Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24303795
Zainab Altai, Claude Fiifi Hayford, Andrew Phillips, Jason Moran, Xiaojun Zhai, Bernar X.W Liew
Osteoporosis, a significant concern among the elderly, results in low-trauma fractures affecting millions globally. Despite the inclusion of physical activities in strategies to mitigate osteoporosis-related fractures, the optimal exercises for bone health remain uncertain. Determining exercises that enhance bone mass requires an understanding of loading on lower limb joints. This study investigates hip, knee, and ankle joint loading during walking, running, jumping, and hopping exercises, assessing impacts at various intensities (maximal, medium, and minimum efforts). A total of 37 healthy, active participants were recruited, with a mean (SD) age of 40.3 (13.1) years, height of 1.7 (0.08) m, and mass of 68.4 (11.7) kg. Motion capture data were collected for each participant while performing six different exercises: a self-selected level of walking, running, counter-movement jump, squat jump, unilateral hopping, and bilateral hopping. A lower body musculoskeletal model was developed for each participant in OpenSim. The static optimization method was used to calculate muscle forces and hip joint contact forces. The study reveals that running and hopping induce increased joint contact forces compared to walking, with increments of 83% and 21%, respectively, at the hip; 134% and 94%, respectively, at the knee; and 94% and 77%, respectively, at the ankle. Jump exercises exhibit less hip and ankle loading compared to walking, with reductions of 36% and 19%, respectively. Joint loading varies across exercises and intensities, running faster increases forces on all joints, especially the hip. Sprinting raises hip forces but lowers forces on the knee and ankle. Higher jumps intensify forces on the hip, knee, and ankle, whereas hopping faster reduces forces on all joints. The study emphasizes the site-specific impact of exercises on lower limb joint loadings, highlighting the potential of running and hopping for bone formation compared to jumping alone. These findings offer insights for optimizing exercise routines to improve bone health, with potential implications for risk prevention, rehabilitation, and prosthetic development.
{"title":"Lower limb joint Loading during high-impact activities: implication for bone health","authors":"Zainab Altai, Claude Fiifi Hayford, Andrew Phillips, Jason Moran, Xiaojun Zhai, Bernar X.W Liew","doi":"10.1101/2024.03.11.24303795","DOIUrl":"https://doi.org/10.1101/2024.03.11.24303795","url":null,"abstract":"Osteoporosis, a significant concern among the elderly, results in low-trauma fractures affecting millions globally. Despite the inclusion of physical activities in strategies to mitigate osteoporosis-related fractures, the optimal exercises for bone health remain uncertain. Determining exercises that enhance bone mass requires an understanding of loading on lower limb joints. This study investigates hip, knee, and ankle joint loading during walking, running, jumping, and hopping exercises, assessing impacts at various intensities (maximal, medium, and minimum efforts).\u0000A total of 37 healthy, active participants were recruited, with a mean (SD) age of 40.3 (13.1) years, height of 1.7 (0.08) m, and mass of 68.4 (11.7) kg. Motion capture data were collected for each participant while performing six different exercises: a self-selected level of walking, running, counter-movement jump, squat jump, unilateral hopping, and bilateral hopping. A lower body musculoskeletal model was developed for each participant in OpenSim. The static optimization method was used to calculate muscle forces and hip joint contact forces.\u0000The study reveals that running and hopping induce increased joint contact forces compared to walking, with increments of 83% and 21%, respectively, at the hip; 134% and 94%, respectively, at the knee; and 94% and 77%, respectively, at the ankle. Jump exercises exhibit less hip and ankle loading compared to walking, with reductions of 36% and 19%, respectively. Joint loading varies across exercises and intensities, running faster increases forces on all joints, especially the hip. Sprinting raises hip forces but lowers forces on the knee and ankle. Higher jumps intensify forces on the hip, knee, and ankle, whereas hopping faster reduces forces on all joints.\u0000The study emphasizes the site-specific impact of exercises on lower limb joint loadings, highlighting the potential of running and hopping for bone formation compared to jumping alone. These findings offer insights for optimizing exercise routines to improve bone health, with potential implications for risk prevention, rehabilitation, and prosthetic development.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140126147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24304109
Peter Fino, Prokopios Antonellis, Lucy Parrington, Margaret M. Weightman, Leland E. Dibble, Mark E. Lester, Carrie W. Hoppes, Laurie A. King
Introduction Balance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and non-straight locomotion, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess 1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and 2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically-relevant functional tasks. Materials and Methods Fifty-three individuals with mTBI and 57 healthy controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically-relevant functional tasks. Results Multivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple clinic-based turning variables. The complex turning course (CTC) yielded the highest multivariate AUC (95% CI) of 0.90 (0.84, 0.95) for single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically-relevant functional tasks and outperformed general assessments of mobility. Discussion Clinic-based turning tasks, especially the CTC, have high diagnostic accuracy, strong associations with ecologically-relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically-relevant to daily function. Future work should continue to examine the CTC alongside other promising tools for return-to-activity assessments.
{"title":"Objective turning measures improve diagnostic accuracy and relate to real-world mobility/combat readiness in chronic mild traumatic brain injury","authors":"Peter Fino, Prokopios Antonellis, Lucy Parrington, Margaret M. Weightman, Leland E. Dibble, Mark E. Lester, Carrie W. Hoppes, Laurie A. King","doi":"10.1101/2024.03.11.24304109","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304109","url":null,"abstract":"Introduction Balance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and non-straight locomotion, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess 1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and 2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically-relevant functional tasks. Materials and Methods Fifty-three individuals with mTBI and 57 healthy controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically-relevant functional tasks. Results Multivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple clinic-based turning variables. The complex turning course (CTC) yielded the highest multivariate AUC (95% CI) of 0.90 (0.84, 0.95) for single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically-relevant functional tasks and outperformed general assessments of mobility. Discussion Clinic-based turning tasks, especially the CTC, have high diagnostic accuracy, strong associations with ecologically-relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically-relevant to daily function. Future work should continue to examine the CTC alongside other promising tools for return-to-activity assessments.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140126144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.1101/2024.03.10.24304061
Caleb Kim, Chantal Lin, Michelle Wong, Shahd Al Hamour Al Jarad, Amy Gao, Nicole Kaufman, Kiera McDuff, Darren A Brown, Saul Cobbing, Alyssa Minor, Soo Chan Carusone, Kelly K O'Brien
Objectives: To explore experiences of physiotherapists working with adults living with Long COVID in Canada. Design: Cross-sectional descriptive qualitative study involving online semi-structured interviews. Participants: We recruited physiotherapists in Canada who self-identified as having clinically treated one or more adults living with Long COVID in the past year. Data collection: Using an interview guide, we inquired about physiotherapists knowledge of Long COVID, assessment and treatment experiences, perspectives on physiotherapists roles, contextual and implementation factors influencing rehabilitative outcomes, and their recommendations for Long COVID rehabilitation. Interviews were audio-recorded, transcribed verbatim, and analyzed using a group-based thematic analytical approach. We administered a demographic questionnaire to describe sample characteristics. Results: Thirteen physiotherapists from five provinces participated; most were women (n=8;62%) and practised in urban settings (n=11;85%). Participants reported variable amounts of knowledge of existing guidelines and experiences working with adults living with Long COVID in the past year. Physiotherapists characterized their experiences working with adults living with Long COVID as a dynamic process involving: 1) a disruption to the profession (encountering a new patient population and pivoting to new models of care delivery), followed by 2) a cyclical process of learning curves and evolving roles of physiotherapists working with persons living with Long COVID (navigating uncertainty, keeping up with rapidly-emerging evidence, trial and error, adapting mindset and rehabilitative approaches, and growing prominence of roles as advocate and collaborator). Participants recommended the need for education and training, active and open-minded listening with patients, interdisciplinary models of care, and organizational- and system-level improvements to foster access to care. Conclusions: Physiotherapists experiences involved a disruption to the profession followed by a dynamic process of learning curves and evolving roles in Long COVID rehabilitation. Not all participants demonstrated an in-depth understanding of existing Long COVID rehabilitation guidelines. Results may help inform physiotherapy education in Long COVID rehabilitation.
目的探讨物理治疗师在加拿大为长期患有 COVID 的成年人提供服务的经验：横断面描述性定性研究，包括在线半结构化访谈。参与者：我们在加拿大招募了一些物理治疗师，他们自称在过去一年中曾在临床上治疗过一名或多名长COVID成人患者：使用访谈指南，我们询问了物理治疗师对 Long COVID 的了解、评估和治疗经验、对物理治疗师角色的看法、影响康复结果的背景和实施因素，以及他们对 Long COVID 康复的建议。我们对访谈进行了录音和逐字转录，并采用小组主题分析法对访谈内容进行了分析。我们还发放了一份人口统计学问卷以描述样本特征：来自 5 个省的 13 名物理治疗师参加了调查，其中大多数为女性（8 人，占 62%），在城市环境中执业（11 人，占 85%）。参与者对现有指南的了解程度不一，过去一年中与长COVID成人患者合作的经验也不尽相同。物理治疗师认为，他们与长COVID成人患者的合作经历是一个动态过程，其中包括1）职业中断（遇到新的患者群体并转向新的护理模式），随后是2）学习曲线的循环过程，以及物理治疗师在与长COVID患者合作过程中不断演变的角色（驾驭不确定性、跟上快速涌现的证据、反复试验、调整心态和康复方法，以及日益突出的倡导者和合作者角色）。与会者建议，需要开展教育和培训，积极、虚心地倾听患者的意见，采用跨学科护理模式，并在组织和系统层面进行改进，以促进患者获得护理：物理治疗师的经历包括对职业的中断，随后是学习曲线的动态过程，以及在 Long COVID 康复中不断演变的角色。并非所有参与者都对现有的 Long COVID 康复指南有深入了解。研究结果可能有助于为Long COVID康复中的物理治疗教育提供参考。
{"title":"Experiences of physiotherapists working with adults living with Long COVID in Canada: a qualitative study","authors":"Caleb Kim, Chantal Lin, Michelle Wong, Shahd Al Hamour Al Jarad, Amy Gao, Nicole Kaufman, Kiera McDuff, Darren A Brown, Saul Cobbing, Alyssa Minor, Soo Chan Carusone, Kelly K O'Brien","doi":"10.1101/2024.03.10.24304061","DOIUrl":"https://doi.org/10.1101/2024.03.10.24304061","url":null,"abstract":"<strong>Objectives:</strong> To explore experiences of physiotherapists working with adults living with Long COVID in Canada.\u0000<strong>Design:</strong> Cross-sectional descriptive qualitative study involving online semi-structured interviews. <strong>Participants:</strong> We recruited physiotherapists in Canada who self-identified as having clinically treated one or more adults living with Long COVID in the past year.\u0000<strong>Data collection:</strong> Using an interview guide, we inquired about physiotherapists knowledge of Long COVID, assessment and treatment experiences, perspectives on physiotherapists roles, contextual and implementation factors influencing rehabilitative outcomes, and their recommendations for Long COVID rehabilitation. Interviews were audio-recorded, transcribed verbatim, and analyzed using a group-based thematic analytical approach. We administered a demographic questionnaire to describe sample characteristics.\u0000<strong>Results:</strong> Thirteen physiotherapists from five provinces participated; most were women (n=8;62%) and practised in urban settings (n=11;85%). Participants reported variable amounts of knowledge of existing guidelines and experiences working with adults living with Long COVID in the past year. Physiotherapists characterized their experiences working with adults living with Long COVID as a dynamic process involving: 1) a disruption to the profession (encountering a new patient population and pivoting to new models of care delivery), followed by 2) a cyclical process of learning curves and evolving roles of physiotherapists working with persons living with Long COVID (navigating uncertainty, keeping up with rapidly-emerging evidence, trial and error, adapting mindset and rehabilitative approaches, and growing prominence of roles as advocate and collaborator). Participants recommended the need for education and training, active and open-minded listening with patients, interdisciplinary models of care, and organizational- and system-level improvements to foster access to care.\u0000<strong>Conclusions:</strong> Physiotherapists experiences involved a disruption to the profession followed by a dynamic process of learning curves and evolving roles in Long COVID rehabilitation. Not all participants demonstrated an in-depth understanding of existing Long COVID rehabilitation guidelines. Results may help inform physiotherapy education in Long COVID rehabilitation.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140106900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1101/2024.03.08.24304010
Yookyung Lee, Won-Seok Kim, Won Kee Chang, Yun Sun Jung, Sungju Jee, Sung-Hwa Ko, Min Kyun Sohn, Yong-Il Shin, Hee-Joon Bae, Beom Joon Kim, Jun Yup Kim, Dong-Ick Shin, Kyu Sun Yum, Hee-Yun Chae, Dae-Hyun Kim, Jae-Kwan Cha, Man-Seok Park, Joon-Tae Kim, Kang-Ho Choi, Jihoon Kang, Nam-Jong Paik
Background Unmet long-term needs and rehabilitation needs are prevalent among stroke survivors and affect their quality of life. We aimed to identify the long-term unmet needs and unmet rehabilitation needs among stroke survivors in South Korea and evaluate their intercorrelations with health-related quality of life. Methods Stroke survivors who were admitted to four Regional Cardiocerebrovascular Disease Centers between January 1, 2015 and December 31, 2019 were telephonically surveyed using a computer-assisted telephone interview method. With the aim of surveying approximately 1,000 patients, 9,204 people were recruited through random sampling. Unmet needs were evaluated on the basis of Longer-term Unmet Needs after Stroke questionnaire items. Quality of life was evaluated using the EuroQoL 5-dimension, 3-level (EQ-5D-3L) questionnaire and the EQ-5D index. Results Among the participants, 93.6% experienced at least one unmet need and 311 (32.6%) reported unmet rehabilitation needs. The number of unmet needs, age, modified Rankin Scale (mRS) score, and previous stroke showed significant negative correlations with the EQ-5D index (p-value < 0.05). The age-adjusted odds ratio (OR) for reporting unmet rehabilitation needs significantly increased with problems in mobility (OR, 4.96; 95% confidence interval [CI], 3.64-6.76), self-care (OR, 4.46; 95% CI, 3.32-5.98), usual activities (OR, 5.78; 95% CI, 4.21-7.93), pain/discomfort (OR, 3.76; 95% CI, 2.76-5.06), anxiety/depression (OR, 3.67; 95% CI, 2.74-4.91), higher mRS score (OR, 3.13; 95% CI, 2.29-4.28), prior hyperlipidemia (OR, 1.35; 95% CI, 1.00-1.81), and number of unmet needs (OR, 1.30; 95% CI, 1.25-1.36). Conclusions Unmet needs were prevalent among stroke survivors and were associated with a lower quality of life and increased odds of reporting unmet rehabilitation needs. Further research is needed to investigate strategies for addressing these subjective unmet needs with the aim of improving the long-term quality of life of stroke survivors.
{"title":"Effects of long-term unmet needs and unmet rehabilitation needs on the quality of life in stroke survivors","authors":"Yookyung Lee, Won-Seok Kim, Won Kee Chang, Yun Sun Jung, Sungju Jee, Sung-Hwa Ko, Min Kyun Sohn, Yong-Il Shin, Hee-Joon Bae, Beom Joon Kim, Jun Yup Kim, Dong-Ick Shin, Kyu Sun Yum, Hee-Yun Chae, Dae-Hyun Kim, Jae-Kwan Cha, Man-Seok Park, Joon-Tae Kim, Kang-Ho Choi, Jihoon Kang, Nam-Jong Paik","doi":"10.1101/2024.03.08.24304010","DOIUrl":"https://doi.org/10.1101/2024.03.08.24304010","url":null,"abstract":"Background\u0000Unmet long-term needs and rehabilitation needs are prevalent among stroke survivors and affect their quality of life. We aimed to identify the long-term unmet needs and unmet rehabilitation needs among stroke survivors in South Korea and evaluate their intercorrelations with health-related quality of life.\u0000Methods\u0000Stroke survivors who were admitted to four Regional Cardiocerebrovascular Disease Centers between January 1, 2015 and December 31, 2019 were telephonically surveyed using a computer-assisted telephone interview method. With the aim of surveying approximately 1,000 patients, 9,204 people were recruited through random sampling. Unmet needs were evaluated on the basis of Longer-term Unmet Needs after Stroke questionnaire items. Quality of life was evaluated using the EuroQoL 5-dimension, 3-level (EQ-5D-3L) questionnaire and the EQ-5D index.\u0000Results\u0000Among the participants, 93.6% experienced at least one unmet need and 311 (32.6%) reported unmet rehabilitation needs. The number of unmet needs, age, modified Rankin Scale (mRS) score, and previous stroke showed significant negative correlations with the EQ-5D index (p-value < 0.05). The age-adjusted odds ratio (OR) for reporting unmet rehabilitation needs significantly increased with problems in mobility (OR, 4.96; 95% confidence interval [CI], 3.64-6.76), self-care (OR, 4.46; 95% CI, 3.32-5.98), usual activities (OR, 5.78; 95% CI, 4.21-7.93), pain/discomfort (OR, 3.76; 95% CI, 2.76-5.06), anxiety/depression (OR, 3.67; 95% CI, 2.74-4.91), higher mRS score (OR, 3.13; 95% CI, 2.29-4.28), prior hyperlipidemia (OR, 1.35; 95% CI, 1.00-1.81), and number of unmet needs (OR, 1.30; 95% CI, 1.25-1.36).\u0000Conclusions\u0000Unmet needs were prevalent among stroke survivors and were associated with a lower quality of life and increased odds of reporting unmet rehabilitation needs. Further research is needed to investigate strategies for addressing these subjective unmet needs with the aim of improving the long-term quality of life of stroke survivors.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140098965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-09DOI: 10.1101/2024.03.07.24303944
Qingcong Mo, Siqi Xu, Fangfei Hu, Xiaoyan Zheng
Introduction Kinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders. Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to disperse and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for the comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in musculoskeletal disorders, and provide evidence maps to visualise the findings. Method and analysis Electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus, ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with musculoskeletal disorders will be included. The primary and additional outcome to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data, and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (e.g., pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically. Ethics and dissemination Formal ethical approval for this study is not required, since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository. PROSPERO registration number CRD42024517528
{"title":"Effectiveness and clinical relevance of kinesio taping in musculoskeletal disorders: A protocol for an overview of systematic reviews and evidence mapping","authors":"Qingcong Mo, Siqi Xu, Fangfei Hu, Xiaoyan Zheng","doi":"10.1101/2024.03.07.24303944","DOIUrl":"https://doi.org/10.1101/2024.03.07.24303944","url":null,"abstract":"Introduction Kinesio taping (KT) has been extensively applied in the management of musculoskeletal disorders. Although plentiful systematic reviews (SRs) have evaluated its efficacy, there are no convincing conclusions due to disperse and inconclusive results, and its clinical relevance remains unclear. Hence, there is a need to summarise all the SRs for the comprehensive and consistent evidence. This overview aims to appraise the overall effectiveness of KT in musculoskeletal disorders, and provide evidence maps to visualise the findings. Method and analysis\u0000Electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, Epistemonikos, PEDro, Scopus, ISI Web of Science) and reference lists will be searched from inception to September 2024 for the SRs of randomised controlled trials (RCTs). The SRs involving comparisons of the effectiveness between single or adjunctive KT and other interventions for patients with musculoskeletal disorders will be included. The primary and additional outcome to be considered will be the core outcome set, and the patient-reported outcome measure and patient-important outcome, respectively. Two reviewers will independently screen and select studies, extract the data, and evaluate the reporting and methodological quality of eligible SRs as well as the risk of bias of included RCTs. For the SRs without meta-analysis, we will collate the number of RCTs that showed any differences in outcomes. For the SRs with meta-analysis, we will provide the original summary of evidence (e.g., pooled effects and heterogeneity) for outcomes with an evaluation of missing results and clinical relevance. The certainty of each outcome will be measured, and user-friendly maps of findings will be presented graphically. Ethics and dissemination Formal ethical approval for this study is not required, since the data will be only collected from published literature in public databases. The results will be disseminated in the peer-reviewed academic journal, and relevant datasets will be preserved in the online repository. PROSPERO registration number CRD42024517528","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140075353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-09DOI: 10.1101/2024.03.08.24303392
Cecile Siobhan Verbaarschot, Vahagn Karapetyan, Charles Greenspon, Michael Boninger, Sliman Bensmaia, Bettina Sorger, Robert Gaunt
Microstimulation of the somatosensory cortex can evoke tactile percepts in people with spinal cord injury, providing a means to restore touch. While location and intensity can be reliably conveyed, two issues that prevent creating more complex naturalistic sensations are a lack of methods to effectively scan the large stimulus parameter space and difficulties with assessing percept quality. Here, we addressed both challenges with an experimental paradigm that enabled three individuals with tetraplegia to control their stimulation parameters in a blinded fashion to create sensations for different virtual objects. Participants felt they could reliably create object-specific sensations and reported vivid object-appropriate characteristics. Despite substantial overlap in stimulus parameter selections across objects, both linear classifiers and participants could match stimulus profiles with their respective objects significantly above chance without any visual cues. We conclude that while visual information contributes to the experience of artificial touch, microstimulation in the somatosensory cortex itself can evoke intuitive percepts with a variety of tactile properties. This novel self-guided stimulation approach may be used to effectively characterize percepts from future stimulation paradigms.
{"title":"Conveying tactile object characteristics through customized intracortical microstimulation of the human somatosensory cortex","authors":"Cecile Siobhan Verbaarschot, Vahagn Karapetyan, Charles Greenspon, Michael Boninger, Sliman Bensmaia, Bettina Sorger, Robert Gaunt","doi":"10.1101/2024.03.08.24303392","DOIUrl":"https://doi.org/10.1101/2024.03.08.24303392","url":null,"abstract":"Microstimulation of the somatosensory cortex can evoke tactile percepts in people with spinal cord injury, providing a means to restore touch. While location and intensity can be reliably conveyed, two issues that prevent creating more complex naturalistic sensations are a lack of methods to effectively scan the large stimulus parameter space and difficulties with assessing percept quality. Here, we addressed both challenges with an experimental paradigm that enabled three individuals with tetraplegia to control their stimulation parameters in a blinded fashion to create sensations for different virtual objects. Participants felt they could reliably create object-specific sensations and reported vivid object-appropriate characteristics. Despite substantial overlap in stimulus parameter selections across objects, both linear classifiers and participants could match stimulus profiles with their respective objects significantly above chance without any visual cues. We conclude that while visual information contributes to the experience of artificial touch, microstimulation in the somatosensory cortex itself can evoke intuitive percepts with a variety of tactile properties. This novel self-guided stimulation approach may be used to effectively characterize percepts from future stimulation paradigms.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140075325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303809
Courtney Celian, Hannah Redd, Kevin Smaller, Partha Ryali, James Lanphier Patton, David Jay Reinkensmeyer, Miriam Rose Rafferty
Objective: To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption. Design: A convergent, mixed-methods study using direct field observations, semi-structured templates, and summative content analysis. Setting: Ten neurorehabilitation units in a single health system. Participants: 3 research clinicians (1OT, 2PTs) observed ~60 OTs and 70 PTs in inpatient; ~18 OTs and 30 PTs in outpatient. Interventions: Not applicable Main Outcome Measures: Characteristics of RT, time spent setting up and using RT, and clinician behaviors. Results: 90 distinct devices across 15 different focus areas were inventoried. 329 RT-uses were documented over 44 hours with 42% of inventoried devices used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vitals (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately AC-powered (56%), actuated (57%), monitor-less (53%), multi-use (68%), and required little familiarization (57%). Set-up times were brief (mean = 3.8 and 0.8 for intervention and measurement, respectively); more time was spent with intervention RT (25.6) than measurement RT (7.3). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%). Therapists' attention was split evenly between direct attention towards the patient during clinician treatment (49.7%) and completing other tasks such as documentation (50%). Conclusions: Even in a tech-friendly hospital, majority of available RT were observed un-used, but identifying these usage patterns is crucial to predict eventual adoption of new designs from earlier stages of RT development. An interactive data visualization page supplement is provided to facilitate this study.
{"title":"Uncovering clinical rehabilitation technology trends: field observations, mixed methods analysis, and data visualization.","authors":"Courtney Celian, Hannah Redd, Kevin Smaller, Partha Ryali, James Lanphier Patton, David Jay Reinkensmeyer, Miriam Rose Rafferty","doi":"10.1101/2024.03.05.24303809","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303809","url":null,"abstract":"Objective: To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption. Design: A convergent, mixed-methods study using direct field observations, semi-structured templates, and summative content analysis. Setting: Ten neurorehabilitation units in a single health system. Participants: 3 research clinicians (1OT, 2PTs) observed ~60 OTs and 70 PTs in inpatient; ~18 OTs and 30 PTs in outpatient. Interventions: Not applicable Main Outcome Measures: Characteristics of RT, time spent setting up and using RT, and clinician behaviors. Results: 90 distinct devices across 15 different focus areas were inventoried. 329 RT-uses were documented over 44 hours with 42% of inventoried devices used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vitals (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately AC-powered (56%), actuated (57%), monitor-less (53%), multi-use (68%), and required little familiarization (57%). Set-up times were brief (mean = 3.8 and 0.8 for intervention and measurement, respectively); more time was spent with intervention RT (25.6) than measurement RT (7.3). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%). Therapists' attention was split evenly between direct attention towards the patient during clinician treatment (49.7%) and completing other tasks such as documentation (50%). Conclusions: Even in a tech-friendly hospital, majority of available RT were observed un-used, but identifying these usage patterns is crucial to predict eventual adoption of new designs from earlier stages of RT development. An interactive data visualization page supplement is provided to facilitate this study.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140075346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1101/2024.02.28.24303260
Natasha S Bhatia, Stephany Kunzweiler, Christopher Conley, Ki H Kim, Adenike Adewuyi, Lisa F Wolfe, Mary Kwasny, Colin K. Franz
Objectives Neuromuscular respiratory failure after spinal cord injury (SCI) can lead to dependence on a ventilator. Ventilator-free breathing after SCI is associated with improved morbidity, mortality, and quality of life. We investigated the use of diaphragm muscle ultrasound to predict ventilator weaning outcomes after spinal cord injury. Methods This is a retrospective case series conducted at a university-affiliated freestanding acute rehabilitation hospital. We identified patients with cervical spinal cord injury who had a tracheostomy and were dependent on an invasive mechanical ventilator at the time of admission to the rehabilitation unit. A diaphragm muscle ultrasound was performed, which included measurements of the thickness of the diaphragm and a calculation of the thickening ratio (TR), a marker of diaphragm contractility. The primary outcome measure was the need for mechanical ventilation at time of discharge from acute inpatient rehabilitation. Results Of the 21 patients enrolled, 11 (52%) were able to wean successfully (partially or fully) from the ventilator. Of the ultrasound measurements that were taken, the TR was the optimal predictor for ventilator weaning outcomes. A threshold of TR≥1.2 as the maximum hemidiaphragm measurement had a sensitivity of 1.0 and specificity of 0.90 for predicting ventilator weaning. Conclusion Normal diaphragm contractility (TR ≥1.2) as determined by diaphragm muscle ultrasound is a strong positive predictor for successful ventilator weaning in patients with cervical spinal cord injury. Diaphragm ultrasound can guide clinical practice by assisting in prognosticating the ability to wean from a ventilator after cervical SCI.
{"title":"The Predictive Value of Diaphragm Muscle Ultrasound for Ventilator Weaning Outcomes after Spinal Cord Injury: A Retrospective Case Series","authors":"Natasha S Bhatia, Stephany Kunzweiler, Christopher Conley, Ki H Kim, Adenike Adewuyi, Lisa F Wolfe, Mary Kwasny, Colin K. Franz","doi":"10.1101/2024.02.28.24303260","DOIUrl":"https://doi.org/10.1101/2024.02.28.24303260","url":null,"abstract":"Objectives\u0000Neuromuscular respiratory failure after spinal cord injury (SCI) can lead to dependence on a ventilator. Ventilator-free breathing after SCI is associated with improved morbidity, mortality, and quality of life. We investigated the use of diaphragm muscle ultrasound to predict ventilator weaning outcomes after spinal cord injury. Methods\u0000This is a retrospective case series conducted at a university-affiliated freestanding acute rehabilitation hospital. We identified patients with cervical spinal cord injury who had a tracheostomy and were dependent on an invasive mechanical ventilator at the time of admission to the rehabilitation unit. A diaphragm muscle ultrasound was performed, which included measurements of the thickness of the diaphragm and a calculation of the thickening ratio (TR), a marker of diaphragm contractility. The primary outcome measure was the need for mechanical ventilation at time of discharge from acute inpatient rehabilitation. Results\u0000Of the 21 patients enrolled, 11 (52%) were able to wean successfully (partially or fully) from the ventilator. Of the ultrasound measurements that were taken, the TR was the optimal predictor for ventilator weaning outcomes. A threshold of TR≥1.2 as the maximum hemidiaphragm measurement had a sensitivity of 1.0 and specificity of 0.90 for predicting ventilator weaning. Conclusion\u0000Normal diaphragm contractility (TR ≥1.2) as determined by diaphragm muscle ultrasound is a strong positive predictor for successful ventilator weaning in patients with cervical spinal cord injury. Diaphragm ultrasound can guide clinical practice by assisting in prognosticating the ability to wean from a ventilator after cervical SCI.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140019266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.25.24302970
Nicola De Meo, David Poselek, Michele Margelli, Andrea Segat, Martina Zaninetti, Giovanni Galeoto, Marco Segat, Filippo Maselli, Federico Minetti, Matteo Fascia
Background: When assessing a patient presenting with thoracic pain it's important for the physiotherapist to quickly understand if the cause is a musculoskeletal condition or a dysfunction of the cardiovascular and circulatory system. Promptly referring the patient is essential to identify potentially life-threatening conditions at an early stage. Objectives: identifying the current state of knowledge regarding cardiovascular and circulatory systems conditions that generate a thoracic pain that resembles a musculoskeletal condition in extra-hospital settings. Methods: PCC considered: Population: Patients with thoracic pain. No limits of age and gender were established. Concept: The symptoms in the thoracic region are caused by cardiovascular disorders or dysfunctions. Context: We decided to exclude emergency contexts from this review to focus on the tools to make differential diagnosis without instrumental examinations. The research will be conducted on the following databases: Medline, CINAHL,Cochrane Library. Grey literature will be searched on Scopus and Google Scholar. The inclusion criteria will be: any type of study design. No geographical or temporal limits of publication will be applied. Only articles in English and Italian or at least with an English abstract will be considered Results:The results will be presented as a map of the data extracted from the included papers in a diagrammatic, tabular form, and in a descriptive format that aligns with the objectives and scope of the review. The results can also be classified under the main conceptual categories, such as: Features of the signs and symptoms; Level of concern; Systems involved (musculoskeletal, cardiovascular, gastroenterological, respiratory, psychological); Setting Instrumental tests
背景：在对胸痛患者进行评估时，物理治疗师必须迅速了解病因是肌肉骨骼疾病还是心血管和循环系统功能障碍。及时转诊对早期发现可能危及生命的病症至关重要。目的：确定在院外环境中产生类似肌肉骨骼疾病的胸痛的心血管和循环系统疾病的知识现状。方法：考虑 PCC：人群：胸痛患者。年龄和性别不限。概念：胸腔部位的症状由心血管疾病或功能障碍引起。背景：我们决定将急诊情况排除在本综述之外，以便在不进行仪器检查的情况下将重点放在进行鉴别诊断的工具上。研究将在以下数据库中进行：Medline, CINAHL, Cochrane Library。灰色文献将在 Scopus 和 Google Scholar 上搜索。纳入标准为：任何类型的研究设计。发表时间不受地域和时间限制。结果：研究结果将以图解、表格和描述的形式呈现，并与综述的目标和范围保持一致。结果还可按照主要概念类别进行分类，例如：体征和症状的特征；关注程度；涉及的系统（肌肉骨骼、心血管、肠胃、呼吸、心理）；环境仪器测试
{"title":"Clinical scenario related to cardiovascular system: is it possible to develop thoracic pain imitating a musculoskeletal disorder? A scoping review","authors":"Nicola De Meo, David Poselek, Michele Margelli, Andrea Segat, Martina Zaninetti, Giovanni Galeoto, Marco Segat, Filippo Maselli, Federico Minetti, Matteo Fascia","doi":"10.1101/2024.02.25.24302970","DOIUrl":"https://doi.org/10.1101/2024.02.25.24302970","url":null,"abstract":"Background: When assessing a patient presenting with thoracic pain it's important for the physiotherapist to quickly understand if the cause is a musculoskeletal condition or a dysfunction of the cardiovascular and circulatory system. Promptly referring the patient is essential to identify potentially life-threatening conditions at an early stage. Objectives: identifying the current state of knowledge regarding cardiovascular and circulatory systems conditions that generate a thoracic pain that resembles a musculoskeletal condition in extra-hospital settings. Methods: PCC considered: Population: Patients with thoracic pain. No limits of age and gender were established. Concept: The symptoms in the thoracic region are caused by cardiovascular disorders or dysfunctions. Context: We decided to exclude emergency contexts from this review to focus on the tools to make differential diagnosis without instrumental examinations. The research will be conducted on the following databases: Medline, CINAHL,Cochrane Library. Grey literature will be searched on Scopus and Google Scholar. The inclusion criteria will be: any type of study design. No geographical or temporal limits of publication will be applied. Only articles in English and Italian or at least with an English abstract will be considered Results:The results will be presented as a map of the data extracted from the included papers in a diagrammatic, tabular form, and in a descriptive format that aligns with the objectives and scope of the review. The results can also be classified under the main conceptual categories, such as:\u0000Features of the signs and symptoms;\u0000Level of concern;\u0000Systems involved (musculoskeletal, cardiovascular, gastroenterological, respiratory, psychological);\u0000Setting\u0000Instrumental tests","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140006062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.26.24303289
Monica F Liu, Robert A Gaunt, Jennifer L Collinger, John E Downey, Aaron P Batista, Michael L Boninger, Douglas J Weber
Vision and proprioception regulate motor output during reaching. To study the effects of sensory input on motor control, brain computer interfaces (BCIs) offer particular advantages. As part of a long-term clinical BCI trial, we implanted two 96-channel microelectrode arrays into M1 of a person who was completely paralyzed below the neck but retained intact somatosensation. Neural recordings from M1 were transformed into a 2-dimensional velocity control signal for a robotic arm using an optimal linear estimator decoder that was calibrated while the participant imagined performing movements demonstrated by a virtual arm. Once the decoder was calibrated, we asked the participant to move the robotic arm left and right past a pair of lines as many times as possible in one minute. We examined how visual and proprioceptive feedback were incorporated into BCI control during this task by providing the participant with either visual or proprioceptive feedback, both, or neither. Proprioceptive feedback was provided by moving the participant's own arm to match the movement of the robotic arm. Task performance with vision or proprioception alone was better than when neither were provided. However, providing proprioceptive feedback impaired performance relative to visual feedback alone, unless the decoder was calibrated with neural data collected while both visual and proprioceptive feedback were provided. Providing proprioceptive feedback during decoder calibration rescued performance because it better captured M1's neural activity during BCI control with proprioceptive feedback. In general, BCI performance was positively correlated with how well the decoder captured variance in neural activity during the task. In summary, we found that while the BCI participant was able to use proprioceptive feedback regardless of whether the decoder was trained with vision only or vision and proprioception, training the decoder with both visual and proprioceptive feedback made performance more robust to the addition or removal of visual or proprioceptive feedback. This was because training a decoder with proprioceptive feedback allows the decoder to take advantage of proprioception-driven activity in M1. Overall, we demonstrated that natural sensation can be effectively combined with BCI to improve performance in humans.
{"title":"Volitional control of movement interacts with proprioceptive feedback in motor cortex during brain-computer interface control in humans","authors":"Monica F Liu, Robert A Gaunt, Jennifer L Collinger, John E Downey, Aaron P Batista, Michael L Boninger, Douglas J Weber","doi":"10.1101/2024.02.26.24303289","DOIUrl":"https://doi.org/10.1101/2024.02.26.24303289","url":null,"abstract":"Vision and proprioception regulate motor output during reaching. To study the effects of sensory input on motor control, brain computer interfaces (BCIs) offer particular advantages. As part of a long-term clinical BCI trial, we implanted two 96-channel microelectrode arrays into M1 of a person who was completely paralyzed below the neck but retained intact somatosensation. Neural recordings from M1 were transformed into a 2-dimensional velocity control signal for a robotic arm using an optimal linear estimator decoder that was calibrated while the participant imagined performing movements demonstrated by a virtual arm. Once the decoder was calibrated, we asked the participant to move the robotic arm left and right past a pair of lines as many times as possible in one minute. We examined how visual and proprioceptive feedback were incorporated into BCI control during this task by providing the participant with either visual or proprioceptive feedback, both, or neither. Proprioceptive feedback was provided by moving the participant's own arm to match the movement of the robotic arm. Task performance with vision or proprioception alone was better than when neither were provided. However, providing proprioceptive feedback impaired performance relative to visual feedback alone, unless the decoder was calibrated with neural data collected while both visual and proprioceptive feedback were provided. Providing proprioceptive feedback during decoder calibration rescued performance because it better captured M1's neural activity during BCI control with proprioceptive feedback. In general, BCI performance was positively correlated with how well the decoder captured variance in neural activity during the task. In summary, we found that while the BCI participant was able to use proprioceptive feedback regardless of whether the decoder was trained with vision only or vision and proprioception, training the decoder with both visual and proprioceptive feedback made performance more robust to the addition or removal of visual or proprioceptive feedback. This was because training a decoder with proprioceptive feedback allows the decoder to take advantage of proprioception-driven activity in M1. Overall, we demonstrated that natural sensation can be effectively combined with BCI to improve performance in humans.","PeriodicalId":501453,"journal":{"name":"medRxiv - Rehabilitation Medicine and Physical Therapy","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140005847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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