasibility of a Telehealth Trimodal Prehabilitation Program for Women with Endometrial Neoplasia
, Paula A. B. Ribeiro 1, Danielle Moreau-Amaru 3, Emmanuelle Robert 3, Sara Forte 3, Alain S. Comtois 2, Vanessa Samouëlian 3,4,5,†and François Tournoux 1,6,†Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear authors congratulations on your work. In the file you can find my comments.
Comments for author File: 
Comments.pdf
Author Response
We carefully considered the comments of the reviewer and hope we have successfully addressed them. Below, we provided detailed responses to the reviewer and a description of the changes we have made.
ABSTRACT
Reviewer comment 1: What do you mean eligible? You don’t state the inclusion criteria. Please include them in one sentence in the abstract
Response: Thank you for this comment. Considering the very limited number of words permitted for the abstract, we have prioritized adding additional information about the assessments (comment 2) and the conclusion (comment 3). Also, the only inclusion criterion is patients with endometrial neoplasia awaiting surgery. We added “awaiting surgery” in the sentence for more precision.
Reviewer comment 2: How did you measure quality of life functional capacity? Please include them in one sentence in the abstract.
Response: We have made the suggested changes to the abstract.
Reviewer comment 3: provides benefits: what kind of them? Seems unclear.
Response: The potential benefits are described in the results such quality of life and functional capacity and possibly higher proportions of same day hospital leave. We have improved the sentence to better reflect this by mentioning clinical gains (hospital leave) and patient-centered gains (quality of life and functional capacity).
INTRODUCTION
Reviewer comment 4: is well written
Response: We thank you for your appraisal
METERIALS AND METHODS
Reviewer comment 5: Line 75: Detailed explanations. please explain how this happened, written material? Conversation? Informed consent?
Response: Thank you for this comment. Explanations were provided by phone and in the written informed consent form that was send by email. We added precisions in the first paragraph of section 2.1 on page 2.
Reviewer comment 6: Line 115-116: All the nutritional and psychological interventions were delivered by professionals from the gyneco-oncology service: who where they? Write in detail which professional did what. Do you have a multidisciplinary team involved?
Response: Yes, there was a multidisciplinary team involved including a registered dietician, an onco-psychologist and kinesiologists all specialized in oncology. Though it is detailed in each intervention subsections, we added a general sentence in section 2.3. to improve the clarity in accordance with your suggestion (page 3).
Reviewer comment 7: Line 168+170: introduce tools..: what tools?
Response: Thank you for this comment. We have improved the clarity of the description of the psychosocial intervention (see section 2.3.4.).
Reviewer comment 8:
- Line 110: write 2 to 8 weeks instead of 2-8.
- Line 122: the reference (Michie et coll. 2013) should be numbered like the others…
- Line 144: RPE… I am missing the full meaning. Please write it.
- Line 245: Zanini 2019: the reference should be numbered like the others…
Response: RPE was already described earlier in the text (see end of section 2.3.1.). All other suggestions provided have been applied to the manuscript. Thank you for your comments.
RESULTS
Reviewer comment 9: are well described.
Response: We thank you for your appraisal
DISCUSSION
Reviewer comment 10: Line 428: MCID: I am missing the full meaning. Please write it.
Response: We thank you for pointing this out. Though we wrote the full meaning of this abbreviation in the methods, we realise it would be best to avoid using it considering this was also mentioned by the other reviewer. We have spelled out the abbreviation for the entire manuscript (pages 11-12 and 14).
CONCLUSION
Reviewer comment 11: Include implications for practice.
Response: Implications for practice would be that telehealth prehabilitation programs could enhance the experience of women with endometrial neoplasia awaiting surgery by improving their quality of life and potentially shortening hospital stays. Considering this is a pilot feasibility study, these clinical and patient-centered gains, would need to be further explored in a larger trial. We added two sentences describing these implications for practice.
Reviewer comment 12: Include future recommendations.
Response: Considering our feasibility results, we recommend offering a choice among a continuum of telehealth interventions (ranging from minimal counseling/education to highly supervised multimodal interventions) which would meet the needs of high proportions of women with endometrial neoplasia during the preoperative phase. We improved the sentence describing these recommendations in the conclusion section on page 15. Also, permitting women to choose the intervention that best suit their needs, having few inclusion and exclusion criteria’s and offering remotely accessible supervised intervention using videoconference, are factors that likely contributed to the study’s feasibility success. These elements are well discussed in the first paragraph of the discussion and in section 4.1 on page 14.
Reviewer 2 Report
Comments and Suggestions for Authorsvery interesting article
innovation noted
you bring an important intervention as this strategy has demonstrated impact
even though it has limitations
Comments for author File: Comments.pdf
Author Response
We wish to thank you for reviewing our manuscript. We carefully considered the comments and hope we have successfully addressed them. Below, we provided detailed responses and a description of the changes we have made.
ABSTRACT
Reviewer comment 1: Line 19-20 describe the abbreviations for SPP and SSPP
Response: We adjusted the abstract accordingly. Thank you for your comment.
INTRODUCTION
Reviewer comment 2: Line 41-42: what do you mean by limited support
Response: Psychosocial support or exercise intervention is not part of the clinical routine in the preoperative phase of cancer treatment in our hospital center. We added precisions in the second paragraph of the introduction as suggested.
METERIALS AND METHODS
Reviewer comment 3: Line 115: how was the nutritional or psychosocial distress assessed
Response: Thank you for this comment. In the PACS group, only participants at risk of malnutrition based on the Canadian Nutrition Screening tool were referred to the dietician. We added a detailed description of the malnutrition screening criteria in section 2.3.3. on page 5.
The criteria for access to the psychosocial intervention for the PACS group was diagnosed clinical depression and was obtained from the participants’ electronic medical record at baseline. We also made this correction and added precisions in section 2.3.4 on page 5.
Reviewer comment 4: Line 143-144: assess how
Response: We think the reviewer is referring to the assessment of the rate of perceived exertion (RPE). It was assed using the Borg RPE scale (0-10) after each exercise during the second counseling session (initial familiarization to the exercises) and adjustments were made when the target intensity was not reached. kinesiologist regularly asked the participants to assess their RPE during and following the exercise session and adjustments were made if the target intensity was not reached. Also, participants were asked to describe in their journal the mean RPE for each exercise session. Precisions were added in section 2.3.1 and 2.3.2. on page 4.
Reviewer comment 5: Line 164: describe how and when the nutritional counseling was offered to the PACS group.
Response: Thank you for this comment. PACS participants that were at risk of malnutrition received the same nutritional intervention as the SPP and SSPP group as described in section 2.3.3. Precisions were added at the end of the section to clarify this.
Comment or query 6: Line 164: describe how psychological distress was assessed for the PACS group.
Response: As described in our response to the comment 3, the criteria to refer to the psychologist was diagnosed clinical depression and was obtained from the participants’ electronic medical record. We corrected the sentence in section 2.3 and added these details at the end of section 2.3.4.
Reviewer comment 7: Line 208: describe when the clinical, economic and patient-centered gains were measured.
Response: Assessment time points for all measurements are described in Table S2 of supplementary file 1 as mentioned in the first paragraph of section 2.4 on page 6. We added an additional reference to the file on this line on page 5.
RESULTS
Reviewer comment 8: Line 341. MCID: describe the full meaning
Response: We thank you for pointing this out. Though we wrote the full meaning of this abbreviation in the methods, we realise it would be best to avoid using it considering this was also mentioned by the other reviewer. We have spelled out the abbreviation for the entire manuscript (pages 11-12 and 14).
