Loading…
Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD
: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overal...
Saved in:
Published in: | Medicina (Kaunas, Lithuania) Lithuania), 2024-02, Vol.60 (2), p.257 |
---|---|
Main Authors: | , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | |
---|---|
cites | cdi_FETCH-LOGICAL-c455t-d6667354d13101d70cf57a2d09b28a96cba079987fb1f4ec90d2eb3f01ada9b23 |
container_end_page | |
container_issue | 2 |
container_start_page | 257 |
container_title | Medicina (Kaunas, Lithuania) |
container_volume | 60 |
creator | Florian, Crisan Alexandru Corina, Pescaru Camelia Adelina, Maritescu Vlad, Carunta Cristian, Oancea Emanuela, Vastag |
description | : Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD.
: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS).
: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (
< 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (
= 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (
= 0.16), ABC (
= 0.07), TUG (
= 0.06), and BBS (
= 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (
< 0.0001), ABC (
< 0.0001), TUG (
< 0.0001), and BBS (
< 0.0001).
: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group. |
doi_str_mv | 10.3390/medicina60020257 |
format | article |
fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_20325588b9a940b086086d527920ea02</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A784102421</galeid><doaj_id>oai_doaj_org_article_20325588b9a940b086086d527920ea02</doaj_id><sourcerecordid>A784102421</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-d6667354d13101d70cf57a2d09b28a96cba079987fb1f4ec90d2eb3f01ada9b23</originalsourceid><addsrcrecordid>eNptkk1vEzEQhlcIREvhzglZ4sIl7fhjP3wsAUqkolZQThysWdsbHGXtYHtB_fd4m7ZAhWzJ1swzr_2OpqpeUjjmXMLJaI3TzmMDwIDV7aPqkDaiW0gqxOO_7gfVs5Q2ALww7Gl1wDsuZS3EYfXts007FzGHeE0-TUlvLbmK6Lzza4LekFVOZDXuUGcSPHmLW_Ta3mTO0GXiPLnE7Kwv2C-Xv5Mv9qeNliwvLt89r54MuE32xe15VH398P5q-XFxfnG2Wp6eL7So67wwTdO0vBaGcgrUtKCHukVmQPasQ9noHqGVsmuHng7CagmG2Z4PQNFgYfhRtdrrmoAbtYtuxHitAjp1EwhxrTBmV6wpNreg7rpeohTQQ9eUbWrWSgYWYdZ6s9faxfBjsimr0SVtt8W2DVNSTPLSaU45L-jrB-gmTNEXpzMFsoNGyj_UGsv7zg8hR9SzqDptO0GBCUYLdfwfqixjR6eDt4Mr8X8KYF-gY0gp2uHeNwU1z4Z6OBul5NXtf6e-JO8L7oaB_wYr77FW</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2930980699</pqid></control><display><type>article</type><title>Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Florian, Crisan Alexandru ; Corina, Pescaru Camelia ; Adelina, Maritescu ; Vlad, Carunta ; Cristian, Oancea ; Emanuela, Vastag</creator><creatorcontrib>Florian, Crisan Alexandru ; Corina, Pescaru Camelia ; Adelina, Maritescu ; Vlad, Carunta ; Cristian, Oancea ; Emanuela, Vastag</creatorcontrib><description>: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD.
: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS).
: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (
< 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (
= 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (
= 0.16), ABC (
= 0.07), TUG (
= 0.06), and BBS (
= 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (
< 0.0001), ABC (
< 0.0001), TUG (
< 0.0001), and BBS (
< 0.0001).
: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group.</description><identifier>ISSN: 1648-9144</identifier><identifier>ISSN: 1010-660X</identifier><identifier>EISSN: 1648-9144</identifier><identifier>DOI: 10.3390/medicina60020257</identifier><identifier>PMID: 38399544</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>activities confidence ; Balance ; Breathing Exercises ; Chronic obstructive pulmonary disease ; COPD ; Diaphragm (Anatomy) ; Exercise ; Fitness training programs ; Gait ; Humans ; Lung diseases, Obstructive ; Muscle strength ; Patients ; Physical fitness ; Postural Balance - physiology ; Pulmonary Disease, Chronic Obstructive - complications ; Quality of Life ; Questionnaires ; Rehabilitation ; respiratory muscle training ; Statistical analysis ; Time and Motion Studies</subject><ispartof>Medicina (Kaunas, Lithuania), 2024-02, Vol.60 (2), p.257</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c455t-d6667354d13101d70cf57a2d09b28a96cba079987fb1f4ec90d2eb3f01ada9b23</cites><orcidid>0009-0002-6020-4593 ; 0000-0003-2083-0581 ; 0000-0003-2112-2923 ; 0000-0002-7573-3714</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2930980699/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2930980699?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,25751,27922,27923,37010,37011,44588,74896</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38399544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Florian, Crisan Alexandru</creatorcontrib><creatorcontrib>Corina, Pescaru Camelia</creatorcontrib><creatorcontrib>Adelina, Maritescu</creatorcontrib><creatorcontrib>Vlad, Carunta</creatorcontrib><creatorcontrib>Cristian, Oancea</creatorcontrib><creatorcontrib>Emanuela, Vastag</creatorcontrib><title>Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD</title><title>Medicina (Kaunas, Lithuania)</title><addtitle>Medicina (Kaunas)</addtitle><description>: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD.
: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS).
: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (
< 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (
= 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (
= 0.16), ABC (
= 0.07), TUG (
= 0.06), and BBS (
= 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (
< 0.0001), ABC (
< 0.0001), TUG (
< 0.0001), and BBS (
< 0.0001).
: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group.</description><subject>activities confidence</subject><subject>Balance</subject><subject>Breathing Exercises</subject><subject>Chronic obstructive pulmonary disease</subject><subject>COPD</subject><subject>Diaphragm (Anatomy)</subject><subject>Exercise</subject><subject>Fitness training programs</subject><subject>Gait</subject><subject>Humans</subject><subject>Lung diseases, Obstructive</subject><subject>Muscle strength</subject><subject>Patients</subject><subject>Physical fitness</subject><subject>Postural Balance - physiology</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Quality of Life</subject><subject>Questionnaires</subject><subject>Rehabilitation</subject><subject>respiratory muscle training</subject><subject>Statistical analysis</subject><subject>Time and Motion Studies</subject><issn>1648-9144</issn><issn>1010-660X</issn><issn>1648-9144</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkk1vEzEQhlcIREvhzglZ4sIl7fhjP3wsAUqkolZQThysWdsbHGXtYHtB_fd4m7ZAhWzJ1swzr_2OpqpeUjjmXMLJaI3TzmMDwIDV7aPqkDaiW0gqxOO_7gfVs5Q2ALww7Gl1wDsuZS3EYfXts007FzGHeE0-TUlvLbmK6Lzza4LekFVOZDXuUGcSPHmLW_Ta3mTO0GXiPLnE7Kwv2C-Xv5Mv9qeNliwvLt89r54MuE32xe15VH398P5q-XFxfnG2Wp6eL7So67wwTdO0vBaGcgrUtKCHukVmQPasQ9noHqGVsmuHng7CagmG2Z4PQNFgYfhRtdrrmoAbtYtuxHitAjp1EwhxrTBmV6wpNreg7rpeohTQQ9eUbWrWSgYWYdZ6s9faxfBjsimr0SVtt8W2DVNSTPLSaU45L-jrB-gmTNEXpzMFsoNGyj_UGsv7zg8hR9SzqDptO0GBCUYLdfwfqixjR6eDt4Mr8X8KYF-gY0gp2uHeNwU1z4Z6OBul5NXtf6e-JO8L7oaB_wYr77FW</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Florian, Crisan Alexandru</creator><creator>Corina, Pescaru Camelia</creator><creator>Adelina, Maritescu</creator><creator>Vlad, Carunta</creator><creator>Cristian, Oancea</creator><creator>Emanuela, Vastag</creator><general>MDPI AG</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>DOA</scope><orcidid>https://orcid.org/0009-0002-6020-4593</orcidid><orcidid>https://orcid.org/0000-0003-2083-0581</orcidid><orcidid>https://orcid.org/0000-0003-2112-2923</orcidid><orcidid>https://orcid.org/0000-0002-7573-3714</orcidid></search><sort><creationdate>20240201</creationdate><title>Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD</title><author>Florian, Crisan Alexandru ; Corina, Pescaru Camelia ; Adelina, Maritescu ; Vlad, Carunta ; Cristian, Oancea ; Emanuela, Vastag</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-d6667354d13101d70cf57a2d09b28a96cba079987fb1f4ec90d2eb3f01ada9b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>activities confidence</topic><topic>Balance</topic><topic>Breathing Exercises</topic><topic>Chronic obstructive pulmonary disease</topic><topic>COPD</topic><topic>Diaphragm (Anatomy)</topic><topic>Exercise</topic><topic>Fitness training programs</topic><topic>Gait</topic><topic>Humans</topic><topic>Lung diseases, Obstructive</topic><topic>Muscle strength</topic><topic>Patients</topic><topic>Physical fitness</topic><topic>Postural Balance - physiology</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Quality of Life</topic><topic>Questionnaires</topic><topic>Rehabilitation</topic><topic>respiratory muscle training</topic><topic>Statistical analysis</topic><topic>Time and Motion Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Florian, Crisan Alexandru</creatorcontrib><creatorcontrib>Corina, Pescaru Camelia</creatorcontrib><creatorcontrib>Adelina, Maritescu</creatorcontrib><creatorcontrib>Vlad, Carunta</creatorcontrib><creatorcontrib>Cristian, Oancea</creatorcontrib><creatorcontrib>Emanuela, Vastag</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>PHMC-Proquest健康医学期刊库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Directory of Open Access Journals</collection><jtitle>Medicina (Kaunas, Lithuania)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Florian, Crisan Alexandru</au><au>Corina, Pescaru Camelia</au><au>Adelina, Maritescu</au><au>Vlad, Carunta</au><au>Cristian, Oancea</au><au>Emanuela, Vastag</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD</atitle><jtitle>Medicina (Kaunas, Lithuania)</jtitle><addtitle>Medicina (Kaunas)</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>60</volume><issue>2</issue><spage>257</spage><pages>257-</pages><issn>1648-9144</issn><issn>1010-660X</issn><eissn>1648-9144</eissn><abstract>: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD.
: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS).
: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (
< 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (
= 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (
= 0.16), ABC (
= 0.07), TUG (
= 0.06), and BBS (
= 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (
< 0.0001), ABC (
< 0.0001), TUG (
< 0.0001), and BBS (
< 0.0001).
: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>38399544</pmid><doi>10.3390/medicina60020257</doi><orcidid>https://orcid.org/0009-0002-6020-4593</orcidid><orcidid>https://orcid.org/0000-0003-2083-0581</orcidid><orcidid>https://orcid.org/0000-0003-2112-2923</orcidid><orcidid>https://orcid.org/0000-0002-7573-3714</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1648-9144 |
ispartof | Medicina (Kaunas, Lithuania), 2024-02, Vol.60 (2), p.257 |
issn | 1648-9144 1010-660X 1648-9144 |
language | eng |
recordid | cdi_doaj_primary_oai_doaj_org_article_20325588b9a940b086086d527920ea02 |
source | Publicly Available Content Database; PubMed Central |
subjects | activities confidence Balance Breathing Exercises Chronic obstructive pulmonary disease COPD Diaphragm (Anatomy) Exercise Fitness training programs Gait Humans Lung diseases, Obstructive Muscle strength Patients Physical fitness Postural Balance - physiology Pulmonary Disease, Chronic Obstructive - complications Quality of Life Questionnaires Rehabilitation respiratory muscle training Statistical analysis Time and Motion Studies |
title | Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T13%3A24%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Respiratory%20Muscle%20Training%20and%20Its%20Impact%20on%20Balance%20and%20Gait%20in%20Patients%20with%20Severe%20COPD&rft.jtitle=Medicina%20(Kaunas,%20Lithuania)&rft.au=Florian,%20Crisan%20Alexandru&rft.date=2024-02-01&rft.volume=60&rft.issue=2&rft.spage=257&rft.pages=257-&rft.issn=1648-9144&rft.eissn=1648-9144&rft_id=info:doi/10.3390/medicina60020257&rft_dat=%3Cgale_doaj_%3EA784102421%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c455t-d6667354d13101d70cf57a2d09b28a96cba079987fb1f4ec90d2eb3f01ada9b23%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2930980699&rft_id=info:pmid/38399544&rft_galeid=A784102421&rfr_iscdi=true |