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Chen Y, Yang C, Nie K, Huang J, Qu Y, Wang T. Effects of scapular treatment on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2024; 25:252. [PMID: 38561733 PMCID: PMC10983729 DOI: 10.1186/s12891-024-07220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. METHODS Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. RESULTS A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment. CONCLUSION Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.
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Affiliation(s)
- Yin Chen
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chunlan Yang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kailu Nie
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingting Wang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane.
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China.
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Threesittidath K, Chaibal S, Nitayarak H. Effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers. J Occup Health 2024; 66:uiae023. [PMID: 38710168 PMCID: PMC11195575 DOI: 10.1093/joccuh/uiae023] [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: 09/25/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To compare the effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers with symptomatic neck pain and asymptomatic office workers. METHODS A total of 40 participants, both male and female office workers, with symptomatic neck pain (n = 20) and asymptomatic (n = 20), were recruited. Pain intensity, ulnar nerve conduction velocity, median nerve conduction velocity, and muscle activity were determined before and after 1 hour of computer use. RESULTS There was a significant increase in pain intensity in the neck area in both groups (P < .001). The symptomatic neck pain group revealed a significant decrease in the sensory nerve conduction velocity of the ulnar nerve (P = .008), whereas there was no difference in the median nerve conduction velocity (P > .05). Comparing before and after computer use, the symptomatic neck pain group had less activity of the semispinalis muscles and higher activity of the anterior scalene muscle than the asymptomatic group (P < .05). The trapezius and wrist extensor muscles showed no significant differences in either group (P > .05). CONCLUSIONS This study found signs of neuromuscular deficit of the ulnar nerve, semispinalis muscle, and anterior scalene muscle after 1 hour of computer use among office workers with symptomatic neck pain, which may indicate the risk of neuromuscular impairment of the upper extremities. The recommendation of resting, and encouraging function and flexibility of the neuromuscular system after 1 hour of computer use should be considered.
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Affiliation(s)
- Kanruethai Threesittidath
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Thai Buri, Tha Sala District, Nakhon Si Thammarat, Thailand 80160
- Movement Science and Exercise Research Center, Walailak University, Thai Buri, Tha Sala District, Nakhon Si Thammarat, Thailand 80160
| | - Supattra Chaibal
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Thai Buri, Tha Sala District, Nakhon Si Thammarat, Thailand 80160
- Movement Science and Exercise Research Center, Walailak University, Thai Buri, Tha Sala District, Nakhon Si Thammarat, Thailand 80160
| | - Haifah Nitayarak
- Movement Science and Exercise Research Center, Walailak University, Thai Buri, Tha Sala District, Nakhon Si Thammarat, Thailand 80160
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Karnjanavanich Road, Hat Yai, Songkhla, Thailand 90110
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Rasmussen-Barr E, Halvorsen M, Bohman T, Boström C, Dedering Å, Kuster RP, Olsson CB, Rovner G, Tseli E, Nilsson-Wikmar L, Grooten WJA. Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord 2023; 24:806. [PMID: 37828488 PMCID: PMC10568903 DOI: 10.1186/s12891-023-06930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence. METHODS We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible. RESULTS Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available. CONCLUSION Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality. TRIAL REGISTRATION Prospero CRD42022336014.
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Affiliation(s)
- Eva Rasmussen-Barr
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden.
| | - Marie Halvorsen
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Tony Bohman
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- The Health and Medical Care Administration, Region Dalarna, Falun, Sweden
| | - Roman P Kuster
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Christina B Olsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - Graciela Rovner
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- ACT Institutet Sweden, Research and Education, Gothenburg, Sweden
| | - Elena Tseli
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lena Nilsson-Wikmar
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
| | - Wilhelmus Johannes Andreas Grooten
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Sweden
- Department of Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals' Theme, Karolinska University Hospital, Stockholm, Sweden
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Prakash N, Cleland J, Harikesavan K. Effect of Scapula Focused Interventions on Pain and Disability in Neck Pain with Mobility Deficits- Protocol for a Single Blinded Randomized Controlled Trial. Rev Recent Clin Trials 2023; 18:282-287. [PMID: 38192198 DOI: 10.2174/1574887118666230519155631] [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: 10/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Neck pain with mobility deficits is a common non-specific disorder often observed in younger individuals. The abnormal position of the scapula has also been identified as a risk factor in individuals with neck pain and mobility deficits. Though literature exists regarding the effects of scapular strengthening exercises, there is a lack of studies that have examined the effects of scapular strengthening exercises in individuals with neck pain and mobility deficits. This randomized controlled trial aims to examine the effects of scapula-focused exercises on pain and disability in individuals with neck pain and mobility deficits. METHODS A single-blind (assessor-blinded) randomized controlled trial will be performed. One hundred and eight participants will be recruited and randomly assigned into two groups. The intervention group will receive scapula-focused exercises, and the control group will receive neckspecific exercises. Both groups will receive supervised sessions 3 days per week for 6 weeks and unsupervised sessions for the remaining weeks. Disability, pain, range of motion, pain pressure threshold, muscle strength, EMG activity, and sensory-motor functions will be assessed at the baseline, the 6th week, and the 12th week. RESULTS This study aims to provide the effectiveness of scapular-focused exercises and its effect on neck pain with mobility deficits. CONCLUSION Analyzing the results can provide insight into how effective scapular-focused exercises are when compared to neck exercises.
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Affiliation(s)
- Nithin Prakash
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Joshua Cleland
- Department of Physiotherapy, Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, USA
| | - Karvannan Harikesavan
- Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Response rate and comparison of clinical features associated with positive or negative responses to a scapular positioning test in patients with neck pain and altered scapular alignment: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8718500 DOI: 10.1136/bmjopen-2021-057459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
ObjectiveTo investigate the frequency and clinical aspects of patients with neck pain who responded and did not respond to scapular repositioning and to determine the clinical features associated with a positive response.DesignCross-sectional study.SettingResearch unit, Department of Physical Therapy, Chiang Mai University.ParticipantsVolunteers with non-specific neck pain aged 18–59 years were recruited between May 2020 and February 2021 from hospitals, clinics, university and community.Outcome measuresClinical data documented were neck pain (intensity, duration and disability), the presence of headache, type of scapular dysfunction, cervical musculoskeletal impairment (range of motion (ROM), flexion rotation test (FRT) and location of any symptomatic cervical joint dysfunction), upper limb functional limitation and self-reported disability. Manual scapular repositioning was performed on the side of neck pain. Participants were categorised as responsive or non-responsive based on a change in pain and/or cervical rotation range.ResultsA total of 219 people with neck pain responded to advertisements, of which 144 were eligible. Of the eligible participants, 107 (74.3%) demonstrated a clinically relevant improvement in either neck pain or rotation range or both following the scapular repositioning and 37 (25.7%) had no relevant improvement. The responsive group had a high incidence of scapular downward rotation, greater neck pain intensity, headache and cervical musculoskeletal impairment (reduced ROM, positive FRT and symptomatic C1-3 dysfunction) compared with the non-responsive group (p<0.05). A logistic regression model revealed that features strongly associated with a positive response were the presence of headache (Exp(B)=6.0, 95% CI 2.3 to 15.8), scapular downward rotation (Exp(B)=5.3, 95% CI 2.3 to 12.6) and a positive FRT (Exp(B)=4.0, 95% CI 1.5 to 10.6).ConclusionAlmost 75% of neck pain patients with altered scapular alignment responded to scapular repositioning. The predominance of upper cervical dysfunction with a downwardly rotated scapular in this group suggests a role of poor axioscapular muscle function which might benefit from rehabilitation.
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Focus on the Scapular Region in the Rehabilitation of Chronic Neck Pain Is Effective in Improving the Symptoms: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10163495. [PMID: 34441791 PMCID: PMC8397110 DOI: 10.3390/jcm10163495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic neck pain is a common human health problem. Changes in scapular posture and alteration of muscle activation patterns of scapulothoracic muscles are cited as potential risk factors for neck pain. The purpose of this study was to compare the effects of neck exercise training (NET) with and without scapular stabilization training (SST) on pain intensity, the scapula downward rotation index (SDRI), forward head angle (FHA) and neck range of motion (ROM) in patients with chronic neck pain and scapular dyskinesia. A total of sixty-six subjects with chronic neck pain and scapular dyskinesia were randomly divided into three groups: neck exercise training, n = 24, combined training (NET + SST), n = 24 and a control group, n = 24. Pain intensity, SDRI, FHA and ROM were measured by the numerical rating scale, caliper, photogrammetry and IMU sensor, respectively. When the combined intervention group consisting of NET and SST was compared with NET alone at six weeks, there was a statistically significant difference in pain intensity, SDRI, FHA and cervical ROM for flexion and extension (p ≤ 0.05). Adding scapular exercises to neck exercises had a more significant effect in decreasing pain intensity, SDRI, FHA and increased cervical ROM than neck exercises alone in patients with chronic neck pain. These findings indicate that focus on the scapular posture in the rehabilitation of chronic neck pain effectively improves the symptoms.
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Villanueva A, Rabal-Pelay J, Berzosa C, Gutiérrez H, Cimarras-Otal C, Lacarcel-Tejero B, Bataller-Cervero AV. Effect of a Long Exercise Program in the Reduction of Musculoskeletal Discomfort in Office Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239042. [PMID: 33291564 PMCID: PMC7729612 DOI: 10.3390/ijerph17239042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to assess the effect of a six week exercise program to reduce the muscle tone of the trapezius and musculoskeletal discomfort (MED) of office workers. Twenty-six workers performed an exercise program based on: (1) stretching of cervical and/or dorsal region; (2) joint mobility of shoulders and rachis; (3) strengthening deep stabilizer and core muscles; and (4) scapula stabilizing exercises. A Myoton device was used to evaluate trapezius tone and the Cornell Musculoskeletal Discomfort Questionnaire was used to assess changes in MED at three points of evaluation: at the beginning (Pre_1) and at the end of the workday (Post_1), and after the training program (Pre_2). The Wilcoxon test and Cohen’s d were performed to examine differences and effect sizes between evaluations. Main results show that trapezius tone remained constant during the workday, but decreased in the dominant upper trapezius (p = 0.003, ES = −0.60) and increased in the non-dominant middle trapezius (p = 0.016, ES = 0.45) after the exercise program, which eliminated significant muscle asymmetries. MED significantly decreased in the neck (p = 0.027, ES = −0.60) and upper back (p = 0.046, ES = −0.67). In conclusion, MED appears to improve in office workers after a six week training program, which may be explained by a decrease in trapezius tone and increase in the left middle trapezius tone.
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Affiliation(s)
- Alberto Villanueva
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
| | - Juan Rabal-Pelay
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
| | - César Berzosa
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
| | - Héctor Gutiérrez
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
| | - Cristina Cimarras-Otal
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
| | | | - A. Vanessa Bataller-Cervero
- Universidad San Jorge, Campus Universitario Villanueva de Gállego, Autov. A-23 Zaragoza - Huesca, Km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (A.V.); (J.R.-P.); (C.B.); (H.G.); (C.C.-O.)
- Correspondence:
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