Maintaining long-term outcomes after rehabilitation in stroke patients: literature review
- Authors: Islamgulov A.K.1, Zinnatullin R.R.1, Kabataeva A.A.2, Khalikova R.F.1, Krasheninnikov V.A.1, Faritov A.N.1, Sibikina A.I.3, Shekhtmester A.M.3, Ramazanov S.R.4, Narly A.5, Tagirova P.M.4, Akhmadieva R.R.1, Orlova D.S.6, Shakhnazarova I.V.6
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Affiliations:
- Bashkir State Medical University
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Ryazan State Medical University named after academician I.P. Pavlov
- Dagestan State Medical University
- N.I. Pirogov Russian National Research Medical University (Pirogov University)
- Rostov State Medical University
- Issue: Vol 28, No 1 (2025)
- Pages: 25-38
- Section: Review
- URL: https://journals.rcsi.science/1560-9537/article/view/316984
- DOI: https://doi.org/10.17816/MSER678665
- ID: 316984
Cite item
Abstract
The relevance of the stroke problem is determined by a significant increase in global morbidity and mortality, especially in developing regions of the world. Despite significant medical advances in recent decades, the burden of stroke continues to increase, posing a serious threat to the health of the planet’s population. Stroke is one of the leading causes of death and disability, having a significant impact on the quality of life of patients and the economy of countries. Over the past decades, a twofold increase in the number of cases of the disease has been noted, with the greatest number of fatalities and sufferers occurring in low- and middle-income countries. Separately, an alarming trend of increasing stroke rates among young population groups is emphasized, which indicates the need to expand preventive measures and improve the quality of specialized care. Russia also faces a high burden due to stroke: the annual number of new cases is increasing, and the mortality rate remains one of the highest among all diseases. The study confirms a significant difference in the incidence of strokes between men and women, reveals a high risk of early strokes in men and emphasizes the importance of taking into account the specifics of various population subgroups when developing a prevention and treatment strategy. International data confirm the trend of increasing strokes even in developed countries such as the United States and China, where there has been a significant increase in the number of fatalities and new cases. This circumstance requires the development of innovative approaches to the diagnosis, treatment and prevention of strokes, as well as intensified efforts to reduce lifestyle and environmental risks. Thus, the problem of combating stroke is of particular importance, since it affects almost all aspects of public health and has a significant impact on the development of national health systems.
Full Text
##article.viewOnOriginalSite##About the authors
Almaz Kh. Islamgulov
Bashkir State Medical University
Author for correspondence.
Email: aslmaz2000@rambler.ru
ORCID iD: 0000-0003-0567-7515
SPIN-code: 8701-3486
assistant
Russian Federation, 47 Zaki Validi st, Ufa, 450008Robert R. Zinnatullin
Bashkir State Medical University
Email: robert_zinnatullin@bk.ru
ORCID iD: 0009-0005-3381-5446
student
Russian Federation, UfaAiana A. Kabataeva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: akabataeva01@gmail.com
ORCID iD: 0009-0002-9016-6444
student
Russian Federation, MoscowRegina F. Khalikova
Bashkir State Medical University
Email: 89610492121@yandex.ru
ORCID iD: 0009-0001-0027-3506
student
Russian Federation, UfaVladislav A. Krasheninnikov
Bashkir State Medical University
Email: krashenvlad@yandex.ru
ORCID iD: 0009-0008-3478-7821
student
Russian Federation, UfaAskar N. Faritov
Bashkir State Medical University
Email: Faritov.askar@yandex.ru
ORCID iD: 0009-0002-1757-6471
student
Russian Federation, UfaAnastasia I. Sibikina
Ryazan State Medical University named after academician I.P. Pavlov
Email: aska906423@gmail.com
ORCID iD: 0009-0008-7738-0642
student
Russian Federation, RyazanAngelina M. Shekhtmester
Ryazan State Medical University named after academician I.P. Pavlov
Email: Angelina-mark33@mail.ru
ORCID iD: 0009-0004-9756-9291
student
Russian Federation, RyazanShirvani R. Ramazanov
Dagestan State Medical University
Email: sirvaniramazanov@gmail.com
ORCID iD: 0009-0008-1280-3341
student
Russian Federation, MakhachkalaAnastasia Narly
N.I. Pirogov Russian National Research Medical University (Pirogov University)
Email: nastya.narly@mail.ru
ORCID iD: 0009-0009-8295-787X
student
Russian Federation, MoscowPatimat M. Tagirova
Dagestan State Medical University
Email: misspatya.02@mail.ru
ORCID iD: 0009-0005-1839-7952
student
Russian Federation, MakhachkalaRegina R. Akhmadieva
Bashkir State Medical University
Email: regina.ahmadieva.01@mail.ru
ORCID iD: 0009-0001-9545-4800
student
Russian Federation, UfaDiana S. Orlova
Rostov State Medical University
Email: diana_orlova18@mail.ru
ORCID iD: 0009-0007-2564-694X
student
Russian Federation, Rostov-on-DonIrina V. Shakhnazarova
Rostov State Medical University
Email: shakhnazarova.02@mail.ru
ORCID iD: 0009-0000-2511-0271
student
Russian Federation, Rostov-on-DonReferences
- GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820. doi: 10.1016/S1474-4422(21)00252-0
- GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222. doi: 10.1016/S0140-6736(20)30925-9
- Scott CA, Li L, Rothwell PM. Diverging Temporal Trends in Stroke Incidence in Younger vs Older People: A Systematic Review and Meta-analysis. JAMA Neurol. 2022;79(10):1036–1048. doi: 10.1001/jamaneurol.2022.1520
- Ignatyeva VI, Voznyuk IA, Shamalov NA, et al. Social and economic burden of stroke in Russian Federation. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(8–2):5–15. doi: 10.17116/jnevro20231230825 EDN: QEIVCM
- Stakhovskaya LV, Klochikhina OA, Bogatyreva MD, Chugunova SA. Analysis of epidemiological indicators of recurrent strokes in the regions of the Russian Federation (based on the results of the territorial-population register 2009–2014). Consilium medicum. 2016;18(9):8–11. EDN: XYBMLD
- Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2024;149(8):e347–e913. doi: 10.1161/CIR.0000000000001209
- Tu WJ, Zhao Z, Yin P, et al. Estimated Burden of Stroke in China in 2020. JAMA Netw Open. 2023;6(3):e231455. doi: 10.1001/jamanetworkopen.2023.1455
- Wafa HA, Wolfe CDA, Emmett E, et al. Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years. Stroke. 2020;51(8):2418–2427. doi: 10.1161/STROKEAHA.120.029606
- Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75(4):394–398. doi: 10.1016/0003-9993(94)90161-9
- Tanaka T, Hamaguchi T, Suzuki M, et al. Estimation of Motor Impairment and Usage of Upper Extremities during Daily Living Activities in Poststroke Hemiparesis Patients by Observation of Time Required to Accomplish Hand Dexterity Tasks. Biomed Res Int. 2019;2019:9471921. doi: 10.1155/2019/9471921
- Lundström E, Smits A, Terént A, Borg J. Risk factors for stroke-related pain 1 year after first-ever stroke. Eur J Neurol. 2009;16(2):188–193. doi: 10.1111/j.1468-1331.2008.02378.x
- Ringman JM, Saver JL, Woolson RF, Clarke WR, Adams HP. Frequency, risk factors, anatomy, and course of unilateral neglect in an acute stroke cohort. Neurology. 2004;63(3):468–474. doi: 10.1212/01.wnl.0000133011.10689.ce
- Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: A 2020 updated review. Gen Hosp Psychiatry. 2020;66:70–80. doi: 10.1016/j.genhosppsych.2020.06.011
- Islamgulov AK, Pervakov MV, Fominova OO, et al. The role of rehabilitation aimed at improving bone function in cancer patients with bone tissue damage. Medical and Social Expert Evaluation and Rehabilitation. 2024;27(3):163–176. doi: 10.17816/MSER646532
- Teasell R, Rice D, Richardson M, et al. The next revolution in stroke care. Expert Rev Neurother. 2014;14(11):1307–1314. doi: 10.1586/14737175.2014.968130
- Salbach NM, Mountain A, Lindsay MP, et al. Canadian Stroke Best Practice Recommendations: Virtual Stroke Rehabilitation Interim Consensus Statement 2022. Am J Phys Med Rehabil. 2022;101(11):1076–1082. doi: 10.1097/PHM.0000000000002062
- Liao ZY, Haycock-Stuart E, Kean S. Biographical continuation: recovery of stroke survivors and their family caregivers in Taiwan. Prim Health Care Res Dev. 2024;25:e2. doi: 10.1017/S1463423623000610
- Jee S, Jeong M, Paik NJ, et al. Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2022;13:755316. doi: 10.3389/fneur.2022.755316
- English C, Hill K, Cadilhac DA, et al. Living clinical guidelines for stroke: updates, challenges and opportunities. Med J Aust. 2022;216(10):510–514. doi: 10.5694/mja2.51520
- Kenah K, Tavener M, Bernhardt J, Spratt NJ, Janssen H. “Wasting time”: a qualitative study of stroke survivors’ experiences of boredom in non-therapy time during inpatient rehabilitation. Disabil Rehabil. 2024;46(13):2799–2807. doi: 10.1080/09638288.2023.2230131
- Kutlubaev MA, Akhmetova AI, Ozerova AI. Emotional disorders after stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(12–2):30–35. doi: 10.17116/jnevro202312312230 EDN: ABNJKQ
- Kong Q, Wang J, Huang X, He J, Chang J. Comparative Efficacy of Cognitive Training for Post-Stroke Aphasia: A Systematic Review and Network Meta-Analysis. Neurorehabil Neural Repair. 2024;38(11–12):863–876. doi: 10.1177/15459683241274755
- Helbach J, Hoffmann F, Hecht N, et al. Information needs of people who have suffered a stroke or TIA and their preferred approaches of receiving health information: A scoping review. Eur Stroke J. 2024;10(1):23969873241272744. doi: 10.1177/23969873241272744
- Thompson S, Barber A, Fink J, et al. New Zealand hospital stroke service provision. N Z Med J. 2020;133(1526):18–30.
- Harwood MLN, Ranta A, Thompson SG, et al. Barriers to optimal stroke service care and solutions: a qualitative study engaging people with stroke and their whānau. N Z Med J. 2022;135(1556):81–93.
- Carey L, Walsh A, Adikari A, et al. Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation. Neural Plast. 2019;2019:5232374. doi: 10.1155/2019/5232374
- Durand A, D’Amours L, Giroux A, et al. Benchmarking length of stay for inpatient stroke rehabilitation without adversely affecting functional outcomes. J Rehabil Med. 2020;52(10):jrm00113. doi: 10.2340/16501977-2746
- Kayes NM, Papadimitriou C. Reflecting on challenges and opportunities for the practice of person-centred rehabilitation. Clin Rehabil. 2023;37(8):1026–1040. doi: 10.1177/02692155231152970
- Bright FAS, Ibell-Roberts C, Featherstone K, et al. “Physical well-being is our top priority”: Healthcare professionals’ challenges in supporting psychosocial well-being in stroke services. Health Expect. 2024;27(2):e14016. doi: 10.1111/hex.14016
- McNaughton H, Gommans J, McPherson K, Harwood M, Fu V. A cohesive, person-centric evidence-based model for successful rehabilitation after stroke and other disabling conditions. Clin Rehabil. 2023;37(7):975–985. doi: 10.1177/02692155221145433
- Egan MY, Laliberté-Rudman D, Rutkowski N, et al. The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization. Disabil Rehabil. 2020;42(23):3403–3415. doi: 10.1080/09638288.2019.1592244
- Mills JA, Cieza A, Short SD, Middleton JW. Development and Validation of the WHO Rehabilitation Competency Framework: A Mixed Methods Study. Arch Phys Med Rehabil. 2021;102(6):1113–1123. doi: 10.1016/j.apmr.2020.10.129
- Lundquist CB, Nielsen JF, Arguissain FG, Brunner IC. Accuracy of the Upper Limb Prediction Algorithm PREP2 Applied 2 Weeks Poststroke: A Prospective Longitudinal Study. Neurorehabil Neural Repair. 2021;35(1):68–78. doi: 10.1177/1545968320971763
- Esenbaeva GT, Zhautikova SB, Mindubaeva FA, Kadyrova IA. A method for predicting probability of stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2014;114(3–2):51–54. EDN: SDIJOH
- Stinear CM, Smith MC, Byblow WD. Prediction Tools for Stroke Rehabilitation. Stroke. 2019;50(11):3314–3322. doi: 10.1161/STROKEAHA.119.025696
- Hinckley J, Jayes M. Person-centered care for people with aphasia: tools for shared decision-making. Front Rehabil Sci. 2023;4:1236534. doi: 10.3389/fresc.2023.1236534
- Bright FA, Kayes NM, Cummins C, Worrall LM, McPherson KM. Co-constructing engagement in stroke rehabilitation: a qualitative study exploring how practitioner engagement can influence patient engagement. Clin Rehabil. 2017;31(10):1396–1405. doi: 10.1177/0269215517694678
- Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil. 2019;41(25):3025-3033. doi: 10.1080/09638288.2018.1483434
- Lens C, Demeestere J, Casolla B, et al. From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion. Eur J Neurol. 2024;31(12):e16417. doi: 10.1111/ene.16417
- Chun HYY, Ford A, Kutlubaev MA, et al. Depression, anxiety, and suicide After stroke: A narrative review of the best available evidence. Stroke. 2022;53(4):1402–10. doi: 10.1161/STROKEAHA.121.035499
- de Graaf JA, Schepers VPM, Nijsse B, et al. The influence of psychological factors and mood on the course of participation up to four years after stroke. Disabil Rehabil. 2022;44(10):1855–1862. doi: 10.1080/09638288.2020.1808089
- Guo Z, Zeng S, Ling K, et al. Experiences and needs of older patients with stroke in China involved in rehabilitation decision-making: a qualitative study. BMC Med Inform Decis Mak. 2024;24(1):330. doi: 10.1186/s12911-024-02735-5
- Kotov SV, Isakova EV, Sheregeshev VI. Possibility of treatment of emotional and behavioral disorders in patients with stroke during rehabilitation. S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(4):26–31. doi: 10.17116/jnevro201911904126 EDN: XFEZEB
- Heran M, Lindsay P, Gubitz G, et al. Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7th Edition Practice Guidelines Update, 2022. Can J Neurol Sci. 2024;51(1):1–31. doi: 10.1017/cjn.2022.344
- Lu H, Tan X, Wang X, et al. Basic psychological needs satisfaction of stroke patients: a qualitative study. BMC Psychol. 2023;11(1):64. doi: 10.1186/s40359-023-01107-4
- Evans JJ. Positive psychology and brain injury rehabilitation. Brain Impair. 2011;12:117–27.
- Kidd L, Millar JD, Mason H, et al. Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study. BMJ Open. 2022;12(1):e055491. doi: 10.1136/bmjopen-2021-055491
- Duncan Millar J, Mason H, Kidd L; IMPETUS Research Team. What is important in supporting self-management in community stroke rehabilitation? A Q methodology study. Disabil Rehabil. 2023;45(14):2307–2315. doi: 10.1080/09638288.2022.2087766
- Jones F, Pöstges H, Brimicombe L. Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke. NeuroRehabilitation. 2016;39(4):471–480. doi: 10.3233/NRE-161379
- Rhoda A, Groenewald R, Altigani R, Jones F. Self-Management and Stroke. Self-Management Chronic Illness. Cham: Springer; 2021:63–73.
- Harwood M, Weatherall M, Talemaitoga A, et al. Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life--a randomized controlled trial. Clin Rehabil. 2012;26(6):493–501. doi: 10.1177/0269215511426017
- Fu V, Weatherall M, McPherson K, et al. Taking Charge after Stroke: A randomized controlled trial of a person-centered, self-directed rehabilitation intervention. Int J Stroke. 2020;15(9):954–964. doi: 10.1177/1747493020915144
- Gangwani R, Cain A, Collins A, Cassidy JM. Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery. Front Neurol. 2022;13:823202. doi: 10.3389/fneur.2022.823202
- Fu V, Fernando KM, Bright F, et al. Coming to my own wisdom: A qualitative study exploring the role of the Take Charge intervention in stroke recovery. Clin Rehabil. 2025;39(3):377–387. doi: 10.1177/02692155241310770
- May C, Bieber K, Chow D, Mortenson WB, Schmidt J. Experiences of adults with stroke attending a peer-led peer-support group. Brain Impair. 2023;24(3):443–455. doi: 10.1017/BrImp.2023.3
- Wu D, Zhang H, Leng Y, et al. A bibliometric analysis of telerehabilitation services for patients with stroke. Front Neurol. 2023;13:1026867. doi: 10.3389/fneur.2022.1026867
- Laver KE, Adey-Wakeling Z, Crotty M, et al. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020;1(1):CD010255. doi: 10.1002/14651858.CD010255.pub3
- Nikolaev VA. Telerehabilitation of stroke patients: current trends in the russian healthcare system. Healthcare Manager. 2022;(2):65–75. doi: 10.21045/1811-0185-2022-2-65-75 EDN: KXSWNB
- Nikolaev VA, Safonicheva OG, Nikolaev AA. SWOT analysis of telerehabilitation after stroke: synchronous format. Russian Journal of Preventive Medicine. 2023;26(12):79–87. doi: 10.17116/profmed20232612179 EDN: ZBKEGY
- Aderinto N, Olatunji G, Abdulbasit MO, et al. Exploring the efficacy of virtual reality-based rehabilitation in stroke: a narrative review of current evidence. Ann Med. 2023;55(2):2285907. doi: 10.1080/07853890.2023.2285907
- Hao J, He Z, Yu X, Remis A. Comparison of immersive and non-immersive virtual reality for upper extremity functional recovery in patients with stroke: a systematic review and network meta-analysis. Neurol Sci. 2023;44(8):2679–2697. doi: 10.1007/s10072-023-06742-8
- Jarvis K, Thetford C, Turck E, Ogley K, Stockley RC. Understanding the Barriers and Facilitators of Digital Health Technology (DHT) Implementation in Neurological Rehabilitation: An Integrative Systematic Review. Health Serv Insights. 2024;17:11786329241229917. doi: 10.1177/11786329241229917
- Bally ELS, Cheng D, van Grieken A, et al. Patients’ Perspectives Regarding Digital Health Technology to Support Self-management and Improve Integrated Stroke Care: Qualitative Interview Study. J Med Internet Res. 2023;25:e42556. doi: 10.2196/42556
- Mou H, Lam SKK, Chien WT. Effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: a pilot study. BMC Nurs. 2022;21(1):364. doi: 10.1186/s12912-022-01145-0
- Choo PY, Shaik MA, Tan-Ho G, Lee J, Ho AHY. Living losses in stroke caregiving: A qualitative systematic review of systematic reviews on psycho-socio-emotional challenges and coping mechanisms. Int J Stroke. 2023;18(3):268–277. doi: 10.1177/17474930221104908
- Qureshi A, Hargest C, Swain N, Aldabe D, Hale L. Psychosocial interventions for building resilience of informal carers of people living with stroke: a systematic review. Disabil Rehabil. 2023;45(9):1419–1432. doi: 10.1080/09638288.2022.2063419
- Willen SS, Williamson AF, Walsh CC, Hyman M, Tootle W. Rethinking flourishing: Critical insights and qualitative perspectives from the U.S. Midwest. SSM Ment Health. 2022;2:100057. doi: 10.1016/j.ssmmh.2021.100057
- Skolarus LE, Sharrief A, Gardener H, Jenkins C, Boden-Albala B. Considerations in Addressing Social Determinants of Health to Reduce Racial/Ethnic Disparities in Stroke Outcomes in the United States. Stroke. 2020;51(11):3433–3439. doi: 10.1161/STROKEAHA.120.030426
- Levine DA, Duncan PW, Nguyen-Huynh MN, Ogedegbe OG. Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment. Stroke. 2020;51(11):3425–3432. doi: 10.1161/STROKEAHA.120.030427
- Evans E, Jacobs M, Ellis C. The Intersection of Social Determinants of Health and Post-stroke Aphasia Outcomes: A Need for Intersectional Analysis. Semin Speech Lang. 2024;45(1):84–98. doi: 10.1055/s-0043-1774783
- Kuznetsova NV, Ivanova EN. Cultural characteristics and ethnic identity as a factor in the effectiveness of rehabilitation in patients with cerebrovascular diseases. Bulletin of the North-Eastern Federal University. 2022;19(4):45–52.
- Brewer KM, Taki TW, Heays G, Purdy SC. Tino rangatiratanga — a rural Māori community’s response to stroke: “I’m an invalid but I’m not invalid”. J R Soc N Z. 2022;53(3):381–394. doi: 10.1080/03036758.2022.2132964
- Lin I, Coffin J, Bullen J, Barnabe C. Opportunities and challenges for physical rehabilitation with indigenous populations. Pain Rep. 2020;5(5):e838. doi: 10.1097/PR9.0000000000000838
- Cochrane F, Singleton-Bray J, Canendo W, Cornwell P, Siyambalapitiya S. “Working together… I can’t stress how important it is”: Indigenous Health Liaison Officers’ insights into working with speech-language pathologists and Aboriginal and Torres Strait Islander peoples with stroke and TBI. Int J Speech Lang Pathol. 2024;26(2):149–161. doi: 10.1080/17549507.2023.2181225
- Newport R, Grey C, Dicker B, et al. Upholding te mana o te wā: Māori patients and their families’ experiences of accessing care following an out-of-hospital cardiac event. Am Heart J Plus. 2023;36:100341. doi: 10.1016/j.ahjo.2023.100341
- . Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (The Lancet —Lowitja Institute Global Collaboration): a population study. Lancet. 2016;388(10040):131–157. doi: 10.1016/S0140-6736(16)00345-7
- Gone JP. Redressing First Nations historical trauma: theorizing mechanisms for indigenous culture as mental health treatment. Transcult Psychiatry. 2013;50(5):683–706. doi: 10.1177/1363461513487669
- Firestone M, McConkey S, Beaudoin E, Bourgeois C, Smylie J. Mental health and cultural continuity among an urban Indigenous population in Toronto, Canada. Can J Public Health. 2024;115(2):263–272. doi: 10.17269/s41997-022-00709-6
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