Adapted Exercise and Adapted Sport as Rights of Health Citizenship in Italy: A Legal–Policy Rationale and Framework for Inclusion in the Livelli Essenziali di Assistenza (LEA) and the Role of the Chinesiologo

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors The article is suitable for publication in this form, but I think that clearly defining the problem questions and answering them through the work would significantly increase understanding of the content.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This well-written and thoughtful manuscript provides a comprehensive and timely discussion on the integration of adapted exercise and adapted sport into Italy’s Livelli Essenziali di Assistenza (LEA). The topic is highly relevant to public health and disability rights, and the paper is clearly structured and well organized.

I would like to offer two supplementary suggestions that may further enhance the quality of the work:

1. Expansion of Comparative Perspective
   It might be beneficial to slightly expand the comparative discussion with other European countries (e.g., Germany, Sweden, Norway). In particular, adding reflections on which national model could serve as the most useful reference for Italy would make the analysis even more insightful.
2. Practical Implementation Challenges
   The paper could be further strengthened by including some reflections on practical challenges in implementing the proposed framework. For example, discussing considerations for the chinesiologo in fulfilling new professional roles would be informative for readers involved in practice.

Overall, this is an original and valuable contribution that effectively links health policy, ethics, and legal perspectives in a coherent and meaningful way. I recommend acceptance after minor revisions.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review your manuscript, which examines the legal–policy rationale for including adapted exercise and adapted sport within Italy’s Livelli Essenziali di Assistenza (LEA) and highlights the central role of the chinesiologo. It makes a meaningful interdisciplinary contribution and offers a valuable model for policy development.

Below I provide several suggestions intended to strengthen clarity, methodological transparency, structural balance, and the articulation of key messages across sections.

 

Comment 1

The abstract is comprehensive and informative, but it is relatively dense. You might consider simplifying the structure by more clearly distinguishing the background, methods, results, and conclusions. In particular, the methods section could benefit from a more concise description of the review approach, and the results paragraph could more clearly foreground the key findings before presenting the proposed LEA framework. This would improve readability and alignment with journal expectations.

 

Comment 2

In the introduction, you may improve the narrative flow by reducing some of the early detail on legal decrees and instead focusing initially on the broader public health and policy problem. Legislative details could be partially moved to the regulatory section, allowing the introduction to maintain clearer thematic progression from the evidence gap to the rationale for your review. A short paragraph explicitly stating the manuscript’s objectives at the end of the introduction would also help orient readers.

 

Comment 3

In the methods section, the description would benefit from greater transparency. I recommend adding information about: specific databases consulted, search periods, key terms used, the process for selecting legislative and policy documents, and any criteria for determining the relevance or credibility of non-scientific sources. While a narrative review does not require meta-analytic rigor, including a clearer methodological protocol would enhance reproducibility and strengthen confidence in the evidence synthesis.

 

Comment 4

In the results section, the volume of detail sometimes obscures the central analytical purpose of the paper (namely, how these scientific findings justify LEA inclusion). You might enhance this section by adding brief summary statements at the end of each clinical subsection, explicitly linking the evidence to policy implications. Additionally, consider clarifying the distinction between adapted exercise and adapted sport when presenting evidence, as this will help maintain conceptual coherence.

 

Comment 5

The discussion may be further strengthened by tightening the structure and more explicitly relating the findings to the proposed integrated model. A more formal discussion of barriers (particularly those related to governance, financing, and workforce heterogeneity) would sharpen the practical relevance of your policy recommendations. Additionally, consider elaborating on how the Italian approach compares not only with strong international examples but also with systems where similar reforms are being debated or implemented.

 

Comment 6

A more explicit limitations section would benefit the manuscript. You could acknowledge, for example, the inherent constraints of narrative reviews (e.g., possible selection bias, limited reproducibility), the heterogeneity of international policy contexts, and the challenges of translating legal recognition into operational practice within Italy’s decentralized system. Articulating these limitations openly does not weaken your argument; it increases the manuscript’s transparency and scholarly rigor.

 

Comment 7

In the conclusion, you might consider offering more concise, actionable messages for policymakers, such as specific steps for LEA inclusion, suggested timelines, or mechanisms for national–regional coordination. Highlighting the broader European relevance of your framework could also increase the manuscript’s international appeal.

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.pdf