Title: Mapping of rehabilitation interventions and assessment methods for patients with liver
cirrhosis: A scoping review
Version: 1 Date: 11 Mar 2025
Reviewer's report:
This scoping review aims to provide further detail on exercise interventions provided to
people with advanced liver disease (cirrhosis), using specific criteria of the FITT principles. I
understand the rationale to provide more details using FITT criteria to help understand the best
exercise treatment for this cohort, however I do suggest some major revisions to the work prior
to being considered for publication.
Overall, it is well written, and uses appropriate tools recommend for a scoping review, such as
the PRISMA-ScR flow diagram.
The major concerns are related to the methodology.
Firstly, the limited database search has left out several important manuscripts that provide
detail on exercise interventions in cirrhosis. I commend the authors for acknowledging this in
the limitations, but I would recommend the authors expand their database searches or search
strategy, to strengthen the scoping review and provide an accurate mapping of current exercise
therapies in cirrhosis. As an example, a recent systematic review from 2022 explored exercise
and nutrition interventions in cirrhosis (https://doi.org/10.3390/nu14163365), and there are at
least 4 articles that would fit the inclusion criteria for this scoping review that have not been
included:
1. Morkane, C.M. et al., An outpatient hospital-based exercise training program for patients with
cirrhotic liver disease awaiting transplantation: A feasibility trial. Transplantation 2020, 104,
97–103.
2. Berzigotti, A. et al., Effects of an intensive lifestyle intervention program on portal
hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology 2017, 65,
1293–1305
3. Schmidt, N.P et al., Nutritional and functional rehabilitation in cirrhotic patients. J.
Gastroenterol. Hepatol. Res. 2021, 10, 3470–3477.
4. Hernández-Conde, M. et al, Adding Branched-Chain Amino Acids to an Enhanced Standard-
of Care Treatment Improves Muscle Mass of Cirrhotic Patients With Sarcopenia: A Placebo-
Controlled Trial. Off. J. Am. Coll. Gastroenterol. 2021, 116, 2241–2249
Another concern relating to the methodology is that the author describes a single author who
was responsible for the screening of title, abstract for inclusion and then a second author was
involved in the data extraction once full texts were selected for inclusion. This opens for potential
biases and can reduce the quality of the data. The recommended methodology is to include
two reviewers in this process, involving a third to discuss any disagreements. Please provide a
detailed explanation as to why this was not done, in the manuscript/limitations section.
Page 4 paragraph 2:  The phrase “those that did not include single-day interventions”, is this
correct, or should it be that those that only included single day interventions?
Title: Mapping of rehabilitation interventions and assessment methods for patients with liver
cirrhosis: A scoping review
Version: 1 Date: 11 Mar 2025
Reviewer's report:
This scoping review aims to provide further detail on exercise interventions provided to
people with advanced liver disease (cirrhosis), using specific criteria of the FITT principles. I
understand the rationale to provide more details using FITT criteria to help understand the best
exercise treatment for this cohort, however I do suggest some major revisions to the work prior
to being considered for publication.
Overall, it is well written, and uses appropriate tools recommend for a scoping review, such as
the PRISMA-ScR flow diagram.
The major concerns are related to the methodology.
Firstly, the limited database search has left out several important manuscripts that provide
detail on exercise interventions in cirrhosis. I commend the authors for acknowledging this in
the limitations, but I would recommend the authors expand their database searches or search
strategy, to strengthen the scoping review and provide an accurate mapping of current exercise
therapies in cirrhosis. As an example, a recent systematic review from 2022 explored exercise
and nutrition interventions in cirrhosis (https://doi.org/10.3390/nu14163365), and there are at
least 4 articles that would fit the inclusion criteria for this scoping review that have not been
included:
1. Morkane, C.M. et al., An outpatient hospital-based exercise training program for patients with
cirrhotic liver disease awaiting transplantation: A feasibility trial. Transplantation 2020, 104,
97–103.
2. Berzigotti, A. et al., Effects of an intensive lifestyle intervention program on portal
hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology 2017, 65,
1293–1305
3. Schmidt, N.P et al., Nutritional and functional rehabilitation in cirrhotic patients. J.
Gastroenterol. Hepatol. Res. 2021, 10, 3470–3477.
4. Hernández-Conde, M. et al, Adding Branched-Chain Amino Acids to an Enhanced Standard-
of Care Treatment Improves Muscle Mass of Cirrhotic Patients With Sarcopenia: A Placebo-
Controlled Trial. Off. J. Am. Coll. Gastroenterol. 2021, 116, 2241–2249
Another concern relating to the methodology is that the author describes a single author who
was responsible for the screening of title, abstract for inclusion and then a second author was
involved in the data extraction once full texts were selected for inclusion. This opens for potential
biases and can reduce the quality of the data. The recommended methodology is to include
two reviewers in this process, involving a third to discuss any disagreements. Please provide a
detailed explanation as to why this was not done, in the manuscript/limitations section.
Page 4 paragraph 2:  The phrase “those that did not include single-day interventions”, is this
correct, or should it be that those that only included single day interventions?
Please review this paper.
user
Title: Mapping of rehabilitation interventions and assessment methods for patients with liver
cirrhosis: A scoping review
Version: 1 Date: 11 Mar 2025
Reviewer's report:
This scoping review aims to provide further detail on exercise interventions provided to
people with advanced liver disease (cirrhosis), using specific criteria of the FITT principles. I
understand the rationale to provide more details using FITT criteria to help understand the best
exercise treatment for this cohort, however I do suggest some major revisions to the work prior
to being considered for publication.
Overall, it is well written, and uses appropriate tools recommend for a scoping review, such as
the PRISMA-ScR flow diagram.
The major concerns are related to the methodology.
Firstly, the limited database search has left out several important manuscripts that provide
detail on exercise interventions in cirrhosis. I commend the authors for acknowledging this in
the limitations, but I would recommend the authors expand their database searches or search
strategy, to strengthen the scoping review and provide an accurate mapping of current exercise
therapies in cirrhosis. As an example, a recent systematic review from 2022 explored exercise
and nutrition interventions in cirrhosis (https://doi.org/10.3390/nu14163365), and there are at
least 4 articles that would fit the inclusion criteria for this scoping review that have not been
included:
1. Morkane, C.M. et al., An outpatient hospital-based exercise training program for patients with
cirrhotic liver disease awaiting transplantation: A feasibility trial. Transplantation 2020, 104,
97–103.
2. Berzigotti, A. et al., Effects of an intensive lifestyle intervention program on portal
hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology 2017, 65,
1293–1305
3. Schmidt, N.P et al., Nutritional and functional rehabilitation in cirrhotic patients. J.
Gastroenterol. Hepatol. Res. 2021, 10, 3470–3477.
4. Hernández-Conde, M. et al, Adding Branched-Chain Amino Acids to an Enhanced Standard-
of Care Treatment Improves Muscle Mass of Cirrhotic Patients With Sarcopenia: A Placebo-
Controlled Trial. Off. J. Am. Coll. Gastroenterol. 2021, 116, 2241–2249
Another concern relating to the methodology is that the author describes a single author who
was responsible for the screening of title, abstract for inclusion and then a second author was
involved in the data extraction once full texts were selected for inclusion. This opens for potential
biases and can reduce the quality of the data. The recommended methodology is to include
two reviewers in this process, involving a third to discuss any disagreements. Please provide a
detailed explanation as to why this was not done, in the manuscript/limitations section.
Page 4 paragraph 2:  The phrase “those that did not include single-day interventions”, is this
correct, or should it be that those that only included single day interventions?
assistant