Journal of Manual & Manipulative Therapy最新文献

{"title":"Manual physical therapy for neck disorders: an umbrella review.","authors":"Breanna Reynolds, Amy McDevitt, Joseph Kelly, Paul Mintken, Derek Clewley","doi":"10.1080/10669817.2024.2425788","DOIUrl":"10.1080/10669817.2024.2425788","url":null,"abstract":"<p><strong>Introduction: </strong>Neck pain is a common musculoskeletal disorder, with a prevalence rate (age-standardized) of 27.0 per 1000 in 2019. Approximately 50-85% of individuals with acute neck pain do not experience complete resolution of symptoms, experiencing chronic pain. Manual therapy is a widely employed treatment approach for nonspecific neck pain (NSNP), cervical radiculopathy (CR) and cervicogenic headaches (CGH). This umbrella review synthesized systematic reviews examining manual physical therapy for individuals with cervical disorders.</p><p><strong>Methods: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed with Prospero registration (CRD42022327434). Four databases were searched from January 2016 to May 2023 for systematic reviews with or without meta-analysis examining manual therapy for individuals with neck pain of any stage. Interventions included any manual physical therapy of the cervical or thoracic spine as well as neuromobilization of the upper quarter. Primary outcomes included pain and disability. Two reviewers screened for eligibility and completed data extraction. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool.</p><p><strong>Results: </strong>A total of 35 SRs were included: 15 NSNP, 7 cervical radiculopathy, 9 CGH and 4 samples with combined diagnoses. AMSTAR 2 ratings of the SRs support high confidence in results for 10 reviews, moderate confidence in 12 reviews and low to critically low confidence in 13 reviews. For NSNP, there was high confidence in the results showing manual therapy combined with exercise was superior to either treatment in isolation. In cervical radiculopathy, neural mobilization, distraction, soft tissue treatment and mobilization/manipulation to cervical and thoracic spine were supported with moderate confidence in results. For CGH, there was high confidence in the results supporting the use of cervical spine mobilization/manipulation, soft tissue mobilization, and manual therapy combined with exercise. Original authors of SRs reported varying quality of primary studies with lack of consistent high quality/low risk of bias designs.</p><p><strong>Conclusion: </strong>Manual therapy plus exercise, cervical or thoracic mobilization and manipulation, neuromobilization, and other types of manual therapy were supported as effective interventions in the management of pain and disability for individuals with NSNP, CGH, or CR in the short-term.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"18-35"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740836","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":"Effect duration of a self-applied talocrural joint mobilization on restricted dorsiflexion: a repeated measures design.","authors":"Camryn A Yacks, Ceili M Y Kacmarcik, Carly A Archambeau, Joaquin A Barrios","doi":"10.1080/10669817.2024.2424545","DOIUrl":"10.1080/10669817.2024.2424545","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the effect duration of a talocrural mobilization on individuals with restricted dorsiflexion during a static weight bearing lunge test (WBLT) and dynamic 3D motion capture-based peak ankle dorsiflexion during a forward step down (FSD) task. Secondarily, we aimed to correlate any immediate changes in ankle mobility with concurrent changes in proximal joint kinematics during the FSD post-mobilization.</p><p><strong>Methods: </strong>Seventy-six individuals were screened for dorsiflexion restriction, of which 26 (15 females, 22.3 ± 2.2 years old, body mass index 25.2 ± 2.9 kg/m2) qualified with a WBLT of ≤ 35° on at least one limb. A baseline WBLT measure and 3D motion capture of 5 consecutive FSD repetitions on a 6-inch box were obtained. Participants then viewed an instructional video of a talocrural joint self-mobilization using a resistance band. WBLT and FSD were collected again immediately post-mobilization and at 5-min intervals for 60 min or until the WBLT returned to baseline for 2 consecutive measures.</p><p><strong>Results: </strong>WBLT dorsiflexion showed a mean increase of 6.5 degrees (<i>p</i> < 0.001) post-mobilization. The effect faded over time and no longer differed from baseline 25 min post-mobilization (<i>p</i> = 0.964). Dynamic peak ankle dorsiflexion did not change post-mobilization at any time point (<i>p</i> ≥ 0.546). No 3D kinematic time-course changes were observed at the hip or knee. However, immediate raw alterations in dorsiflexion correlated with alterations for hip and knee flexion.</p><p><strong>Discussion/conclusion: </strong>A talocrural joint mobilization increased static dorsiflexion per the WBLT for a 20-25-min period with regression to baseline. However, increased dynamic ankle dorsiflexion was not observed during the FSD task. Improved mobility alone does not appear to change movement patterns. Clinicians should be aware of both effect duration and the potential need for task-specific training to better facilitate dynamic utilization of increased mobility.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"54-62"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605579","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":"Authors response to 'Tendential and unscientific opinion' letter-to-the-editor by Dr. Marc Wuttke MD, PhD.","authors":"Kenneth A Olson, Derek Clewley, Nikki Milne, Jean-Michel Brismee, Jan Pool, Annalie Basson, Jenifer L Dice, Anita R Gross","doi":"10.1080/10669817.2024.2425003","DOIUrl":"10.1080/10669817.2024.2425003","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"13-15"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648696","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":"Practice what we teach: why academic PT faculty should stay in the trenches.","authors":"Timothy W Flynn, Britt Smith, Paul Mintken","doi":"10.1080/10669817.2024.2426264","DOIUrl":"10.1080/10669817.2024.2426264","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"557-560"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584480","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":"Management of concussion symptoms utilizing Mechanical Diagnosis and Therapy: a case series.","authors":"David J Pleva, Jared C Hanson, Brian Greer","doi":"10.1080/10669817.2024.2368923","DOIUrl":"10.1080/10669817.2024.2368923","url":null,"abstract":"<p><strong>Objective: </strong>Concussions are a common condition in athletes leading to symptoms including headache, dizziness, and sometimes vestibular deficits. Concussion management typically involves rest and a gradual return to activity among other interventions. This case series includes three patients who were evaluated using Mechanical Diagnosis and Therapy (MDT) after sport-related injuries involving concussion-like symptoms. MDT is a system of evaluating patients using repeated movements and sustained positions to assess symptomatic and mechanical changes.</p><p><strong>Results: </strong>Patients in this case series demonstrated rapid reduction of symptoms using variations of repeated cervical movements and sustained positions, which enabled them to return to play with a lasting resolution of symptoms.</p><p><strong>Discussion/conclusion: </strong>This highlights the importance of a classification system for the appropriate treatment of these cases who did not require management using concussion protocol, as they were classified as cervical derangement.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"640-645"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471557","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":"Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials.","authors":"Robert J Trager, Anthony N Baumann, Hudson Rogers, Joshua Tidd, Kevin Orellana, Gordon Preston, Keith Baldwin","doi":"10.1080/10669817.2024.2316420","DOIUrl":"10.1080/10669817.2024.2316420","url":null,"abstract":"<p><strong>Introduction: </strong>This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS).</p><p><strong>Methods: </strong>We searched six databases, including gray literature, on 24 October 2023, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions.</p><p><strong>Results: </strong>We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: -0.88; 95%-CI: -1.84; 0.08, <i>p</i> = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: -0.67; 95% CI: -1.32; -0.03, <i>p</i> = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of 'good' (56%) or 'fair' (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes.</p><p><strong>Conclusion: </strong>SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise.</p><p><strong>Registration: </strong>PROSPERO (CRD42023394326).</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"561-572"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730685","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":"Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial.","authors":"Gerard Farrell, Cathy Chapple, Ewan Kennedy, Matthew Reily-Bell, Kesava Sampath, Angela Spontelli Gisselman, Chad Cook, Rajesh Katare, Steve Tumilty","doi":"10.1080/10669817.2024.2363018","DOIUrl":"10.1080/10669817.2024.2363018","url":null,"abstract":"<p><strong>Introduction: </strong>The peripheral stress response, consisting of the autonomic nervous system (ANS) and hypothalamic pituitary adrenal-axis (HPA-axis), functions to maintain homeostasis in response to stressors. Cervical spine manual therapy has been shown to differentially modulate the stress response in healthy populations. No study has investigated whether cervical spine mobilizations can differentially modulate the stress response in individuals with persistent post-concussion symptoms (PPCS), a population characterized by a dysfunctional stress response.</p><p><strong>Methods: </strong>A randomized, controlled, parallel design trial was performed to investigate whether upper or lower cervical spine mobilization can differentially modulate components of the stress response in individuals with PPCS. The outcomes were salivary cortisol (sCOR) concentration (primary) and the HRV metric, rMSSD, measured with a smartphone application (secondary). Nineteen males diagnosed with PPCS, aged 19-35, were included. Participants were randomly assigned into either intervention group, upper (<i>n</i> = 10) or lower (<i>n</i> = 9) cervical spine mobilization. Each outcome was collected at different time points, pre- and post-intervention. Statistical analyses were performed using the Friedman's Two-Way ANOVA, Mann-Whitney U test, and Wilcoxon Signed Rank Test.</p><p><strong>Results: </strong>There was a statistically significant within-group reduction in sCOR concentration 30 minutes following lower cervical spine mobilizations and statistically significant within-group increase in rMSSD 30 minutes following upper cervical spine mobilizations.</p><p><strong>Conclusion: </strong>The results of this trial provide preliminary evidence for cervical spine mobilizations to differentially modulate components of the stress response at specific time points. Understanding the mechanisms of the effect of cervical spine mobilizations on the stress response provides a novel rationale for selecting cervical spine mobilizations to rehabilitate individuals with PPCS.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"602-618"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433098","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":"Recognition of a patient with neck autonomic dysfunction: findings from a rare case report of harlequin syndrome in direct access physiotherapy.","authors":"Firas Mourad, Irene Scotto, James Dunning, Andrea Giudice, Giorgio Maritati, Filippo Maselli, Rik Kranenburg, Alan Taylor, Roger Kerry, Nathan Hutting","doi":"10.1080/10669817.2024.2349338","DOIUrl":"10.1080/10669817.2024.2349338","url":null,"abstract":"<p><strong>Background: </strong>Harlequin syndrome is a rare autonomic condition consisting of unilateral facial flushing and sweating induced by heat, emotion or physical activity. The affected side presents anhidrosis and midline facial pallor due to denervation of the sympathetic fibers.</p><p><strong>Case description: </strong>This case describes a patient who reported right-side redness of the face associated with hyperhidrosis during physical activity. She had two previous major motor vehicle accidents. The patient demonstrated difficulties in the visual accommodation of the left eye, but cranial nerve assessment was unremarkable; the patient was then referred to an ophthalmologist, who excluded any autonomic dysfunction as the primary cause of convergence and visual acuity.</p><p><strong>Outcomes: </strong>A left-sided sympathetic dysfunction with Harlequin sign diagnosis was made followed by a progressive compensatory adaptation of the right face. The patient was educated and reassured about the benign nature of her problem.</p><p><strong>Discussion: </strong>Knowledge of the autonomic nervous system is still limited in clinical practice. Although challenging, physiotherapists should develop the knowledge and ability needed to perform appropriate assessment of autonomic dysfunctions.</p><p><strong>Conclusion: </strong>A dispositional reasoning model should be considered in differential diagnosis.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"646-653"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960176","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":"Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study.","authors":"E Anarte-Lazo, D Falla, V Devecchi, C Bernal-Utrera, C Rodriguez-Blanco","doi":"10.1080/10669817.2024.2372911","DOIUrl":"10.1080/10669817.2024.2372911","url":null,"abstract":"<p><strong>Aim: </strong>To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache.</p><p><strong>Methods: </strong>In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed.</p><p><strong>Results: </strong>Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%.</p><p><strong>Conclusions: </strong>Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"619-629"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499276","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":"Plantar massage or ankle mobilization do not alter gait biomechanics in those with chronic ankle instability: a randomized controlled trial.","authors":"Raed Alamri, Kimmery Migel, M Spencer Cain, Kyeongtak Song, Brian Pietrosimone, J Troy Blackburn, Jason R Franz, Jaeho Jang, Feng-Chang Lin, Erik A Wikstrom","doi":"10.1080/10669817.2024.2410048","DOIUrl":"10.1080/10669817.2024.2410048","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI.</p><p><strong>Methods: </strong>A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (<i>n</i> = 20), plantar massage (<i>n</i> = 20), and control (<i>n</i> = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (<i>p</i> > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"594-601"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401612","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}