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Ickert EC, Hughes T, Berg-Carramusa CA, Dudash S, Kerns L. Overestimation of Balance Ability Among Older Adults at Risk for Falls. J Aging Health 2024; 36:286-298. [PMID: 37358257 DOI: 10.1177/08982643231186630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Objective: This study examined alignment of subjective balance confidence with Stopping Elderly Accidents, Deaths and Injuries (STEADI) fall risk. Methods: Cross-sectional analysis of 155 community-dwelling adults (60 + y/o) from 2016 to 2018 who completed a STEADI fall assessment. Descriptive statistics, Chi-Square analysis, and biserial point correlations were applied. Results: Adults who overestimate balance confidence, 55.6% (n = 50) reported a fall in the past year, 62.2% (n = 56) were worried about falling, 48.9% (n = 44) felt unsteady when standing/walking, and 70.0% (n = 63) had a score of ≥4 on the Stay Independent Questionnaire (SIQ). Physical performance for these adults were mean TUG score 10.9s (SD = 3.4), mean 30 second chair stands 10.8 (SD = 3.5), and mean 4-stage balance score 3.1 (SD = .76). Discussion: Older adults are more likely to overestimate their subjective balance confidence. Individuals are equally likely to have reported a fall in the past year if they were "at fall risk," regardless of their subjective balance confidence.
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Affiliation(s)
- Edmund C Ickert
- Department of Graduate Studies in Rehabilitation Sciences, Youngstown State University, Youngstown, OH, USA
| | - Tiffany Hughes
- Department of Graduate Studies in Rehabilitation Sciences, Youngstown State University, Youngstown, OH, USA
| | - Cara A Berg-Carramusa
- Department of Graduate Studies in Rehabilitation Sciences, Youngstown State University, Youngstown, OH, USA
| | - Shannon Dudash
- Department of Graduate Studies in Rehabilitation Sciences, Youngstown State University, Youngstown, OH, USA
| | - Lucy Kerns
- Department of Mathematics and Statistics, Youngstown State University, Youngstown, OH, USA
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Gill SV, Shin D, Kim TW, Magane KM, Hereen T, Winter M, Helfrich C, Saitz R. A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241238956. [PMID: 38554013 DOI: 10.1177/15394492241238956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.
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Rein DB, Hackney ME, Haddad YK, Sublett FA, Moreland B, Imhof L, Peterson C, Legha JK, Mark J, Vaughan CP, Johnson Ii TM, Bergen G. Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial. JMIR Res Protoc 2024; 13:e54395. [PMID: 38346180 PMCID: PMC11005432 DOI: 10.2196/54395] [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: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial. OBJECTIVE This study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting. METHODS STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)-led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment. RESULTS The study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025. CONCLUSIONS The STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention's effectiveness and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/54395.
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Affiliation(s)
- David B Rein
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Yara K Haddad
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Farah A Sublett
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Briana Moreland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurie Imhof
- Department of Health Sciences, NORC at the University of Chicago, Chicago, IL, United States
| | - Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jaswinder K Legha
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janice Mark
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
| | - Camille P Vaughan
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
| | - Theodore M Johnson Ii
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Haag S, Kepros J. Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation. JMIR Hum Factors 2024; 11:e54854. [PMID: 38502170 PMCID: PMC10988374 DOI: 10.2196/54854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. OBJECTIVE We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. METHODS A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. RESULTS Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. CONCLUSIONS The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.
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Affiliation(s)
- Susan Haag
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
| | - John Kepros
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
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Walter N, Szymski D, Kurtz SM, Lowenberg DW, Alt V, Lau EC, Rupp M. Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population. Sci Rep 2023; 13:12734. [PMID: 37543668 PMCID: PMC10404231 DOI: 10.1038/s41598-023-40087-8] [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: 03/12/2023] [Accepted: 08/04/2023] [Indexed: 08/07/2023] Open
Abstract
Proximal femoral fractures are a serious complication, especially for elderly patients. Detailed epidemiological analyzes provide a valuable resource for stakeholders in the health care system in order to foresee future development possibly influenceable by adaption of therapeutic procedures and prevention strategies. This work aimed at answering the following research questions: (1) What are the incidence rates of proximal femoral fractures in the elderly U.S. population? (2) What is the preferred treatment procedure for these fractures? Proximal femoral fractures occurred between January 1, 2009 and December 31, 2019 in patients ≥ 65 years were identified from the Medicare Physician Service Records Data Base. The 5% sample of Medicare beneficiaries, equivalent to the records from approximately 2.5 million enrollees formed the basis of this study. Fractures were grouped into head/neck, intertrochanteric, and subtrochanteric fractures. The overall incidence rate, age and sex specific incidence rates as well as incidence rate ratios were calculated. Common Procedural Terminology (CPT) codes were used to identify procedures and operations. In 2019, a total number of 7982 femoral head/neck fractures was recorded. In comparison to 9588 cases in 2009, the incidence substantially decreased by 26.6% from 666.7/100,000 inhabitants to 489.3/100,000 inhabitants (z = - 5.197, p < 0.001). Also, in intertrochanteric fractures, a significant decline in the incidence by 17.3% was evident over the years from 367.7/100,000 inhabitants in 2009 to 304.0 cases per 100,000 inhabitants in 2019 (z = - 2.454, p = 0.014). A similar picture was observable for subtrochanteric fractures, which decreased by 29.6% (51.0 cases per 100,000 to 35.9 cases per 100,000) over the time period (z = - 1.612, p = 0.107). Head/neck fractures were mainly treated with an arthroplasty (n = 36,301, 40.0%). The majority of intertrochanteric fractures and subtrochanteric fractures received treatment with an intramedullary device (n = 34,630, 65.5% and n = 5870, 77.1%, respectively). The analysis indicated that the incidence of all types of proximal femoral neck fractures decreased for the population of elderly patients in the U.S. within the last decade. Treatment of head and neck fractures was mainly conducted through arthroplasty, while intertrochanteric and subtrochanteric fractures predominantly received an intramedullary nailing.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Steven M Kurtz
- Implant Research Center, Drexel University, Philadelphia, USA
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | | | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Kulkarni S, Nagarkar A. Effect of a video-assisted fall prevention program on fall incidence in community-dwelling older adults during COVID. Geriatr Nurs 2023; 50:31-37. [PMID: 36640516 DOI: 10.1016/j.gerinurse.2022.12.022] [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: 09/28/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The study evaluated the effectiveness of a video-assisted exercise intervention program on fall incidence, activities of daily living, and fear of falling in community-dwelling older adults. METHODS A video-assisted 16-week exercise intervention consisting of stretching, strengthening, balance, and dual-task training was delivered to randomly selected 95 older adults with a high risk of falls. The fidelity of implementation was assessed for three areas; exercise program delivery, participant receipt, and enactment. RESULTS The fall incidence reduced significantly by 45% (IRR 0.55, (95% CI, 0.13-0.86) and difficulty in daily activities decreased (OR: 0.74, 95% CI, 0.16 - 0.96) among participants in the intervention group. Fear of falls did not show any significant difference in the groups at the 12-month follow-up. CONCLUSION The video-assisted exercise program was found to be effective in reducing fall incidence among older adults at a higher risk of falls.
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Affiliation(s)
- Snehal Kulkarni
- School of Health Sciences, Savitribai Phule Pune University, India
| | - Aarti Nagarkar
- School of Health Sciences, Savitribai Phule Pune University, India.
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Tsekoura M, Kastrinis A, Nomikou E, Katsoulaki M. Telerehabilitation and Fall Prevention in Older Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:485-489. [PMID: 37581822 DOI: 10.1007/978-3-031-31986-0_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The objective of this review is to summarize the evidence regarding the use of telerehabilitation in the fall prevention of older adult patients. Medline and Google Scholar databases were searched from July to August 2022 for studies related to telerehabilitation interventions in older adults above 60 years of age. The study included all trials related to the telerehabilitation programs and fall prevention in older adults. The search items included "telerehabilitation," "falls," and "older adults." Five studies were included involving 694 older adults. The interventions included online exercise classes and exercise sessions via digital video disks (DVDs) and phone calls. The results of the present review showed that telerehabilitation offers positive clinical results for fall prevention.
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Affiliation(s)
- M Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece.
| | - A Kastrinis
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, University of Thessaly, Lamia, Greece
| | - E Nomikou
- "The House" Physio and Rehab Clinic, Athens, Greece
| | - M Katsoulaki
- "Physiodrasis," Physio and Rehab Clinic, Athens, Greece
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Haynes A, Gilchrist H, Oliveira JS, Sherrington C, Tiedemann A. "I wouldn't have joined if it wasn't online": understanding older people's engagement with teleyoga classes for fall prevention. BMC Complement Med Ther 2022; 22:283. [PMID: 36324148 PMCID: PMC9628174 DOI: 10.1186/s12906-022-03756-1] [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: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Yoga-based exercise is a promising strategy for promoting healthy ageing, with the potential to reduce falls and increase physical, cognitive and psychological wellbeing. Teleyoga (real-time yoga provided via interactive videoconferencing) can deliver yoga programs at scale, potentially reducing costs, increasing convenience, and reaching people who cannot attend studio-based classes. But better understanding of how older people perceive and engage with teleyoga is needed to optimise its design, implementation and promotion. METHODS This study built on a previous realist process evaluation of the SAGE yoga trial which is testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60 + years. In this second phase of evaluation we conducted focus groups with participants who had completed the SAGE program online and with the yoga instructors who were delivering it. We also conducted interviews with participants who had withdrawn from the trial. Six program theories developed in the earlier evaluation provided a framework for data analysis, supplemented by inductive coding and an analytical workshop. RESULTS Participants described physical and psychological benefits from the SAGE teleyoga program. While noting that teleyoga cannot facilitate hands-on correction or the same quality of observation or interaction as studio classes, participants were highly appreciative of their yoga instructors' strategies for optimising visibility, instruction, social connection and therapeutic alliance, and for adapting to constrained home environments. Some participants argued that teleyoga was superior to studio classes due to its accessibility and convenience, its lower exposure to potential embarrassment about physical appearance or capabilities, and a reduced sense of peer competition and distraction. Our program theories applied across studio and online modes of delivery. CONCLUSION Teleyoga increases accessibility for people in diverse locations and circumstances; it provides a psychologically safer space which combats self-consciousness and unwanted competitiveness; it may enhance embodiment and mindfulness for some; and it has the potential to be offered relatively cheaply at scale which could support free or reduced price classes for people on low incomes and pensions, thereby encouraging a wider population to engage in yoga for healthy ageing and fall prevention.
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Affiliation(s)
- Abby Haynes
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Heidi Gilchrist
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Juliana S Oliveira
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Catherine Sherrington
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
| | - Anne Tiedemann
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Gadigal Country, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, Sydney, NSW Australia
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