Exercise for People with Acquired Brain Injury: An ICF Perspective

Round 1

Reviewer 1 Report

The article is completed in all part

Author Response

We appreciate your positive feedback. Thank you very much

Reviewer 2 Report

the work is well written and done with the correct method. Interesting topic, but paper needs some revisions, look carefully at these points to improve:

• Lines 15-24: In the abstract section, please add some results.
• Lines 28-29: "Acquired brain injury (ABI) is one of the leading cause of disability in the world, the first etiologies being stroke, followed by traumatic brain injury" And they also cause high morbidity and mortality. Considers these 2 refs: -- Posttraumatic synchronous double acute epidural hematomas: Two craniotomies, single skin incision. Surg Neurol Int. 2020 Dec 11;11:435. doi: 10.25259/SNI_697_2020. -- Age related outcome in acute subdural haematoma following traumatic head injury. Ir Med J. 2009 Sep;102(8):255.
• Lines 322-326: "On the other hand, the proposal has taken into account the ... addressing functional heterogeneity and capturing the most important. In this way, the high scores in the items referring to the ability to apply exercise for AB" What do authors mean at this point?
• As this topic is very current, authors could add some lines in the introduction about the role of virtual/augmented reality in rehabilitation. Look at these refs: -- Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial --- Evaluation of a Wearable AR Platform for Guiding Complex Craniotomies in Neurosurgery.
• Lines 308-310: "The panel stated.. exercise programs for people with ABI could be a useful tool in the context of sub-acute and chronic settings" Which are these settings ?
• Figure 1: please add more details in figure legend.

Author Response

 We agree with the reviewer´s comment and we have taken into account all comments. You can see the changes in the document and also we note in here the modifications. As general remark, introduction has been improved, apart from the following specific comments.

Lines 15-24. A new line refers to experts perceptions has been added in the abstract section

Line 28-29 Thanks for suggestions. However, we think those proposed references does not fit with our study topic. Nevertheless, appreciate it.

Lines 322-326: Thanks! Text has been rewritten as follows: “On the other hand, the key parameters proposal presented to the experts was designed taking into account the most common ABI deficits (at physical, cognitive, sensory and socio-affective levels), addressing the functional heterogeneity of this population. In this way, the high results along the items´ score assessment from the experts may come from the adequacy and usefullness of the ICF as theoretical framework, as a crossroad for multidisciplinary approach when dealing with exercise for ABI”

Virtual reality: We appreciate the input. We consider that this paper is focus in present / live exercise programs; however, it has been included the following phrase in the discussion last part: “One potential line for future studies could be the appropriateness of these results in relation with virtual / augmented reality exercise programs in ABI rehabilitation (Bergmann et al., 2018)”.

Lines 308-310: Thanks! Phrase has been rewritten: “The panel stated that the proposed criteria for the key parameters based on ICF domain is appropriate to design and to implement exercise programs for people with ABI in sub-acute and chronic rehabilitation settings”

Figure 1. Legend has been improved following your suggestion in this way: “Research Design: phases and methodological development of the study”. Thanks

Author Response File: Author Response.docx

Reviewer 3 Report

The paper addresses an important topic of rehabilitation after brain
injury. Please find my suggestions for improvements below.

Although in principle of interest, the study remains descriptive and
imaginary. It seems that no real outcomes were related to the program.
Why not? The reader cannot evaluate the effectiveness of the proposed
program.

It seems that only expert opinions on the different parts of the program
have been collected. Although this is essential, it represents only a
first step in designing a new tool. It should also be evaluated.

Moreover, the conceptual fundaments of the propositions could be
elaborated in more detail. How does the program advance already existing
programs? The authors could be more specific in these regards.

What is the cost-(expected)-outcome ratio compared to existing programs?
For which subpopulations it could be envisaged, for which not? Again,
without scrutinized evaluation, this can not be entirely answered.

 

Author Response

We appreciate your general feedback.

We would like to highlight the purpose of our study because we believe that there may have been a misunderstanding with the objective and content of the paper. This paper does not propose a concrete program or its effectiveness: it is an original proposal of criteria for the design of exercise programs focused on people with ABI. These criteria are based in ICF (OMS, 2001) and has been (positively) assessed by a panel of experts.

We agree with the reviewer this first step is essential in the development of future new tools and protocols, and that´s why it is the main aim of the manuscript.

Thanks for the feedback. In our opinion, the used conceptual fundaments based on ICF (WHO, 2001) are the common language that multidisciplinary experts and professionals dealing with rehabilitation and health promotion use in their every day practice, and also, ICF is a framework for research. In our opinion, this is exposed in the manuscript in detail, from introduction to assessment tool development.

Thanks for the fruitful final remark. As we are not comparing exercise programs for ABI population (this can be a future line to explore, as they are really sparse in the literature), cost-outcome ratio of a (given) program or between programs is not our focus. However, your suggestion has been included at the end of the discussion (see lines 368-373) to tackle this in future studies from our group.

Author Response File: Author Response.docx

Reviewer 4 Report

The paper is in general well written however I have some minor comments

 

 

TITLE

 

I am not sure if abbbreviation ICF is clear for every reader. Editors should decide, hovewer for me it is clear, ‘clean; and simple

 

 

Abstract

 

Line 17 - stablish is rather archaic form for establish

The last sentence is too general and poorly informing what is about

 

 

Introduction

Line 28 – rather among people not „in the world”

In paragraph between 52-58 please mention how exercises can be divided.

For instance:

According to Baar exercise can be classified into three subclasses: resistance, endurance, and patterned movements.

You can cite paper below

Baar K. Training for endurance and strength: lessons from cell signaling. Med Sci Sports Exerc. 2006 Nov; 38(11):1939-1944.

Methods

 

1. What was the exclusion criteria?
2. There is a lack of year when experiments was done or I missed it?

Discussion

 

It seem necessary to discuss and cite paper concerning Cognicise. This is exercise combining physical training and cognitive training in a single bout

 

http://tss.awf.poznan.pl/files/2021/Vol%2028%20no%201/1_GRONEK_TSS_2021_281_5-10.pdf

 

The article includes very valuable info with good practical outcome. The list of reference is guite appropriate (at least 2 mentioned by reviewer shoul be added). There are just couple issues to be improved.

Minor corrections are needed

 

 

 

 

Author Response

Title: Thank you for your review and positive opinion. We also think is clear enough, we leave in the hands of the editor a possible reconsideration

Abstract: Thanks! Updated. Last sentence has been rewritten following your considerations

Introduction: line 28 changed

Line 58: Thank you very much for the consideration. We have stressing the three most validated types of exercise programs in ABI population, better than a general classification of exercise.

Methods:

1. The inclusion-exclusion criteria to be part of the expert panel is defined in lines 122-126. We hope that this information will be sufficiently clear.
2. We are grateful for this reminder. We have added the time when the experiment was conducted
   
   

Discussion
Thanks very much for the suggestion. However, as we focus in exercise as a tool for rehabilitation across different professionals, we rely in ICF classification to tackle the main considerations for exercise planning and methodological guidance.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Good.

Reviewer 3 Report

The answers to my questions are acceptable, and the changes done improved the manuscript. So, I don't have further suggestions on the manuscript.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Dear Edior.
thank you for giving me the opportunity to review the following article.
The article is very important at the rehabilitation level and is very useful for evaluation and practice in the rehabilitation field.

The objective of the presented work is clear and the proposed results are in line with what was stated by the authors within the materials and methods.
The topic is original and very well presented according to cosmin guidelines.
The validation and psychometric properties of the ICF were found to be very consistent with the impact of rehabilitation treatment in patients.
The test presented is clear in every section and drafted with the guidelines for the cross sectional study
The conclusions presented by the author are consistent with what was highlighted in the results and discussions.

I recommend to accept it in the following form.

Reviewer 2 Report

Dear the authors, 

I understand that the current study aims to qualitatively identify the key parameters to design and implement exercise programs in people with acquired brain injury (ABI). However, this topic will not be concordant with the scope of the journal including applied physics, applied chemistry, engineering, environmental and earth sciences and applied biology. In addition, to my knowledge, a quantitative research's methodology should be explained more clearly in the section of Methods. Especially, the methodology reported by Heinemann (2003) remains unclear, without a citation of the related literature. Consequently, I kindly suggest that the submitted paper would be unacceptable for this journal.

Reviewer 3 Report

Thanks for the opportunity to review this manuscript. You have produced a really nice article with some useful insights. Some of your tables presented in the article are quite large and I am wondering if there is a more reader friendly way of presenting this information. Thanks for sharing

Reviewer 4 Report

Dear authors,

Although I create motion programs myself, the meaning of this paper is unclear to me. The meaning of tables 1 and 2 are incomprehensible. Many statements in these checklists are trivial or very inaccurate. My suggestion would be to create concrete exercise programs and then evaluate them.