Corey Morrow, Michelle Woodbury, Annie N Simpson, Eyad Almallouhi, Kit N Simpson
{"title":"Differences in rehabilitation evaluation access for rural and socially disadvantaged stroke survivors.","authors":"Corey Morrow, Michelle Woodbury, Annie N Simpson, Eyad Almallouhi, Kit N Simpson","doi":"10.1080/10749357.2024.2312638","DOIUrl":"10.1080/10749357.2024.2312638","url":null,"abstract":"<p><strong>Background: </strong>Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors' function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation.</p><p><strong>Objectives: </strong>The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations.</p><p><strong>Methods: </strong>We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations.</p><p><strong>Results: </strong>Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors.</p><p><strong>Conclusions: </strong>These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"625-631"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11269038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900484","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}
Birol Önal, Nezire Köse, Şeyma Nur Önal, Hatice Yağmur Zengin
{"title":"Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke.","authors":"Birol Önal, Nezire Köse, Şeyma Nur Önal, Hatice Yağmur Zengin","doi":"10.1080/10749357.2024.2307195","DOIUrl":"10.1080/10749357.2024.2307195","url":null,"abstract":"<p><strong>Introduction: </strong>Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment.</p><p><strong>Methods: </strong>Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods.</p><p><strong>Results: </strong>The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions.</p><p><strong>Conclusions: </strong>We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"547-555"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547296","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}
Elizabeth G S Munsell, Quoc Bui, Katherine J Kaufman, Stephanie E Tomazin, Bridget A Regan, Eric J Lenze, Jin-Moo Lee, David C Mohr, Mandy W M Fong, Christopher L Metts, Vy Pham, Alex W K Wong
{"title":"Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach.","authors":"Elizabeth G S Munsell, Quoc Bui, Katherine J Kaufman, Stephanie E Tomazin, Bridget A Regan, Eric J Lenze, Jin-Moo Lee, David C Mohr, Mandy W M Fong, Christopher L Metts, Vy Pham, Alex W K Wong","doi":"10.1080/10749357.2024.2307203","DOIUrl":"10.1080/10749357.2024.2307203","url":null,"abstract":"<p><strong>Introduction: </strong>Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes.</p><p><strong>Methods: </strong>Participants (<i>N</i> = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance.</p><p><strong>Results: </strong>The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains.</p><p><strong>Discussion: </strong>EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"564-575"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567562","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}
Jordana P Magalhães, Iza Faria-Fortini, Kênia Kp Menezes, Isadora A Lara, Ludmilla R Batista, Romeu Sant'anna, Christina Dcm Faria
{"title":"Determinants of access to rehabilitation professionals by individuals with stroke in the first six months after hospital discharge in Brazil: a study based on the Andersen model.","authors":"Jordana P Magalhães, Iza Faria-Fortini, Kênia Kp Menezes, Isadora A Lara, Ludmilla R Batista, Romeu Sant'anna, Christina Dcm Faria","doi":"10.1080/10749357.2024.2304969","DOIUrl":"10.1080/10749357.2024.2304969","url":null,"abstract":"<p><strong>Background: </strong>determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known.</p><p><strong>Objectives: </strong>To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge.</p><p><strong>Methods: </strong>Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%).</p><p><strong>Results: </strong>201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01).</p><p><strong>Conclusion: </strong>Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"615-624"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698396","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":"Effects of aerobic and resistance exercises on psychological and cognitive functions in patients with post-stroke migraine.","authors":"Nana Niu, Yanzhe Hao, Yang Cui, Miao Li","doi":"10.1080/10749357.2024.2377515","DOIUrl":"https://doi.org/10.1080/10749357.2024.2377515","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of a combination of aerobic and resistance exercises on the psychological and cognitive functions of post-stroke migraine patients.</p><p><strong>Methods: </strong>This study recruited 100 patients suffering from post-stroke migraine pain who were admitted to the hospital, categorizing them into a control group (<i>n</i> = 50) and an intervention group (<i>n</i> = 50). The control group received conventional drug treatment, while the intervention group received the exercise-based intervention that combined aerobic exercise with resistance exercise.</p><p><strong>Results: </strong>Before treatment, both groups displayed similar Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Mini-mental State Examination (MMSE) and MoCA scores. However, after the intervention, the intervention group exhibited lower scores on these measures compared to the control group (all <i>p</i> < 0.05). Additionally, there were no discernible disparity in Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) scores between the two cohorts of patients before treatment (<i>p</i> > 0.05), whereas the intervention group demonstrated significantly lower MIDAS and HIT-6 scores following the intervention (<i>p</i> < 0.05). Although there were no discernible distinctions in National Institute of Health stroke scale (NIHSS) and Stroke Specialized Quality of Life Scale (SS-QOL) measurements between the two patient groups before treatment (<i>p</i> > 0.05), the intervention group exhibited a significant decrease in NIHSS scores and a notable increase in SS-QOL scores after the intervention (<i>p</i> > 0.05). Moreover, the satisfaction rate and overall satisfaction rate were significantly higher in the intervention group (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The combination of aerobic and resistance exercises demonstrated positive effects on the psychological well-being and overall quality of life for post-stroke migraine patients.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617160","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":"Efficacy of plantar tactile sensation and balance in patients with subacute stroke following plantar kinesio taping: a randomized, cross-over preliminary study.","authors":"Seongho Yun, Youngsook Bae","doi":"10.1080/10749357.2024.2377519","DOIUrl":"https://doi.org/10.1080/10749357.2024.2377519","url":null,"abstract":"<p><strong>Background: </strong>Kinesio tape (KT) is known to enhance tactile sensation. In stroke rehabilitation, KT is often used alongside conventional therapy (CT) to improve balance recovery.</p><p><strong>Objective: </strong>In this study, we aimed to evaluate the effectiveness of plantar KT in enhancing plantar tactile sensation (PTS) and balance ability in subacute stroke patients.</p><p><strong>Methods: </strong>In this randomized crossover trial, 22 subacute stroke participants were randomly assigned to receive no taping, paretic plantar KT, or bilateral plantar KT, with a 24-h washout period between each condition. All participants underwent 30 min of CT. The primary outcome was PTS, involving tactile sensitivity in five areas on the plantar surface and the contact area with the ground of the paretic foot. The one-leg stand (OLS) time, functional reach test (FRT), and timed up-and-go test (TUG) were employed as secondary outcomes.</p><p><strong>Results: </strong>Paretic plantar KT application led to significant increases in the contact area, OLS, FRT, and TUG test times. Particularly, bilateral plantar KT showed significantly greater improvement in PTS compared to paretic plantar KT. Additionally, bilateral plantar KT significantly improved OLS (<i>p</i> < 0.001, η<sup>2</sup> = 0.575), FRT (<i>p</i> < 0.001, η<sup>2</sup> = 781), and TUG (<i>p</i> < 0.001, η<sup>2</sup> = 0.771) times compared with paretic plantar KT.</p><p><strong>Conclusions: </strong>This study demonstrated that plantar KT improved PTS and balance ability in stroke rehabilitation. The findings suggest that bilateral plantar KT as an adjunct to CT may have a beneficial effect on balance recovery in patients with subacute stroke.</p><p><strong>Trial registration: </strong>Clinical trial KCT0009048.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580908","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}
Kathleen Mellahn, Monique Kilkenny, Samantha Siyambalapitiya, Ali Lakhani, Tara Purvis, Megan Reyneke, Dominique A Cadilhac, Miranda L Rose
{"title":"Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter.","authors":"Kathleen Mellahn, Monique Kilkenny, Samantha Siyambalapitiya, Ali Lakhani, Tara Purvis, Megan Reyneke, Dominique A Cadilhac, Miranda L Rose","doi":"10.1080/10749357.2023.2295128","DOIUrl":"10.1080/10749357.2023.2295128","url":null,"abstract":"<p><strong>Background: </strong>People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown.</p><p><strong>Objectives: </strong>To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia.</p><p><strong>Methods: </strong>Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital.</p><p><strong>Results: </strong>Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% <i>p</i> = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, <i>p</i> = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89).</p><p><strong>Conclusions: </strong>Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"527-536"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138806223","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}
Lily Y W Ho, Cynthia Y Y Lai, Claudia K Y Lai, Shamay S M Ng
{"title":"Fatigue predicts level of community integration in people with stroke.","authors":"Lily Y W Ho, Cynthia Y Y Lai, Claudia K Y Lai, Shamay S M Ng","doi":"10.1080/10749357.2023.2298536","DOIUrl":"10.1080/10749357.2023.2298536","url":null,"abstract":"<p><strong>Background: </strong>The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke.</p><p><strong>Objectives: </strong>To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke.</p><p><strong>Methods: </strong>This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score.</p><p><strong>Results: </strong>After controlling for age, the CIM score significantly correlated with the scores for FAS (<i>r</i>=-0.48, <i>p</i> < 0.001), 6MWT distance (<i>r</i> = 0.24, <i>p</i> = 0.039), and SAFE (<i>r</i>=-0.39, <i>p</i> = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, <i>p</i> < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores.</p><p><strong>Conclusions: </strong>This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"464-473"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139098678","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":"The Association between fatigue and physical activity in patients hospitalized with subacute stroke.","authors":"Ayano Makihara, Masashi Kanai, Kazuhiro P Izawa, Hiroki Kubo, Asami Inamoto, Asami Ogura, Ikko Kubo, Shinichi Shimada","doi":"10.1080/10749357.2023.2293337","DOIUrl":"10.1080/10749357.2023.2293337","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the association between fatigue and physical activity in patients hospitalized with subacute stroke.</p><p><strong>Objectives: </strong>The aim of this study was to investigate the association between fatigue and physical activity in patients hospitalized with subacute stroke.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 244 consecutive patients with stroke who were admitted to a subacute rehabilitation ward at our hospital. We assessed fatigue with the Fatigue Assessment Scale (FAS) and used an accelerometer (Active style Pro HJA750-C, OMRON) to record the mean duration of sedentary behavior, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA). We assessed all factors at 1 month after stroke. Multivariate linear regression analysis revealed the associations between FASscore and objectively measured physical activity.</p><p><strong>Results: </strong>In total, we analyzed 85 patients. The duration of the sedentary behavior was significantly associated with the FAS score (<i>β</i> = 1.46, <i>p</i> = 0.037) and the Functional Balance Scale score (<i>β</i> = -1.35, <i>p</i> = 0.045). The LIPA time was significantly associated only with the FBS score (<i>β</i> = 1.38, <i>p</i> = 0.045), whereas MVPA was not associated with any variable.</p>","PeriodicalId":23164,"journal":{"name":"Topics in Stroke Rehabilitation","volume":" ","pages":"457-463"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075123","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}