Cardiac Rehabilitation to Inpatient Heart Transplant—HRN4HTx Intervention Protocol

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this paper. The author has enrolled 19 heart transplant patients and a novel rehab design. On this alone I will support this paper being published.

Prior to these however I feel there are sloppy and important mistakes in how the data is presented:

Title: - fails to mention the purpose of the study which is the novel protovol

Abstract - description of results is too little and poor. Im not sure if feasible is the word I would use in a phase 1 study with this design. Maybe encouraging, supportive evidence to pursue a phase 2? Please check.

Methods - very good. Please describe self-care in more detail in outcomes part. Statistics - will need a statistics person to check.

Results - well written here but poor in abstracts.

Discussion/ conclusion - fine Please advice what the next steps are

Comments on the Quality of English Language

fine

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

Response 1: Title: - fails to mention the purpose of the study which is the novel protocol

 

We modified “ Cardiac Rehabilitation to Inpatient Heart Transplant- HRN4HTx intervention protocol” (page n. 1, line -1-2 )

 

Response 2: Abstract - description of results is too little and poor. Im not sure if feasible is the word I would use in a phase 1 study with this design. Maybe encouraging, supportive evidence to pursue a phase 2? Please check.

 

We are conditioned by the number of words in the abstract, but we change the word used, as recommended “. The study encouraged that RN4HTx..” (page n. 1, line -35 )

 

Response 3: Methods - very good. Please describe self-care in more detail in outcomes part.

We have changed .to emphasize this point: Regarding self-care capacity, patients admitted from other hospital units have greater levels of self-care commitment than those who come from home, with an average difference in Barthel index scores of 32.21. There was an improvement in all (page n. 6, line - 209 )

 

Response 5: Results - well written here but poor in abstracts.

We made an effort internally and in discussion with the research team we were unable to find an alternative to be able to write the results in a richer way, maintaining the number of words required by the journal's rules. We are available and open to suggestions, if the esteemed reviewer so understands

We changed – “There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035meters (6MWT)”. ..” (page n. 1, line -34 )

 

Response 6 Discussion/ conclusion - fine Please advice what the next steps are

We hope that what is contained in the “Nursing Implications” item responds to this important comment. (page n. 8, line - 326 )

 

Reviewer 2 Report

Comments and Suggestions for Authors

Maria Loureiro, Vítor Parola, João Duarte, Isabel Oliveira, Margarida Antunes, Gonçalo Coutinho, Maria Manuela Martins and André Novo have written an interesting study titled “Cardiac Rehabilitation to Inpatient Heart Transplant”. The proposed manuscript is interesting and important. The most important publications in the topic area were analyzed and cited.

There is interest to evaluate the role of cardiac rehabilitation in the postoperative period of heart transplantation, but the available literature has focused on phase 2 of CR. There is lack of publications focused on the phase 1 of CR.

The aim of the study of authors was to analyse the safety of a phase 1 cardiac rehabilitation protocol in people with heart transplants and its effects on self- care capacity.

The size of the analyzed group of patients is small, but this is due to the number of heart transplants performed, which is not big.

The limitations of the study is the absence of a matched control group, but it was addressed by authors.

The conclusions of the study result from the analysis carried out and would be better if there was a larger group and if there was a control group, but these limitations were described by the authors

The most important publications in the topic area were analyzed and cited.

Minor revision:

1.   It was described that 34 patients had a heart transplant and 19 took part in rehabilitation. It would be interesting to describe what happened to the 15 patients who had a heart transplant and did not participate in rehabilitation and what was the reason for this.

2. The time elapsed from heart transplantation to the start of rehabilitation was not specified.

3. Table No. 1 is difficult to read. The description to the protocol stages are not clearly separated. It should be improved.

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files

Response 1: We agree with this comment.” It was described that 34 patients had a heart transplant and 19 took part in rehabilitation. It would be interesting to describe what happened to the 15 patients who had a heart transplant and did not participate in rehabilitation and what was the reason for this.”

 

We modified “Of the 15 who were not integrated into the program, 9 died in the immediate post-operative period, 2 suffered a stroke with changes in consciousness, 3 had 2R rejection. (page n. 5, line -196 )

 

Response 2:.” The time elapsed from heart transplantation to the start of rehabilitation was not specified.”

 

We have changed .to emphasize this point: “The program started after extubation, with an average start of approximately 19 (±6.89) hours after transplantation.”  (page n. 6, line -202 )

 

Response 3: Table No. 1 is difficult to read. The description to the protocol stages are not clearly separated. It should be improved.

We have changed the type of table to be clearly (page n. 4, line-161)