Musculoskeletal Care最新文献

{"title":"Healthcare Utilisation in Danish Primary Care Among Patients With Low Back or Neck/Thoracic Spine Pain Before and After Assessment in Secondary Care.","authors":"Stine Clausen, Jan Hartvigsen, Melker S Johansson, Lise Grethe Kjønø, Søren Grøn, Christian V Skovsgaard, Kjersti Storheim, Karin Magnusson, Margreth Grotle, Casper Nim","doi":"10.1002/msc.70017","DOIUrl":"https://doi.org/10.1002/msc.70017","url":null,"abstract":"<p><strong>Objectives: </strong>To describe characteristics and primary healthcare utilisation in Danish patients with low back pain (LBP) or neck/thoracic spine pain (NTP) 8 years before and 2 years after assessment in secondary care.</p><p><strong>Methods: </strong>In this cohort study, we included patients aged ≥ 18 who were assessed at an outpatient spine clinic from 2013 to 2021 and linked self-reported information with national registry data. We calculated the prevalence of all-cause healthcare utilisation in primary care. Then, we determined changes in the number of consultations from before to after assessment in secondary care using generalised estimating equations.</p><p><strong>Results: </strong>We included 56,949 LBP patients and 18,926 NTP patients. The baseline characteristics were similar overall. For both LBP and NTP, all-cause healthcare utilisation increased slightly over time, with a substantial increase in the quarter before the secondary care assessment and a decrease after. Before the assessment, almost all patients consulted general practitioners (95%), while some consulted physiotherapists or chiropractors (60%). Overall, consultations decreased by 19% and 17% for patients with LBP and NTP from 12 to 1 month before to 1-12 months after the assessment. In contrast, 13-24 months after assessment, we found a slight increase in consultations in both groups compared to the same period before.</p><p><strong>Conclusions: </strong>Patients with LBP and NTP were similar and used similar primary healthcare, which slightly increased over the 10 years. As physiotherapists and chiropractors are first-line providers of guideline-recommended spine pain treatment, the finding that 40% did not consult these professions the year before the secondary care assessment indicates that not all patients receive recommended care before referral.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 4","pages":"e70017"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthosis Management in Knee Osteoarthritis: Evaluating Existing Recommendations and Achieving Consensus on Implementation Through the Delphi Method.","authors":"Zilan Bazancir-Apaydin","doi":"10.1002/msc.70018","DOIUrl":"https://doi.org/10.1002/msc.70018","url":null,"abstract":"<p><strong>Objective: </strong>The available evidence on orthosis management in the knee osteoarthritis (KOA) remains questionable. This study aims to evaluate existing recommendations and achieve consensus on their implementation through the modified Delphi method.</p><p><strong>Methods: </strong>Experienced experts in orthosis management for KOA patients participated in three Delphi rounds. Each round involved addressing various questions related to recommended orthosis type such as insole, knee brace, footwear, indications and contraindications, dosage of orthosis usage, follow-up period, long-term side effects, fitting, and weaning procedure. Consensus was defined as  ≥ 70% agreement with a question.</p><p><strong>Results: </strong>Consensus was achieved for all questions. Experts frequently recommended custom-made insoles, neoprene knee braces, and appropriate footwear. The recommended duration of insole and knee brace usage averaged 3-6 months. Insole usage was advised during all weight-bearing activities, while knee braces were suggested for 4-6 h per day. Experts recommended orthosis follow-up for an average of 4-6 months. Reduced compliance with orthoses was highlighted by experts as the most significant long-term side effect. The fitting of orthoses is typically evaluated through gait analyses, assessment of symptoms and comfort, and observation of the corrective effects on impaired biomechanics in the clinical setting. Besides, experts commonly recommend a gradual weaning process from orthoses.</p><p><strong>Conclusions: </strong>This study addresses the existing lack of consensus on orthosis management in KOA and provides essential clinical practice recommendations from multidisciplinary experts.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 4","pages":"e70018"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand Performance Assessed by Functional Dexterity Test Correlates With Clinical Disease Activity but Remains Altered in Rheumatoid Arthritis Patients Achieving Treatment Goals: A Cross-Sectional Cohort Study.","authors":"Aniela Shouval, Amihai Levkoviz, Shiri Keret, Itzhak Rosner, Irina Rokhyan, Boris Tchalabian, Esther Hof, Gleb Slobodin","doi":"10.1002/msc.70023","DOIUrl":"https://doi.org/10.1002/msc.70023","url":null,"abstract":"<p><strong>Objectives: </strong>Direct hand function is not commonly evaluated in patients with rheumatoid arthritis (RA). The Functional Dexterity Test (FDT) assesses a patient's ability to use the hand for daily tasks and is an accepted quantitative assessment tool in occupational medicine. This pilot study aimed to examine the correlations of FDT-measured hand performance with disease activity status in a cohort of RA patients.</p><p><strong>Methods: </strong>Forty-eight patients with established RA performed the FDT during their regular follow-up visits. The dominant and non-dominant hands were assessed separately. FDT results were compared among patients with active RA and Clinical Disease Activity Index (CDAI) > 10, RA patients achieving controlled disease activity state (CDAI ≤ 10), and 20 volunteers with no rheumatic disease.</p><p><strong>Results: </strong>Mean FDT for the dominant hand was 43 s in active RA, 35 s in controlled RA, and 25 s in persons without arthritis. Corresponding FDT results for the non-dominant hand were 50, 38, and 29 s, respectively. FDT significantly correlated with CDAI in the entire cohort of RA patients and the subgroup with CDAI > 10. Patients with controlled disease, CDAI ≤ 10, still demonstrated significantly reduced hand performance compared with non-rheumatic controls.</p><p><strong>Conclusions: </strong>FDT is a sensitive tool for assessing rheumatoid hand function. Reduced hand performance by FDT in many RA patients who have already achieved existing treatment goals speaks to the question of the suitability of direct hand performance assessment as an RA outcome measure.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 4","pages":"e70023"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Congruence Between Patient and Clinician Expectations of Benefit in the Non-Surgical Management of Common Musculoskeletal Conditions in Tertiary Care.","authors":"Darryn Marks, Peter Window, Maree Raymer, Patrick Swete Kelly, Alison Smith, Graham MacGregor, Helen O'Gorman, Ellen Jang, Steve Erceg, Daniel Wickins, Grahame Milne, Helen Cooper, Ian Seels, Brendan Diplock, Nikhil Taneja, Ian McLoughlin, Steven M McPhail, Shaun O'Leary","doi":"10.1002/msc.70036","DOIUrl":"10.1002/msc.70036","url":null,"abstract":"<p><strong>Background: </strong>Patient and clinician expectations of benefit from recommended management approaches may potentially impact the success of managing musculoskeletal conditions.</p><p><strong>Methods: </strong>This was a multisite study in an advanced practice musculoskeletal service across Queensland, Australia. Relationships between patient and clinician (advanced physiotherapy practitioner) expectations of benefit, patient characteristics, and clinical outcome recorded 6 months later were explored with regression analysis in 619 patients undergoing non-surgical multidisciplinary care for either knee osteoarthritis (n = 286), low back pain (n = 249) or shoulder impingement syndrome (n = 84).</p><p><strong>Results: </strong>Patient and clinician expectation ratings had a weak positive association (standardized coefficient (β) 0.28, adjusted R² 0.09). Higher patient expectation ratings were associated with higher readiness for change scores (β 0.31, model adjusted R² = 0.18), while higher clinician expectation ratings were associated with the condition managed, higher patient education level, lower potential presence of neuropathic pain or yellow flags, and more favourable radiological findings (model adjusted R² 0.4). Patient expectations and self-reported engagement with care were poorly correlated. Higher patient (β 0.33, adjusted R² 0.12) and clinician (β 0.32, adjusted R² 0.14) expectations were associated with better clinical outcomes. This positive association was stronger when patient and clinician expectation ratings were congruent.</p><p><strong>Conclusions: </strong>Findings suggest that expected benefits from recommended care may impact outcomes and should be considered in the initial phases of management. In particular, congruence between patient and clinician expectations appears to have relevance to outcomes.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 4","pages":"e70036"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Patients With Axial Spondyloarthritis Require Almost a Decade To Be Diagnosed Leading to Severe Functional Limitation. Results From the International Map of Axial Spondyloarthritis (IMAS).","authors":"Proton Rahman, Marco Garrido-Cumbrera, Sherry Rohekar, Michael G Mallinson, Elie Karam, Algis V Jovaisas, Nigil Haroon, Jeff Beach, Artur J de Brum-Fernandes, Martin Cohen, Jonathan Chan, Jose Correa-Fernández, Patrick Leclerc, Robert D Inman","doi":"10.1002/msc.70010","DOIUrl":"10.1002/msc.70010","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the sociodemographic characteristics and disease-related factors associated with diagnostic delay in Canadian patients with axial spondyloarthritis (axSpA).</p><p><strong>Methods: </strong>Data from 542 Canadian patients who participated in the International Map of Axial Spondyloarthritis online survey were analysed. Diagnostic delay was calculated as the difference between age at diagnosis and age at onset of the first symptoms reported by participants. Univariate and multivariate analyses were used to evaluate possible factors associated with diagnostic delay.</p><p><strong>Results: </strong>The mean age (± SD) of the surveyed participants was 44.3 ± 13.9 years and 63.1% were female. The average diagnostic delay was 9.0 ± 10.5 years (median, 5.0 years; interquartile range, 1.0-13.8). In the multivariate regression analysis, the three variables most strongly associated with longer diagnostic delay were use of nonsteroidal anti-inflammatory drugs (NSAIDs) (B = 2.991; 95% CI = 1.075-4.909), medium or high functional limitation (B = 1.541; 95%CI = 0.186-2.896), and number of HCPs seen before diagnosis (B = 1.524, 95%CI = 1.072-1.977).</p><p><strong>Conclusion: </strong>Diagnostic delay continues to be a barrier to optimal care for Canadian axSpA patients. Significant diagnostic delay, associated with a high number of HCP visits prior to diagnosis, high use of NSAIDs, and marked functional limitation in daily life, illustrate the convoluted axSpA patient journey.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 4","pages":"e70010"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of the Effectiveness of Rehabilitation Programmes or Strategies to Treat People With Persistent Knee Pain Following a Total Knee Replacement.","authors":"Nathan Johns, Justine M Naylor, Dean McKenzie, Bernadette Brady, Brinda Thirugnanam, John Olver","doi":"10.1002/msc.1945","DOIUrl":"10.1002/msc.1945","url":null,"abstract":"<p><strong>Background: </strong>Persistent high levels of knee pain after a total knee replacement have been estimated to affect 5%-10% of people and this is related to dissatisfaction with surgery, reduced function and reduced quality of life. This systematic review aims to evaluate the effectiveness of rehabilitation programs or strategies to reduce persistent pain and improve function and quality of life in people following a total knee replacement.</p><p><strong>Methods: </strong>The systematic review was conducted following PRISMA guidelines with a search of relevant online databases up to 17 July 2024. The search criteria included English language randomised controlled trials of rehabilitation programs or strategies in any setting to treat people with persistent knee pain more than 3 months after a total knee replacement. Rehabilitation could include exercise, education, cognitive strategies and self-management programs and excluded medication trials, procedural techniques and complementary therapies.</p><p><strong>Results: </strong>After removal of duplicates, there were 468 abstracts screened for eligibility with 23 remaining for full-text screening and finally, one study meeting the eligibility criteria. This study's interventions were pain neuroscience education alone and pain neuroscience education plus neuromuscular exercise. There were no statistically significant between-group differences for pain reduction or functional improvement.</p><p><strong>Conclusion: </strong>The evidence examining the value of rehabilitation programs or strategies for pain reduction and functional improvement in people with persistent pain following total knee replacement is deficient. Given the high number of people affected annually, further research concerning both prevention and management of persistent pain after knee replacement is warranted.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 3","pages":"e1945"},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact and Patient Experience of a Pharmacist-Led Osteoporosis Clinic: A Service Evaluation.","authors":"Yunzheng Jiao, Natalie Mitchell, Jennifer Marwick, Feryal Malik","doi":"10.1002/msc.1936","DOIUrl":"https://doi.org/10.1002/msc.1936","url":null,"abstract":"","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 3","pages":"e1936"},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study on the Effectiveness of Musculoskeletal Corticosteroid Injections for Reducing Patient Symptom Scores in Primary Care Practice.","authors":"Abigail Harmer, John Ribchester, Inderpal Malhi, Brad Robinson, Nosa Eguakun","doi":"10.1002/msc.1933","DOIUrl":"https://doi.org/10.1002/msc.1933","url":null,"abstract":"<p><strong>Objectives: </strong>To present data on the effectiveness of corticosteroid injections (CSI) in reducing symptom scores for musculoskeletal conditions in patients treated in an NHS primary care CSI service. The data will also examine whether adding local anaesthetic to the corticosteroid preparation affects the overall patient outcomes in symptom scores.</p><p><strong>Methods: </strong>A Patient-reported outcomes (PRO) questionnaire was used to collect data. Patients were asked to complete the questionnaire post-CSI. Patients were asked to rate their symptoms on a score of 0-6 before and after their injection. Data were calculated using standard deviation and paired t-test to assess the effectiveness of CSI in reducing symptom scores.</p><p><strong>Results: </strong>Overall, 172 patients (79.6%) reported an improvement in symptomatology post CSI. Improvements were seen across all injection sites. Of those taking medication for their symptoms, 73 patients (55.7%) reported that they were able to reduce their medication. Data did not suggest that adding local anaesthetic to the injectate resulted in better patient outcomes. Post-injection symptom scores were statistically similar across all clinicians.</p><p><strong>Conclusion: </strong>83.7% of patients experienced a reduction in symptom scores post injection. Adding lidocaine to the injectate preparation did not result in any statistically significant improvement in patient outcome. Over half of the participants were able to reduce their medication post injection, which demonstrates this is a highly effective primary care service for treatment/management of some MSK conditions.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 3","pages":"e1933"},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Corticosteroid Injections in the Treatment of Sacroiliitis: A Narrative Review.","authors":"Peter D Vu, Aila Malik, Alexa Ryder, Ovie Enaohwo, Greg Blazek, Jason W Chen","doi":"10.1002/msc.1932","DOIUrl":"https://doi.org/10.1002/msc.1932","url":null,"abstract":"<p><strong>Objectives: </strong>Axial spondyloarthritis (axSpA) is a chronic rheumatic, musculoskeletal, inflammatory disease with a propensity to present as sacroiliitis, which manifests as low back, buttock, or thigh pain. Effective primary management of axSpA requires a comprehensive approach specific to each patient and disease severity. Non-pharmacological measures form the cornerstone of treatment. With refractory disease, management also consists of local periarticular and intraarticular injections. The use of sacroiliac joint (SIJ) corticosteroid injections for the treatment of axSpA and localised inflammation, however, is a continuously burgeoning management option. This narrative review aims to present consolidated findings and summarise previously unreferenced or recently available evidence regarding corticosteroid injections to the SIJ for treating sacroiliitis and axSpA.</p><p><strong>Methods: </strong>A comprehensive literary review with the following electronic databases was searched: MEDLINE via PubMed, Web of Science, Cochrane Library, and EMBASE.</p><p><strong>Results: </strong>The initial search yielded a total of 126 references. After duplicates were removed and the remainder analysed for inclusion criteria, 7 studies were included. To stratify each study, injection methodology and characteristics were defined.</p><p><strong>Discussion: </strong>The use of SIJ corticosteroid injections can be an appropriate and effective treatment option for refractory axSpA. The studies presented in this review reported a general trend towards a reduction in pain severity after SIJ corticosteroid injections. Because of the complexity and heterogeneity of the anatomy of the SIJ, image guidance is recommended when performing SIJ injections. Image-guided injections seem to produce better outcomes when compared to anatomic landmark-guided injections.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 3","pages":"e1932"},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Google Internet searches related to inflammatory arthritis: An observational study using Google Trends data.","authors":"Mumina Akthar, Kayleigh J Mason, Ian C Scott","doi":"10.1002/msc.1916","DOIUrl":"10.1002/msc.1916","url":null,"abstract":"<p><strong>Objective: </strong>The Internet has transformed how patients access health information. We examined Google search engine data to understand which aspects of health are most often searched for in combination with inflammatory arthritis (IA).</p><p><strong>Methods: </strong>Using Google Trends data (2011-2022) we determined the relative popularity of searches for 'patient symptoms' (pain, fatigue, stiffness, mood, work) and 'treat-to-target' (disease-modifying drugs, steroids, swelling, inflammation) health domains made with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (AxSpA) in the UK/USA. Google Trends normalises searches by popularity over time and region, generating 0-100 scale relative search volumes (RSV; 100 represents the time-point with most searches). Up to five search term combinations can be compared.</p><p><strong>Results: </strong>In all IA forms, pain was the most popular patient symptom domain. UK/USA searches for pain gave mean RSVs of 58/79, 34/51, and 39/63 with RA, PsA, and AxSpA; mean UK/USA RSVs for other patient symptom domains ranged 2-7/2-8. Methotrexate was the most popular treat-to-target search term with RA/PsA in the UK (mean 28/21) and USA (mean 63/33). For AxSpA, inflammation was most popular (mean UK/USA 9/34). Searches for pain were substantially more popular than searches for methotrexate in RA and PsA, and inflammation in AxSpA. Searches increased over time.</p><p><strong>Conclusions: </strong>Pain is the most popular search term used with IA in Google searches in the UK/USA, supporting surveys/qualitative studies highlighting the importance of improving pain to patients with IA. Routine pain assessments should be embedded within treat-to-target strategies to ensure patient perspectives are considered.</p>","PeriodicalId":46945,"journal":{"name":"Musculoskeletal Care","volume":"22 3","pages":"e1916"},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}