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Funabashi M, Gorrell LM, Pohlman KA, Bergna A, Heneghan NR. Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review. PLoS One 2022; 17:e0270671. [PMID: 35839253 PMCID: PMC9286262 DOI: 10.1371/journal.pone.0270671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.
Methods
An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.
Results
From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe).
Conclusion
A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- * E-mail:
| | - Lindsay M. Gorrell
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University of Zürich and University Hospital Balgrist, Zürich, Switzerland
| | | | - Andrea Bergna
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
- AISO-Associazione Italiana Scuole di Osteopatia, Pescara, Italy
| | - Nicola R. Heneghan
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Chin J, Woo H, Choi D, Dube E, Volokitin, M, Lomiguen C. Perceptions of the Osteopathic Profession in New York City's Korean Communities. ACTA ACUST UNITED AC 2021. [DOI: 10.33181/13011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Korean communities in New York City.
Design: A cross-sectional study was designed in which a culturally appropriate survey in Korean and English versions was administered anonymously to measure community perceptions and knowledge of osteopathic medicine.
Setting: Data collection occurred in the municipal delineations for the Bayside neighborhood within the New York, New York borough of Queens.
Participants: Community members were selected using convenience sampling from high-density areas to participate. The survey included demographics, education level, health care habits and knowledge of the osteopathic profession.
Results: 105 surveys were conducted with 47 males and 58 females, with an average age = 66. Only 14% (n=15) indicated knowledge about osteopathic manipulative medicine (OMM) and 9% (n=9) indicated knowledge of osteopathic physicians (DOs), with the primary language spoken at home (Korean) as the sole statistically significant factor in recognition of OMM and DOs among the study variables.
Conclusion: Compared to research on the general U.S. population, a general lack of knowledge of osteopathic medicine exists within New York City's Korean community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all health care resources available during the current shortage of primary care physicians in the U.S.
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Affiliation(s)
| | - Haeinn Woo
- New York Institute of Technology College of Osteopathic Medicine
| | - Diane Choi
- New York Institute of Technology College of Osteopathic Medicine
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Sanei M, Roozafzai F, Abousaidi SR, Hamze M, Negarestani AM, Mokaberinejad R. Persian manual therapy method for chronic low-back pain with lumbar radiculopathy; a randomized controlled trial. J Bodyw Mov Ther 2020; 24:123-130. [PMID: 32825977 DOI: 10.1016/j.jbmt.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/10/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Manual therapy is a non-surgical approach for management of musculoskeletal symptoms. This study investigated safety and efficacy of a Persian manual therapy method (Fateh technique) for management of chronic low-back pain (LBP) and radiculopathy. METHODS In this controlled trial, 52 eligible patients with chronic LBP and lumbar radiculopathy were randomly assigned into two intervention groups; one received a 16-min soft tissue manipulation for four weekly sessions and did two daily home active exercises. The other group only did the two daily exercises for four weeks. Roland-Morris disability score, Visual Analogue Scale scores of LBP, radiculopathy and paresthesia, and finger-to-floor test result were assessed at the baseline, and in fourth and eighth weeks of trial. RESULTS Data of 48 participants was analyzed. Distributions of age, sex, and duration of symptoms in two groups were the same. Fateh technique respectively decreased pain, radiculopathy, paresthesia, and disability, by 4.28 [95% confidence interval: 3.36-5.19], 3.85 [2.67-5.03], 1.32 [0.37-2.27], and 4.58 [3.23-5.93] units, and increased body flexibility by 35.42 [6.91-63.92] millimeters. Compared with home exercise, Fateh technique was associated with greater changes in all outcomes. No adverse event has occurred. CONCLUSIONS Fateh technique is safe and effective for management of LBP and radiculopathy in patients without severe progressive symptoms.
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Affiliation(s)
- Mohamad Sanei
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzin Roozafzai
- Digestive Disease Research Institute, Shariati Hopital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Hamze
- Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | | | - Roshanak Mokaberinejad
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Comparative Effectiveness of Chuna Manipulative Therapy for Non-Acute Lower Back Pain: A Multi-Center, Pragmatic, Randomized Controlled Trial. J Clin Med 2020; 9:jcm9010144. [PMID: 31948083 PMCID: PMC7019562 DOI: 10.3390/jcm9010144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/17/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022] Open
Abstract
Current evidence on the effectiveness and safety of Chuna manipulative therapy (CMT) for managing non-acute lower back pain (LBP) is insufficient. We investigated the comparative effectiveness and safety of CMT, a Korean style of manipulation, plus usual care (UC) compared to UC alone for non-acute LBP. We conducted a parallel, two-armed, multi-centered, assessor blinded, pragmatic, randomized controlled trial at four major Korean medical hospitals. Overall, 194 patients were randomly allocated to either CMT plus UC (n = 97) or UC alone (n = 97), for six weeks of treatment and six months follow-up. The primary outcome was measured using the numerical rating scale (NRS) of LBP intensity at 7 weeks. Secondary outcomes included NRS of leg pain, Oswestry Disability Index (ODI) for functional disability, patient global impression of change (PGIC) scale, and safety. A total of 194 patients were included in the intention-to-treat analysis, and 174 patients provided complete data for the primary outcome. At 7 weeks, clinically significant differences between groups were observed in the NRS of LBP (CMT + UC: −3.02 ± 1.72, UC: −1.36 ± 1.75, p < 0.001), ODI scores (CMT + UC: −5.65 ± 4.29, UC: −3.72 ± 4.63, p = 0.003), NRS of leg pain (CMT + UC: −2.00 ± 2.33, UC: −0.44 ± 1.86, p < 0.0001), and PGIC (CMT + UC: −0.28 ± 0.85, UC: 0.01 ± 0.66, p = 0.0119). Mild to moderate safety concerns were reported in 21 subjects. CMT plus UC showed higher effectiveness compared to UC alone in patients with non-acute LBP in reducing LBP and leg pain and in improving function with good safety results using a powered sample size and including mid-term follow-up.
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Snow M, Trexler S, Gates C, Pudoka K, Wilhelm M. The fidelity of comparison intervention in manual therapy trial for patients with low back pain: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1674545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mackenzie Snow
- Physical Therapy, Walsh University, North Canton, Ohio, USA
| | - Sean Trexler
- Physical Therapy, Walsh University, North Canton, Ohio, USA
| | | | - Kathryn Pudoka
- Physical Therapy, Walsh University, North Canton, Ohio, USA
| | - Mark Wilhelm
- Physical Therapy, Walsh University, North Canton, Ohio, USA
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Lim KT, Hwang EH, Cho JH, Jung JY, Kim KW, Ha IH, Kim MR, Nam K, Lee A MH, Lee JH, Kim N, Shin BC. Comparative effectiveness of Chuna manual therapy versus conventional usual care for non-acute low back pain: a pilot randomized controlled trial. Trials 2019; 20:216. [PMID: 30987662 PMCID: PMC6466698 DOI: 10.1186/s13063-019-3302-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain (LBP) is common, with a lifetime prevalence of 80%, and as such it places substantial social and economic burden on individuals and society. Chuna manual therapy (CMT) combines aspects of physiology, biodynamics of spine and joint motion, and basic theory of movement dynamics. This study aimed to test the comparative effectiveness and safety of CMT for non-acute LBP. Methods A three-arm, multicenter, pragmatic, randomized controlled pilot trial was conducted from 28 March 2016 to 19 September 2016, at four medical institutions. A total of 60 patients were randomly allocated to the CMT group (n = 20), usual care (UC) group (n = 20), or combined treatment (CMT + UC) group (n = 20), and received the relevant treatments for 6 weeks. The primary outcome was a numeric rating scale (NRS) representation of LBP intensity, while secondary outcomes included NRS of leg pain, Oswestry disability index (ODI), Patient Global Impression of Change (PGIC), the EuroQol-5 dimensions (EQ-5D), lumbar range of motion, and safety. Results A total of 60 patients were included in the intention-to-treat analysis and 55 patients (CMT, 18; UC, 18; CMT + UC, 19) were included in the per-protocol analysis (drop-out rate 5.3%). Over the treatment period there were significant differences in the NRS score for LBP (CMT mean − 3.28 (95% CI − 4.08, − 2.47); UC − 1.95 (− 2.82, − 1.08); CMT + UC − 1.75 (− 2.70, − 0.80), P < 0.01) and the ODI scores in each group (CMT − 12.29 (− 16.86, − 7.72); UC − 10.34 (− 14.63, − 6.06); CMT + UC − 9.27 (− 14.28, − 4.26), P < 0.01). The changes in other secondary outcomes did not significantly differ among the three groups. Sixteen minor-to-moderate safety concerns were reported. Conclusions Our results suggest that CMT has comparative efficacy for non-acute LBP and is generally safe. As this was a preliminary study, a well-powered (over 192 participants) two-arm (CMT versus UC) verification trial will be performed to assess the generalizability of these results. Trial registration Clinical Research Information Service (CRIS), KCT0001850. Registered on 12 March 2016.
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Affiliation(s)
- Kyeong-Tae Lim
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea.,Department of Korean Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Eui-Hyoung Hwang
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea.,3rd Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Jae-Heung Cho
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Jae-Young Jung
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Koh-Woon Kim
- Department of Rehabilitation Medicine of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06017, Republic of Korea
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06017, Republic of Korea
| | - Kibong Nam
- Mokhuri Neck & Back Hospital, Repulic of, Seoul, 06272, South Korea
| | - Min Ho Lee A
- Mokhuri Neck & Back Hospital, Repulic of, Seoul, 06272, South Korea
| | - Jun-Hwan Lee
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Namkwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea
| | - Byung-Cheul Shin
- Department of Rehabilitation Medicine of Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, 50612, Republic of Korea. .,3rd Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
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Kim K, Shin KM, Hunt CL, Wang Z, Bauer BA, Kwon O, Lee JH, Seo BN, Jung SY, Youn Y, Lee SH, Choi JC, Jung JE, Kim J, Qu W, Kim TH, Eldrige JS. Nonsurgical integrative inpatient treatments for symptomatic lumbar spinal stenosis: a multi-arm randomized controlled pilot trial. J Pain Res 2019; 12:1103-1113. [PMID: 30992679 PMCID: PMC6445233 DOI: 10.2147/jpr.s173178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a chronic condition that causes low back pain and neurogenic claudication, often resulting in significant limitation of daily activities. In this open-label randomized controlled pilot study, we assessed the safety and feasibility of 4-week novel integrative inpatient treatments for LSS. Methods Thirty-six symptomatic LSS patients were randomly and equally allocated to one of the three groups: Mokhuri Chuna treatment 1 (MT1) group, Mokhuri Chuna treatment 2 (MT2) group, or conventional management treatment (CMT) group. MT1 patients were treated with herbal medication, Mokhuri Chuna, and acupuncture, and received daily physician consultation; MT2 patients were treated with Mokhuri Chuna and acupuncture without any herbal medication, and received daily physician consultation; and CMT patients received conventional pain management therapy that included epidural steroid injection, oral NSAID, and muscle relaxant medication, along with daily physiotherapy. The primary outcome of this pilot study was safety as measured by the type and incidence of adverse events (AEs). The secondary outcome measures included VAS score for low back pain and leg pain, Oswestry Disability Index, Oxford Claudication Score (OCS), walking capacity on a 50 m flat track and treadmill, and EuroQol-5D score. Magnetic resonance imaging was also performed up to 6 months after treatment cessation. Results Thirty-four treated patients were included in the analysis, based on the modified intention-to-treat principle. No serious AEs were observed or reported. Compared to the CMT group, the MT1 and MT2 groups did show significant improvement at 3 and 6 months in various domains, including pain (VAS score for leg and back pain) and function (OCS and treadmill walking). Conclusion These novel multimodal integrative treatments for LSS are both clinically safe and logistically feasible. Larger, adequately powered randomized controlled trials will be necessary to assess comparative efficacy and thoroughly analyze the cost-effectiveness of each treatment approach. Clinical trial registration number (CRIS) KCT0001218.
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Affiliation(s)
- Kiok Kim
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Kyung-Min Shin
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Christy L Hunt
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Brent A Bauer
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, University of Science & Technology (UST), Daejeon, South Korea
| | - Bok-Nam Seo
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - So-Young Jung
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Yousuk Youn
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Sang Ho Lee
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Jung Chul Choi
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Jae Eun Jung
- Hongik Neurosurgery Hospital, Seongnam, South Korea
| | - Jaehong Kim
- Department of Spine Center, Mokhuri Neck & Back Hospital, Seoul, South Korea
| | - Wenchun Qu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.,Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Jason S Eldrige
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA,
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Shin S, Kim J, Yu A, Seo HS, Shin MR, Hong SU, Jung CY, Kim KW, Cho JH, Lee E. Can a Traditional Korean Manual Therapy Be a Complementary and Alternative Strategy for Cervicogenic Dizziness? A Study Protocol for a Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:1062593. [PMID: 29967645 PMCID: PMC6008796 DOI: 10.1155/2018/1062593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/29/2018] [Indexed: 12/13/2022]
Abstract
Cervicogenic dizziness is dizziness triggered by movement or positioning of the cervical spine and is often accompanied by neck pain or stiffness. This is a prospective, pragmatic, assessor-blind, randomized controlled trial aimed at testing the efficacy and safety of adjuvant Chuna Manual Therapy (CMT) in patients with cervicogenic dizziness under usual care treatments. Fifty patients with cervicogenic dizziness will be randomly allocated to CMT or usual care (UC) groups in a 1 : 1 ratio. Extensive screening procedures, including examinations for central nervous system problems and nystagmus, will be applied to exclude other dizziness-inducing disorders. The eligible participants will receive 12 sessions of CMT plus UC or only UC over 6 weeks. CMT includes mandatory and discretionary techniques, whereas UC includes electrotherapy, thermotherapy, and patient education. The efficacy will be evaluated primarily as Dizziness Handicap Inventory score. The severity and frequency of dizziness, the level of neck pain or stiffness, and the cervical range of motion will also be evaluated. Safety will be assessed by adverse events. The data will be statistically analyzed at p < 0.05. Trial Registration. This trial was registered with Clinical Research Information Service (CRIS) in Korea, KCT0002565, on 29 November 2017, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=9610<ype=&rtype=.
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Affiliation(s)
- Seungwon Shin
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Jinyoung Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Ami Yu
- STAT Department, HERINGS, 726 Nonhyeon-ro, Gangnam-gu, Seoul 06051, Republic of Korea
| | - Hyung-Sik Seo
- Department of Korean Medical Ophthalmology & Otolaryngology & Dermatology, School of Korean Medicine, Pusan National University, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do 50612, Republic of Korea
| | - Mi-Ran Shin
- Department of Sasang Constitutional Medicine, College of Oriental Medicine, Semyung University, 65 Semyung-ro, Jecheon, Chungcheongbuk-do 27136, Republic of Korea
| | - Seung-Ug Hong
- Department of Oriental Medicine Ophthalmology & Otolaryngology & Dermatology, College of Oriental Medicine, Dongguk University, 27 Dongguk-ro, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Republic of Korea
| | - Chan Yung Jung
- Institute of Oriental Medicine, College of Korean Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do 38066, Republic of Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Euiju Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
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