Virtual Reality Mindfulness and Personalized Exercise for Patients on Hemodialysis with Depressive Symptoms: A Feasibility Study

Round 1

Reviewer 1 Report

This paper evaluated the impact of virtual reality mindfulness (VRM) and personalized exercise prescription (PARx) on patients on HD with depressive symptoms, mainly regarding their feasibility. The topic of this study is novel and clinically relevant, and this paper is overall well written, although this is merely a pilot study and has several limitations. Additionally, there are some points that need to be clarified further.

Major concerns and questions for authors:

1.     Although secondary outcomes are clearly stated in the “2.8 Secondary Outcomes” sections, the primary outcome is difficult to understand from the text. Additionally, Assuming that the primary outcome is feasibility, the description in the Materials and Methods section and the description in the Results do not seem to correspond.

2.     Please attach any questionnaires you used to assess for these “feasibility.”

3.     Please consider to create a Table regarding the results of primary outcome similar to that of secondary outcomes (Table 3).

4.     Are there any differences in the feasibility of PARx between both groups (with or without VRM)?

5.     Although repeated measures ANOVA was used to assess between-group difference, how was the interaction between group × time calculated? Additionally, to take the difference in the baseline values into consideration, linear-mixed model including baseline values (and other potential confounders) as fixed effects was preferred.

Minor concerns and questions for authors:

6.     Please explain why “Observation” subscale (of FFMQ-SF) decreased by VRM from T1 to T2 while that of PARx alone group increased, which led to significant between-group difference? Or, did it merely reflect the difference in the baseline value between the groups?

Author Response

Thank you for your comments. Please see the attached document regarding our responses. 

Author Response File: Author Response.pdf

Reviewer 2 Report

This is an excellent written research paper with high clinical significance. Indeed as a pilot feasibility study, the power is low something that has been recognized by the authors. All strengths and limitations are reported in the discussion section. The study was conducted during COVID period and therefore the majority of the pitfalls related to recruitment are well justified.

I don't have any major comments.

Some minor suggestions to the authors are:

Please include a post hoc power analysis in order to report the achieved power with N=10 participants. This is going to be very helpful for designing the next large multicenter RCT project. 

Author Response

Thank you for your comment. Please see the attached document regarding our response. 

Author Response File: Author Response.pdf