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The effects of orthotics device on the balance control in multiple sclerosis patients: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 66:104005. [PMID: 35839616 DOI: 10.1016/j.msard.2022.104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/15/2022] [Accepted: 06/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis refers to a progressive autoimmune inflammatory disease in the central nervous system usually accompanied by balance disorder. Our systematic review aimed to investigate the effects of orthotic devices on balance control of multiple sclerosis patients. METHODS The search procedure was according to the population, intervention, comparison, and outcome (PICO) strategy. We looked into PubMed, Embase, ISI Web of Knowledge, and Scopus databases and included all studies published since 1980. Two researchers did the searches separately and evaluated the selected papers' quality based on the physiotherapy evidence database (PEDro) scale and Cochrane risk of bias tool. We did a meta-analysis to evaluate the interventions' effects on the balance factors. RESULTS We found nine studies, of which seven studies with 162 participants were included in our meta-analysis. Four studies investigated the effect of foot orthoses, one evaluated the effect of shoe modifications and four evaluated the effect of ankle foot orthoses. There was no significant immediate difference between the insole and control groups in center of pressure velocity change, C7 displacement, in both open and closed eyes conditions. Also, there was no significant immediate difference between ankle foot orthosis' intervention and control groups in center of pressure velocity and displacement changes in antero-posterior and medio-lateral directions, in both open and closed eyes conditions. We could not do a meta-analysis for shoe modification. CONCLUSION Few studies have assessed the effects of orthoses on balance control in multiple sclerosis patients. Studies on ankle foot and foot orthoses show inconsistent results. According to our meta-analysis, orthotic interventions do not seem to improve the balance of people with multiple sclerosis.
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McGibbon C, Sexton A, Gryfe P, Dutta T, Jayaraman A, Deems-Dluhy S, Novak A, Fabara E, Adans-Dester C, Bonato P. Effect of using of a lower-extremity exoskeleton on disability of people with multiple sclerosis. Disabil Rehabil Assist Technol 2021:1-8. [DOI: 10.1080/17483107.2021.1874064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Chris McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
| | - Pearl Gryfe
- Assistive Technology Clinic, Toronto, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Arun Jayaraman
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Susan Deems-Dluhy
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | | - Eric Fabara
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Catherine Adans-Dester
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
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Madroñero-Miguel B, Cuesta-García C. [Effects of rehabilitation on fatigue, disability and quality of life in people with multiple sclerosis: A systematic review]. Rehabilitacion (Madr) 2021; 55:38-48. [PMID: 32441265 DOI: 10.1016/j.rh.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/31/2019] [Accepted: 01/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the effectiveness of rehabilitation, highlighting the role of Occupational Therapy, in people with multiple sclerosis, in terms of disability, fatigue and quality of life. MATERIALS AND METHODS A literature search was carried out in the BVS, Cochrane, OT-Seeker, PubMed and PEDro databases. INCLUSION CRITERIA Controlled clinical trials published between January 2011 and April 2019 in Spanish or English with a score of ≥5 on the PEDro scale whose purpose was rehabilitation through the use of assistive technology, skills training, vestibular rehabilitation, behaviour modification, therapeutic education or specific Occupational Therapy interventions. RESULTS A total of 16 studies (1,279 subjects) were included. Rehabilitation improved patients' fatigue and disability and slightly enhanced their quality of life. CONCLUSIONS Rehabilitation can provide benefits to the performance of people with multiple sclerosis by reducing their perceived fatigue and disability. LIMITATIONS The heterogeneity of the sample, the type and duration of the interventions and variability of the instruments for measuring results.
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Affiliation(s)
- B Madroñero-Miguel
- Departamento de Terapia Ocupacional y Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, España.
| | - C Cuesta-García
- Departamento de Terapia Ocupacional y Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, España; Grupo de Investigación Occupational Thinks, Centro Superior de Estudios Universitario La Salle, Universidad Autónoma de Madrid, Madrid, España
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Stolt M, Laitinen AM, Ruutiainen J, Leino-Kilpi H. Research on lower extremity health in patients with multiple sclerosis: a systematic scoping review. J Foot Ankle Res 2020; 13:54. [PMID: 32854741 PMCID: PMC7457257 DOI: 10.1186/s13047-020-00423-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background Multiple sclerosis (MS) often affects ambulation and the function of the lower limbs. However, little is known about how much research has been conducted on lower extremity health in patients with MS. Objective To analyse empirical studies and their evidence on lower extremity health in patients with MS, in order to identify the need for future studies in key areas. Methods A systematic scoping review was conducted. A literature search of Medline (PubMed), CINAHL (EBSCO) and the Cochrane Library databases was performed. The search covered the period up to 15 January 2020 from the earliest records available. This led to the inclusion of 42 empirical articles. The data were analysed using content analysis and quantification techniques. Results The research on lower extremity health focused primarily on two main areas: gait and lower extremity muscle strength. Lower extremity health was assessed using a variety of methods, most of which consisted of objective physical tests and gait analysis. Patients with MS had many problems with the health of their lower extremities, which manifested in walking difficulties, balance problems, muscle weaknesses and spasticity. In the feet, pes cavus, claw toes, oedema and altered foot sensation were common. Conclusions MS affects lower limb and foot health, and these problems can affect patients’ daily lives. However, the extent of these problems is poorly understood, partly due to the dearth of research on lower limb and foot health. Therefore, further research is warranted in order to better understand the impact of MS on foot and lower limb health in everyday life.
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Affiliation(s)
- Minna Stolt
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.
| | - Anne-Marie Laitinen
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Juhani Ruutiainen
- Finnish Neuro Society, Masku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, 20014, Turku, Finland.,Turku University Hospital, Turku, Finland
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Ramari C, Hvid LG, David ACD, Dalgas U. The importance of lower-extremity muscle strength for lower-limb functional capacity in multiple sclerosis: Systematic review. Ann Phys Rehabil Med 2019; 63:123-137. [PMID: 31816449 DOI: 10.1016/j.rehab.2019.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle strength) appear to have critical implications for lower-limb functional capacity. However, no review has summarized the current knowledge about the importance of muscle strength for functional tasks in PwMS. Expanding the current knowledge would advance the design of both clinical and research interventions aiming to improve functional capacity in PwMS. OBJECTIVES (1) To identify studies that measured lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS, and (2) to map associations between muscle strength and functional capacity. METHODS This review was based on a literature search (databases: PubMed, Embase). Included studies had to report data on lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS. The associations between muscle strength and functional capacity were analyzed by using the reported correlation coefficients (R) recalculated to the determination coefficient R2. Randomized trials and observational studies were included. RESULTS A total of 59 articles were reviewed; 17 (773 participants) reported associations between muscle strength and functional capacity. Lower-extremity muscle mechanical function explained a significant part of the variance in most lower-limb functional capacity tests (approximately 20-30%). This was particularly evident in muscle strength from the weakest leg. Muscle strength was predominantly tested on knee extensors and knee flexors by using isokinetic dynamometry during maximal isometric (0°/s) and dynamic (30-60°/s) contractions. Walking tests such as the timed 25-Foot Walk Test and 10-Min, 2-Min and 6-Min Walk Test were the most frequently performed functional capacity tests. CONCLUSIONS In PwMS, muscle strength of particularly the weakest limb explains 20% to 30% of the variance across a number of lower-limb functional capacity tests. Thus, exercise programs should focus on increasing lower-extremity muscle mechanical function in PwMS and minimizing strength asymmetry between limbs.
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Affiliation(s)
- Cintia Ramari
- Faculty of Physical Education, University of Brasilia, Brasília, Brazil.
| | - Lars G Hvid
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | - Ulrik Dalgas
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark.
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McGibbon CA, Sexton A, Jayaraman A, Deems-Dluhy S, Gryfe P, Novak A, Dutta T, Fabara E, Adans-Dester C, Bonato P. Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial. J Neuroeng Rehabil 2018; 15:117. [PMID: 30541585 PMCID: PMC6291941 DOI: 10.1186/s12984-018-0468-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background Although physical activity and exercise is known to benefit people with multiple sclerosis (MS), the ability of these individuals to participate in such interventions is difficult due to the mobility impairments caused by the disease. Keeogo is a lower-extremity powered exoskeleton that may be a potential solution for enabling people with MS to benefit from physical activity and exercise. Methods An open-label, randomized, cross-over trial was used to examine the immediate performance effects when using the device, and the potential benefits of using the device in a home setting for 2 weeks. Clinical performance tests with and without the device included the 6 min walk test, timed up and go test and the 10-step stair test (up and down). An activity monitor was also used to measure physical activity at home, and a patient-reported questionnaire was used to determine the amount and extent of home use. Generalized linear models were used to test for trial effects, and correlation analysis used to examine relationships between trial effects and usage. Results Twenty-nine patients with MS participated. All measures showed small decrements in performance while wearing the device compared to not wearing the device. However, significant improvements in unassisted (Rehab effect) performance were found after using the device at home for 2 weeks, compared to 2 weeks at home without the device, and participants improved their ability to use the device over the trial period (Training effect). Rehab and Training effects were related to the self-reported extent that participants used Keeogo at home. Conclusions Keeogo appears to deliver an exercise-mediated benefit to individuals with MS that improved their unassisted gait endurance and stair climbing ability. Keeogo might be a useful tool for delivering physical activity interventions to individuals with mobility impairment due to MS. Trial registration ClinicalTrials.gov: NCT02904382. Registered 19 September 2016 - Retrospectively registered.
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Affiliation(s)
- Chris A McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada. .,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada.
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Arun Jayaraman
- Shirley Ryan AbilityLab / Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Susan Deems-Dluhy
- Shirley Ryan AbilityLab / Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Pearl Gryfe
- Assistive Technology Clinic, Toronto, ON, Canada
| | - Alison Novak
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Eric Fabara
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Catherine Adans-Dester
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
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Boes MK, Bollaert RE, Kesler RM, Learmonth YC, Islam M, Petrucci MN, Motl RW, Hsiao-Wecksler ET. Six-Minute Walk Test Performance in Persons With Multiple Sclerosis While Using Passive or Powered Ankle-Foot Orthoses. Arch Phys Med Rehabil 2018; 99:484-490. [DOI: 10.1016/j.apmr.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
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Almuklass AM, Davis L, Hamilton LD, Hebert JR, Alvarez E, Enoka RM. Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial. Neurorehabil Neural Repair 2018; 32:84-93. [PMID: 29366377 DOI: 10.1177/1545968317753681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) eventually compromises the walking ability of most individuals burdened with the disease. Treatment with neuromuscular electrical stimulation (NMES) can restore some functional abilities in persons with MS, but its effectiveness may depend on stimulus-pulse duration. OBJECTIVE To compare the effects of a 6-week intervention with narrow- or wide-pulse NMES on walking performance, neuromuscular function, and disability status of persons with relapsing-remitting MS. METHODS Individuals with MS (52.6 ± 7.4 years) were randomly assigned to either the narrow-pulse (n = 13) or wide-pulse (n = 14) group. The NMES intervention was performed on the dorsiflexor and plantar flexor muscles of both legs (10 minutes each muscle, 4 s on and 12 s off) at a tolerable level for 18 sessions across 6 weeks. Outcomes were obtained before (week 0) and after (week 7) the intervention and 4 weeks later (week 11). RESULTS There was no influence of stimulus-pulse duration on the outcomes ( P > .05); thus, the data were collapsed across groups. The NMES intervention improved ( P < .05) gait speed and walking endurance, dorsiflexor strength in the more-affected leg, plantar flexor strength in the less-affected leg, force control for plantar flexors in the less-affected leg, and self-reported levels of fatigue and walking limitations. CONCLUSION There was no influence of stimulus-pulse duration on the primary outcomes (gait speed and walking endurance). The 6-week NMES intervention applied to the lower leg muscles of persons with mild to moderate levels of disability can improve their walking performance and provide some symptom relief.
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Affiliation(s)
- Awad M Almuklass
- 1 University of Colorado, Boulder, CO, USA.,2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Leah Davis
- 1 University of Colorado, Boulder, CO, USA
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Almuklass AM, Davis L, Hamilton LD, Vieira TM, Botter A, Enoka RM. Motor unit discharge characteristics and walking performance of individuals with multiple sclerosis. J Neurophysiol 2018; 119:1273-1282. [PMID: 29357453 DOI: 10.1152/jn.00598.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Walking performance of persons with multiple sclerosis (MS) is strongly influenced by the activation signals received by lower leg muscles. We examined the associations between force steadiness and motor unit discharge characteristics of lower leg muscles during submaximal isometric contractions with tests of walking performance and disability status in individuals who self-reported walking difficulties due to MS. We expected that worse walking performance would be associated with weaker plantar flexor muscles, worse force steadiness, and slower motor unit discharge times. Twenty-three individuals with relapsing-remitting MS (56 ± 7 yr) participated in the study. Participants completed one to three evaluation sessions that involved two walking tests (25-ft walk and 6-min walk), a manual dexterity test (grooved pegboard), health-related questionnaires, and measurement of strength, force steadiness, and motor unit discharge characteristics of lower leg muscles. Multiple regression analyses were used to construct models to explain the variance in measures of walking performance. There were statistically significant differences (effect sizes: 0.21-0.60) between the three muscles in mean interspike interval (ISI) and ISI distributions during steady submaximal contractions with the plantar flexor and dorsiflexor muscles. The regression models explained 40% of the variance in 6-min walk distance and 47% of the variance in 25-ft walk time with two or three variables that included mean ISI for one of the plantar flexor muscles, dorsiflexor strength, and force steadiness. Walking speed and endurance in persons with relapsing-remitting MS were reduced in individuals with longer ISIs, weaker dorsiflexors, and worse plantar flexor force steadiness. NEW & NOTEWORTHY The walking endurance and gait speed of persons with relapsing-remitting multiple sclerosis (MS) were worse in individuals who had weaker dorsiflexor muscles and greater force fluctuations and longer times between action potentials discharged by motor units in plantar flexor muscles during steady isometric contractions. These findings indicate that the control of motor unit activity in lower leg muscles of individuals with MS is associated with their walking ability.
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Affiliation(s)
- Awad M Almuklass
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences , Riyadh , Saudi Arabia
| | - Leah Davis
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Landon D Hamilton
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
| | - Taian M Vieira
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Turin , Italy
| | - Alberto Botter
- LISiN, Department of Electronics and Telecommunications, Politecnico di Torino, Turin , Italy
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado , Boulder, Colorado
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) and the most widespread nontraumatic cause of disability in young adults around the world. MS occurs in people of all ages, races, and ethnicities. MS is characterized by clinical symptoms resulting from lesions in the brain, spinal cord, or optic nerves that can affect balance, gait, and fall risk. Lesions accumulate over time and occur in different areas of the CNS causing symptoms that include weakness, spasticity, and fatigue, as well as changes in sensation, coordination, vision, cognition, and bladder function. Thus, it is not surprising that imbalance, gait dysfunction, and falls are common in people with MS. The overwhelming majority have abnormalities of postural control and gait even early in the disease course. In all, 50-80% have balance and gait dysfunction and over 50% fall at least once each year. Balance dysfunction in MS is conceptualized as three interrelated problems: decreased ability to maintain position, limited and slowed movement towards limits of stability, and delayed responses to postural displacements and perturbations. In addition, functional balance performance may be affected by impaired dual-task integration. Walking changes in MS include reduced gait speed, impaired walking balance, and reduced walking-related physical activity. Falls in people with MS are associated with injuries, reduced participation, and increased fear of falling. A wide and growing range of rehabilitation and medical interventions are available to address the changes in balance, gait, and fall risk associated with MS.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Ylva Nilsagard
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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McLoughlin JV, Barr CJ, Patritti B, Crotty M, Lord SR, Sturnieks DL. Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis. Disabil Rehabil 2015; 38:535-43. [DOI: 10.3109/09638288.2015.1047969] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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