Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review

Critical illness, critical care, intensive care, concept analysis ALL Metrics - Views Downloads How to cite this article Jerrard K, O'Neill B, Bradley JM and Connolly B. Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.14140.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Study Protocol [version 1; peer review: 1 approved, 2 approved with reservations] Kirsty Jerrard https://orcid.org/0000-0002-4727-5541 1, Brenda O'Neill https://orcid.org/0000-0002-6471-1413 2, Judy M Bradley1, Bronwen Connolly https://orcid.org/0000-0002-5676-5497 1,3Kirsty Jerrard https://orcid.org/0000-0002-4727-5541 1, Brenda O'Neill https://orcid.org/0000-0002-6471-1413 2, Judy M Bradley1, Bronwen Connolly https://orcid.org/0000-0002-5676-5497 1,3 PUBLISHED 14 Jan 2026 Author details Author details 1 Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK 2 School of Health Sciences, Ulster University Institute of Nursing and Health Research, Londonderry, Northern Ireland, BT48 7JL, UK 3 Department of Physiotherapy, The University of Melbourne Melbourne Centre for Data Science, Melbourne, Victoria, Australia 2 School of Health Sciences, Ulster University Institute of Nursing and Health Research, Londonderry, Northern Ireland, BT48 7JL, UK 3 Department of Physiotherapy, The University of Melbourne Melbourne Centre for Data Science, Melbourne, Victoria, Australia Kirsty Jerrard Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Brenda O'Neill Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Judy M Bradley Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Bronwen Connolly Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Critically ill patients present with highly complex care needs that necessitate specialised, efficient collaboration across multidisciplinary teams. Effective communication and shared understanding of clinical concepts are imperative to delivering optimised care and enhancing patient outcomes. Concept analysis methodology offers a structured approach to clarifying complex clinical concepts to promote consistency in understanding and application. Gaining insight into concepts already described in this patient population, alongside identifying gaps, could support more collaborative understanding. This scoping review aims to systematically identify, synthesise, and map concepts underpinning the management of critically ill adult patients along the stages of the critical illness care pathway. We will search the databases MEDLINE ALL, EMBASE, CINAHL Complete, and Web of Science Core Collection from inception to date of search. Grey literature will be identified via ProQuest Dissertations & Theses Global. Reference lists of included studies will be screened to identify additional relevant literature. We will include studies using concept analysis methodology that explore, or define, concepts related to the management of critically ill adult patients at any stage of the care pathway. Screening and data extraction processes will be piloted and conducted independently and in duplicate. Extracted data will be analysed using descriptive statistics and narrative synthesis. Study characteristics will be summarised in tables. We will describe which concepts have been explored and how they have been defined, detail of the concept analysis method used, and in what populations and phases of the care pathway. Concepts will be mapped visually to illustrate their distribution across the pathway. No reviews to date have summarised or mapped the concepts relating to the management of critically ill adult patients across the care pathway. Results of this review will inform clinical practice and help identify gaps for future research. This protocol is registered on OSF https://doi.org/10.17605/OSF.IO/Z63CW Patients who become critically ill may receive care in a range of settings, such as the emergency department, hospital ward, intensive care unit, rehabilitation services, and community after discharge home. Their treatment often needs input from many healthcare professionals working together. To make sure this care is safe and effective, clear communication and a shared understanding of medical concepts (ideas or ways of doing things) are essential. However, some of these concepts can be difficult to understand or may mean something different to individual healthcare professionals. We want to understand which concepts have already been identified in relation to the care of critically ill adult patients in any setting. We will carry out an organised search of the research papers to find studies that explore these concepts. Two members of the research team will review the studies to decide which ones are relevant. For each relevant study, we will record key details in a spreadsheet, then summarise and describe the findings. We will also create a diagram to show how these concepts are used across different stages of critical illness care, from the beginning of treatment to recovery. The results of this review will help healthcare teams to develop a shared understanding about key concepts, improve communication, and work together more effectively. It will also highlight areas where further research is needed to improve care for critically ill adults. In addition, patients may benefit from knowing that these concepts have been explored, which could help them better understand their own critical illness journey. Critical illness, critical care, intensive care, concept analysis Corresponding Author(s) Bronwen Connolly ([email protected]) Grant information: This project is funded by the National Institute for Health and Care Research (NIHR) under its Health Technology Assessment (HTA) Programme (Grant Reference Number NIHR130454). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Additional funding is provided by the Belfast Health and Social Care Trust Charitable Trust Funds Research (Reference J-2425-505). The Sponsor for the MARCH trial is Belfast Health and Social Care Trust. Funding for the MARCH trial process evaluation is, in part, from the Northern Ireland Public Health Agency (PHA) Research and Development Division (Reference EAT/5781/24), via a Doctoral Fellowship Programme (KJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 Jerrard K et al. This is an open access article 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. How to cite: Jerrard K, O'Neill B, Bradley JM and Connolly B. Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.14140.1) First published: 14 Jan 2026, 6:8 (https://doi.org/10.3310/nihropenres.14140.1) Latest published: 18 Mar 2026, 6:8 (https://doi.org/10.3310/nihropenres.14140.2) Additional funding is provided by the Belfast Health and Social Care Trust Charitable Trust Funds Research (Reference J-2425-505). The Sponsor for the MARCH trial is Belfast Health and Social Care Trust. Funding for the MARCH trial process evaluation is, in part, from the Northern Ireland Public Health Agency (PHA) Research and Development Division (Reference EAT/5781/24), via a Doctoral Fellowship Programme (KJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There is a newer version of this article available. of this article available. Critically ill patients often present with life-threatening, complex, and multifaceted needs, requiring intensive treatment from multiple clinical specialities1. Effective multidisciplinary team collaboration, both across and within specialities, is fundamental to delivering optimised, evidence-based, and high quality patient care2. This is especially relevant in this population as the care pathway of critically ill patients can span a wide variety of settings including the emergency department, intensive care unit (ICU) and high dependency unit, general wards, rehabilitation settings, and ultimately the home/community environment following discharge. Care delivered both before and after ICU admission plays a crucial role in optimising outcomes for patients3,4. However, at each stage of the care pathway, patients may be managed by different teams, often with varying staffing levels and expertise, clinical priorities, professional cultures, and organisational pressures5. These differences can lead to inconsistencies in care delivery, such as variations in treatment decisions, which may impact patient outcomes. As the primary setting for the management of critically ill patients, the ICU is a distinct geographical and clinical setting, characterised by higher staff to patient ratios, specialised training in the management of critical illness, the use of high-risk and complex interventions, advanced physiological monitoring, and varying levels of care depending on the degree of organ support4. For example, care may range from Level 1 (patients at risk of deterioration or requiring basic support) to Level 2 (those needing support for multiple organs or prolonged respiratory support), and Level 3 (patients requiring advanced respiratory or multi-organ support)6. In such a complex and dynamic environment, a wide range of concepts7 (principles or ideas) may be applied to guide clinical decision-making8. However, when patients transition into or out of the ICU setting these concepts may be inconsistently understood or operationalised differently, resulting in fragmented patient care. A shared understanding of concepts is essential to support effective collaboration across teams, promote consistent use of terminology, and optimise patient outcomes; therefore, they require clear and agreed definitions. A lack of clarity and poor communication may lead to ambiguity, inconsistency in clinical practice, and an increased risk of patient harm5. One methodological approach used to clarify complex clinical concepts is concept analysis9. This method has been applied in healthcare to define concepts such as clinical decision-making8,10, end-of-life care11, and post-intensive care syndrome12. Different frameworks to concept analysis have been described, including those by Walker and Avant13, Rodgers14, Schwartz-Barcott and Kim, Chinn and Kramer9. These frameworks share some common elements, but also contrast with each other9. For example, both Walker and Avant13 and Rodgers14 emphasise the importance of identifying the attributes of the concept, while Walker and Avant13 and Chinn and Kramer9 highlight the need to clearly choose the concept under analysis. However, Walker and Avant13 employ a linear, stepwise process, whereas Rodger’s Evolutionary Method14 adopts a cyclical model that emphasises iterative analysis, reflecting the dynamic nature of concepts9. Concept analysis typically involves several steps to clarify the meaning of a concept and explore its defining features9, including selection of a concept of interest, determining the purpose of the analysis, identifying all the various uses of the concept (often through a literature review), and characterising its defining attributes. Walker and Avants approach also involves identifying antecedents (events or circumstances that must occur before the concept can arise) and consequences (outcomes or effects resulting from the presence of the concept), as well as developing exemplar case studies to illustrate the concept, clarify its boundaries and consider its practical application in context9. For example, concept analysis of post-intensive care syndrome12 using Walker and Avant’s framework clarified the multidimensional nature of the syndrome. By systematically reviewing relevant qualitative and quantitative literature, the analysis provided a comprehensive and holistic insight into the syndrome’s defining attributes and subsequently a theoretical basis to inform clinical practice, research, and future application. Regardless of the adopted approach, concept analysis provides an opportunity to enhance conceptual clarity and promote consistency in clinical practice. Although various concepts relating to the care of critically ill patients have been explored through concept analysis in the literature11,12,15–17, there has been no systematic synthesis to date examining how these concepts map to the entire care pathway. Mapping which concepts have been explored in the literature could support shared understanding among multidisciplinary team members and facilitate knowledge translation across the critical illness care pathway, benefiting clinicians both within and beyond the ICU environment. This, in turn could inform clinical practice and guide future research. Therefore, the aim of this review is to identify, synthesise, and map concepts related to critical illness and the management of critically ill adult patients across the stages of the care pathway. A scoping review was chosen for this study as its methodology is well-suited to exploring and mapping broad, complex topics18. This scoping review will examine diverse concepts, definitions, and the frameworks used to analyse these concepts in relation to the management of critically ill adult patients along the care pathway. A preliminary search of Open Science Framework registries and Figshare was conducted on 11th July 2025 and no current or planned scoping reviews on this topic were identified. Research question What concepts related to critical illness and the management of critically ill patients have been examined through concept analysis?

1. To identify and describe the concepts that have been explored related to the management of critically ill adult patients. 2. To describe the concept analysis frameworks used to conduct these concept analyses. 3. To identify the populations, clinical contexts, and stages of the care pathway (e.g. pre-ICU, ICU, recovery) in which these concepts have been studied. 4. To visually map identified concepts to illustrate their distribution across the care pathway. The protocol was developed in accordance with updated JBI recommendations18 and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist19. It was reviewed and revised by the study team (KJ, BO’N, JB, BC) before being finalised. The final protocol was registered prospectively on the Open Science Framework (OSF) registries (https://doi.org/10.17605/OSF.IO/Z63CW)20 on 31st July 2025. This scoping review forms part of a process evaluation of the NIHR Health Technology Assessment Programme-funded MARCH trial in which concept analysis will be employed as one methodological and analytical approach (MARCH; Mucoactive drugs for acute respiratory failure: A 2×2 factorial, randomised, controlled, open-label, Phase 3, pragmatic, clinical and cost effectiveness trial with internal pilot, https://www.fundingawards.nihr.ac.uk/award/NIHR130454). Patients and members of the public were first involved in this research during the planning phase, through consultation with the MARCH trial’s Patient and Family Advisory Group (PFAG) The aim, purpose, and proposed methods of this review were discussed with the PFAG, who expressed strong support and highlighted the novelty and relevance of the study. PFAG members were keen to understand who defines the concepts used in clinical care, what sources of literature are used to support these definitions, and which stakeholders are involved in shaping them. Their lived experience informed the development of the research questions, particularly around improving communication and understanding through clearer, more standardised terminology used by healthcare professionals across different care settings (which reflected their real-world experience). PFAG members also contributed to the design and conduct of the review, by raising important context-specific considerations. These included geographical variation in clinical practice, differences in service provision, and resource availability. They recommended that the review be transparent about the applicability and transferability of its findings across different healthcare jurisdictions and settings. This feedback will be reflected in data analysis, interpretation, and discussion. One member provided feedback on the plain English summary, noting it was clear and emphasising that this is a vital piece of research for healthcare professionals, patients and their loved ones. PFAG members were also interested in understanding how the review could benefit patients and how its findings could be shared with both healthcare professionals and patients at different stages of the critical illness journey. The group agreed to share their perspectives on the review findings, and to co-develop strategies for effective dissemination. Studies will be selected according to the Population-Concept-Context framework18. Population We will include studies relating to adult patients, aged 16 years and over, with critical illness (as defined by the original study authors), regardless of diagnosis or underlying condition. Concept We will include studies that explicitly use any concept analysis method to explore, define, or clarify concepts relating to the management of critically ill adult patients. Context We will include studies conducted at any stage of the patient’s critical illness care pathway, including but not limited to: Pre-ICU care (e.g. emergency department, ward) ICU and high dependency unit (HDU) Post-ICU care (e.g. ward, rehabilitation unit, follow-up clinic) Types of studies We will include any study types that align with the research question. To maximise inclusivity, no language restrictions will be applied. Non-English publications will be translated where local resources permit. To identify potentially relevant literature, we will search the following electronic databases for full text published literature: MEDLINE ALL, EMBASE, CINAHL Complete, and Web of Science Core Collection from inception until date of search. To capture grey literature, we will search ProQuest Dissertations & Theses Global using a combination of key terms related to the population, concept, and context. To assess the relevance of grey literature, 10% of the most relevant search results will be screened by one reviewer (KJ). Following the initial screening, the study team will determine whether further review of the remaining grey literature is warranted. Only full-text sources will be included. Where full texts are unavailable, the reviewer (KJ) will contact the primary or corresponding author to confirm publication status. Finally, the reference lists of included studies and the research team’s personal libraries will be reviewed to identify any additional relevant studies. The search strategy was initially drafted by one of the reviewers (KJ) and subsequently refined in collaboration with an experienced health science librarian to identify suitable MeSH terms and keywords. Final search strategies for MEDLINE ALL and ProQuest Dissertations & Theses Global are provided as additional project files associated with the OSF registration20,21. The search strategy will be adapted as needed for each database to ensure comprehensive retrieval of relevant literature. Search results will be collated and uploaded into reference software management programme EndNote 21 (Clarivate Analytics, PA, USA) by one reviewer (KJ) to allow for removal of duplicates and non-relevant results. Remaining search results will be imported into a systematic review programme, Covidence (Veritas Health Innovation, Melbourne, Australia), for screening. To ensure rigour, the screening process will be piloted by two reviewers (KJ and one other); a random sample of up to 25 titles and abstracts will be screened using the eligibility criteria, any discrepancies will be discussed. Following completion of the pilot, all titles and abstracts will be screened independently by two reviewers (KJ and one other). Potentially relevant sources will be retrieved in full along with any associated supplementary material and imported into Covidence. The full text of selected citations will be assessed in detail for inclusion independently by two reviewers (KJ and one other). Reasons for excluding sources of evidence at full text stage will be recorded and reported. The results of the search and the study inclusion process will be reported in a PRISMA flow diagram. Data will be extracted into a pre-defined Microsoft Excel database, initially developed by one reviewer (KJ) and finalised in collaboration with the study team (KJ, BO’N, JB, BC). The data extracted will focus on: 1. Individual study characteristics (e.g. author, year, country of conduct, setting) 2. Population characteristics (e.g. whether the concept is related to a specific disease or condition) 3. Concept characteristics (e.g. concept name, description, clinical application, detail of method) 4. Context characteristics (e.g. the stage of the patient’s critical illness care pathway– pre-ICU, ICU, or recovery) The data extraction template will be piloted by two reviewers (KJ and one other) to confirm all relevant data are captured in a consistent manner and ensure consistency in application. An iterative approach will also be used to refine the template as appropriate, should new insights regarding data extraction emerge during the review. Any modifications made will be detailed in the final report. Data from each eligible study will be extracted independently by two reviewers (KJ and one other) and then cross-checked for completeness. Data will be stored on a university (Queen’s University Belfast) server. Any disagreements in screening and data extraction between reviewers will be resolved via discussion, with arbitration by a third reviewer, if necessary, where consensus cannot be achieved. In keeping with established scoping review methodology, a formal assessment of risk of bias for the included studies will not be conducted. Risk of bias assessment would not influence data extraction, analysis, or synthesis. Extracted data will be analysed using descriptive statistics and narrative synthesis. Study characteristics will be summarised and presented in tabular form. We plan to visually map the identified concepts in diagrammatic form, aligned with the phases of the critical illness care pathway (e.g. pre-ICU, ICU, or recovery), to illustrate how these concepts are distributed across the pathway. Additionally, we will identify whether each concept identified is broadly applicable to all critically ill adult patients or specific to a particular subgroup of disease or condition. This scoping review will provide a comprehensive overview of concepts related to critical illness and the management of critically ill adult patients that have been examined using concept analysis methodology. Mapping these concepts across different stages of the critical illness care pathway and identifying their clinical and population specific applications, this review will offer valuable insights into current conceptual understandings in this area. It is anticipated that the findings will help inform clinical practice, guide future research, and highlight potential areas in existing literature which would benefit from further exploration. Importantly, the review may also benefit patients and their families by supporting clearer communication and improving their understanding of key concepts used throughout the critical illness journey, helping them feel more informed and engaged in their care. The review will adhere to rigorous JBI methodology18 and will be reported in accordance with PRISMA-ScR guidelines19, ensuring a systematic and transparent approach. To enhance transparency and mitigate the risk of reporting bias, the protocol has been prospectively registered on OSF20. Search strategies were developed in collaboration with expert input to maximise the identification of potentially relevant literature. These strategies encompass a broad range of databases as well as unpublished and grey literature. To promote inclusivity, we will include studies written in any language. Screening and data extraction will be piloted and conducted independently by two reviewers to ensure consistency and reduce bias. Finally, the research team comprises individuals with experience in both clinical practice and research methodology, which will ensure robust data identification and interpretation. One potential limitation of the review is the absence of a formal quality appraisal of the included studies, though this falls outside the remit of a scoping review. Furthermore, given the heterogeneity of critically ill patients and the different management needed for subsequent treatment, this may result in diverse concepts identified in the literature. Our planned approach to synthesis should offer some mitigation to this by considering the generalisability versus specificity of these concepts. Following completion of the synthesis, the results of this review will be submitted for publication in a peer-reviewed journal. We will also engage with the MARCH PFAG to discuss how best to share the results with patients and the public, ensuring the findings are accessible and meaningful across different stages of the critical illness journey. PFAG; Patient and Family Advisory Group PRISMA-ScR; Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Extension for Scoping Reviews ICU; Intensive Care Unit OSF; Open Science Framework No underlying data are associated with this article as it describes a study protocol rather than reporting study findings. Additional files supporting this article can be accessed via the Open Science Framework. The registered protocol is available at https://doi.org/10.17605/OSF.IO/Z63CW20 Project files can be accessed at https://doi.org/10.17605/OSF.IO/BQFK521 This project contains the following files: Description of data: The completed PRISMA-ScR Checklist, which outlines how each item was addressed in the scoping review. Description of data: Tables presenting the comprehensive search strategy used to identify relevant literature for this review. Includes detailed search strings applied to both published literature databases (MEDLINE ALL) and grey literature sources (ProQuest Dissertations & Theses Global), structured using the Population, Concept, and Context (PCC) framework. Description of data: Predefined Microsoft Excel-style data extraction template used in the scoping review. Outlines key fields for capturing study characteristics, population details, conceptual focus, and contextual information from included studies. The protocol was developed in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist, available at https://doi.org/10.17605/OSF.IO/BQFK521. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). The authors thank Richard Fallis, Health Science Librarian at Queen’s University Belfast, for his invaluable contribution to the methodology development and search strategy. We would also like to thank the NIHR-funded MARCH trial’s Patient and Family Advisory Group (PFAG) for their valuable contributions to the development of this review. Their input helped ensure the review remains grounded in real-world experiences and priorities, with the potential to benefit patients, families, and healthcare professionals. Faculty Opinions recommendedReferences - 1. Quinn D: Advancing patient outcomes in the ICU: the role of multidisciplinary collaboration in critical care nursing. J Intensive Crit Care Nurs. 2024; 7(5): 230. Reference Source - 2. Ndoro S: Effective multidisciplinary working: the key to high-quality care. Br J Nurs. 2014; 23(13): 724–727. PubMed Abstract | Publisher Full Text - 3. Vincent JL: The continuum of critical care. Crit Care. 2019; 23(Suppl 1): 122. PubMed Abstract | Publisher Full Text | Free Full Text - 4. Jackson M, Cairns T: Care of the critically ill patient. Surgery (Oxf). 2021; 39(1): 29–36. 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OSF, 2025; [cited 2025 Nov 03]. http://www.doi.org/10.17605/OSF.IO/BQFK5 Author details Author details 1 Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK 2 School of Health Sciences, Ulster University Institute of Nursing and Health Research, Londonderry, Northern Ireland, BT48 7JL, UK 3 Department of Physiotherapy, The University of Melbourne Melbourne Centre for Data Science, Melbourne, Victoria, Australia 2 School of Health Sciences, Ulster University Institute of Nursing and Health Research, Londonderry, Northern Ireland, BT48 7JL, UK 3 Department of Physiotherapy, The University of Melbourne Melbourne Centre for Data Science, Melbourne, Victoria, Australia Kirsty Jerrard Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Brenda O'Neill Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Judy M Bradley Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Bronwen Connolly Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This project is funded by the National Institute for Health and Care Research (NIHR) under its Health Technology Assessment (HTA) Programme (Grant Reference Number NIHR130454). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Additional funding is provided by the Belfast Health and Social Care Trust Charitable Trust Funds Research (Reference J-2425-505). The Sponsor for the MARCH trial is Belfast Health and Social Care Trust. Funding for the MARCH trial process evaluation is, in part, from the Northern Ireland Public Health Agency (PHA) Research and Development Division (Reference EAT/5781/24), via a Doctoral Fellowship Programme (KJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Additional funding is provided by the Belfast Health and Social Care Trust Charitable Trust Funds Research (Reference J-2425-505). The Sponsor for the MARCH trial is Belfast Health and Social Care Trust. Funding for the MARCH trial process evaluation is, in part, from the Northern Ireland Public Health Agency (PHA) Research and Development Division (Reference EAT/5781/24), via a Doctoral Fellowship Programme (KJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) Copyright © 2026 Jerrard K et al. This is an open access article 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. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Jerrard K, O'Neill B, Bradley JM and Connolly B. Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.14140.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 14 Jan 2026 Views 0 How to cite this report: O'Grady HK. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39544) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39544 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39544 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 09 Mar 2026 Heather K O'Grady, Niagara Health Knowledge Institute, Niagara Health System (Ringgold ID: 27363), Saint Catharines, Ontario, Canada Approved with Reservations VIEWS 0 Jerrard and colleagues report a protocol for a scoping review of concept analyses related to critical care and the management of critical illness. The authors provide a clear, detailed description of the proposed methods. Thank you very ... Continue reading 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. Close Thank you very ... Continue reading Jerrard and colleagues report a protocol for a scoping review of concept analyses related to critical care and the management of critical illness. The authors provide a clear, detailed description of the proposed methods. Thank you very much for the opportunity to review this manuscript! This work addresses an important question in the multidisciplinary field of critical care. Particularly, the authors are to be congratulated for a comprehensive review protocol, with the inclusion of patient and public involvement. This protocol manuscript is well written and transparently reported. In general, I agree with the other peer reviewers that the scope of this review could use some clarification, particularly in the title and the background. While I feel the methods were clearly reported, the background was vague. For the title, I might suggest something a little closer to your research question (e.g., A Scoping Review of Concept Analyses Related to Critical Illness). It wasn’t until I got to this research question that I truly understood the design of this project. In the background, perhaps providing some upfront examples of the concepts you are considering or that might be included could be helpful. For example, are you only interested in concepts related to the biopsychosocial care for critically ill patients? The references you cite (11, 12, 15-17) seem to suggest this. Or would you also include concepts related to other elements of critical care such as family experiences, communication and decision making, care processes etc.? Additional explanation in the background and in your inclusion criteria would enhance clarity for readers. Below, I will have included some minor comments for consideration. Thank you very much for the opportunity to review this manuscript! This work addresses an important question in the multidisciplinary field of critical care. Particularly, the authors are to be congratulated for a comprehensive review protocol, with the inclusion of patient and public involvement. This protocol manuscript is well written and transparently reported. In general, I agree with the other peer reviewers that the scope of this review could use some clarification, particularly in the title and the background. While I feel the methods were clearly reported, the background was vague. For the title, I might suggest something a little closer to your research question (e.g., A Scoping Review of Concept Analyses Related to Critical Illness). It wasn’t until I got to this research question that I truly understood the design of this project. In the background, perhaps providing some upfront examples of the concepts you are considering or that might be included could be helpful. For example, are you only interested in concepts related to the biopsychosocial care for critically ill patients? The references you cite (11, 12, 15-17) seem to suggest this. Or would you also include concepts related to other elements of critical care such as family experiences, communication and decision making, care processes etc.? Additional explanation in the background and in your inclusion criteria would enhance clarity for readers. Below, I will have included some minor comments for consideration. - Patient and Public Involvement – I suggest revising the following sentence “PFAG members also contributed to the design and conduct of the review, by raising important context-specific considerations” to drop “and conduct”. It is a bit confusing for the reader as it sounds like the PFAG was actually involved in conducting the review, where if I understand correctly they were involved in informing the design and protocol. - Screening and Data Extraction – some methods for screening and data extraction are unclear. In the abstract, the authors state that screening and data extraction processes will be conducted “independently and in duplicate”. However, in the methods, it seems that review and data extraction are occurring independently by one of two reviewers. It would be helpful to clarify what, if any processes will be conducted in duplicate (i.e., two reviewers looking at the same citation or data) versus what is being done by one of two reviewers. - Disagreements – following up on my previous comment, if it is only the piloting of screening and data extraction that are being done in duplicate, it is unclear why you would have disagreements that need to be resolved (i.e., if only one reviewer is looking at each citation, then there shouldn’t be any disagreements). Additional clarification would be helpful! - Grey Literature – the authors indicate that they are including grey literature in the review. However, it appears that the database selected only reflects one type of grey literature (theses/dissertations). If this is the case, I suggest revising to more clearly reflect that you are including concept analyses reported in published manuscripts or in theses/dissertations. - Discussion – the authors state that “the findings will help inform clinical practice, guide future research and highlight potential areas in existing literature which would benefit from further exploration.” Can the authors briefly elaborate on how they expect findings to inform clinical practice and guide future research? I do not disagree with this point, but by explicitly addressing this in the discussion, the impact of this important work will be more readily understood. - Dissemination – these are amazing considerations! I look forward to seeing your results and any dissemination tools you create with your PFAG. - 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? Partly - Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Literature reviews, knowledge translation, critical care rehabilitation CITE HOW TO CITE THIS REPORT O'Grady HK. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39544) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39544 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39544 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: Arjunan P. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39548) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39548 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39548 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 04 Mar 2026 Porkodi Arjunan, King Faisal University, Al Hofuf, Saudi Arabia Approved with Reservations VIEWS 0 The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or ... Continue reading 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. Close The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or on critical illness concepts. The authors are encouraged to clearly specify the scope of the review and refine the aim accordingly. The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. - 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 - Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: critical care nursing, cardiac rehabilitation, medical surgical nursing CITE HOW TO CITE THIS REPORT Arjunan P. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39548) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39548 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39548 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 18 Mar 2026Kirsty Jerrard, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK18 Mar 2026Author ResponseWe thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below. 1. Comment: The aim of ... Continue reading We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below. 1. Comment: The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or on critical illness concepts. The authors are encouraged to clearly specify the scope of the review and refine the aim accordingly. Response: The scope of the review and its aim have been refined. The intention is to address both concepts regarding critical illness as well as management. The revised aim is now more explicit and reads: “The aim of this scoping review is to identify, synthesise, and map the concepts that underpin critical illness and the management of critically ill adult patients across the stages of the care pathway.” 2. Comment: The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. Response: Our intention is to map a identified concepts across the care pathway, and whether these pertain to patients, family members, healthcare professionals, and organisational or operational processes. The revised objective now reads: “To identify the populations, clinical contexts, and stages of the care pathway (e.g. pre‑ICU, ICU, recovery) in which these concepts have been studied, including concepts relating to patient‑level management, family involvement, healthcare professional practice, and organisational or operational processes.” 3. Comment: The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. Response: The inclusion of individuals aged 16–17 years reflects that admission practices in some adult ICUs include patients within this age range. Using 16 years as the lower age threshold ensures maximum inclusiveness of potentially eligible search results based on the local practice of the ICU involved in the source study. An additional sentence has been added to clarify this rationale: “This reflects admission age thresholds commonly used in adult critical care research and service provision.” 4. Comment: The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. Response: The timeframe for included studies is now explicitly stated within the Types of studies section. Studies of any publication year will be eligible, as the databases will be searched from inception to the date of the search. The following sentence has been added to the manuscript: “Studies of any publication year will be eligible, as databases will be searched from inception to the date of the search.”We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below.Competing Interests: No competing interests were disclosed. Close 1. Comment: The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or on critical illness concepts. The authors are encouraged to clearly specify the scope of the review and refine the aim accordingly. Response: The scope of the review and its aim have been refined. The intention is to address both concepts regarding critical illness as well as management. The revised aim is now more explicit and reads: “The aim of this scoping review is to identify, synthesise, and map the concepts that underpin critical illness and the management of critically ill adult patients across the stages of the care pathway.” 2. Comment: The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. Response: Our intention is to map a identified concepts across the care pathway, and whether these pertain to patients, family members, healthcare professionals, and organisational or operational processes. The revised objective now reads: “To identify the populations, clinical contexts, and stages of the care pathway (e.g. pre‑ICU, ICU, recovery) in which these concepts have been studied, including concepts relating to patient‑level management, family involvement, healthcare professional practice, and organisational or operational processes.” 3. Comment: The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. Response: The inclusion of individuals aged 16–17 years reflects that admission practices in some adult ICUs include patients within this age range. Using 16 years as the lower age threshold ensures maximum inclusiveness of potentially eligible search results based on the local practice of the ICU involved in the source study. An additional sentence has been added to clarify this rationale: “This reflects admission age thresholds commonly used in adult critical care research and service provision.” 4. Comment: The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. Response: The timeframe for included studies is now explicitly stated within the Types of studies section. Studies of any publication year will be eligible, as the databases will be searched from inception to the date of the search. The following sentence has been added to the manuscript: “Studies of any publication year will be eligible, as databases will be searched from inception to the date of the search.” COMMENTS ON THIS REPORT - Author Response 18 Mar 2026Kirsty Jerrard, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK18 Mar 2026Author ResponseWe thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below. 1. Comment: The aim of ... Continue reading We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below. 1. Comment: The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or on critical illness concepts. The authors are encouraged to clearly specify the scope of the review and refine the aim accordingly. Response: The scope of the review and its aim have been refined. The intention is to address both concepts regarding critical illness as well as management. The revised aim is now more explicit and reads: “The aim of this scoping review is to identify, synthesise, and map the concepts that underpin critical illness and the management of critically ill adult patients across the stages of the care pathway.” 2. Comment: The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. Response: Our intention is to map a identified concepts across the care pathway, and whether these pertain to patients, family members, healthcare professionals, and organisational or operational processes. The revised objective now reads: “To identify the populations, clinical contexts, and stages of the care pathway (e.g. pre‑ICU, ICU, recovery) in which these concepts have been studied, including concepts relating to patient‑level management, family involvement, healthcare professional practice, and organisational or operational processes.” 3. Comment: The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. Response: The inclusion of individuals aged 16–17 years reflects that admission practices in some adult ICUs include patients within this age range. Using 16 years as the lower age threshold ensures maximum inclusiveness of potentially eligible search results based on the local practice of the ICU involved in the source study. An additional sentence has been added to clarify this rationale: “This reflects admission age thresholds commonly used in adult critical care research and service provision.” 4. Comment: The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. Response: The timeframe for included studies is now explicitly stated within the Types of studies section. Studies of any publication year will be eligible, as the databases will be searched from inception to the date of the search. The following sentence has been added to the manuscript: “Studies of any publication year will be eligible, as databases will be searched from inception to the date of the search.”We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the comments are outlined below.Competing Interests: No competing interests were disclosed. Close 1. Comment: The aim of the review requires further clarification. The phrase “concepts related to critical illness” may include a broad range of aspects. It is therefore unclear whether the review focuses specifically on the management of critically ill adult patients or on critical illness concepts. The authors are encouraged to clearly specify the scope of the review and refine the aim accordingly. Response: The scope of the review and its aim have been refined. The intention is to address both concepts regarding critical illness as well as management. The revised aim is now more explicit and reads: “The aim of this scoping review is to identify, synthesise, and map the concepts that underpin critical illness and the management of critically ill adult patients across the stages of the care pathway.” 2. Comment: The authors are encouraged to clarify whether the review intends to comprehensively address management across all three phases or focus on specific aspects within each stage. Narrowing or clearly defining the scope of management within these phases would improve the clarity and feasibility of the objective. Response: Our intention is to map a identified concepts across the care pathway, and whether these pertain to patients, family members, healthcare professionals, and organisational or operational processes. The revised objective now reads: “To identify the populations, clinical contexts, and stages of the care pathway (e.g. pre‑ICU, ICU, recovery) in which these concepts have been studied, including concepts relating to patient‑level management, family involvement, healthcare professional practice, and organisational or operational processes.” 3. Comment: The population is described as adults; however, the inclusion criteria specify participants aged 16 years and above. The authors should provide a clear justification for including individuals aged 16–17 years in the adult population. Response: The inclusion of individuals aged 16–17 years reflects that admission practices in some adult ICUs include patients within this age range. Using 16 years as the lower age threshold ensures maximum inclusiveness of potentially eligible search results based on the local practice of the ICU involved in the source study. An additional sentence has been added to clarify this rationale: “This reflects admission age thresholds commonly used in adult critical care research and service provision.” 4. Comment: The section describing the types of studies should clearly specify the time frame for the included studies. The authors are encouraged to mention the range of publication years considered in the review. Response: The timeframe for included studies is now explicitly stated within the Types of studies section. Studies of any publication year will be eligible, as the databases will be searched from inception to the date of the search. The following sentence has been added to the manuscript: “Studies of any publication year will be eligible, as databases will be searched from inception to the date of the search.” Views 0 How to cite this report: Salisbury L. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39399) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39399 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39399 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 25 Feb 2026 Lisa Salisbury, Queen Margaret University, Musselburgh, Scotland, UK Approved VIEWS 0 This protocol proposes is a novel approach to gaining further understanding of the management of critically ill patients which is an important area of work as critical illness and recovery are complex and there are still large variations in practice ... Continue reading 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. Close This protocol proposes is a novel approach to gaining further understanding of the management of critically ill patients which is an important area of work as critical illness and recovery are complex and there are still large variations in practice and support individuals receive after critical illness. The protocol for this review is clearly reported and justified with detailed descriptions and explanations of steps that will be undertaken. In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather then the multi-disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi-disciplinary management of people after critical illness. In the Patient and Public Involvement section there is a full stop missing after (PFAG). The protocol for this review is clearly reported and justified with detailed descriptions and explanations of steps that will be undertaken. In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather then the multi-disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi-disciplinary management of people after critical illness. In the Patient and Public Involvement section there is a full stop missing after (PFAG). - 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? Yes - Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Evaluation of rehabilitation interventions after critical illness; Experiences of individuals after critical illness. CITE HOW TO CITE THIS REPORT Salisbury L. Reviewer Report For: Examining concepts related to critical illness and the management of critically ill patients: a protocol for a scoping review [version 1; peer review: 1 approved, 2 approved with reservations]. NIHR Open Res 2026, 6:8 (https://doi.org/10.3310/nihropenres.15386.r39399) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39399 https://openresearch.nihr.ac.uk/articles/6-8/v1#referee-response-39399 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 18 Mar 2026Kirsty Jerrard, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK18 Mar 2026Author ResponseWe thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below. 1. Comment: In the ... Continue reading We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below. 1. Comment: In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather than the multi‑disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi‑disciplinary management of people after critical illness. Response: The plain English summary has been revised to ensure consistency with the main manuscript and to avoid implying a doctor‑specific focus. The term “medical concepts” has been removed and replaced with the broader phrase “key concepts” to reflect the multi‑disciplinary nature of critical illness care. The suggestion to use “medical and rehabilitation concepts” was considered; however, this phrasing introduces additional technical terms and was therefore not used in order to preserve plain‑language accessibility. 2. Comment: In the Patient and Public Involvement section there is a full stop missing after (PFAG). Response: The punctuation has been corrected, and a full stop has been added after “(PFAG).”We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below.Competing Interests: No competing interests were disclosed. Close 1. Comment: In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather than the multi‑disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi‑disciplinary management of people after critical illness. Response: The plain English summary has been revised to ensure consistency with the main manuscript and to avoid implying a doctor‑specific focus. The term “medical concepts” has been removed and replaced with the broader phrase “key concepts” to reflect the multi‑disciplinary nature of critical illness care. The suggestion to use “medical and rehabilitation concepts” was considered; however, this phrasing introduces additional technical terms and was therefore not used in order to preserve plain‑language accessibility. 2. Comment: In the Patient and Public Involvement section there is a full stop missing after (PFAG). Response: The punctuation has been corrected, and a full stop has been added after “(PFAG).” COMMENTS ON THIS REPORT - Author Response 18 Mar 2026Kirsty Jerrard, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University of Belfast, Northern Ireland, BT9 7BL, UK18 Mar 2026Author ResponseWe thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below. 1. Comment: In the ... Continue reading We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below. 1. Comment: In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather than the multi‑disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi‑disciplinary management of people after critical illness. Response: The plain English summary has been revised to ensure consistency with the main manuscript and to avoid implying a doctor‑specific focus. The term “medical concepts” has been removed and replaced with the broader phrase “key concepts” to reflect the multi‑disciplinary nature of critical illness care. The suggestion to use “medical and rehabilitation concepts” was considered; however, this phrasing introduces additional technical terms and was therefore not used in order to preserve plain‑language accessibility. 2. Comment: In the Patient and Public Involvement section there is a full stop missing after (PFAG). Response: The punctuation has been corrected, and a full stop has been added after “(PFAG).”We thank the reviewer for taking the time to review our manuscript and for their helpful feedback. Our responses to the two comments are outlined below.Competing Interests: No competing interests were disclosed. Close 1. Comment: In the plain English summary the term 'medical concepts' is used. This is the only place this term is used as other places it is 'clinical concepts' or just 'concepts'. Using the word 'medical' in this context may lead people to assume this is just concepts related to doctors rather than the multi‑disciplinary team. Perhaps this could be reviewed and if 'medical' is the preferred term by the PFAG group perhaps the term rehabilitation could be included so it is 'medical and rehabilitation concepts' which represents the multi‑disciplinary management of people after critical illness. Response: The plain English summary has been revised to ensure consistency with the main manuscript and to avoid implying a doctor‑specific focus. The term “medical concepts” has been removed and replaced with the broader phrase “key concepts” to reflect the multi‑disciplinary nature of critical illness care. The suggestion to use “medical and rehabilitation concepts” was considered; however, this phrasing introduces additional technical terms and was therefore not used in order to preserve plain‑language accessibility. 2. Comment: In the Patient and Public Involvement section there is a full stop missing after (PFAG). Response: The punctuation has been corrected, and a full stop has been added after “(PFAG).” Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | ||| |---|---|---|---| | 1 | 2 | 3 | | | Version 2 (revision) 18 Mar 26 | read | read | | | Version 1 14 Jan 26 | read | read | read | - Lisa Salisbury, Queen Margaret University, Musselburgh, UK - Porkodi Arjunan, King Faisal University, Al Hofuf, Saudi Arabia - Heather K O'Grady, Niagara Health System (Ringgold ID: 27363), Saint Catharines, Canada Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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