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Barbalho-Moulim MC, Paro FM, Pedrosa DF, Serafim LM, Kuster E, Carmo WAD, de Oliveira GP, de Lima MHBS, Pedreira AB, Duarte H, Wittmer VL. Effects of upper limbs' neuromuscular electrical stimulation (NMES) superimposed to voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise, in muscle strength, functional capacity and quality of life of adult patients with CKD: a randomized clinical trial protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2079. [PMID: 38477078 DOI: 10.1002/pri.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of unilateral upper limbs' (ULM) neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise on muscle strength, functional capacity and quality of life of adult patients with chronic kidney disease (CKD). METHODS This randomized controlled clinical trial will be carried out at a Brazilian University Hospital. The patients will be evaluated and randomly allocated to an intervention group (i.e., unilateral NMES on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min) or a control group (i.e., unilateral NMES-Sham on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min). The patients will be treated for 8 weeks, with three weekly treatment sessions totaling 24 sessions. MEASUREMENTS ULM muscle strength, functional capacity, quality of life and also the feasibility, safety and patient adherence to the exercise protocol. All physical measurements will be collected by trained researchers before treatment (week 0) and at the end of treatment (week 9), always in the second hemodialysis session of the week. It will be used in an intention-to-treat analysis. RESULTS/CONCLUSIONS The outcomes of this clinical trial protocol may help to know the possible benefits of unilateral ULM' NMES superimposed on a voluntary contraction added to a protocol of leg cycle ergometer for patients with CKD and to aid clinical decisions about future implementation or not of this technique (NMES) in intradialytic physical training programs.
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Affiliation(s)
| | - Flavia Marini Paro
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Diego França Pedrosa
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Lais Mello Serafim
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Elizângela Kuster
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Willian Assis do Carmo
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Gabriela P de Oliveira
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Maria Helena B S de Lima
- Cassiano Antônio Moraes University Hospital (HUCAM), Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Alexandre Bittencourt Pedreira
- Hemodialysis Sector-Nephrology Unit, Cassiano Antônio Moraes University Hospital (HUCAM), Brazilian Hospital Services Company (EBSERH), Vitória, Espírito Santo, Brazil
| | - Halina Duarte
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Verônica Lourenço Wittmer
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
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Perez-Dominguez B, Suso-Marti L, Dominguez-Navarro F, Perpiña-Martinez S, Calatayud J, Casaña J. Effects of resistance training on patients with End-Stage Renal Disease: an umbrella review with meta-analysis of the pooled findings. J Nephrol 2023; 36:1805-1839. [PMID: 37318646 PMCID: PMC10543800 DOI: 10.1007/s40620-023-01635-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This umbrella review aimed to review the effects of resistance training on patients with end-stage renal disease and assess the methodological quality of the available literature. METHODS An umbrella review and meta-meta-analysis was performed. A systematic search was conducted until May 2022. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The meta-meta-analyses were performed with a random-effects model and the summary statistics were presented in the form of a forest plot with a weighted compilation of all standardized mean differences and corresponding 95% confidence interval. Twenty-four reviews were eventually included. The protocol was registered in the international registry PROSPERO (CRD42022321702). RESULTS Resistance training showed positive effects on functional capacity (g = 0.614), aerobic capacity (g = 0.587), health-related quality of life (g = 0.429), and peak force (g = 0.621). Fifteen of the included studies (63%) presented low risk of bias, and the remaining studies (37%) showed unclear risk of bias. CONCLUSION Resistance training in patients undergoing hemodialysis is an intervention that shows positive results regarding physical and functional outcomes. The quality level of the literature is inconclusive, but the included studies present low risk of bias.
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Affiliation(s)
- Borja Perez-Dominguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| | - Luis Suso-Marti
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| | - Fernando Dominguez-Navarro
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
| | - Sara Perpiña-Martinez
- Department of Nursing and Physiotherapy, Pontifical University of Salamanca, Salamanca, Spain
| | - Joaquin Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain.
| | - Jose Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
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Schinner L, Nagels K, Scherf J, Schmaderer C, Heemann U, Küchle C, Hannemann L. Intradialytic neuromuscular electrical stimulation with optional virtual reality distraction improves not only muscle strength and functional capacity but also serum albumin level in haemodialysis patients: a pilot randomized clinical trial. BMC Nephrol 2023; 24:246. [PMID: 37608265 PMCID: PMC10464068 DOI: 10.1186/s12882-023-03283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Sarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients. METHODS We conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group. RESULTS The final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive. CONCLUSION Intradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed. TRIAL REGISTRATION German Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022).
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Affiliation(s)
- Lena Schinner
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstraße 25, 95445, Bayreuth, Bavaria, Germany.
| | - Klaus Nagels
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstraße 25, 95445, Bayreuth, Bavaria, Germany
| | - Julia Scherf
- Kuratorium Für Dialyse Und Nierentransplantation (KfH), Nierenzentrum München-Giesing, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Claudius Küchle
- Department of Nephrology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Liya Hannemann
- Department of Nephrology, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
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Moraes IG, Brito CP, Francisco DDS, Faria LM, Luders C, de Brito CMM, Yamaguti WP. Efficacy of neuromuscular electrical stimulation with combined low and high frequencies on body composition, peripheral muscle function and exercise tolerance in patients with chronic kidney disease undergoing haemodialysis: a protocol for a randomised, double-blind clinical trial. BMJ Open 2022; 12:e062062. [PMID: 36351736 PMCID: PMC9664278 DOI: 10.1136/bmjopen-2022-062062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) as an adjunctive strategy to increase isolated muscular strength or endurance has been widely investigated in patients with chronic kidney disease (CKD) undergoing haemodialysis (HD). However, the efficacy of combined low and high frequencies, to improve both muscular strength and endurance, is unknown. This trial aims to evaluate the efficacy of this combined NMES strategy in this population. METHODS AND ANALYSIS This is a randomised controlled trial with blinded assessments and analysis. A total of 56 patients with CKD undergoing HD will be recruited and randomised to an NMES protocol. The evaluations will be performed on three different days at baseline and after 24 sessions of follow-up. Assessments will include the background, insulin-like growth factor, lactate measurement, malnutrition and inflammation score evaluation, an electrical bioimpedance examination, global muscular evaluation by means of the Medical Research Council scale, handgrip strength evaluation, muscular isokinetic evaluation of lower limbs, 6 min step test performance and quality of life (QoL) questionnaire with emphasis on physical function. The patients will be allocated in one of the following four groups: 1) combined low and high frequencies; 2) low frequency; 3) high frequency; and 4) sham stimulation with minimal intensity to generate only sensory perception (with no visible contraction). In all groups, the intensity throughout the session will be the highest tolerated by patient (except for control group). The primary endpoint is the change of peripheral muscle function (muscular strength and endurance). The secondary endpoints will be the changes of body composition; muscle trophism; exercise tolerance; QoL; and nutritional, inflammatory, and metabolic markers. The findings of this study are expected to provide valuable knowledge on how to optimise the NMES intervention, with improvements in both muscle strength and endurance. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee on Research with Humans of Hospital Sírio-Libanês (approval no. 24337707). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03779126.
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Affiliation(s)
| | | | | | | | - Claudio Luders
- Haemodialysis Centre, Hospital Sírio-Libanês, São Paulo, Brazil
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Belt Electrode-Skeletal Muscle Electrical Stimulation in Older Hemodialysis Patients with Reduced Physical Activity: A Randomized Controlled Pilot Study. J Clin Med 2022; 11:jcm11206170. [PMID: 36294490 PMCID: PMC9605129 DOI: 10.3390/jcm11206170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although patients receiving hemodialysis are more likely to develop metabolic disorders and muscle weakness at an earlier stage than healthy individuals, many older dialysis patients have difficulty establishing exercise habits to prevent these problems. Therefore, we evaluated the use of belt electrode-skeletal muscle electrical stimulation (B-SES), which can stimulate a wider area than conventional electrical muscle stimulation (EMS), to examine its application and safety in older hemodialysis patients as a means to improve lower extremity function without voluntary effort. Methods: This study was a randomized controlled trial (RCT) involving 20 older dialysis patients (>65 years old) with reduced physical activity. The control group received 12 weeks of routine care only and the intervention group received 12 weeks of B-SES during hemodialysis in addition to routine care. The primary endpoint was the 6 min walk test (6MWT) distance, while the Short Physical Performance Battery (SPPB), body composition, Functional Independence Measure (FIM), biochemistry test, and blood pressure/pulse measurements were used as secondary endpoints. Results: As a result of the 12-week B-SES intervention, no increase in creatine kinase or C-reactive protein levels was observed after the intervention in either group, and no adverse events attributed to the B-SES intervention were observed in the intervention group. Furthermore, the intervention group showed a significant improvement in the 6MWT and SPPB scores after the intervention. Conclusions: The results of this study suggest that a 12-week B-SES intervention during hemodialysis sessions safely improves 6MWT distance and SPPB scores in older patients with a reduced level of physical activity.
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Yabe H, Kono K, Yamaguchi T, Yamada N, Ishikawa Y, Yamaguchi Y, Azekura H. Effect of intradialytic exercise on geriatric issues in older patients undergoing hemodialysis: a single-center non-randomized controlled study. Int Urol Nephrol 2022; 54:2939-2948. [PMID: 35524833 DOI: 10.1007/s11255-022-03205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study investigated the effect of 1 year of intradialytic exercise on older hemodialysis patients with geriatric issues. METHODS Forty-six patients aged ≥ 70 years were non-randomly assigned to two groups (exercise group: 27, control group: 19). Intradialytic exercise consisted of 30 min of aerobic exercise using a cycle ergometer, and resistance training comprising four exercises using an elastic tube three times per week for 1 year. Handgrip strength, leg extremity muscle strength, 10-m walk speed, short physical performance battery, serum albumin, Geriatric Nutritional Risk Index (GNRI), geriatric depression scale, frailty, and mobility were each assessed before and after the intervention. RESULTS The control group exhibited a significant reduction in handgrip strength, 10-m walking speed, serum albumin, and GNRI after intervention compared to baseline (p < 0.05). Conversely, no significant reductions were observed in the exercise group. The ΔGNRI (effect size, 0.69; 95% confidence interval [CI] - 5.21, - 0.1; p < 0.05) and Δserum albumin (effect size, 0.72; 95% CI - 0.31, - 0.02; p < 0.05) before and after the intervention declined significantly less in the exercise group than in the control group. Other between-group values were not significantly different. The number of frail patients and patients requiring walking assistance exhibited no significant intra-group or between-group differences before and after the intervention. CONCLUSION Intradialytic exercise prevented the worsening of nutritional status and physical function in the exercise group compared to the control group. Exercise therapy during dialysis is an important aspect of patient care that helps prevent functional decline in older patients.
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Affiliation(s)
- Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
| | - Kenichi Kono
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Naomi Yamada
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Yumiko Ishikawa
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Yoshiko Yamaguchi
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Hisanori Azekura
- Department of Nephrology, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
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Matsuzawa R. Renal rehabilitation as a management strategy for physical frailty in CKD. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AbstractAn aging population and the increasing prevalence of lifestyle-related diseases have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of individuals requiring dialysis therapy has been increasing, and Japanese patients are aging more rapidly than those in the USA and Europe. Patients undergoing renal replacement therapy are at increased risk of sarcopenia/frailty compared with people with normal kidney function due to comorbid burden, long-standing malnutrition, chronic inflammation, metabolic acidosis, anabolic resistance, hormonal changes, physical inactivity and amino acid loss via dialysis treatment in addition to aging. Sarcopenia and frailty are serious global health problems that can decrease access to kidney transplantation and lead to various adverse health outcomes, including functional dependence, hospitalizations and deaths in patients on dialysis treatment. However, sarcopenia/frailty fortunately is potentially modifiable by early identification of poor physical functioning, sustainment and enhancement of daily physical activity, and participation in exercise treatments. The Japanese Society of Renal Rehabilitation was established in 2011 and published a clinical practice guideline for “Renal Rehabilitation” targeting nondialysis-dependent and dialysis-dependent patients and renal transplant recipients, in 2019. The guideline emphasized the importance of physical management for patients with kidney diseases in addition to nutritional supports and anemia management. Kidney health professionals should manage sarcopenia and physical frailty as a part of routine clinical care for patients undergoing hemodialysis to improve poor physical functioning, functional dependence, decreased quality of life and poor prognosis.
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Bündchen DC, Sousa H, Afreixo V, Frontini R, Ribeiro O, Figueiredo D, Costa E. Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies. Clin Rehabil 2021; 35:812-828. [PMID: 33530715 DOI: 10.1177/0269215520986784] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This umbrella review aimed to understand the clinical benefits and adverse events associated with different modalities of intradialytic exercise in patients with end-stage renal disease undergoing hemodialysis. DATA SOURCES The search was performed until September 10th, 2020 on Scopus, Web of Science, the Cochrane Database, CINAHL, and PubMed. METHODS This umbrella review was conducted following the PRISMA guideline statement. The methodological quality of the reviews was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I-squared statistic was used to assess heterogeneity and the Eggers' test was performed to test asymmetry/small-study effects. RESULTS Eleven reviews were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence (P < 0.05, small heterogeneity, absence of small-study effects, and excess significance bias). Clinical benefits were found for functional capacity associated with aerobic exercise (d = 0.81; k = 6), resistance training (d = 0.58; k = 6), neuromuscular electrical stimulation (d = 0.70; k = 5), and inspiratory muscle training (d = 1.13; k = 2), measured by the distance covered in the 6-minutes walking test. This outcome was also associated with aerobic exercise (d = 0.28; k = 7) and combined exercise, measured by VO2peak (d = 1.01; k = 5) and by the duration of the cardiopulmonary test (d = 1.07; k = 4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation (d = 1.19; k = 7) while patients' perception of vitality improved with combined exercise (d = 0.60; k = 3). CONCLUSIONS Suggestive evidence was found for the associations between various modalities of intradialytic exercise and functional capacity. Combined exercise was associated with improvements in physical and psychosocial variables. Few or no adverse events were reported.
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Affiliation(s)
- Daiana Cristine Bündchen
- Department for Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil.,Research Unit on Applied Molecular Biosciences, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
| | - Helena Sousa
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- Institute for Biomedicine, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Roberta Frontini
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto, Porto, Portugal
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