Therapeutic Doll Interventions for People Living with Dementia in Care Homes: A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I hope that my comments are useful. Excellent manuscript.

Comments for author File: Comments.pdf

Author Response

1. Thank you for the opportunity to review this interesting manuscript. Although the use of
dolls in long term care facilities is a common practice, doll intervention therapy is not an
established practice

- Thank you for this supportive comment.
2. The use of the PRISMA tool is commendable as it provides a gold standard for researchers

- Thank you for this supportive feedback.
3. The identified method and data analysis strategies are clearly described and can be
replicated.  

-Thank you for this supportive feedback.
4. The writing style is scholarly and there is a clear and logical flow to the manuscript.  

-Thank you for this supportive feedback.
5. There may be a missing supplementary document. The single sheet provided is listed as
“Supplementary Material 2” is this a typing error or is there a document missing? The
provided document identifies “Example” which suggests it may be incomplete. Incomplete
data does not inform the reader. 

-Thank you for this comment.  We have clearly acknowledged supplementary files 1 (ScR checklist) and supplementary files 2 (search example) within the main body of the text.
6. Can consideration be given to the inclusion of doi numbers in the reference list. This would
be helpful for the reader.  

-Thank you.  These have been included where possible.
7. Grammatical concerns include but are not limited to:
a. Abstract line 17, the use of the term “things” is immature; the authors should refer
to themes 

-thank you.  We have made this change.
b. P. 6, line 185, “Eleven studies … reported” is an example of anthropomorphism,
please correct.  

-Thank you.  We have corrected.  
c. P. 6, line 187, “The other study suggested” anthropomorphism.   

-Thank you for this supportive feedback, we have corrected. 
8. With minor revisions, I would recommend publication.   

-Thank you for this supportive feedback.

Reviewer 2 Report

Comments and Suggestions for Authors

Reviewer’s comments for manuscript:

Therapeutic Doll Interventions for People Living with Dementia in Care Homes: A Scoping Review

Thank you to the authors who conducted this scoping review.  The review is generally well written. The research question needs to be clearly stated. What is this review adding beyond the 3 previous reviews? Does the focus on care settings make it unique? 

One editorial comment.  “Data” is plural so the verb needs to reflect this – data were not was.

Line 17

There three main things from this review relate to……..

-The above start of the sentence is incomplete.  Need to revise.

-Use of the term “things” is too generic – are these things findings? Outcomes? ???

Consider using this statement (starts on line 178) from the manuscript as an alternative to the sentence that starts on Line 17

From a narrative synthesis of the data, three main themes emerged: a reduction in levels of behavioral and psychological symptoms of dementia (BPSD), increased communication skills, and a reduction in caregiver distress.

Line 74

“While previous systematic reviews have examined specific outcomes of doll therapy, they have not focused specifically on its implementation and impact within care home settings. This scoping review aims to map the evidence in  the context of care homes, identifying gaps, and considering aspects such as cultural acceptability and feasibility that are often overlooked in more narrowly focused systematic reviews.”

Reflecting on the above statements:

-          If this review is focused on implementation in care settings – where were the early studies that were reviewed in the previous 3 reviews conducted? 

-          Is “map” the correct term in this context?

-          Criteria for selection was written in English.  Studies were conducted in several different countries but not sure that “cultural acceptability and feasibility” is a focus.  How were the previous reviews more “narrow”?

Line 85

“The process included formulating a research question”

What is the specific research question?  Not sure I saw it stated.  

Line 144

Provide content of the template

Line 156 PRISMA diagram

Why were dissertations not included if they met all of the other criteria?

Line 177

“shed light on the holistic needs of individuals”

Did these studies really shed light on the holistic needs?  I am not sure that studies focused on the implementation of Doll Therapy would address holistic needs.

Line 190

Instead of “many” use the exact number – Six

Line 208

“ A qualitative study in Europe discussed how doll therapy  can enhance purpose, responsibility, and pride among participants, fostering a sense of 209 fulfillment and agency [21]. Another study in the Far East”

Recommend to revise to “in Europe” to conducted in a Euopean long term care facility…. Same with “Far East”

Please revise throughout the manuscript when noting location that the study was conducted.

Line 330

“highlights the therapy's effectiveness in reducing challenging behaviors and distress  among professional caregivers.”

The way this statement is presented makes it sound like the therapy reduces challenging behaviors of the caregivers.  Reword.

Discussion

In addition to what has been identified as areas for future research add:

-          Best practice for education of staff in use of Doll therapy

-          Approaches for determining acceptability of Doll therapy for each individual

Author Response

Thank you to the authors who conducted this scoping review.  The review is generally well written. The research question needs to be clearly stated. What is this review adding beyond the 3 previous reviews? Does the focus on care settings make it unique? 

The rationale for this scoping review on doll therapy in dementia, despite existing system-atic reviews [6, 8, 12], lies in the need to address a gap in the literature. While previous systematic reviews have examined specific outcomes of doll therapy, they have not fo-cused specifically on its implementation and impact within care home settings

We have also explicitly highlighted our review question within the introduction section of the manuscript: “What is the impact of doll therapy interventions on people living with dementia in care home settings?”

One editorial comment.  “Data” is plural so the verb needs to reflect this – data were not was.

Thank you.  This has been corrected within the manuscript.

Line 17

There three main things from this review relate to……..

-The above start of the sentence is incomplete.  Need to revise.

Thank you.  We have revised “The three main themes…”

-Use of the term “things” is too generic – are these things findings? Outcomes? ???

Thank you.  We have revised to “themes”.

Consider using this statement (starts on line 178) from the manuscript as an alternative to the sentence that starts on Line 17

From a narrative synthesis of the data, three main themes emerged: a reduction in levels of behavioral and psychological symptoms of dementia (BPSD), increased communication skills, and a reduction in caregiver distress.

Thank you.  We have revised based on this recommendation.

Line 74

“While previous systematic reviews have examined specific outcomes of doll therapy, they have not focused specifically on its implementation and impact within care home settings. This scoping review aims to map the evidence in  the context of care homes, identifying gaps, and considering aspects such as cultural acceptability and feasibility that are often overlooked in more narrowly focused systematic reviews.”

Reflecting on the above statements:

-          If this review is focused on implementation in care settings – where were the early studies that were reviewed in the previous 3 reviews conducted? 

      Thank you.  We have removed the word implementation and kept the word ‘impact’.  We have also added an explicit review question as recommended above.

-          Is “map” the correct term in this context?           

      Thank you.  We have changed the word ‘map’ to ‘unexplored area’.

-          Criteria for selection was written in English.  Studies were conducted in several different countries but not sure that “cultural acceptability and feasibility” is a focus.  How were the previous reviews more “narrow”?

      Thank you.  We have revised the final paragraph of the introduction for greater clarity: “Therefore, this scoping review aims to examine the evidence specifically within care home settings, identifying gaps that may have been overlooked in previous systematic re-views, which have considered all types of settings. By focusing on care homes, the authors aim to present findings that are unique to these settings and that differ from those reported by authors in broader reviews.”

Line 85

“The process included formulating a research question”

What is the specific research question?  Not sure I saw it stated.  

Thank you.  We have explicitly stated this now: “what is the impact of doll therapy interventions on people living with dementia in care home settings?

Line 156 PRISMA diagram

Why were dissertations not included if they met all of the other criteria?

Thank you.  We have clarified – ‘non-peer reviewed papers or disserations…”

Line 177

“shed light on the holistic needs of individuals”

Did these studies really shed light on the holistic needs?  I am not sure that studies focused on the implementation of Doll Therapy would address holistic needs.

We have removed ‘implementation’ from the manuscript.  The review was broader than this.  We have also reworded the section above to say “the included studies explored and examined the holistic needs of individuals with dementia…”

Line 190

Instead of “many” use the exact number – Six

Thank you.  We have made this change.

Line 208

“ A qualitative study in Europe discussed how doll therapy  can enhance purpose, responsibility, and pride among participants, fostering a sense of 209 fulfillment and agency [21]. Another study in the Far East”

Recommend to revise to “in Europe” to conducted in a Euopean long term care facility…. Same with “Far East”

Please revise throughout the manuscript when noting location that the study was conducted.

Thank you.  We have made these recommended changes.

Line 330

“highlights the therapy's effectiveness in reducing challenging behaviors and distress  among professional caregivers.”

The way this statement is presented makes it sound like the therapy reduces challenging behaviors of the caregivers.  Reword.

Thank you.  We have reworded for clarity: “This review highlights the therapy's effectiveness in reducing challenging behaviors in people living with dementia”

Discussion

In addition to what has been identified as areas for future research add:

-          Best practice for education of staff in use of Doll therapy

-          Approaches for determining acceptability of Doll therapy for each individual

Thank you.  We have now added the following sentence: “Additionally, future research should focus on developing and implementing best practice guidelines and education for using doll therapy in care home settings, with an emphasis on assessing its suitability for the individual needs of people living with dementia”.