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Gilanyi YL, Shah B, Cashin AG, Gibbs MT, Bellamy J, Day R, McAuley JH, Jones MD. Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence. Pain 2024:00006396-990000000-00578. [PMID: 38635470 DOI: 10.1097/j.pain.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.
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Affiliation(s)
- Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Brishna Shah
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Jessica Bellamy
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Richard Day
- St Vincent's Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Rogers CJ, Hackney ME, Zubkoff L, Echt KV. The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review. Pain Manag 2022; 12:653-664. [PMID: 35350847 DOI: 10.2217/pmt-2021-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic low back pain (cLBP) impacts millions of adults annually. Several nonsurgical interventions are recommended for treating this condition, however, limited literature exists regarding the impact patient-led goals may have on outcomes in the treatment of cLBP. The purpose of this narrative review is to identify gaps and synthesize literature examining the associations of patient-led goals combined with care for cLBP. A total of 12 studies were reviewed and findings were synthesized. Patient-led goal setting may serve as an effective intervention for adults with cLBP. Current outcome measures may not align with patient-led goals. Further investigation is required to understand patient-led goals with ancillary treatments and specific age groups, such as adults over age 65.
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Affiliation(s)
- Casey J Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA
| | - Madeleine E Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Katharina V Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Healthcare System, Birmingham, AL 35233, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, GA 30033, USA.,Department of Medicine, Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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3
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Angel S. Helpful factors in a healthcare professional intervention for low-back pain: Unveiled by Heidegger's philosophy. Nurs Philos 2021; 23:e12364. [PMID: 34514702 DOI: 10.1111/nup.12364] [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: 08/25/2020] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Low-back pain can be invalidating physically as well as mentally. Despite professional help to treat and prevent low-back pain, the pain often persists, and so do the problems related to low-back pain. An intervention that made it possible for a significant part of patients with low-back pain to improve health and well-being raised the question: Why was it possible to help some and not others? The aim of the present paper was to achieve a deeper understanding of factors patients experienced as helpful in professional support related to low-back pain. This was explored using a hermeneutic-phenomenological approach while analysing 20 interviews with patients with low-back pain purposively chosen interviews conducted in relation to the intervention. An analysis was made using Ricoeur's interpretation theory. Data on both positive and negative experiences were read and reflected upon. We found that healthcare professionals' adoption of a narrative approach facilitating the patient's perspective was perceived as helpful. Patients experienced this as being taken seriously; an experience that could be explained at a deeper, more nuanced level using Heidegger's philosophy. Facilitating the patient's perspective was conditional not only on the professional obtaining access to the patient's perspective but also on understanding and acknowledging the patient's existence. The challenge for healthcare professionals in this respect is to bridge the gap between the consultation's fact-focused concern with the medical implications of low-back pain and the patient's concern with the implications low-back pain has for his or her personal identity and life. Listening to the patient's perspective in itself supports the subjective recovery process, while also supporting the quality of patient-centred support and strengthening the patient's trust in its helpfulness.
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Affiliation(s)
- Sanne Angel
- Research Unit of Nursing and Healthcare, Institute of Public Health, Aarhus University, Aarhus, Denmark.,Department for Health and Social Care, Molde University College, Molde, Norway
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Grant M, O-Beirne-Elliman J, Froud R, Underwood M, Seers K. The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography. BMJ Open 2019; 9:e025743. [PMID: 31227529 PMCID: PMC6596973 DOI: 10.1136/bmjopen-2018-025743] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model. DESIGN Synthesis of qualitative research using meta-ethnography. DATA SOURCES Eleven bibliographic databases from inception to April 2017 supplemented by citation tracking. REVIEW METHODS We used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument. RESULTS We included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working. CONCLUSIONS For people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.
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Affiliation(s)
- Mary Grant
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | | | - Robert Froud
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
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Galvani C, Caramaschi P, Mura P, Paladini A, Piroli A, Arnaudo E, De Franceschi L, Evangelista M, Pari A, Ongaro G, Finco G, Ciannameo A, Carletto A, Varrassi G, Biasi D. Postural counseling represents a novel option in pain management of fibromyalgia patients. J Pain Res 2019; 12:327-337. [PMID: 30666151 PMCID: PMC6333156 DOI: 10.2147/jpr.s164714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM. Patients and methods This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score. Results Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC. Conclusion Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM.
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Affiliation(s)
- Carla Galvani
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paolo Mura
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | | | - Alba Piroli
- Department of MESVA, University of L'Aquila, L'Aquila, Italy
| | - Elisa Arnaudo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Lucia De Franceschi
- Internal Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Evangelista
- Emergency Department, Institute of Anesthesia, Resuscitation and Pain Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Alice Pari
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Giovanna Ongaro
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Gabriele Finco
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Anna Ciannameo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Giustino Varrassi
- Department of MESVA, University of L'Aquila, L'Aquila, Italy.,Paolo Procacci Foundation, Rome, Italy
| | - Domenico Biasi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
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Angel S. Movement perceived as chores or a source of joy: a phenomenological-hermeneutic study of physical activity and health. Int J Qual Stud Health Well-being 2018; 13:1516088. [PMID: 30192717 PMCID: PMC6136354 DOI: 10.1080/17482631.2018.1516088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 01/16/2023] Open
Abstract
Physical activity has become the most documented and acknowledged health advice in relation to both staying healthy and regaining health both physically and mentally. Thus, physical activity in relation to spinal cord injury, low back pain and heart disease is respectively means to regain bodily function, avoid or reduce pain and early death. A second analysis of three studies with a phenomenological-hermeneutic approach building on Ricoeur's philosophy on how people understand themselves and their world through narrative configurations revealed that physical activity had different meanings to people. This revealed that the meanings of physical activity could range from movements being unpleasant, maybe even painful to movements being a source of joy. This caused participants (1) to engage in movement as a source of joy, (2) to overcome the bodily struggle to do their chores, and maybe feel better as a result or (3) to minimize bodily functions equivalent to a functional daily life. Illustrated by 10 different approaches this provides knowledge about driving forces for health professional support. As joy and passion are the strongest driving forces to physical activity, this highlights the importance of supporting people to find a kind of physical activity that they like.
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Affiliation(s)
- Sanne Angel
- Section for Nursing, Institute of Public Health, Aarhus University, Aarhus C, Denmark
- Faculty of Health Sciences and Social Care Molde University College, Norway
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Narratives of life with long-term low back pain: A follow up interview study. Scand J Pain 2017; 17:382-389. [DOI: 10.1016/j.sjpain.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/21/2022]
Abstract
Abstract
Background
Long-term low back pain is associated with multiple challenges to a person’s identity and social position. Despite efforts to understand the challenges of low back pain, recovery remains a major problem both personally and socially. This indicate a need for a different approach. Although personal stories have been used to extend knowledge of issues that relate to low back pain, they also make i possible to learn about how people understand themselves and their lives. As such, analysis of narrative: may provide further insights into people’s coping processes and novel insights about how best to support them.
Objective
The aim of the study was to analyse personal recovery narratives to gain an insight into how people understand themselves and cope with long-term low back pain 2-4 years after a bio-psycho-social counselling intervention.
Study design
Using a Ricoeurian phenomenological-hermeneutic perspective, qualitative in-depth interviews were undertaken and interpreted to explore people’s narratives of long-term recovery after an intervention.
Methods
We interviewed 25 informants 2-4 years after participating in a counselling intervention for low back pain where they were advised to exercise regularly; they were part of the intervention group in a randomised clinical trial. The sample included both informants who had benefited from the intervention and some who had not. Analysis was informed by Ricoeur’s interpretation theory.
Findings
The informants’ stories revealed two main narratives regarding themselves and their lives: (1) getting on with life without pain, (2) life with continual pain and variations of the emplotment. The first included Recovering from low back pain and returning to prior lifestyle if possible, Keeping low back pain in check by strict regimes, or Developing strategies when low back pain recurs. The second related to Finding a way to a functioning everyday life with continual pain while narratives of being stuck with low back pain and finding no way out highlight the significance of being able to configure a narrative that can support an understanding of the pain and how to deal with it to have a functioning life. Furthermore, the health professional has a significant role to play in the configuration of narratives.
Conclusions
The challenge for people with low back pain was to find ways of getting on with life, and this included their ability to configure an understandable narrative that opened up for a future, implying new understandings of the self and how life could be lived. When healthcare professionals offered personal and realistic suggestions to the informants’ configuration of narratives of life with low back pain, they supported a positive change in the informants’ ways of coping with their situation.
Implications
Health professionals can play an important role in low back pain sufferers’ configuration of meaningful narratives that help in coping with pain and learning about the relationship between pain and everyday life.
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Carr EC, Watt-Watson J, McGillion M, Huizinga A. The quest of pain education leaders in Canada and the United States: a qualitative study. J Adv Nurs 2016; 72:2728-2737. [DOI: 10.1111/jan.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Judy Watt-Watson
- Faculty of Nursing (Lawrence S. Bloomberg); University of Toronto; Ontario Canada
| | - Michael McGillion
- Heart and Stroke Foundation/Michael G. DeGroote Chair in Cardiovascular Nursing; School of Nursing; McMaster University; Hamilton Ontario Canada
| | - Anne Huizinga
- Faculty of Nursing; University of Calgary; Alberta Canada
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Andreas F, Kerstin D, Inger E. Life is lived forwards and understood backwards – Experiences of being affected by acute coronary syndrome: Commentary on Fors et al. (2013). Int J Nurs Stud 2015; 52:492-3. [DOI: 10.1016/j.ijnurstu.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
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Buus N, Jensen LD, Maribo T, Gonge BK, Angel S. Low back pain patients' beliefs about effective/ineffective constituents of a counseling intervention: a follow-up interview study. Disabil Rehabil 2014; 37:936-41. [PMID: 25104215 DOI: 10.3109/09638288.2014.948135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Everyday activities are important factors for avoiding the development of chronic low back pain (LBP). The purpose this study was to explore LBP patients' perspective on long-term effects of participating in a counseling intervention designed to motivate them to change work routines and to exercise. METHOD Follow-up qualitative study. Semi-structured interviews were made of 25 LBP patients who had received the counseling intervention. Interviews were transcribed and explored with an interpretative thematic analysis. The findings were organized around Kleinman's conception of "explanatory models". RESULTS For the individual participant the beliefs about the illness were internally coherent, but most often they were idiosyncratic and fitted to the particular participants' overall explanatory model. Participation in the counseling intervention had created a sense of certainty and potential control over the disease and had legitimized their sick role at work and at home. The majority of the patients reported having integrated exercise into their explanatory models and understood exercise to be beneficial in their continual and concrete management of their LBP. CONCLUSIONS The intervention had affected the patients' personal agency and space for action. We suggest that this effect was linked to the individually tailored approach drawing on both educational and motivational agents. IMPLICATIONS FOR REHABILITATION Maintaining everyday activities, including retaining one's occupation, is an important factor in low back pain rehabilitation. Counselling on low back pain rehabilitation must be aligned with people's beliefs about their illness. A counselling intervention made patients adopt exercising into their long-term management of low back pain.
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Affiliation(s)
- Niels Buus
- Institute of Public Health, University of Southern Denmark , Odense C , Denmark
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McLeod J, McLeod J. Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology. COUNSELLING PSYCHOLOGY QUARTERLY 2014. [DOI: 10.1080/09515070.2014.942774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Parahoo K. Research and Theory. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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