Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom

COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. An online survey was conducted amongst CR participants from May to October 2020, COVI...

Full description

Saved in:
Bibliographic Details
Published in:BMC sports science, medicine & rehabilitation medicine & rehabilitation, 2022-04, Vol.14 (1), p.67-11, Article 67
Main Authors: Kirwan, Richard, Perez de Heredia, Fatima, McCullough, Deaglan, Butler, Tom, Davies, Ian G
Format: Article
Language:English
Subjects:
Cardiovascular disease
Consent
Coronary heart disease
Coronaviruses
COVID-19
Demographics
Ethics
Ethnicity
Exercise
Health aspects
Health behaviour
Hospitals
Pandemics
Perceptions
Physical activity
Physical fitness
Quality of life
Questionnaires
Rehabilitation
SARS-CoV-2
Shelter in place
Social distancing
Surveys
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863
cites cdi_FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863
container_end_page 11
container_issue 1
container_start_page 67
container_title BMC sports science, medicine & rehabilitation
container_volume 14
creator Kirwan, Richard
Perez de Heredia, Fatima
McCullough, Deaglan
Butler, Tom
Davies, Ian G
description COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p 
doi_str_mv 10.1186/s13102-022-00459-5
format article
fullrecord <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_78cf5ea57af843e9a90a4bde825450e8</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A700421077</galeid><doaj_id>oai_doaj_org_article_78cf5ea57af843e9a90a4bde825450e8</doaj_id><sourcerecordid>A700421077</sourcerecordid><originalsourceid>FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863</originalsourceid><addsrcrecordid>eNptkl9v0zAUxSMEYtPYF-ABWUJCvGTYjp04L0hTx5-KSXthvFo39k3rkdjFTob49rjtGC0iUWT7-ndP7KNTFC8ZvWBM1e8SqxjlJeX5o0K2pXxSnHIqecmUaJ4ezE-K85TuaH5U07S8fV6cVFIwVVFxWszLcQNmIqEni5tvy6uStWQI5rsNPz2JmKbozOSCTyR4YiBaBybX19C5wU2w3SIbiJMzbrNfgbeky8C9C3NMxHkyrZHcejehJV-cX9kwviie9TAkPH8Yz4rbjx--Lj6X1zeflovL69JILqZS8FZ1LcNWIOvrngNlFhEqo5jsalCyERbBYiVo01ABRlayYxXtpW0RVV2dFcu9rg1wpzfRjRB_6QBO7wohrvTu7APqRpleIsgGeiUqbKGlIDqLikshKaqs9X6vtZm7Ea1BP0UYjkSPd7xb61W41y2lDa-3h3n7IBDDjzlbq0eXDA4DeAxz0ryWlMtKMJrR1_-gd9lMn63aUpxyljPwl1pBvoDzfcj_NVtRfdnkUHCWbcnUxX-o_FocnQkee5frRw1vDhrWCMO0TmGYdzE4BvkeNDGkFLF_NINRvQ2p3odU55DqXUi1zE2vDm18bPkTyeo34pTgeg</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2652021118</pqid></control><display><type>article</type><title>Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom</title><source>Publicly Available Content (ProQuest)</source><source>SPORTDiscus</source><source>PubMed Central</source><source>Coronavirus Research Database</source><creator>Kirwan, Richard ; Perez de Heredia, Fatima ; McCullough, Deaglan ; Butler, Tom ; Davies, Ian G</creator><creatorcontrib>Kirwan, Richard ; Perez de Heredia, Fatima ; McCullough, Deaglan ; Butler, Tom ; Davies, Ian G</creatorcontrib><description>COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p &lt; 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p &lt; 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p &lt; 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format. Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.</description><identifier>ISSN: 2052-1847</identifier><identifier>EISSN: 2052-1847</identifier><identifier>DOI: 10.1186/s13102-022-00459-5</identifier><identifier>PMID: 35418304</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Cardiovascular disease ; Consent ; Coronary heart disease ; Coronaviruses ; COVID-19 ; Demographics ; Ethics ; Ethnicity ; Exercise ; Health aspects ; Health behaviour ; Hospitals ; Pandemics ; Perceptions ; Physical activity ; Physical fitness ; Quality of life ; Questionnaires ; Rehabilitation ; SARS-CoV-2 ; Shelter in place ; Social distancing ; Surveys</subject><ispartof>BMC sports science, medicine &amp; rehabilitation, 2022-04, Vol.14 (1), p.67-11, Article 67</ispartof><rights>2022. The Author(s).</rights><rights>COPYRIGHT 2022 BioMed Central Ltd.</rights><rights>2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863</citedby><cites>FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863</cites><orcidid>0000-0002-9882-9639 ; 0000-0003-3722-8466 ; 0000-0003-0818-1566 ; 0000-0002-2537-3327 ; 0000-0003-4645-0077</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9007266/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2652021118?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,38516,43895,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35418304$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirwan, Richard</creatorcontrib><creatorcontrib>Perez de Heredia, Fatima</creatorcontrib><creatorcontrib>McCullough, Deaglan</creatorcontrib><creatorcontrib>Butler, Tom</creatorcontrib><creatorcontrib>Davies, Ian G</creatorcontrib><title>Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom</title><title>BMC sports science, medicine &amp; rehabilitation</title><addtitle>BMC Sports Sci Med Rehabil</addtitle><description>COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p &lt; 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p &lt; 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p &lt; 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format. Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.</description><subject>Cardiovascular disease</subject><subject>Consent</subject><subject>Coronary heart disease</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Demographics</subject><subject>Ethics</subject><subject>Ethnicity</subject><subject>Exercise</subject><subject>Health aspects</subject><subject>Health behaviour</subject><subject>Hospitals</subject><subject>Pandemics</subject><subject>Perceptions</subject><subject>Physical activity</subject><subject>Physical fitness</subject><subject>Quality of life</subject><subject>Questionnaires</subject><subject>Rehabilitation</subject><subject>SARS-CoV-2</subject><subject>Shelter in place</subject><subject>Social distancing</subject><subject>Surveys</subject><issn>2052-1847</issn><issn>2052-1847</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>COVID</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkl9v0zAUxSMEYtPYF-ABWUJCvGTYjp04L0hTx5-KSXthvFo39k3rkdjFTob49rjtGC0iUWT7-ndP7KNTFC8ZvWBM1e8SqxjlJeX5o0K2pXxSnHIqecmUaJ4ezE-K85TuaH5U07S8fV6cVFIwVVFxWszLcQNmIqEni5tvy6uStWQI5rsNPz2JmKbozOSCTyR4YiBaBybX19C5wU2w3SIbiJMzbrNfgbeky8C9C3NMxHkyrZHcejehJV-cX9kwviie9TAkPH8Yz4rbjx--Lj6X1zeflovL69JILqZS8FZ1LcNWIOvrngNlFhEqo5jsalCyERbBYiVo01ABRlayYxXtpW0RVV2dFcu9rg1wpzfRjRB_6QBO7wohrvTu7APqRpleIsgGeiUqbKGlIDqLikshKaqs9X6vtZm7Ea1BP0UYjkSPd7xb61W41y2lDa-3h3n7IBDDjzlbq0eXDA4DeAxz0ryWlMtKMJrR1_-gd9lMn63aUpxyljPwl1pBvoDzfcj_NVtRfdnkUHCWbcnUxX-o_FocnQkee5frRw1vDhrWCMO0TmGYdzE4BvkeNDGkFLF_NINRvQ2p3odU55DqXUi1zE2vDm18bPkTyeo34pTgeg</recordid><startdate>20220413</startdate><enddate>20220413</enddate><creator>Kirwan, Richard</creator><creator>Perez de Heredia, Fatima</creator><creator>McCullough, Deaglan</creator><creator>Butler, Tom</creator><creator>Davies, Ian G</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</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>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9882-9639</orcidid><orcidid>https://orcid.org/0000-0003-3722-8466</orcidid><orcidid>https://orcid.org/0000-0003-0818-1566</orcidid><orcidid>https://orcid.org/0000-0002-2537-3327</orcidid><orcidid>https://orcid.org/0000-0003-4645-0077</orcidid></search><sort><creationdate>20220413</creationdate><title>Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom</title><author>Kirwan, Richard ; Perez de Heredia, Fatima ; McCullough, Deaglan ; Butler, Tom ; Davies, Ian G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cardiovascular disease</topic><topic>Consent</topic><topic>Coronary heart disease</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Demographics</topic><topic>Ethics</topic><topic>Ethnicity</topic><topic>Exercise</topic><topic>Health aspects</topic><topic>Health behaviour</topic><topic>Hospitals</topic><topic>Pandemics</topic><topic>Perceptions</topic><topic>Physical activity</topic><topic>Physical fitness</topic><topic>Quality of life</topic><topic>Questionnaires</topic><topic>Rehabilitation</topic><topic>SARS-CoV-2</topic><topic>Shelter in place</topic><topic>Social distancing</topic><topic>Surveys</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirwan, Richard</creatorcontrib><creatorcontrib>Perez de Heredia, Fatima</creatorcontrib><creatorcontrib>McCullough, Deaglan</creatorcontrib><creatorcontrib>Butler, Tom</creatorcontrib><creatorcontrib>Davies, Ian G</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing &amp; Allied Health Source</collection><collection>Physical Education Index</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</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>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC sports science, medicine &amp; rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirwan, Richard</au><au>Perez de Heredia, Fatima</au><au>McCullough, Deaglan</au><au>Butler, Tom</au><au>Davies, Ian G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom</atitle><jtitle>BMC sports science, medicine &amp; rehabilitation</jtitle><addtitle>BMC Sports Sci Med Rehabil</addtitle><date>2022-04-13</date><risdate>2022</risdate><volume>14</volume><issue>1</issue><spage>67</spage><epage>11</epage><pages>67-11</pages><artnum>67</artnum><issn>2052-1847</issn><eissn>2052-1847</eissn><abstract>COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p &lt; 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p &lt; 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p &lt; 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format. Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>35418304</pmid><doi>10.1186/s13102-022-00459-5</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9882-9639</orcidid><orcidid>https://orcid.org/0000-0003-3722-8466</orcidid><orcidid>https://orcid.org/0000-0003-0818-1566</orcidid><orcidid>https://orcid.org/0000-0002-2537-3327</orcidid><orcidid>https://orcid.org/0000-0003-4645-0077</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2052-1847
ispartof BMC sports science, medicine & rehabilitation, 2022-04, Vol.14 (1), p.67-11, Article 67
issn 2052-1847
2052-1847
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_78cf5ea57af843e9a90a4bde825450e8
source Publicly Available Content (ProQuest); SPORTDiscus; PubMed Central; Coronavirus Research Database
subjects Cardiovascular disease
Consent
Coronary heart disease
Coronaviruses
COVID-19
Demographics
Ethics
Ethnicity
Exercise
Health aspects
Health behaviour
Hospitals
Pandemics
Perceptions
Physical activity
Physical fitness
Quality of life
Questionnaires
Rehabilitation
SARS-CoV-2
Shelter in place
Social distancing
Surveys
title Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T01%3A44%3A09IST&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=Impact%20of%20COVID-19%20lockdown%20restrictions%20on%20cardiac%20rehabilitation%20participation%20and%20behaviours%20in%20the%20United%20Kingdom&rft.jtitle=BMC%20sports%20science,%20medicine%20&%20rehabilitation&rft.au=Kirwan,%20Richard&rft.date=2022-04-13&rft.volume=14&rft.issue=1&rft.spage=67&rft.epage=11&rft.pages=67-11&rft.artnum=67&rft.issn=2052-1847&rft.eissn=2052-1847&rft_id=info:doi/10.1186/s13102-022-00459-5&rft_dat=%3Cgale_doaj_%3EA700421077%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c524t-4298b91e94e1f6f2a01deea3c815b6a8574deade3407704ac535b130f5d9ee863%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2652021118&rft_id=info:pmid/35418304&rft_galeid=A700421077&rfr_iscdi=true