Contributions of a Rehabilitation Nursing Program in the Self-Care of Women Undergoing Breast Surgery

Round 1

Reviewer 1 Report

In their single center quantitative study "Contributions of a rehabilitation nursing program in the self- 3 care of women undergoing breast surgery" Rodrigues et al. showed that rehabilitation nursing programs after breast cancer treatment can improve self-care performance and overall quality of life.

The authors investigated 48 women between February 2018 and June 2019.

The study is well written and design is clear. It is easy to understand and the results are clearly presented. However, I have some minor comments:

 

1. Please include an Abbreviations section

2. Table 1. is rather confusing for the reader and I dont see the benefit. I would suggest to include table 1 as an online supplement.

3. I would recommend that the authors elaborate, if for other malignancies rehabilitation programs have the same infuence on quality of life.

 

 

Author Response

"Por favor, verifique o anexo."

Author Response File: Author Response.docx

Reviewer 2 Report

In this study, using 0.5 represents a “medium” effect size to estimate the sample size, it needs to state the reason or evidence to support this effect size.

 This study only has 48 subjects in the intervention group, this sample size may not be enough to represent the target population.

 Introduce the role and teaching function of the leading researcher who implemented the program in participants' homes; these interactions may build emotional support, which may have " Hawthorne effect" or other threats to " External Validity" that need to be discussed.

 It was needed to describe the procedure of exercises in more detail, such as whether patients do each exercise by themselves or need any assistance or any equipment for performing these exercises.

 Although this study implemented an intervention program, the study lacked a control group sample, which affected the effectiveness of the research program.

 It is needed to provide the literature review for the Dose of the following intervention: "intervention applied for three months, the women performed the rehabilitation nursing program daily, lasting 45 minutes and repeating each exercise ten times."

 Although there have positive effects of the intervention, what may impact the women participants to perform this intervention in these three months regularly?

 Despite the positive intervention effect, are there any circumstances that will impact the subjects from implementing this intervention regularly during these three months? When extending this intervention to other subjects in the future, please discuss and suggest the program that can be improved.

 

 

NO comment.

 

Author Response

"Please see the attachment." 

Author Response File: Author Response.docx

Reviewer 3 Report

Dear authors, first of all, congratulations on your interesting research and quality article. In the following, I am writing a few of my recommendations for minimal correction.

·         The Topic is interesting, current, and in line with the focus of the special issue.

·         The Title is appropriate. I do not recommend any corrections.

·         Abstract describes the main objectives of the research and presents key results and conclusions. I do not recommend any corrections.

·         The Introductions section clearly presents and explains the problem. It is emphasized what is known and what is not known about the researched problem. The Introduction contains a critical analysis of relevant and current literature. The aim of the study is clearly set.

·         In the Methods section, the theoretical framework of the research is clearly described, the methodological approach is clearly described in accordance with the research objectives, the design is also clear and detailed, and the sampling methods are appropriate and clearly described. Explained and appropriate way to calculate sample size (G*Power 3.1.9.4). The instruments are convenient and clearly described. The data collection method is detailed enough to understand the process. Statistical analysis is appropriate.

·         The Results section provides a presentation and description of the main results.

ü  After Table 2, you have a detailed description of the results, and there I see two minor errors:

I don't see in the description of the results, which description refers to the Table 2. and while reading, you have to scroll to the table to see if these are descriptions of the data from that table.

 

ü  Or for example: line 173. Writes: “The graph above clearly 173 depicts this difference.”

Do you mean table 1 or ?

 

ü  In describing the results, there is a part of concluding about the results. Which should actually go to the discussion section, and interpret them there. For example line 159. “In summary, women with moderate to severe levels of disability predominated before the program.”

 

·         In the Discussion section is appropriately written. Sources of previous similar research are cited.

·         The Conclusions are directly related to the research objectives and are based on reliable results. I do not recommend any changes.

·         References - a sufficient number of properly structured references that are key, current, and relevant.

Final impressions- the manuscript is easy to read, and it is written clearly and of high quality.

I wish the authors good luck with the publication of the article.

Author Response

"Please see the attachment." 

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

A second revision of this manuscript has added a literature review of ALND for postoperative sequelae in women with breast cancer. However, please refer to the following comments for this manuscript.

1.      Upper extremity lymphedema is a chronic and common complication caused by damage to lymph nodes and lymphatic vessels during ALND. The incidence of postoperative lymphedema in breast cancer patients has been reported to be 15%-33%. Lymphedema often happens half a year after ALND to even several years afterward. Lymphedema and its related symptoms seriously affect the quality of patients' life. Therefore, it is particularly important to study the effect of nursing intervention on controlling the occurrence of postoperative lymphedema.

2.      Check and correct the abbreviation of Axillary Lymph Node Dissection (ALDN) in line 72 as ALDN or ALND.

3.      ALND surgery for women with breast cancer, can cause multiple sequelae such as lymphedema, paresthesia, range-of-motion restriction, and pain in the arm ipsilateral to the lymph node dissection, sequelae of functional surgery. In lines 63-66 of the manuscript, it is mentioned that “after breast cancer treatment, many symptoms occur due to decreased patient functionality, limiting their ability to carry out ADLs”. It is suggested that link the postoperative complications with the functional limitations. And tell reader how long will it take for the chance and time to recover from the sequelae? It is recommended to have literature supported.

4.      Although in this manuscript Line 84 stated that Rehabilitation programs are not widely available, and resources are limited. However, the literature in this manuscript should introduce the major methods for helping patients to do for preventing complications and self-care. It is suggested that: describe the methods for the nurses how to train women with breast cancer to perform exercises, and how to teach the patients to maintain or improve their functional capacity and enhance their independence. These nurses need to be trained by what program, or need what professional preparation.

5.      This study only has 48 subjects in the intervention group, this sample size may not be enough to represent the target population. This manuscript does not explain setting an effect size of 0.5 as the basis for estimating the sample size for this study. According to the calculation formula and conditions of G*Power 3.1.9.4, if the effect size is set to 0.3 (medium effect size), the estimated sample size should have 111 research subjects. Therefore, the author should explain the empirical basis for setting the effect size of 0.5, and discuss the impact of underestimating the sample size on the research results. Cohen gives the following guidelines for the social sciences: "The terms 'small (effect size=0.1),' 'medium (effect size=0.3),' and 'large (effect size=0.5)' are relative.

6.      The principal investigator visited the participants' homes to supervise the program, promote their adherence, and detect complications. As the author said, such intervention measures may have many advantages, but the author did not discuss or explain how controlling or avoiding these interactions may build emotional support, which may have "Hawthorne effect" or other threats to "External Validity" that need to be discussed.

7.   It is needed to provide the literature review for the Dose of the following intervention: "intervention applied for three months, the women performed the rehabilitation nursing program daily, lasting 45 minutes and repeating each exercise ten times. (Line 128-129)" According to the feedback from the authors, that only introduce the process of this Rehabilitation nursing program was built, but does not provide scientific evidence to support the Dose of this program.

8.     It is suggested that the results section can have two parts, for reporting part 1: the results of physical functioning, and part 2: the symptoms of the upper limbs, separately. This suggestion is based on the following reason: The rehabilitation program in this study changes the sequelae of lymphedema, paresthesia, limited range of motion, or pain in the arm ipsilateral to lymph node dissection in women with breast cancer after surgery were more significant for this study results and should be focused presented in this study results.

9.     The discussion can put more information regarding the strategies or methods of Rehabilitation programs of this study, and how can benefit breast cancer nursing for nursing care. 

10.   Are patients required to pay for the rehabilitation program and what are the implications for future expansion of rehabilitation efforts? Suggested discussion of payment or nursing manpower as possible reasons why the program is not widely available and resources are limited.

 

 

 

The results section can be more organized and focus on the major aims of this study.

Author Response

Please see the attachment

Author Response File: Author Response.pdf