We understand your concern, there are a lot of abbreviations, the abbreviations have been re-written in each section to help follow the flow, and we have now added an abbreviation and key word table before the introduction to provide additional help for readers, thank you for this comment lines 37-45.
Line 90 need to put in the full name Health Related Quality of Life (HRQoL). You have so many abbreviations confusing to follow in places. The authors may know what these are, but many reader will not. To assist the reader’s comprehension, explain the instruments more as you develop the paper.