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Merino M, Maravilla-Herrera P, Lorenzo TM, Arance JA, Bobes J, Corrales M, Guzmán F, Morales M, Mur C. The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain. Glob Reg Health Technol Assess 2024; 11:82-93. [PMID: 38601072 PMCID: PMC11005448 DOI: 10.33393/grhta.2024.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults highly interfere with function in multiple dimensions, increasing the economic burden associated with ADHD. The aim of this study was to explore the impact of ADHD in Spanish adults and estimate the associated economic burden within the healthcare, social, economic, and legal domains. Methods An economic model was developed from a social perspective using a bottom-up approach, based on the scientific literature and a multidisciplinary expert group. Results The cost incurred per diagnosed adult patient with ADHD included an annual cost of €15,652 and a one-time cost of €7,893 (3,035 M€ and 1,531 M€ for Spain, respectively). Regarding the annual cost, 50% was attributed to costs within the economic domain, of which 53% were work-absenteeism-related. Moreover, 28% was attributed to costs within the social domain, of which 74% were substance-abuse-related. Regarding the one-time cost, 52% was attributed to costs within the healthcare domain, of which approximately 50% were hospitalization-related costs. Moreover, 42% was attributed to costs within the legal domain, of which 62% were imprisonment-related costs. Conclusions This is the first report on the socioeconomic burden of ADHD in Spanish adults, shedding light on the large burden that adult ADHD poses on the healthcare system and society at large, as symptoms have been shown to impact almost every aspect of life. This is particularly important for undiagnosed/untreated patients with ADHD in Spain, as appropriate treatments have shown positive results in these areas and may reduce its associated socioeconomic burden.
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Affiliation(s)
| | | | | | | | - Julio Bobes
- Department of Medicine, Oviedo University, Oviedo - Spain
- Network Biomedical Research Centre on Mental Health—CIBERSAM, Oviedo - Spain
| | - Montse Corrales
- Department of Psychiatry, Vall d’Hebron University Hospital, Barcelona - Spain
| | | | - María Morales
- Department of Psychiatry, Puerta de Hierro University Hospital, Majadahonda - Spain
| | - Carlos Mur
- Department of Psychiatry, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany - Andorra
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Merino M, Martín Lorenzo T, Maravilla-Herrera P, Ancochea J, Gómez Sáenz JT, Hass N, Molina J, Peces-Barba G, Trapero-Bertran M, Trigueros Carrero JA, Hidalgo-Vega Á. A Social Return on Investment Analysis of Improving the Management of Chronic Obstructive Pulmonary Disease Within the Spanish National Healthcare System. Int J Chron Obstruct Pulmon Dis 2022; 17:1431-1442. [PMID: 35761956 PMCID: PMC9233487 DOI: 10.2147/copd.s361700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives. Patients and Methods A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. A one-year forecast-type social return on investment (SROI) analysis was used to estimate the impact that implementing the set of proposals would have in relation to the investment required. A sensitivity analysis was used to test the strength of the model when varying assumption-based data-points. Results The hypothetical implementation of the complete set of 15 proposals would require a €668 million investment and would generate a €2079 million social impact concerning savings for the SNHS and quality of life improvements for patients and their informal caregivers, among others. Accordingly, for every euro invested in the set of proposals, a social return of €3.11 would be generated (€2.71 in the worst-case scenario and €3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%). Conclusion Altogether, implementing this set of 15 proposals would generate a positive social impact, threefold the required investment. The results may inform decisions relative to healthcare policy and practice regarding COPD management within the SNHS, further contributing to reduce the large burden of COPD.
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Affiliation(s)
| | | | | | - Julio Ancochea
- Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain
| | | | - Nicole Hass
- Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain
| | - Jesús Molina
- Francia Health Centre, Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, Spain
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Soto I, Mateo J, García-Diego DA, Gil B, Ruiz-Beato E, Ivanova Y, Martín Lorenzo T, Maravilla-Herrera P, Hidalgo-Vega Á, Merino M. The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis. BMC Health Serv Res 2022; 22:115. [PMID: 35081958 PMCID: PMC8793183 DOI: 10.1186/s12913-021-07447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective. METHODS A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment. RESULTS This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively). CONCLUSIONS These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.
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Affiliation(s)
| | - José Mateo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Yoana Ivanova
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
| | | | | | | | - María Merino
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
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Merino M, Ivanova Y, Martín Lorenzo T, Hidalgo-Vega Á. Improving rheumatoid arthritis management within the Spanish National Health System: a social return on investment study. Clin Exp Rheumatol 2022; 40:104-111. [PMID: 33635230 DOI: 10.55563/clinexprheumatol/mh38sy] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define a set of proposals that would improve the current management of patients with rheumatoid arthritis (RA) within the Spanish National Health System (SNHS), and to estimate the impact of their implementation from a social perspective. METHODS A one-year forecast-type Social Return on Investment (SROI) analysis was performed on the basis of information collected from a scientific literature review, official data, and multiple stakeholders regarding RA. A sub-analysis was performed within the areas of diagnosis, early RA (<2 years from diagnosis), and established RA (≥2 years from diagnosis). RESULTS Stakeholders agreed on a set of 22 proposals, which included incorporating specialised nursing, addressing adherence issues, providing psychological support, or promoting the role of patient associations, among others. Their implementation would require an investment of 289 million euros and yield a social return of 913 million euros, i.e. a social return of 3.16 euros per euro invested (2.92 euros in the worst-case scenario and 3.40 euros in the best-case scenario). The greatest social return relative to investment and the greatest attributed to intangible aspects were observed within the area of early RA. CONCLUSIONS Evidence-based recommendations for the management of RA are aspirational. Nevertheless, the present study estimated that the implementation of the set of proposals would result in a positive impact relative to the investment needed to implement them. The results may guide management decisions to reduce the burden associated with RA, and help bridge the gap between evidence-based recommendations and routine clinical practice.
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Affiliation(s)
| | - Yoana Ivanova
- Pharmacoeconomics and Market Access, Weber, Madrid, Spain
| | | | - Álvaro Hidalgo-Vega
- University of Castilla-La Mancha, Economic Analysis and Finance Department, Toledo, Spain
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Comín-Colet J, Martín Lorenzo T, González-Domínguez A, Oliva J, Jiménez Merino S. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes 2020; 18:329. [PMID: 33028351 PMCID: PMC7542693 DOI: 10.1186/s12955-020-01566-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine the impact of non-cardiovascular comorbidities on the health-related quality of life (HRQoL) of patients with chronic heart failure (CHF). METHODS A scoping review of the scientific literature published between 2009 and 2019 was carried out. Observational studies which assessed the HRQoL of patients with CHF using validated questionnaires and its association with non-cardiovascular comorbidities were included. RESULTS The search identified 1904 studies, of which 21 fulfilled the inclusion criteria to be included for analysis. HRQoL was measured through specific, generic, or both types of questionnaires in 72.2%, 16.7%, and 11.1% of the studies, respectively. The most common comorbidities studied were diabetes mellitus (12 studies), mental and behavioral disorders (8 studies), anemia and/or iron deficiency (7 studies), and respiratory diseases (6 studies). Across studies, 93 possible associations between non-cardiovascular comorbidities and HRQoL were tested, of which 21.5% regarded anemia or iron deficiency, 20.4% mental and behavioral disorders, 20.4% diabetes mellitus, and 14.0% respiratory diseases. Despite the large heterogeneity across studies, all 21 showed that the presence of a non-cardiovascular comorbidity had a negative impact on the HRQoL of patients with CHF. A statistically significant impact on worse HRQoL was found in 84.2% of associations between mental and behavioral disorders and HRQoL (patients with depression had up to 200% worse HRQoL than patients without depression); 73.7% of associations between diabetes mellitus and HRQoL (patients with diabetes mellitus had up to 21.8% worse HRQoL than patients without diabetes mellitus); 75% of associations between anemia and/or iron deficiency and HRQoL (patients with anemia and/or iron deficiency had up to 25.6% worse HRQoL than between patients without anemia and/or iron deficiency); and 61.5% of associations between respiratory diseases and HRQoL (patients with a respiratory disease had up to 21.3% worse HRQoL than patients without a respiratory disease). CONCLUSION The comprehensive management of patients with CHF should include the management of comorbidities which have been associated with a worse HRQoL, with special emphasis on anemia and iron deficiency, mental and behavioral disorders, diabetes mellitus, and respiratory diseases. An adequate control of these comorbidities may have a positive impact on the HRQoL of patients.
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Affiliation(s)
- Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Ramírez Barragán A, Lerma Lara S. Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy. Med Hypotheses 2017; 109:65-69. [DOI: 10.1016/j.mehy.2017.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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Martín Lorenzo T, Albi Rodríguez G, Rocon E, Martínez Caballero I, Lerma Lara S. Relationship of medial gastrocnemius relative fascicle excursion and ankle joint power and work performance during gait in typically developing children: A cross-sectional study. Medicine (Baltimore) 2017; 96:e7572. [PMID: 28723790 PMCID: PMC5521930 DOI: 10.1097/md.0000000000007572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the muscles' force generating capacity, maximum excursion, and contraction velocity is enhanced. Thus, longer fascicles suggest a greater capacity to develop joint power and work. However, static fascicle length measurements may not be taking sarcomere length differences into account. Thus, we considered relative fascicle excursions through passive ankle dorsiflexion may better correlate with the capacity to generate joint power and work than fascicle length. Therefore, the aim of the present study was to determine if medial gastrocnemius relative fascicle excursions correlate with ankle joint power and work generation during gait in typically developing children. A sample of typically developing children (n = 10) were recruited for this study and data analysis was carried out on 20 legs. Medial gastrocnemius relative fascicle excursion from resting joint angle to maximum dorsiflexion was estimated from trigonometric relations of medial gastrocnemius pennation angle and thickness obtained from B-mode real-time ultrasonography. Furthermore, a three-dimensional motion capture system was used to obtain ankle joint work and power during the stance phase of gait. Significant correlations were found between relative fascicle excursion and peak power absorption (-) r(14) = -0.61, P = .012 accounting for 31% variability, positive work r(18) = 0.56, P = .021 accounting for 31% variability, and late stance positive work r(15) = 0.51, P = .037 accounting for 26% variability. The large unexplained variance may be attributed to mechanics of neighboring structures (e.g., soleus or Achilles tendon mechanics) and proximal joint kinetics which may also contribute to ankle joint power and work performance, and were not taken into account. Further studies are encouraged to provide greater insight on the relationship between relative fascicle excursions and joint function.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón
| | - Gustavo Albi Rodríguez
- Servicio de Radiodiagnóstico, Hospital Infantil Universitario Niño Jesús
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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García CC, Alcocer-Gamboa A, Ruiz MP, Caballero IM, Faigenbaum AD, Esteve-Lanao J, Saiz BM, Lorenzo TM, Lara SL. Metabolic, cardiorespiratory, and neuromuscular fitness performance in children with cerebral palsy: A comparison with healthy youth. J Exerc Rehabil 2016; 12:124-31. [PMID: 27162775 PMCID: PMC4849492 DOI: 10.12965/jer.1632552.276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess metabolic, cardiorespiratory, and neuromuscular fitness parameters in children with spastic cerebral palsy (CP) and to compare these findings with typically developing children. 40 children with CP (21 males, 19 females; mean age, 11.0±3.3 yr; range, 6.5–17.1 yr; Gross Motor Function Classification System levels 1 or 2) and 40 healthy, age- and sex-matched children completed a test battery that consisted of 8 tests and 28 measures that assessed cardio-respiratory fitness, energy expenditure, anaerobic endurance, muscle strength, agility, stability and flexibility. Children with CP had significantly lower performance (P<0.05) on most cardiorespiratory and metabolic tests than those of healthy children, Differences in neuromuscular measures of muscular strength, speed, agility, anaerobic endurance, and flexibility between groups were most apparent. Grouped differences in cardiorespiratory variables revealed a 25% difference in performance, whereas grouped differences in metabolic and neuromuscular measures were 43% and 60%, respectively. The physical fitness of contemporary children with CP is significantly less than healthy, age-matched children. Significant differences in neuromuscular measures between groups can aid in the identification of specific fitness abilities in need of improvement in this population.
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Affiliation(s)
- Claudia Cardona García
- Universidad Europea de Madrid, Madrid, Spain; Universidad Autónoma de Yucatán, Mérida, México
| | - Alberto Alcocer-Gamboa
- Universidad Europea de Madrid, Madrid, Spain; Universidad Autónoma de Yucatán, Mérida, México
| | | | | | | | - Jonathan Esteve-Lanao
- Universidad Europea de Madrid, Madrid, Spain; Universidad Autónoma de Yucatán, Mérida, México; University of Greenwich, London, UK
| | | | | | - Sergio Lerma Lara
- Hospital Universitario Niño Jesús, Madrid, Spain; Department of Physiotherapy, Faculty of Health Science, Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Research Group on Movement and Behavioral Science and Study of Pain, Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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