A protocol for a scoping review of methodologies used to explore patient experience in post-acute rehabilitation settings

Background Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. Methods The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey & O’Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented – beside the descriptive format - as a map of data in chart and tabular formats. Conclusions This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled “An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital”.


Introduction
Patient experience is an important feature of patient-centred care; interest in which has been increasing in recent years.Patient-centred care has been valued as a means to enhance quality of care in healthcare settings (Richards et al., 2015) The aim of patient-centred care is to effectively address the needs and values of the patient by focusing on including the patient in the decision-making process (Cheng et al., 2016).The provision of patient-centred care has had a positive impact on patient satisfaction and self-management or self-care practices (Rathert et al., 2013).Additionally, patient-centred care has been found to be comparable or superior to physician-or disease-centred care (Morgan & Yoder, 2012;Rathert et al., 2013).In 2015, the World Health Organization published a global strategy on integrated people-centred health services (IPCHS) which highlighted the importance of people-and patient-centred care for improving access to and satisfaction with care, improved health and clinical outcomes, and improved health literacy (World Health Organization, 2015).
Patient experience encompasses the wide variety of interactions that a patient has within the healthcare system, as well as the patient's satisfaction with these interactions.Incorporating patient experience into healthcare provision and research has been shown to improve clinical safety and effectiveness (Doyle et al., 2013), as it allows for the identification of strengths and shortcomings in current services.By understanding patient experience, healthcare systems have the opportunity to implement change and potentially improve services based directly on feedback from the people they intend to serve and avoids prescribing what is assumed to be valuable.There has been a significant increase in research regarding Patient and Public Involvement (PPI) (Brett et al., 2014).PPI entails working in collaboration or partnership with patients, carers, service users or the public in planning, designing, managing, conducting, dissemination and translation of research (Stewart et al., 2011).By involving patient experience in the improvement of services, it may be possible to create care experiences that are not only effective but personally meaningful to patients.The collection of patient experience data offers a different, non-clinical perspective on the operation of healthcare systems and is thus an essential consideration in the improvement of healthcare delivery.
Collection of patient experience data is unlikely to solely lead to significant changes in clinical practice (Ahmed et al., 2014).Though opportunities to give feedback are regularly offered to patients across many health disciplines (for example, the National Patient Experience Survey which commenced in 2017) (Health Information and Quality Authority, 2017), no change will come into effect unless this feedback is acted upon.It is the responsibility of healthcare providers to incorporate and integrate patient feedback into efforts to improve healthcare practice and service delivery.Failure to do so is unethical; it is morally incorrect to request feedback from patients if that feedback will be ignored (Coulter et al., 2014).Therefore, it is essential to not only understand how patient experience data is collected but how learnings from this data are integrated to inform change in healthcare settings.
Recent systematic reviews broadly examined this topic in healthcare.Gleeson et al. (2016) reviewed approaches to using patient experience data for quality improvement in healthcare settings.They found that patient experience data were most commonly collected by using questionnaires.These were typically administered and analysed by external organisations who offered limited support for healthcare staff to interpret and use the results.The collected patient experience data were typically used to identify minor areas of process changes that did not require major structural alterations or changes to the practice.While most studies reported having made effective improvements, the authors found it difficult to determine the actual changes or ascertain their impact.Cadel et al. (2022) reviewed studies that used patient experience data to inform quality improvement and found a wide range of quality improvement initiatives implemented in hospital settings but limited information on the process of using patient experience data and how initiatives were implemented.They concluded that there is a broad understanding in the literature that it is important to act on patient experience data, but less consensus exists on how these data should be actioned.
The authors decided to limit the present review to the field of rehabilitation because it is being undertaken to inform a research project conducted in a post-acute rehabilitation hospital.Specifically focusing on post-acute rehabilitation patients within this context allows for a targeted exploration of their unique experiences and needs.Rehabilitation patients more often live with chronic impairments, co-morbidities, and face more complex problems, in consequence receiving care for a longer period of time and meeting a larger number and variety of healthcare professionals.Additionally, present study examines post-acute rehabilitation as a crucial phase in patient care after the acute stage.It is especially important therefore to capture and learn from the perceptions and experiences across various components of received care to ensure the quality of the person-centred care in rehabilitation.
A recently published scoping review examined the use of patient experience feedback for person-centred rehabilitation quality improvement (Jesus et al., 2022).It focused on the outcomes and included papers that contained an analysis of the impact of the quality improvement informed by patient experience data.They identified only a few examples of the use of patient experience feedback in quality improvement or codesign activities in the rehabilitation literature.They also found that these patient experience improvement activities relied exclusively on retrospective experience survey data, not making use of more actionable, real-time, and inclusive forms of patient experience feedback.The authors of the present review consulted the lead author in the preparation of the current protocol to discuss remaining gaps in the current evidence synthesis.The team made the decision to focus on the process of collection and usage of patient experience feedback.Therefore, the aim of the current scoping review is to examine the methods of obtaining, analysing, reporting, and using patient experience data to inform quality improvement in post-acute rehabilitation settings.

Methods
A scoping review is described as "a type of evidence synthesis that aims to systematically identify and map the breadth of evidence available on a particular topic, field, concept, or issue (…) within or across particular contexts."(Munn et al., 2022) The protocol for this scoping review was developed under the methodological guidance of Levac et al. (2010) and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guidelines (Peters et al., 2020).As outlined in Arksey and O'Malley (2005), the scoping reviews often contain iterative processes, and the researchers potentially may need to revisit previous stages in the light of newly acquired knowledge.These changes to the protocol will be reported in the final paper, which will be composed in accordance with the Preferred reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018).
The methodological framework by Arksey and O'Malley consists of six stages: (1) identifying the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting/mapping the data, (5) collating, summarising, and reporting results and (6) expert consultation.The framework will be guiding this review protocol and the subsequent scoping review.Based on the above, the following research question was identified: How are patient experience data collected, analysed, reported and used for healthcare improvement within a rehabilitation setting?
To explore and categorize the diverse methodologies employed for collecting patient experience data in post-acute rehabilitation settings, assess their implementation, and investigate their impact on improving patient care internationally.2. To determine the extent and scope of existing literature related to the applied methods of collecting, communicating, and utilizing patient experience data for quality improvement in post-acute rehabilitation settings.
3. To identify and highlight gaps in the current literature pertaining to the methods used for collecting patient experience data in post-acute rehabilitation settings.
Stage 2: Identifying relevant studies Following the recommendation by the JBI Manual for Evidence Synthesis (Peters et al., 2020), a three-step process will be used to carry out the search.Step 1 -a preliminary search for relevant articles on two online databases -has already been performed, followed by an analysis of the titles, abstracts, and index terms of the retrieved papers to identify the relevant key terms and phrases.Step 2 will involve the search using the identified key words (as outlined in Table 1) across the included databases.In Step 3, reference lists of selected sources will be manually searched to identify any additional relevant studies.In addition, we will compile a list of measures and instruments widely used for capturing patients' feedback and perform a search for these applied in rehabilitation settings to find studies relevant to our review.
A comprehensive search of the literature will be undertaken within the following databases: Grey literature search will be also performed in a range of healthcare-related evidence sources and data-hubs including Lenus, greynet.org and Google.

Key search terms and search strings.
The key search concepts for this review are 'Patient experience', 'Healthcare improvement' and 'Rehabilitation setting'.Keywords, together with synonyms, alternative and related terms will be used to build a search string, and exclusion terms will be added to eliminate results linked to acute medical rehabilitation and substance abuse rehabilitation.Table 1 contains the search terms and exclusion terms for the search strings.
The search query was built from the identified key terms, and adapted for each database using Boolean operators, proximity operators, truncation markers, and applicable MeSH-, subject-and index terms and headings.An expert university librarian was consulted for designing the search strategy.Table 2 contains the search strings for each database.
Inclusion/exclusion criteria.Following the PRISMA-ScR guidelines, the Population, Concept, Context (PCC) framework was used to guide the framing of the research question and key screening criteria.In line with the methodological guidance from Arksey and O'Malley (2005), the final inclusion and exclusion criteria will be refined based on increasing familiarity with the body of literature and type of data available.
All peer-reviewed and non-peer-reviewed articles and reports published in the English language, with a focus on patient experience or feedback in rehabilitation setting, will be considered for inclusion in the review.Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement, conducted within a rehabilitation setting or with relevance to a rehabilitation context will be included.
Articles describing collecting patient feedback or testing survey instruments will not be included unless they also include a specific focus on using the collected data for healthcare improvement.Articles will be excluded if they contain no discussion of using patient experience or user satisfaction for the improvement of quality of healthcare and/or are unrelated to rehabilitation settings.As formal assessment of methodological quality of the included studies is not required for scoping reviews, appraisal of the methodological quality will not be performed.
Careful consideration was given to the timeframe of the search strategy and the authors decided to limit the search to the previous ten years of evidence, in order to keep focus on recent findings and relevant contexts.

Stage 3: Study selection
Before the start of the screening, the team of reviewers will meet to decide on study inclusion and exclusion criteria.All abstracts will be screened by two reviewers and a third reviewer will resolve any conflict and decide on final inclusion.The articles found from the database searches will be imported into the bibliographic reference management software Endnote.Duplicate articles will be removed.The Covidence systematic review software tool will be used for screening of the retrieved literature.Free tools, such as Rayyan, can also be used as an alternative.The reviewers will meet at the beginning, midpoint, and final stages of each review process.
At the first meeting, study inclusion and exclusion criteria will be decided on.The reviewers will independently screen 25 titles/abstracts that were randomly selected for the pilot testing process (in accordance with the JBI Manual for Evidence Synthesis), and then meet to discuss the differences and modify the inclusion criteria, if needed.The screening will start when 75% (or greater) agreement is achieved.All abstracts will be screened by two reviewers and a third reviewer will resolve any conflict and decide on final inclusion.
Potentially relevant papers will be retrieved in full and imported into Covidence systematic review software.The full text article review will be undertaken by the same reviewers using the same method, piloting first the screening process on a sample of randomly selected papers.The full text of selected articles will be assessed against the inclusion criteria by two reviewers.Reasons for exclusion of sources that do not meet the inclusion criteria will be documented and reported in the scoping review.Any disagreement will be resolved by a third reviewer.
Stage 4: Mapping/charting the data A provisional data charting table, for extracting relevant data from sources deemed eligible for inclusion, will be developed and piloted by the review team at the protocol stage, in line with the JBI Manual for Evidence Synthesis (Peters et al., 2020).
The following types of information will be extracted: A small sample of publications (n=10) will be randomly selected to pilot the data charting table, then the reviewers will meet to ascertain accuracy and consistency and discuss the discrepancies.It is anticipated that data charting will be an iterative and reflexive process and consequently the data chart will be refined throughout the data extraction stage.
Stage 5: Collating, summarising and reporting the results The PRISMA-ScR guidelines (Tricco et al., 2018) will be used to report the findings and a PRISMA flow diagram will be created to report the details of the screening and selection process.As per JBI guidance, the extracted data will be presented in tabular and/or diagrammatic form in a manner that aligns with the objective of this scoping review.The extracted results will be descriptively mapped to provide an overview of the various methods employed in the collection and utilization of patient experience feedback in rehabilitation settings.Simple frequency counts covering key concepts, methods, or attributes will be carried out to demonstrate the general characteristics of the included studies, and a narrative synthesis approach will be utilized to answer the research questions.Descriptive qualitative content analysis will be employed to gain a deeper understanding of the methods used in obtaining, analysing, reporting, and utilizing patient experience data.Evidence synthesis will not be performed, as this would be beyond the scope of a scoping review (Peters et al., 2020).Basic coding and categorization methods will be systematically employed to analyse and label extracted data, identifying recurring themes and patterns relevant to the methods of obtaining, analysing, reporting, and utilizing patient experience data.This process will allow to assess the completeness of information within each category, aligning findings with research questions, and ultimately identifying areas in which a literature gap exists.
This scoping review is being undertaken to inform a research project entitled "An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital," which will investigate the methods of collection and subsequent implementation of patient experience data in a post-acute rehabilitation setting.The findings of this project will be disseminated to key experts and stakeholders within the National Rehabilitation Hospital (NRH).The review will be submitted for publication in a peer reviewed academic journal, and the results will be presented at conferences.

Stage 6. Expert consultation
Expert consultation -the optional, but recommended stage of the methodological framework by Arksey and O'Malley (Daudt et al., 2013) is going to be embedded throughout the whole review process.Professional stakeholders (i.e., health and social care professionals, managers) were consulted to identify priorities and consequently to help guide the research question and design.Throughout the course of the scoping review, expert stakeholders will be engaged in consultation to obtain recommendations for the types of data extracted and the presentation of findings, in order to shape the direction of the scoping review so it will support the research project as closely as possible.

Study status
Step 1 of the three-step process for applying a search strategy (Peters et al., 2020) has already been completed.A preliminary search for relevant articles has been performed.The titles, abstracts, and index terms of the retrieved papers were analysed to identify the relevant key terms and phrases.Search queries were built and adapted for each database based on the identified terms.The search queries were tested and are ready to be run.

Conclusion
This scoping review will address a gap in the current evidence synthesis by exploring the methodologies employed to collect patient experience data and how it is implemented within post-acute rehabilitation settings to improve patient care internationally.The findings from this review, as outlined in the current protocol, will highlight the extent and scope of the literature on the topic of using patient experience to improve healthcare delivery in rehabilitation settings.Additionally, the review will map the research on the applied methods of obtaining, analysing, reporting, and using patient experience for quality improvement, as well as an evaluation of the methods employed.While the impetus for this review is to inform a research project ("An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital"), the review may be applied to other clinical settings and offer an opportunity for researchers and healthcare providers to reflect on methods used to gather patient experience data in various clinical settings.

Deborah Edwards
Cardiff University, Cardiff, Wales, UK JBI no longer refer to themselves as the Joanna Briggs Institute -please just use JBI In the abstract please list the databases and the search dates In the main text please provide the dates of the search and why the restriction to English language.
I would suggest additionally searching SCOPUS of Web of Science.
Please provide a definitive list of grey literature sites and do you mean an advanced Google.
Please provide the details of the databases where the preliminary search was conducted and the full search strategies including the number of hits for each line If you are using Covidence then there is no need to mention Rayyan In the abstract you mention citation tracking but I cannot find this in the manuscript.
Evidence synthesis is an overarching term for different types of systematic reviews.There please replace the line "Evidence synthesis will not be performed..." with a more suitable word such as thematic synthesis.
Is the rationale for, and objectives of, the study clearly described?Yes

Is the study design appropriate for the research question? Yes
Are sufficient details of the methods provided to allow replication by others?
Is the rationale for, and objectives of, the study clearly described?Not applicable

Is the study design appropriate for the research question? Not applicable
Are sufficient details of the methods provided to allow replication by others?Not applicable

Are the datasets clearly presented in a useable and accessible format? Not applicable
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Physiotherapy and rehabilitation, Musculoskeletal disorders, Systematic review and meta analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
Reviewer Report 24 June 2024 https://doi.org/10.21956/hrbopenres.15213.r40397 © 2024 GARTNER J.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comments to the author(s)
This study protocol formulates a proposal for a scoping review using the JBI guideline and the Arksey & O'Malley framework.
INTRODUCTION/LITERATURE REVIEW -The background and the context are rather well presented, and the writing is fluid.
-However, certain points need to be clarified: 1.The statement "The aim of patient-centred care is to effectively address the needs and values of the patient by focusing on including the patient in the decision-making process" needs to be reformulated.Nowadays, the decision-making process is just one component, not the only one.For this literature, see: reference 1-3 2. "Patient experience encompasses the wide variety of interactions that a patient has within the healthcare system, as well as the patient's satisfaction with these interactions."(Reference ?).See reference 4-6 3. Patient and Public Involvement: See 10.1186/s12961-020-00644-3 (reference 7) ○ 10.1016/j.healthpol.2021.07.008 (reference 8) ○ -Overall: However, I find the literature too limited.In addition, I find it problematic that the literature cited in the introduction does not go beyond 2017.In fact, there is a wealth of literature on these topics and many more recent articles exist.My suggestions for improvements are along these lines.
I invite you to strengthen your motivation to justify the scoping review and your positioning: -A search for protocols and reviews published in recent years should be carried out in the Cochrane Database, the JBI Database of Systematic Reviews and Implementation Reports and PROSPERO to show how your scoping review proposal fits in with existing or ongoing work.

METHODS
The methodology is interesting and diverse.A minor change could be made: - The study is clearly presented and of scientific quality.Patient experience in post rehabilitation setting is a key component of the rehabilitation service which should be measured and used as an input to improve the service.This scoping review will add new information in this regard.
In some sections too detailed information (not needed for scoping review) is presented and might induce some confusion such as the use of PCC framework (usually used for systematic review of observational studies) and too much quantitative data extraction and or analysis.
Scoping review is implemented to map the literature on a certain topic and to identify gaps.It will be better if authors consider this in stating the aim of the study.
The current protocol looks as a full "systematic review" protocol rather than scoping review protocol.It needs to be contextualized for a scoping review protocol, mainly methods section and "Stage 5: Collating, summarising and reporting the results" section.
The study focus on "rehabilitation patients more often live with chronic impairments, comorbidities, and face more complex problems, in consequence receiving care for a longer period of time……" and the title mentioned about patient experience in post-acute rehabilitation settings.While the treatment is taking longer time and involves multidisciplinary professionals why authors want to focus on "post-acute rehabilitation"?or What is "post-acute rehabilitation" refers in this study? 1.
Regarding the "Population, Concept, Context (PCC) framework"; the framework might 2. narrow your search results.Your research question is again wider than the abovementioned framework.The research question has an OUTCOME assessment.It is not clear why authors are choosing the PCC framework for a scoping review.
As per the protocol (see also mapping/charting the data) you have data for both qualitative and quantitative analysis.Authors should have to consider this (probably not going to much on the quantitative data extraction/analysis) to align with their research design (Scoping review)

3.
Is the rationale for, and objectives of, the study clearly described?Yes

Are sufficient details of the methods provided to allow replication by others? Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Physiotherapy and rehabilitation, Musculoskeletal disorders, Systematic review and meta analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Scoping review is implemented to map the literature on a certain topic and to identify gaps. It will be better if authors consider this in stating the aim of the study.
The current protocol looks as a full "systematic review" protocol rather than scoping review protocol.It needs to be contextualized for a scoping review protocol, mainly methods section and "Stage 5: Collating, summarising and reporting the results" section.

Response:
Thank you for the feedback and drawing our attention to omissions.The development of the review protocol was guided by the Chapter 11: Scoping reviews in JBI Manual for Evidence Synthesis (Peters et al., 2020) that recommends using the PCC to guide the review objective and the inclusion criteria.In order to clearly state the objective of mapping the literature and identifying gaps, we are proposing to complete the aim of the study section with listing the following objectives: Objectives: To explore and categorize the diverse methodologies employed for collecting patient experience data in post-acute rehabilitation settings, assess their implementation, and investigate their impact on improving patient care internationally. 1.
To determine the extent and scope of existing literature related to the applied methods of collecting, communicating, and utilizing patient experience data for quality improvement in post-acute rehabilitation settings.

2.
To identify and highlight gaps in the current literature pertaining to the methods used for collecting patient experience data in post-acute rehabilitation settings.

3.
We are also proposing a revision for the Stage 5: Collating, summarising and reporting the results section, located on page 12.

Response:
Thank you for drawing our attention to this omission.
In the present study, 'post-acute rehabilitation' refers to the phase of care that occurs after the acute phase, involving ongoing rehabilitation efforts to optimize functional outcomes.In our opinion, post-acute rehabilitation represents a critical phase in the continuum of care after the acute phase.Understanding the methods of obtaining and utilizing patient experience data in this specific phase is essential for comprehensively addressing the diverse and long-term needs of individuals in their recovery journey.
As patients transition from acute care to post-acute rehabilitation, the emphasis often shifts towards patient-centered care, as acute care primarily focuses on stabilizing and treating immediate medical issues, allowing less emphasis on individualized and holistic patient preferences.
Another reason for focusing on post-acute rehabilitation is that the review's findings will inform a research project within a post-acute rehabilitation hospital.Therefore, we wanted the patient population of the review to resemble the hospital's patient profile, which does not include patients in their acute stages of their injury.This rationale is reflected in the revised fifth paragraph in the Introduction section on page 4. and quoted here: "The authors decided to limit the present review to the field of rehabilitation because it is being undertaken to inform a research project conducted in a post-acute rehabilitation hospital.Specifically focusing on post-acute rehabilitation patients within this context allows for a targeted exploration of their unique experiences and needs.Rehabilitation patients more often live with chronic impairments, co-morbidities, and face more complex problems, in consequence receiving care for a longer period of time and meeting a larger number and variety of healthcare professionals.Additionally, present study examines post-acute rehabilitation as a crucial phase in patient care after the acute stage.It is especially important therefore to capture and learn from the perceptions and experiences across various components of received care to ensure the quality of the person-centred care in rehabilitation."

Response:
Thank you for the feedback.The development of the review protocol was guided by the Chapter 11: Scoping reviews in JBI Manual for Evidence Synthesis (Peters et al., 2020) that recommends using the PCC to guide the review objective and the inclusion criteria.Our initial scoping search of the literature showed that patient experience has been studied using heterogenous methods.We chose to use the PCC framework to ensure that the search strategy captured both qualitative and quantitative research with may have be inhibited using the PICOT framework which is generally used for quantitative studies.

Response:
Thank you for the feedback and the advice.For quantitative data analysis, we are planning to conduct simple frequency counts, to recognize patterns and trends, and use visual representations to compare findings across studies, with a focus on identifying themes and potential research gaps.For the qualitative data, we are aiming to perform a descriptive qualitative content analysis, employing basic coding and categorization methods to analyse and label extracted data, and identify recurring themes and patterns.This is reflected in the revision of Stage 5 description, located on page 12.

Bronwyn Simpson
The University of Sydney, Sydney, New South Wales, Australia The purpose of the protocol (and subsequent study) are clear and understanding methods of collecting patient experiences will make an important contribution to the literature.
A scoping review is a suitable design for the study aims.
The methods are appropriate and clearly described.The use of deductive thematic analysis (under stage 5) is a little confusing and needs elaboration -will a framework be used for this deductive analysis?The research questions?Some inductive analysis also seems appropriate here.
Quality appraisal is not mentioned -the mapping of the research should ideally include some kind of appraisal and reporting on methodological quality of the included studies.
Is the rationale for, and objectives of, the study clearly described?Yes

Are sufficient details of the methods provided to allow replication by others? Yes
Are the datasets clearly presented in a useable and accessible format?Yes Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Qualitative research, scoping reviews, case study research in the field of disability-related inclusion and well-being.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Author Response 16 Feb 2024

Zsofia Torok
The use of deductive thematic analysis (under stage 5) is a little confusing and needs elaboration -will a framework be used for this deductive analysis?The research questions?Some inductive analysis also seems appropriate here.
Response: Thank you for the feedback.After careful consideration we decided against a full thematic analysis, and decided to employ basic coding and categorization methods that are more appropriate for a scoping review in order to identify trends and relevant comparison and/or divergence.This is reflected in the revision of Stage 5 description, located on page 12.

Quality appraisal is not mentioned -the mapping of the research should ideally include some kind of appraisal and reporting on methodological quality of the included studies.
Response: Thank you for drawing our attention to this omission.According to the Chapter 11: Scoping reviews in JBI Manual for Evidence Synthesis (Peters et al., 2020), the formal assessment of methodological quality of the included sources of evidence is not required for scoping reviews.We are planning to conduct an inclusive and comprehensive mapping of literature, aiming for a broader overview of the topic without conducting formal assessments of the methodological quality of included studies.Our approach will involve transparent reporting, narrative synthesis, and the identification of research gaps to inform future investigations, acknowledging the diverse range of evidence.To make it clear for the protocol, we are proposing to complete the penultimate paragraph in the section Stage 2: Identifying relevant studies with a following sentence: As formal assessment of methodological quality of the included studies is not required for scoping reviews, appraisal of the methodological quality will not be performed.

Table 2 . Search strings for each database. Database Core search (title, abstract) MeSH-, subject- or index terms
patient satisfaction/ or Patient Advocacy/ or Patient Reported Outcome Measures/ or Personal Narratives as Topic/ and *"quality of health care"/ or *quality improvement/ or Quality Assurance, Health Care/ or Benchmarking/ or Staff Development/ or Inservice Training/ or Routinely Collected Health Data/ or "Public Reporting of Healthcare Data"/ or Organizational Innovation/ or "Diffusion of Innovation"/ or Organizational Case Studies/ or Models, Organizational/ or Knowledge Management/ or Change Management/ or Capacity Building/ or Clinical Governance/ or Management Information Systems/ adj3 (experience* or satisfaction or feedback or percep* or percei* or attitude* or perspective* or view* or preference or narrative*) and (care or healthcare or health care) and (quality or process or performance* or procedure* or practice*) and (improv* or enhanc*) and (rehabilitati* or physiotherapy or physical therapy or occupational therapy or neurorehabilitation or habilitation) *

Current Peer Review Status: Version 2
This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
Reviewer Report 14 September 2024 https://doi.org/10.21956/hrbopenres.15213.r38331© 2024 Seid A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Abubeker Alebachew Seid Samara
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