The Experiences of Older Adults with Dementia of “Balance Wise”—An Individual or Group-Delivered Exercise Programme: A Qualitative Study

Round 1

Reviewer 1 Report

Thank-you for doing work in this much needed area, and involving people with dementia and their care partners. The authors may wish to consider the following points/feedback:

- Consent process: It would be useful to provide further details about how informed consent was obtained in this population, e.g. how did you ensure that participants fully understood what they were agreeing to participate in, as understanding verbal instructions is not the same as providing informed consent.

In relation to the above point, the reviewer also later notes that demographic data was collected by self-report or support person proxy reported (Line 158). How did you ensure that the person with dementia consented to this information being provided if they were unable to provide it themselves? In this regard it is also noted that there is reference to ‘surrogate decision making’ (Line 256-257) which is not referenced in the informed consent process and indicates that at least one participant’s ability to consent may have been impaired.

- Terminology: The authors may wish to consider changing the terminology they use to refer to a person providing care for the person with dementia. The reviewers understand is that ‘care partner’ is the preferred term recommended by Alzheimer’s NZ when referring to a family member/whānau/friend supporting a person living with dementia.

- Line 88 – 89: I am assuming that the approval number for the study has been omitted for review purposes, and has not been mistakenly omitted by the authors

- Line 152: Should this read ‘… both of whom were appropriately trained …’

- Line 196-197: It is noted that 12 individuals did not meet eligibility criteria. For completeness, it would be useful for the reader to know why (is this because they could not provide informed consent, for health reasons, or for some other reason).

- Line 227- 229: The quote from Leslie is not italicised.

- Line 295: missing a full stop in the sentence ‘…. was continued outside the intervention. The participants …’

- Line 377: the following part of the sentence is unnecessarily italicised ‘…and encouraged him to …’

- Line 430: With the current formatting, it is not immediately clear to the reader that this (Safety and adverse events) is a new section.

- Line 445 – 446: Please note, that while short term memory can be a challenge in dementia this is not always the case (the types of cognitive impairments experienced vary dependent on the type of dementia). The reviewer would recommend changing this sentence to read ‘Whilst short term memory can be a challenge in dementia, …’  

- Line 539-540: The sentence is slightly confusing and may require rewording (should it have the word ‘In’ at the start of the sentence?).

- References: The authors may wish to check the accuracy of the references – it is noted that reference 1 has an error in the title of the article. The remaining references have not been checked for accuracy.

Author Response

Please see attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

The manuscript by Mesbah et al., The experiences of older adults with dementia of the Balance Wise exercise programme: a qualitative study describes the experience of older adults with dementia towards, and the practicality of, the Balance Wise exercise programme. The authors present evidence to support the use of the specially designed fall prevention intervention named Balance Wise. The manuscript is stepwise structured and the experiments are carefully designed to match the conclusions that are given.

I have carefully read through the manuscript and have these comments to help to improve understanding and add clarity to the work.

1.   In the Introduction, the authors should describe more detailed the physiological mechanisms of the exercise program "Balance Wise" and the effects on dementia patients.

2. In the Results part, lines 203-204 (page 5), authors state: "All participants had a diagnosis of dementia with a Mini-Mental State Examination score of ≥ 10". Who completed the diagnostic procedure?

3. In the Results part, lines 204-205 (page 5), the sentence feels like out of the context. Some more explanation would be helpful.

4. Page 8, line 295. The dot symbol is missing at the end of the sentence.

5. Page 10, line 430. I think that section "Safety and adverse events" should be separated from the paragraph above.

6. In the Discussion part, paragraph 2. The abbreviations are not explained (HBM, MCI).

7. In the Discussion part,lines 480-482: these two sentences feel like "not in line" within context of the whole paragraph. While discussing about instructors and their competencies, you would expect the generalization at the end of the paragraph. However, the new image suddenly arise about the social context and adherence to physical activity.

8. Lastly, the Conclusion part could be more specific and summarizing.

Author Response

Please see attachment

Author Response File: Author Response.pdf