A Qualitative Study Exploring the Impact and Effects Following Hospital Discharge of COVID-19

Round 1

Reviewer 1 Report

A Qualitative Study Exploring the Impact and Effects following hospital discharge of Covid-19

The protocol by Reay and colleagues aims to gain an understanding of how COVID-19 affects quality of life (QoL) and functional abilities. They plan to collect  They expected to collect a large number of discharged patients to discuss their hospitalization experience and the impact of Covid-19 on QoL. Quantify these results and analyze biostatistics. This research will provide important qualitative insights and may provide information for clinical interventions and mission decisions. So they wrote about the experiment process and topic design. The following issues must be addressed:

1. According to reports, mutated COVID-19 virus strains (alpha, beta, gamma, lamda…etc) have different phenotypes and their corresponding symptoms are also different. It is necessary to understand the virus strains infected by the patient in order to conduct a more effective analysis.
2. Continuing with the previous question, it is also an important question to know whether the patient has been vaccinated. After full vaccination, the chance of getting serious illness is much lower than that of unvaccinated people. Not knowing the patient's vaccination status will lead to bias.
3. By interviewing patients, the experience can be very abstract and cannot be quantified. How to set different levels of tables as categories is very important. It is recommended to set multiple questions in the appendix as levels to attribute the patient's answers
4. The questions posed to patients involve professional diagnostic approaches and treatment strategies. The patient may not understand or answer the wrong answer. How to avoid these variables?
5. The integrity of pulmonary function tests will be an important part of the QoL assessment of patients discharged from the hospital after COVID-19 infection. In addition to the patient's own feelings, medical equipment or biomedical imaging tool is also needed as an aid. In addition, it also needs to be clarified whether the patient himself is exercising or recovering.
6. It is recommended that the author can first make a hypothetical statistical analysis chart in appendix 2 to convince reviewers and readers.

Author Response

Thank you for reviewing our manuscript. We have responded to the minor revisions below.

1. According to reports, mutated COVID-19 virus strains (alpha, beta, gamma, lamda…etc) have different phenotypes and their corresponding symptoms are also different. It is necessary to understand the virus strains infected by the patient in order to conduct a more effective analysis.

We will collect the virus strain the patient had – I’ve added this into the protocol under ‘study interventions’.

1. Continuing with the previous question, it is also an important question to know whether the patient has been vaccinated. After full vaccination, the chance of getting serious illness is much lower than that of unvaccinated people. Not knowing the patient's vaccination status will lead to bias. 

We will collect whether or not the patient has been vaccinated – this has been added into the protocol under ‘study interventions’

1. By interviewing patients, the experience can be very abstract and cannot be quantified. How to set different levels of tables as categories is very important. It is recommended to set multiple questions in the appendix as levels to attribute the patient's answers?

Thank you for providing this comment, however as this is a qualitative research project, the appendix includes semi-structured interviews that are used as a guide to conduct the interviews. A thematic analysis will be performed to generate themes across the entire data set. We do no feel given the qualitative design, that set multiple questions are needed.

1. The questions posed to patients involve professional diagnostic approaches and treatment strategies. The patient may not understand or answer the wrong answer. How to avoid these variables? 

This is a qualitative design and there are no variables included. Patients are being advised that they do not need to answer any questions that they do not want to answer. The researcher is experienced in qualitative interviews.

1. The integrity of pulmonary function tests will be an important part of the QoL assessment of patients discharged from the hospital after COVID-19 infection. In addition to the patient's own feelings, medical equipment or biomedical imaging tool is also needed as an aid. In addition, it also needs to be clarified whether the patient himself is exercising or recovering. 

Thank you for providing this comment, however QoL is not objectively measured and is being explored in a subjective matter by use of the semi-structured interviews. We are aware of another study taking place within our Trust that is quantitative and using objective validated tools. We opted for a qualitative design in order for patients to fully express themselves and tell their narratives of the experiences. Therefore, QoL is subjective and explored in relation to difficulties that they may be experiencing that may not be captured with the use of objective measures.

1. It is recommended that the author can first make a hypothetical statistical analysis chart in appendix 2 to convince reviewers and readers. 

Qualitative research does not require a hypothetical statistical analysis chart. The analyse is thematic analysis which involves generating themes across the entire data set.

Reviewer 2 Report

This is a very interesting protocol to explore patient experiences post-hospital discharge following a diagnosis of   COVID-19. The research aims to gain an understanding of how COVID-19 affects the quality of life and functional abilities. Patients discharged from the hospital will be invited to participate in semi-structured interviews discussing their experiences of hospitalization and the impact of Covid-19 on their QoL. Interviews will be conducted at 3- and 6-months following discharge from the hospital. This study will provide important qualitative insight and may inform clinical interventions and commissioning decisions. The paper was written in a professional style, and it was a pleasure to read it. Albeit, I still have a minor suggestion for the manuscript.

1, It would be much better if the authors can provide some Workflow or Scheme for this protocol, I suggest that they can take a look at the recent paper in MDPI.

https://www.mdpi.com/1660-4601/18/7/3416/htm

https://www.mdpi.com/2409-9279/4/1/17/htm

https://www.mdpi.com/2409-9279/4/2/32/htm

https://www.mdpi.com/1660-4601/17/22/8449/htm

https://www.mdpi.com/2073-4425/12/8/1114/htm

2, The reference list and format should be improved.

https://www.mdpi.com/journal/jor/instructions#references

Author Response

We have included a recruitment and assessment flow chart in the protocol. And have tidied up the references, thank you