Elena Ierardi, J Chris Eilbeck, Frederike van Wijck, Myzoon Ali, Fiona Coupar
{"title":"Data mining versus manual screening to select papers for inclusion in systematic reviews: a novel method to increase efficiency.","authors":"Elena Ierardi, J Chris Eilbeck, Frederike van Wijck, Myzoon Ali, Fiona Coupar","doi":"10.1097/MRR.0000000000000595","DOIUrl":"10.1097/MRR.0000000000000595","url":null,"abstract":"<p><p>Systematic reviews rely on identification of studies, initially through electronic searches yielding potentially thousands of studies, and then reviewer-led screening studies for inclusion. This standard method is time- and resource-intensive. We designed and applied an algorithm written in Python involving computer-aided identification of keywords within each paper for an exemplar systematic review of arm impairment after stroke. The standard method involved reading each abstract searching for these keywords. We compared the methods in terms of accuracy in identification of keywords, abstracts' eligibility, and time taken to make a decision about eligibility. For external validation, we adapted the algorithm for a different systematic review, and compared eligible studies using the algorithm with those included in that review. For the exemplar systematic review, the algorithm failed on 72 out of 2,789 documents retrieved (2.6%). Both methods identified the same 610 studies for inclusion. Based on a sample of 21 randomly selected abstracts, the standard screening took 1.58 ± 0.26 min per abstract. Computer output screening took 0.43 ± 0.14 min per abstract. The mean difference between the two methods was 1.15 min ( P < 0.0001), saving 73% per abstract. For the other systematic review, use of the algorithm resulted in the same studies being identified. One study was excluded based on the interpretation of the comparison intervention. Our purpose-built software was an accurate and significantly time-saving method for identifying eligible abstracts for inclusion in systematic reviews. This novel method could be adapted for other systematic reviews in future for the benefit of authors, reviewers and editors.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 3","pages":"284-292"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10281759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association between the amount of rehabilitation and the outcomes in patients with aspiration pneumonia.","authors":"Yuki Kato, Shinsuke Hori, Kenta Ushida, Miho Shimizu, Yuka Shirai, Ryo Momosaki","doi":"10.1097/MRR.0000000000000581","DOIUrl":"10.1097/MRR.0000000000000581","url":null,"abstract":"<p><p>The appropriate amount of rehabilitation for aspiration pneumonia remains unknown. We conducted a historical cohort study to investigate the association between the amount of rehabilitation provided and the outcome of patients with aspiration pneumonia. A total of 4148 patients with aspiration pneumonia recruited from a database created by JMDC were categorized into three groups based on daily rehabilitation units: none or <1 unit (low-volume group), 1-2 units (medium-volume group), and more than 2 units (high-volume group). The main outcome measures were death in the hospital, discharge home, and length of hospital stay. The results showed that the middle-volume and high-volume groups had significantly fewer in-hospital deaths [middle-volume group, odds ratio (OR) 0.62; 95% confidence interval (CI), 0.46-0.83; high-volume group, OR 0.66; 95% CI, 0.45-0.97], more patients were discharged home (middle-volume group, OR 1.29; 95% CI, 1.03-1.62; high-volume group, OR 2.00; 95% CI, 1.48-2.71), and shorter hospital stay (middle-volume group, coefficient -3.30; 95% CI, -6.42 to -0.19; high-volume group, coefficient -4.54; 95% CI, -8.69 to -0.40) compared with the low-volume group. In conclusion, higher rehabilitation units per day provided to patients with aspiration pneumonia were associated with fewer deaths, more home discharges, and shorter hospital stays.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 3","pages":"216-220"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanaz Pournajaf, Leonardo Pellicciari, Stefania Proietti, Francesco Agostini, Debora Gabbani, Michela Goffredo, Carlo Damiani, Marco Franceschini
{"title":"Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study.","authors":"Sanaz Pournajaf, Leonardo Pellicciari, Stefania Proietti, Francesco Agostini, Debora Gabbani, Michela Goffredo, Carlo Damiani, Marco Franceschini","doi":"10.1097/MRR.0000000000000584","DOIUrl":"10.1097/MRR.0000000000000584","url":null,"abstract":"<p><p>The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R 2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R 2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 3","pages":"230-237"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/a4/ijrr-46-230.PMC10396075.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9930783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pendulum test parameters are useful for detecting knee muscle hypertonia and quantifying response to an intrathecal baclofen bolus injection.","authors":"John W Chow, Dobrivoje S Stokic","doi":"10.1097/MRR.0000000000000590","DOIUrl":"10.1097/MRR.0000000000000590","url":null,"abstract":"<p><p>Our objective was to determine which pendulum test parameters are useful for detecting hypertonia in the knee muscles and assessing the group and individual responses to intrathecal baclofen (ITB) bolus injection among prospective pump recipients. We included 15 neurological patients with lower limb hypertonia (mainly spinal cord injury, n = 7) and collected data the day before (baseline), and 2.5 and 5.0 h after the 50-µg ITB bolus injection. For comparison, data were collected in 15 healthy controls. The average over six test repetitions was obtained for the number of oscillations, swing time (SwingT), amplitudes of the first flexion and extension, maximum angular velocities of the first flexion (F1V) and extension (E1V), relaxation index, and damping coefficient (DampC). Across the patient group, all pendulum parameters indicated a significant decrease in hypertonia from baseline to postinjection (analysis of variance P ≤ 0.004), except DampC. On the basis of the cutoffs from the receiver operating characteristic curve, all parameters were good or excellent discriminators of hypertonia in patients from normotonia in controls (area under the curve ≥0.85), with the highest sensitivity for SwingT and E1V (≥93%). Furthermore, all parameters except F1V revealed a significant shift from preinjection hypertonia to postinjection normotonia among patients (McNamar test P ≤ 0.002, DampC excluded due to missing data), with the greatest responsiveness for E1V and relaxation index (≥73%). The results confirm the overall usefulness of pendulum test parameters in this patient population and indicate that some parameters are better at detecting hypertonia (SwingT, E1V) whereas others (E1V, relaxation index) are more responsive to the ITB injection.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 3","pages":"238-247"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9914601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Factors affecting association between pain severity and physical activity among people with low back pain.","authors":"Mikhail Saltychev, Henri Hellgren, Juhani Juhola","doi":"10.1097/MRR.0000000000000591","DOIUrl":"10.1097/MRR.0000000000000591","url":null,"abstract":"<p><p>The aim was to identify factors, which may affect the relationship between physical activity and pain severity among patients with low back pain (LBP). It was a cross-sectional survey-based study among 1332 consecutive patients with LBP. Linear regression models were employed. Patients were 47.6 years old and 64% were women. For the entire sample, pain severity and the intensity of physical activity were negatively associated. Higher physical activity was associated with younger age, higher educational level, normal weight and optimal perceived general health. Sex, smoking, marital status and occupation did not demonstrate significant interactions on the association. The severity of disability showed paradoxical effect on the relationship between pain and physical activity - severe disability was associated with increase in physical activity.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 3","pages":"293-296"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9923830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects of a treatment program based on constraint-induced movement therapy for the lower extremities on gait and balance in chronic stroke: a 6-month follow-up pilot study.","authors":"Tomoyoshi Kobari, Takashi Murayama, Kazuhiro Matsuzawa, Katsuya Sakai","doi":"10.1097/MRR.0000000000000578","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000578","url":null,"abstract":"<p><p>Constraint-induced movement therapy (CIMT) for the lower extremities CIMT (LE-CIMT) has been shown feasible and promising but the long-term outcomes remain uncertain. In this pilot study, we recruited eight participants with chronic stroke from our facility for persons with disabilities to determine changes in gait and balance throughout an extended treatment program based on the principles of LE-CIMT. The program consisted of a run-in phase (3 weeks), LE-CIMT phase (3 weeks), and maintenance phase (6 months). In the LE-CIMT phase (3.5 h/day, 5 days/week, 3 weeks), the participants received task-oriented training (3 h) and transfer package training (30 min). The maintenance phase (30 min/day, 2-3 times/week, 6 months) included a transfer package and conventional training. The assessments were performed in the beginning and after each phase using the Fugl-Meyer Assessment, 6-min walk test (6MWT), Berg Balance Scale (BBS), and 10-m walk test from which walking speed, cadence, and stride length were derived. Overall, 6MWT, BBS, walking speed, and cadence improved significantly over time (analysis of variance P < 0.001). When comparing the results from before to after the LE-CIMT phase, 6MWT, BBS, walking speed, and cadence improved significantly ( P = 0.002 to 0.022). At the end of the 6-month maintenance phase, further improvements relative to the after LE-CIMT phase were found for 6MWT, walking speed, and cadence ( P = 0.002 to 0.034). These pilot results suggest that an extended treatment program based on the principles of LE-CIMT can improve balance and more so walking in the chronic phase of stroke.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 2","pages":"187-192"},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10281176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessia Marcassoli, Erika Guastafierro, Claudia Toppo, Matilde Leonardi, Anna Bersano, Giorgio Boncoraglio, Isabella Canavero, Alberto Raggi
{"title":"Psychosocial factors as main predictors of quality of life 5 years after stroke: a cross-sectional study from a third-level Italian center.","authors":"Alessia Marcassoli, Erika Guastafierro, Claudia Toppo, Matilde Leonardi, Anna Bersano, Giorgio Boncoraglio, Isabella Canavero, Alberto Raggi","doi":"10.1097/MRR.0000000000000570","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000570","url":null,"abstract":"<p><p>Stroke causes a significant reduction in health-related quality of life (HRQoL), and studies addressing its predictors often rely on models with few variables. This study aimed to assess the degree to which health status, health habits, and features of the environment predict HRQoL in stroke survivors with stable clinical condition. WHO Quality of Life questionnaire for old-Age subjects (WHOQOL-AGE) was used to assess HRQoL. We ran a multivariable linear regression to predict WHOQOL-AGE variation, entering measures of health state, bad habits, healthy behaviors, physical environment features, and social support. Patients were stroke survivors with a stable clinical condition, distance from acute event of more than 6 months, and National Institutes of Health Stroke Scale (NIHSS) of 10 or less. A total of 122 participants (47 females, 97 with ischemic stroke) were enrolled, the mean age was 64.1, mean NIHSS 2.9, and mean distance from the acute event was 5.1 years. State anxiety (β = -0.202), trait anxiety (β = -0.232), depression (β = -0.255), social support (β = 0.247), and functional independence (β = -0.210) predicted WHOQOL-AGE variation (Adj. R2 = 0.549). Our results show that psychological symptoms, reduced social network, and functional dependence together have a negative impact on HRQoL. These elements, which are partly stroke-specific, should be taken into account in the recovery process to enhance patients' health outcomes.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 2","pages":"151-156"},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10281065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of different constraint-induced movement therapy protocols on recovery of stroke survivors with upper extremity dysfunction: a systematic review and network meta-analysis.","authors":"Qian Gao, Yasu Zhang, Junzi Long, Mengyang Pan, Jing Wang, Fangjie Yang","doi":"10.1097/MRR.0000000000000577","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000577","url":null,"abstract":"<p><p>We aimed to assess and rank comparative efficacy of different constraint-induced movement therapy (CIMT) protocols on motor function of upper extremity and activities of daily living (ADL) in stroke survivors. A comprehensive search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library to identify randomized controlled trials on CIMT. Included studies were evaluated using the revised Cochrane risk of bias tool. Then a random-effects network meta-analysis was performed within a frequentist framework using Stata v16.0. Of the 1150 studies retrieved, 44 studies with 1779 participants were included. In terms of motor recovery of upper extremity, CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked as the most effective intervention for the improvement of the Fugl-Meyer Assessment-Upper Extremity and the Action Research Arm Test score. In terms of ADL improvement, constraining the less affected arm for at least 4 h but no more than 6 h per day in CIMT combined with trunk restraint, was found to significantly improve the Motor Activity Log of quality of movement scale and amount of use scale score. The protocol of CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked the highest in this analysis and might be considered in practice.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 2","pages":"133-150"},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10282080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ensar Abazović, Erol Kovačević, Josipa Nakić, Stanislav Peharec, Armin H Paravlic
{"title":"The effectiveness of unilateral isokinetic resistance training on cross-education is independent of contraction velocity: a case of female dorsiflexors and plantar flexors.","authors":"Ensar Abazović, Erol Kovačević, Josipa Nakić, Stanislav Peharec, Armin H Paravlic","doi":"10.1097/MRR.0000000000000580","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000580","url":null,"abstract":"<p><p>The large body of published literature has shown that the effects of strength training can transfer from trained to untrained homologous limb muscles after unilateral training. These effects on strength have been shown to be very specific to the type and speed of training contraction. The aim of this study was to investigate the effects of a 4-week unilateral slow and fast velocity isokinetic concentric training, to compare the effects, and thus investigate whether these effects are speed-specific. Forty-four healthy female students allocated to slow training, fast training, or control performed 12 isokinetic concentric-concentric plantar/dorsal flexors training sessions (3 × 4 weeks) using their nondominant leg. Participants in the two experimental groups showed statistically significant gains in strength in both the trained (ranging from 8 to 41%) and untrained leg (5-26%), thus showing cross-education on strength effects. The present study demonstrated that 4 weeks (12 training sessions) of unilateral isokinetic resistance training in the concentric mode improved the strength of contralateral, untrained homologous muscles to the same extent, regardless of the contraction velocity used in females. Furthermore, the amount of concentric overload (50% more than during 60°/s) did not appear to affect the increase in strength gains. Therefore, practitioners are encouraged to use both training speeds when strength gains in the contralateral leg are the primary goal. If the training time is limited, however, training with a higher contraction speed is recommended.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 2","pages":"199-204"},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10282084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clara Selves, Thierry Lejeune, Christine Detrembleur, Marie-Adeline Haustrate, Gaëtant Stoquart
{"title":"Validity and reliability of the assessment of hand flexors stiffness using a new electromechanical oscillatory device in people with stroke.","authors":"Clara Selves, Thierry Lejeune, Christine Detrembleur, Marie-Adeline Haustrate, Gaëtant Stoquart","doi":"10.1097/MRR.0000000000000574","DOIUrl":"https://doi.org/10.1097/MRR.0000000000000574","url":null,"abstract":"<p><p>Hyper-resistance after a central nervous system injury has been largely referred to as spasticity, which is but one of its neural components. Assessment largely relies on clinical scales (Modified Ashworth scale - MAS and Modified Tardieu scale, MTS) which are unable to distinguish between the non-neural (tissue-related) and the neural (central nervous system-related) components. This study assessed criterion validity and reliability (reproducibility) of muscle stiffness measures, namely, maximum elastic stiffness (ELmax), viscous stiffness (VI), and path length (L-path) in the hand flexor muscles among people with stroke. Measurements were obtained with a wrist-electromechanical oscillatory device (w-EOD). Twenty-four people with arm impairment after stroke were evaluated with the w-EOD and clinical assessment (MAS and MTS), twice on the same day (short-term reliability) and once 10 days later (long-term reliability). For criterion validity, a Spearman coefficient ( r ) was calculated between stiffness values and the clinical scales. For reliability, intraclass correlation coefficients (ICCs), SEM, and MDC95 were calculated. Moderate correlations were observed between EL max and MAS ( r = 0.49) and MTS (V2, r = 0.43; V3, r = 0.49) of the wrist flexors, and finger flexors (MAS, r = 0.60; MTS V2, r = 0.56; MTS V3, r = 0.55). There was a poor correlation between the clinical scales and VI and L-path. Reliability was excellent for all stiffness measurements at short term (EL max : 0.95, VI: 0.94, L-path: 0.92) and good at long term (EL max : 0.87, VI: 0.76, L-path: 0.82). In conclusion, stiffness measurements are valid and reliable to evaluate hyper-resistance in people with stroke.</p>","PeriodicalId":14301,"journal":{"name":"International Journal of Rehabilitation Research","volume":"46 2","pages":"170-177"},"PeriodicalIF":1.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10330582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}