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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Unibaso-Markaida I, Iraurgi I. Commercial videogames in stroke rehabilitation: systematic review and meta-analysis. Top Stroke Rehabil 2021; 29:551-567. [PMID: 34176453 DOI: 10.1080/10749357.2021.1943798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The aim of this article was to perform a systematic review of all studies (both observational and experimental) wherein commercial video games were used in comprehensive rehabilitation (both physical and cognitive areas) after stroke.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed, and all observational and experimental studies that met at least six PEDro scale criteria were included. A total of 50 studies were included in the Meta-Analysis. Data analysis was performed using RevMan 5.3 and the bias with JAMOVI.Results: In observational studies, results favored intervention with video games in terms of functionality such as Fulg-Meyer Assessment scores [standard mean difference (SMD) = -0.45; 95% CI = -0.74 to -0.15; p = .94; I2 = 0%)] and when measured in the upper limbs using the Wolf Motor Function Test (SMD = 0.41; 95% CI = 0.07 to 0.74; p = .47; I2 = 0%). Other results showed heterogeneity. In the experimental group, most results tended to favor the experimental group and showed homogeneity, but they were not significant. Fail Safe N was calculated, and the results were not biased.Conclusions: Results tend to favor intervention with commercial video games, but the heterogeneity of the measuring instruments and small sample size do not allow for significant results to be obtained. Future research should provide the number of participants, mean, and standard deviation to facilitate future meta-analyses. Commercial video games appear to be a feasible tool in physical and cognitive stroke rehabilitation.
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Affiliation(s)
| | - Ioseba Iraurgi
- Department of Psychology, University of Deusto, Bilbao, Spain
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Espy D, Reinthal A, Dal Bello-Haas V. A Clinical Decision-Making Framework for the Use of Video Gaming as a Therapeutic Modality. Front Neurol 2021; 12:610095. [PMID: 34122293 PMCID: PMC8193226 DOI: 10.3389/fneur.2021.610095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Virtual reality and video gaming offer modulation of more exercise and motor learning parameters simultaneously than other modalities; however, there is a demonstrated need for resources to facilitate their effective use clinically. This article presents a conceptual framework to guide clinical-decision making for the selection, adaptation, modulation, and progression of virtual reality or gaming when used as a therapeutic exercise modality, and two cases as exemplars. This framework was developed by adapting the steps of theory derivation, whereby concepts and parent theories are brought together to describe a new structure or phenomenon of interest. Specifically, motor learning theory, integrated motor control theory, Gentile's Taxonomy of Tasks, and therapeutic exercise principles were integrated to develop this framework. It incorporates person (body segment), environmental, and task demands; each demand is comprised of realm, category, choice, and continuum parameters as motor training considerations and alternatives for decision-making. This framework: (1) provides structure to guide clinical decisions for effective and safe use of virtual reality or gaming to meet therapeutic goals and requirements, (2) is a concise and organized method to identify, document, and track the therapeutic components of protocols and client progression over time; (3) can facilitate documentation for reimbursement and communication among clinicians; and, (4) structures student learning, and (5) informs research questions and methods.
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Affiliation(s)
- Debbie Espy
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
| | - Ann Reinthal
- School of Health Sciences, Cleveland State University, Cleveland, OH, United States
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Rohrbach N, Chicklis E, Levac DE. What is the impact of user affect on motor learning in virtual environments after stroke? A scoping review. J Neuroeng Rehabil 2019; 16:79. [PMID: 31248439 PMCID: PMC6598261 DOI: 10.1186/s12984-019-0546-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purported affective impact of virtual reality (VR) and active video gaming (AVG) systems is a key marketing strategy underlying their use in stroke rehabilitation, yet little is known as to how affective constructs are measured or linked to intervention outcomes. The purpose of this scoping review is to 1) explore how motivation, enjoyment, engagement, immersion and presence are measured or described in VR/AVG interventions for patients with stroke; 2) identify directional relationships between these constructs; and 3) evaluate their impact on motor learning outcomes. METHODS A literature search was undertaken of VR/AVG interventional studies for adults post-stroke published in Medline, PEDro and CINAHL databases between 2007 and 2017. Following screening, reviewers used an iterative charting framework to extract data about construct measurement and description. A numerical and thematic analytical approach adhered to established scoping review guidelines. RESULTS One hundred fifty-five studies were included in the review. Although the majority (89%; N = 138) of studies described at least one of the five constructs within their text, construct measurement took place in only 32% (N = 50) of studies. The most frequently described construct was motivation (79%, N = 123) while the most frequently measured construct was enjoyment (27%, N = 42). A summative content analysis of the 50 studies in which a construct was measured revealed that constructs were described either as a rationale for the use of VR/AVGs in rehabilitation (76%, N = 38) or as an explanation for intervention results (56%, N = 29). 38 (76%) of the studies proposed relational links between two or more constructs and/or between any construct and motor learning. No study used statistical analyses to examine these links. CONCLUSIONS Results indicate a clear discrepancy between the theoretical importance of affective constructs within VR/AVG interventions and actual construct measurement. Standardized terminology and outcome measures are required to better understand how enjoyment, engagement, motivation, immersion and presence contribute individually or in interaction to VR/AVG intervention effectiveness.
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Affiliation(s)
- Nina Rohrbach
- Chair of Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Emily Chicklis
- Department of Physical Therapy, Movement & Rehabilitation Science, Northeastern University, Boston, MA USA
| | - Danielle Elaine Levac
- Department of Physical Therapy, Movement & Rehabilitation Science, Northeastern University, Boston, MA USA
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Hung JW, Chou CX, Chang YJ, Wu CY, Chang KC, Wu WC, Howell S. Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial. Eur J Phys Rehabil Med 2019; 55:542-550. [PMID: 30781936 DOI: 10.23736/s1973-9087.19.05598-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Virtual reality and interactive video games could decrease the demands on the time of the therapists. However, the cost of a virtual reality system and the requirement for technical support limits the availability of these systems. Commercial exergames are not specifically designed for therapeutic use, most patients with hemiplegic stroke are either too weak to play the games or develop undesirable compensatory movements. AIM To develop Kinect2Scratch games and compare the effects of training with therapist-based training on upper extremity (UE) function of patients with chronic stroke. DESIGN A randomized controlled single-blinded trial. SETTING An outpatient rehabilitation clinic of a tertiary hospital. POPULATION Thirty-three patients with chronic hemiplegic stroke. METHODS We developed 8 Kinect2Scratch games. The participants were randomly assigned to either a Kinect2Scratch game group or a therapist-based training group. The training comprised 24 sessions of 30 minutes over 12 weeks. The primary outcome measure was the Fugl-Meyer UE scale and the secondary outcome measures were the Wolf Motor Function Test and Motor Activity Log. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. We used the Pittsburgh participation scale (PPS) to assess the participation level of patients at each training session and an accelerometer to assess the activity counts of the affected UE of patients was used at the 12th and 24th training sessions. RESULTS Seventeen patients were assigned to the Kinect2Scratch group and 16 were assigned to the therapist-based training group. There were no differences between the two groups for any of the outcome measures postintervention and at the 3-month follow-up (all P>0.05). The level of participation was higher in the Kinect2Scratch group than in the therapist-based training group (PPS 5.25 vs. 5.00, P=0.112). The total activity counts of the affected UE was significantly higher in the Kinect2Scratch group than in the therapist-based training group (P<0.001). CONCLUSIONS Kinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke. CLINICAL REHABILITATION IMPACT Kinect2Scratch games are low-cost and easily set-up games, which may serve as a complementary strategy to conventional therapy to decrease therapists' work load.
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Affiliation(s)
- Jen-Wen Hung
- Department of Rehabilitation, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan - .,School of Physical Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan -
| | - Chiung-Xia Chou
- Department of Rehabilitation, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yao-Jen Chang
- Department of Electronic Engineering, Chung Yuan Christian University, Chung-Li, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy, Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Wu
- Department of Rehabilitation, Kaohsiung Medical Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Cannell J, Jovic E, Rathjen A, Lane K, Tyson AM, Callisaya ML, Smith ST, Ahuja KDK, Bird ML. The efficacy of interactive, motion capture-based rehabilitation on functional outcomes in an inpatient stroke population: a randomized controlled trial. Clin Rehabil 2018; 32:191-200. [PMID: 28719977 PMCID: PMC5777543 DOI: 10.1177/0269215517720790] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/24/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the efficacy of novel interactive, motion capture-rehabilitation software to usual care stroke rehabilitation on physical function. DESIGN Randomized controlled clinical trial. SETTING Two subacute hospital rehabilitation units in Australia. PARTICIPANTS In all, 73 people less than six months after stroke with reduced mobility and clinician determined capacity to improve. INTERVENTIONS Both groups received functional retraining and individualized programs for up to an hour, on weekdays for 8-40 sessions (dose matched). For the intervention group, this individualized program used motivating virtual reality rehabilitation and novel gesture controlled interactive motion capture software. For usual care, the individualized program was delivered in a group class on one unit and by rehabilitation assistant 1:1 on the other. MAIN MEASURES Primary outcome was standing balance (functional reach). Secondary outcomes were lateral reach, step test, sitting balance, arm function, and walking. RESULTS Participants (mean 22 days post-stroke) attended mean 14 sessions. Both groups improved (mean (95% confidence interval)) on primary outcome functional reach (usual care 3.3 (0.6 to 5.9), intervention 4.1 (-3.0 to 5.0) cm) with no difference between groups ( P = 0.69) on this or any secondary measures. No differences between the rehabilitation units were seen except in lateral reach (less affected side) ( P = 0.04). No adverse events were recorded during therapy. CONCLUSION Interactive, motion capture rehabilitation for inpatients post stroke produced functional improvements that were similar to those achieved by usual care stroke rehabilitation, safely delivered by either a physical therapist or a rehabilitation assistant.
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Affiliation(s)
- John Cannell
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Tasmanian Health Service, Hobart, TAS, Australia
| | - Emelyn Jovic
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Tasmanian Health Service, Hobart, TAS, Australia
| | - Amy Rathjen
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Tasmanian Health Service, Hobart, TAS, Australia
| | - Kylie Lane
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Tasmanian Health Service, Hobart, TAS, Australia
| | - Anna M Tyson
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Tasmanian Health Service, Hobart, TAS, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Kiran DK Ahuja
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
| | - Marie-Louise Bird
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Research Rehabilitation Laboratory, Vancouver, BC, Canada
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Barrett N, Swain I, Gatzidis C, Mecheraoui C. The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation. J Rehabil Assist Technol Eng 2016; 3:2055668316643644. [PMID: 31186903 PMCID: PMC6453078 DOI: 10.1177/2055668316643644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/04/2016] [Indexed: 12/30/2022] Open
Abstract
Upper limb exercise is often neglected during post-stroke rehabilitation. Video
games have been shown to be useful in providing environments in which patients
can practise repetitive, functionally meaningful movements, and in inducing
neuroplasticity. The design of video games is often focused upon a number of
fundamental principles, such as reward, goals, challenge and the concept of
meaningful play, and these same principles are important in the design of games
for rehabilitation. Further to this, there have been several attempts for the
strengthening of the relationship between commercial game design and
rehabilitative game design, the former providing insight into factors that can
increase motivation and engagement with the latter. In this article, we present
an overview of various game design principles and the theoretical grounding
behind their presence, in addition to attempts made to utilise these principles
in the creation of upper limb stroke rehabilitation systems and the outcomes of
their use. We also present research aiming to move the collaborative efforts of
designers and therapists towards a model for the structured design of these
games and the various steps taken concerning the theoretical classification and
mapping of game design concepts with intended cognitive and motor outcomes.
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Affiliation(s)
- N Barrett
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - I Swain
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK.,Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - C Mecheraoui
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK
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Paquin K, Ali S, Carr K, Crawley J, McGowan C, Horton S. Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation. Disabil Rehabil 2015; 37:2184-91. [PMID: 25586794 DOI: 10.3109/09638288.2014.1002574] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke. METHODS Ten chronic phase post-stroke participants (mean time since CVA = 39 mos; mean age = 72 yrs) completed a 16-session program using the Nintendo Wii for 15 min two times per week with their more affected hand (10 right handed). Functional recovery (Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT)), and quality of life (QOL; Stroke Impact Scale (SIS)) were measured at baseline (pre-testing), after 8 sessions (mid-testing) and after 16 sessions (post-testing). RESULTS Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing (p = 0.03, p = 0.03, p = 0.01, respectively). As well, there was an increase in perceived QOL from pre-testing to post-testing, as determined by the SIS (p = 0.009). CONCLUSION Commercial gaming may be a viable resource for those with chronic stroke. Future research should examine the feasibility of this as a rehabilitation tool for this population. IMPLICATIONS FOR REHABILITATION Stroke survivors often live with lasting effects from their injury, however, those with chronic stroke generally receive little to no rehabilitation due to a perceived motor recovery plateau. Virtual reality in the form of commercial gaming is a novel and motivating way for clients to complete rehabilitation. The Nintendo Wii may be a feasible device to improve both functional ability and perceived quality of life in chronic stroke survivors.
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Affiliation(s)
| | | | | | - Jamie Crawley
- b Faculty of Nursing , University of Windsor , Windsor , Ontario , Canada
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