Wheelchair users' perceived exertion during typical mobility activities

Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s −1 ), functional walking speed (1.3 m s −1 ), a relatively challenging speed (1.6 m s −1 ) and a self-selected speed. Each participant also completed a graded exercise...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Spinal cord 2015-09, Vol.53 (9), p.687-691
Hauptverfasser: Qi, L, Ferguson-Pell, M, Salimi, Z, Haennel, R, Ramadi, A
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 691
container_issue 9
container_start_page 687
container_title Spinal cord
container_volume 53
creator Qi, L
Ferguson-Pell, M
Salimi, Z
Haennel, R
Ramadi, A
description Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s −1 ), functional walking speed (1.3 m s −1 ), a relatively challenging speed (1.6 m s −1 ) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO 2peak ). Objectives: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Methods: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE _arm and RPE _respiration ) and oxygen uptake (VO 2 ) and heart rate were recorded during each exercise. Results: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s −1 . Speeds of 1 m s −1 and 1.3 m s −1 are typical of everyday functional propulsion. The corresponding RPE_ respiration and RPE_ arm ranged from 7 to 13 on the Borg scale; the %VO 2peak measured in these trials ranged from 37 to 80% VO 2peak. For propulsion intensities used in the present study—low, moderate, high and graded exercise intensity—no difference could be observed between RPE _respiration and RPE _arm . There were no significant differences between RPE _arm and RPE _respiration at the termination of the GXT. Conclusion: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.
doi_str_mv 10.1038/sc.2015.30
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1722181630</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1722181630</sourcerecordid><originalsourceid>FETCH-LOGICAL-c490t-e1b04d707b8d26b9ca543ca00cc932d0c7ccca089630e5ec70bb3b7c7a299bb23</originalsourceid><addsrcrecordid>eNqNkU9LxDAQxYMo_lm9-AGk4EFRuk6StmmOIroKghfFY0mmoxtptzVpxf32dt1VRC-eZgZ-8x7zhrF9DmMOMj8LOBbA07GENbbNE5XFaSaS9aGXmYgTqeUW2wnhBQA01_km2xKpUkoKvc0mj1OiCqfG-agP5MNR1JJHcm9URvROvnPNLCp772bPUTdvHZoqqhvrKtfNI4Ode3Odo7DLNp5MFWhvVUfs4ery_uI6vr2b3Fyc38aYaOhi4haSUoGyeSkyq9GkiUQDgKilKAEV4jDmOpNAKaECa6VVqIzQ2lohR-x4qdv65rWn0BW1C0hVZWbU9KHgSgie82H9HyhoxYHn6YAe_kJfmt7PhkM-qWSIKssH6mRJoW9C8PRUtN7Vxs8LDsXiE0XAYvGJ4tP9YCXZ25rKb_Qr-gE4XQKhXYRL_ofnX7kPBWuRXg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1709432968</pqid></control><display><type>article</type><title>Wheelchair users' perceived exertion during typical mobility activities</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Qi, L ; Ferguson-Pell, M ; Salimi, Z ; Haennel, R ; Ramadi, A</creator><creatorcontrib>Qi, L ; Ferguson-Pell, M ; Salimi, Z ; Haennel, R ; Ramadi, A</creatorcontrib><description>Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s −1 ), functional walking speed (1.3 m s −1 ), a relatively challenging speed (1.6 m s −1 ) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO 2peak ). Objectives: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Methods: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE _arm and RPE _respiration ) and oxygen uptake (VO 2 ) and heart rate were recorded during each exercise. Results: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s −1 . Speeds of 1 m s −1 and 1.3 m s −1 are typical of everyday functional propulsion. The corresponding RPE_ respiration and RPE_ arm ranged from 7 to 13 on the Borg scale; the %VO 2peak measured in these trials ranged from 37 to 80% VO 2peak. For propulsion intensities used in the present study—low, moderate, high and graded exercise intensity—no difference could be observed between RPE _respiration and RPE _arm . There were no significant differences between RPE _arm and RPE _respiration at the termination of the GXT. Conclusion: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/sc.2015.30</identifier><identifier>PMID: 25777329</identifier><identifier>CODEN: SPCOFM</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/1647/767/2200 ; 692/308/409 ; Adult ; Anatomy ; Biomedical and Life Sciences ; Biomedicine ; Exercise Test ; Fatigue - physiopathology ; Fatigue - psychology ; Female ; Heart Rate ; Human Physiology ; Humans ; Locomotion - physiology ; Lumbar Vertebrae ; Male ; Middle Aged ; Neurochemistry ; Neuropsychology ; Neurosciences ; original-article ; Oxygen Consumption ; Paraplegia - physiopathology ; Paraplegia - psychology ; Perception ; Physical Exertion - physiology ; Physical Fitness - physiology ; Physical Fitness - psychology ; Spinal Cord Injuries - physiopathology ; Spinal Cord Injuries - psychology ; Thoracic Vertebrae ; Wheelchairs</subject><ispartof>Spinal cord, 2015-09, Vol.53 (9), p.687-691</ispartof><rights>International Spinal Cord Society 2015</rights><rights>Copyright Nature Publishing Group Sep 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c490t-e1b04d707b8d26b9ca543ca00cc932d0c7ccca089630e5ec70bb3b7c7a299bb23</citedby><cites>FETCH-LOGICAL-c490t-e1b04d707b8d26b9ca543ca00cc932d0c7ccca089630e5ec70bb3b7c7a299bb23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sc.2015.30$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sc.2015.30$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25777329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qi, L</creatorcontrib><creatorcontrib>Ferguson-Pell, M</creatorcontrib><creatorcontrib>Salimi, Z</creatorcontrib><creatorcontrib>Haennel, R</creatorcontrib><creatorcontrib>Ramadi, A</creatorcontrib><title>Wheelchair users' perceived exertion during typical mobility activities</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s −1 ), functional walking speed (1.3 m s −1 ), a relatively challenging speed (1.6 m s −1 ) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO 2peak ). Objectives: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Methods: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE _arm and RPE _respiration ) and oxygen uptake (VO 2 ) and heart rate were recorded during each exercise. Results: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s −1 . Speeds of 1 m s −1 and 1.3 m s −1 are typical of everyday functional propulsion. The corresponding RPE_ respiration and RPE_ arm ranged from 7 to 13 on the Borg scale; the %VO 2peak measured in these trials ranged from 37 to 80% VO 2peak. For propulsion intensities used in the present study—low, moderate, high and graded exercise intensity—no difference could be observed between RPE _respiration and RPE _arm . There were no significant differences between RPE _arm and RPE _respiration at the termination of the GXT. Conclusion: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.</description><subject>631/1647/767/2200</subject><subject>692/308/409</subject><subject>Adult</subject><subject>Anatomy</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Exercise Test</subject><subject>Fatigue - physiopathology</subject><subject>Fatigue - psychology</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Locomotion - physiology</subject><subject>Lumbar Vertebrae</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>original-article</subject><subject>Oxygen Consumption</subject><subject>Paraplegia - physiopathology</subject><subject>Paraplegia - psychology</subject><subject>Perception</subject><subject>Physical Exertion - physiology</subject><subject>Physical Fitness - physiology</subject><subject>Physical Fitness - psychology</subject><subject>Spinal Cord Injuries - physiopathology</subject><subject>Spinal Cord Injuries - psychology</subject><subject>Thoracic Vertebrae</subject><subject>Wheelchairs</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkU9LxDAQxYMo_lm9-AGk4EFRuk6StmmOIroKghfFY0mmoxtptzVpxf32dt1VRC-eZgZ-8x7zhrF9DmMOMj8LOBbA07GENbbNE5XFaSaS9aGXmYgTqeUW2wnhBQA01_km2xKpUkoKvc0mj1OiCqfG-agP5MNR1JJHcm9URvROvnPNLCp772bPUTdvHZoqqhvrKtfNI4Ode3Odo7DLNp5MFWhvVUfs4ery_uI6vr2b3Fyc38aYaOhi4haSUoGyeSkyq9GkiUQDgKilKAEV4jDmOpNAKaECa6VVqIzQ2lohR-x4qdv65rWn0BW1C0hVZWbU9KHgSgie82H9HyhoxYHn6YAe_kJfmt7PhkM-qWSIKssH6mRJoW9C8PRUtN7Vxs8LDsXiE0XAYvGJ4tP9YCXZ25rKb_Qr-gE4XQKhXYRL_ofnX7kPBWuRXg</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Qi, L</creator><creator>Ferguson-Pell, M</creator><creator>Salimi, Z</creator><creator>Haennel, R</creator><creator>Ramadi, A</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</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>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Wheelchair users' perceived exertion during typical mobility activities</title><author>Qi, L ; Ferguson-Pell, M ; Salimi, Z ; Haennel, R ; Ramadi, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-e1b04d707b8d26b9ca543ca00cc932d0c7ccca089630e5ec70bb3b7c7a299bb23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>631/1647/767/2200</topic><topic>692/308/409</topic><topic>Adult</topic><topic>Anatomy</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Exercise Test</topic><topic>Fatigue - physiopathology</topic><topic>Fatigue - psychology</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Locomotion - physiology</topic><topic>Lumbar Vertebrae</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>original-article</topic><topic>Oxygen Consumption</topic><topic>Paraplegia - physiopathology</topic><topic>Paraplegia - psychology</topic><topic>Perception</topic><topic>Physical Exertion - physiology</topic><topic>Physical Fitness - physiology</topic><topic>Physical Fitness - psychology</topic><topic>Spinal Cord Injuries - physiopathology</topic><topic>Spinal Cord Injuries - psychology</topic><topic>Thoracic Vertebrae</topic><topic>Wheelchairs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qi, L</creatorcontrib><creatorcontrib>Ferguson-Pell, M</creatorcontrib><creatorcontrib>Salimi, Z</creatorcontrib><creatorcontrib>Haennel, R</creatorcontrib><creatorcontrib>Ramadi, A</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>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</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 Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</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><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qi, L</au><au>Ferguson-Pell, M</au><au>Salimi, Z</au><au>Haennel, R</au><au>Ramadi, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Wheelchair users' perceived exertion during typical mobility activities</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>53</volume><issue>9</issue><spage>687</spage><epage>691</epage><pages>687-691</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><coden>SPCOFM</coden><abstract>Study design: Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s −1 ), functional walking speed (1.3 m s −1 ), a relatively challenging speed (1.6 m s −1 ) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO 2peak ). Objectives: The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Methods: Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE _arm and RPE _respiration ) and oxygen uptake (VO 2 ) and heart rate were recorded during each exercise. Results: The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s −1 . Speeds of 1 m s −1 and 1.3 m s −1 are typical of everyday functional propulsion. The corresponding RPE_ respiration and RPE_ arm ranged from 7 to 13 on the Borg scale; the %VO 2peak measured in these trials ranged from 37 to 80% VO 2peak. For propulsion intensities used in the present study—low, moderate, high and graded exercise intensity—no difference could be observed between RPE _respiration and RPE _arm . There were no significant differences between RPE _arm and RPE _respiration at the termination of the GXT. Conclusion: The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>25777329</pmid><doi>10.1038/sc.2015.30</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1362-4393
ispartof Spinal cord, 2015-09, Vol.53 (9), p.687-691
issn 1362-4393
1476-5624
language eng
recordid cdi_proquest_miscellaneous_1722181630
source MEDLINE; EZB-FREE-00999 freely available EZB journals; SpringerLink Journals - AutoHoldings
subjects 631/1647/767/2200
692/308/409
Adult
Anatomy
Biomedical and Life Sciences
Biomedicine
Exercise Test
Fatigue - physiopathology
Fatigue - psychology
Female
Heart Rate
Human Physiology
Humans
Locomotion - physiology
Lumbar Vertebrae
Male
Middle Aged
Neurochemistry
Neuropsychology
Neurosciences
original-article
Oxygen Consumption
Paraplegia - physiopathology
Paraplegia - psychology
Perception
Physical Exertion - physiology
Physical Fitness - physiology
Physical Fitness - psychology
Spinal Cord Injuries - physiopathology
Spinal Cord Injuries - psychology
Thoracic Vertebrae
Wheelchairs
title Wheelchair users' perceived exertion during typical mobility activities
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T01%3A30%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Wheelchair%20users'%20perceived%20exertion%20during%20typical%20mobility%20activities&rft.jtitle=Spinal%20cord&rft.au=Qi,%20L&rft.date=2015-09-01&rft.volume=53&rft.issue=9&rft.spage=687&rft.epage=691&rft.pages=687-691&rft.issn=1362-4393&rft.eissn=1476-5624&rft.coden=SPCOFM&rft_id=info:doi/10.1038/sc.2015.30&rft_dat=%3Cproquest_cross%3E1722181630%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1709432968&rft_id=info:pmid/25777329&rfr_iscdi=true