scholarly journals Comparison of Bioabsorbable and Metallic Interference Screws for Graft Fixation During ACL Reconstruction: A Meta-analysis of Randomized Controlled Trials

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110215
Author(s):  
Baoyun Xu ◽  
Yuling Yin ◽  
Yanling Zhu ◽  
Yu Yin ◽  
Weili Fu
Keyword(s):  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Graft Fixation ◽  
Joint Effusion ◽  
Pivot Shift Test ◽  
Controlled Trials ◽  
Interference Screws ◽  
Randomized Controlled ◽  
Bioabsorbable Screws

Background: Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior. Purpose: To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR). Study Design: Systematic review; Level of evidence, 1. Methods: The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data. Results: Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection. Conclusion: The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications.

scholarly journals Poly(ADP-Ribose) Polymerase Inhibitors (PARPi) for Patients With Advanced Breast Cancer: a Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
YongCheng Su ◽  
XiaoGang Zheng
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Parp Inhibitors ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Grade 3

Abstract BACKGROUND: Poly(ADP–ribose) polymerase (PARP) inhibitors are new class of drugs that are currently being studied in several malignancies. However, datas about the efficacy and safety of the PARP inhibitors are limited. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) in patients with breast cancer.METHODS: Pubmed/Medline, Embase, Cochrane Library, and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018.Summary incidences and the RR, HR with 95% confidence intervals, were calculated by using a random-effects or fixed-effects model.RESULTS: The summary HR indicated PARPi was not associated with OS (HR=0.83, 95%CI 0.66–1.06, Z=1.49, P=0.14), while it could significantly improve PFS ande time to deterioration (TTD) of global health status/quality of life(GHS/QoL) as compared with traditional standard therapy, the HR was 0.60(95%CI 0.50-0.72; Z=5.52, P＜0.00001) and 0.4 (95%CI 0.29–0.54,z=5.80 ,p=0.000),respectively.The RR of grade 3 or more anemia ,fatigue and headache was 3.02 (95% CI, 0.69–13.17;p = 0.14,,I2=90%),0.77 (95%CI, 0.34–1.73;p=0.52,I2=7%) and 1.13 (95% CI,0.30–4.18;p=0.86,I2=0%),respectively.CONCLUSION: The findings of this meta-analysis showed that PARPi has no significant effect on OS, while it could significantly improve in PFS and TTD of GHS/QoL for patients with advanced or metastatic breast cancer.Furthermore,our findings also demonstrated that the PARPi treatment is connected with an increased risk of grade 3 or more anemia adverse events.

Efficacy and safety of bempedoic acid in patients with hypercholesterolemia: A systematic review and meta-analysis of randomized controlled trials

2020 ◽  
pp. 204748732093058 ◽  
Author(s):  
Lei Dai ◽  
Yuyue Zuo ◽  
Qiqi You ◽  
Hesong Zeng ◽  
Shiyi Cao
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Oral Drug ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

Aim Bempedoic acid is a novel oral drug, which has been increasingly researched to play an important role in the treatment of hypercholesterolemia recently. However, results from original studies were inconsistent and inconclusive. We aimed to conduct a meta-analysis to quantitatively appraise the efficacy and safety of bempedoic acid. Methods PubMed, Embase, Web of Science and Scopus were searched from inception to 30 January 2020. We included randomized controlled trials that compared the efficacy and safety of bempedoic acid with placebo in patients with hypercholesterolemia. Results from trials were presented as mean differences or odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled by random or fixed effects model. The risk of bias and heterogeneity among trials were also assessed and analyzed. Results Pooled analysis of 10 eligible trials showed that bempedoic acid treatment resulted in greater lowering of the low-density lipoprotein cholesterol level than the placebo group (mean difference –23.16%, 95% CI –26.92% to –19.04%). We also found that improvements in lipid parameters and biomarkers were still maintained at weeks 24 and 52 from the long-term trials. As for safety, bempedoic acid did not increase the risk of overall adverse events (OR 1.02, 95% CI 0.88 to 1.18). However, the incidence of adverse events leading to discontinuation was higher in the bempedoic acid group (OR 1.44, 95% CI 1.14 to 1.82). Conclusions Available evidence from randomized controlled trials suggests that bempedoic acid provides a well-tolerated and effective therapeutic option for lipid lowering in patients with hyperlipidemia

scholarly journals Treatment effects of Ginkgo biloba extract EGb 761® on the spectrum of behavioral and psychological symptoms of dementia: meta-analysis of randomized controlled trials

2017 ◽  
Vol 30 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Egemen Savaskan ◽  
Heiko Mueller ◽  
Robert Hoerr ◽  
Armin von Gunten ◽  
Serge Gauthier
Keyword(s):  
Randomized Controlled Trials ◽  
Ginkgo Biloba ◽  
Fixed Effects ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Caregiver Distress ◽  
Egb 761 ◽  
Randomized Controlled ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:In randomized controlled trials, Ginkgo biloba extract EGb 761® has been found to be effective in the treatment of behavioral and psychological symptoms of dementia (BPSD).Methods:To assess the effects of EGb 761® on specific BPSD, we analyzed data from all randomized, placebo-controlled, at least 20-week, trials of EGb 761® enrolling patients with dementia (probable Alzheimer's disease (AD), probable vascular dementia or probable AD with cerebrovascular disease) who had clinically significant BPSD (Neuropsychiatric Inventory (NPI) total score at least 6). Data were pooled and joint analyses of NPI single item composite and caregiver distress scores were performed by meta-analysis with a fixed effects model.Results:Four trials involving 1628 patients (EGb 761®, 814; placebo, 814) were identified; treatment duration was 22 or 24 weeks; the daily dose of EGb 761® was 240 mg in all trials. Pooled analyses including data from the full analysis sets of all trials (EGb 761®, 796 patients; placebo, 802 patients) revealed significant superiority of EGb 761® over placebo in total scores and 10 single symptom scores. Regarding caregiver distress scores, EGb 761®-treated patients improved significantly more than those receiving placebo in all symptoms except delusions, hallucinations, and elation/euphoria. The benefit of EGb 761® mainly consists of improvement in symptoms present at baseline, but the incidence of some symptoms was also decreased.Conclusions:Twenty two- to twenty four-week treatment with Ginkgo biloba extract EGb 761® improved BPSD (except psychotic-like features) and caregiver distress caused by such symptoms.

scholarly journals Incidence of Adverse Psychiatric Events During Treatment of Inflammatory Bowel Disease With Biologic Therapies: A Systematic Review

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Avni Jain ◽  
Ruth Ann Marrie ◽  
Leigh Anne Shafer ◽  
Lesley A Graff ◽  
Scott B Patten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Biologic Therapy ◽  
Meta Analysis ◽  
Risk Difference ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inflammatory Bowel ◽  
Biologic Medication

Abstract We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident adverse psychiatric events (APE) including depression, anxiety, psychosis, or suicide were associated with biologic therapy in IBD. Six randomized controlled trials and a cohort study met criteria, reporting an incidence of APE in 4,882 patients. The risk difference per 100 person-months of any APE with a biologic medication was 0.01 (95% confidence interval = 0.00–0.02). There was insufficient evidence available in randomized controlled trials to conclude that biologic therapy in IBD is associated with an increased incidence of APE.

scholarly journals THE EFFICACY COMPARISON OF MIRABEGRON AS A MONOTHERAPY VERSUS ITS COMBINATION WITH SOLIFENACIN IN OVERACTIVE BLADDER: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 28 (2) ◽  
pp. 202-210
Author(s):  
Hasan Madani ◽  
Soetojo ◽  
Wahjoe Djatisoesanto
Keyword(s):  
Overactive Bladder ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Forest Plot ◽  
Controlled Trials ◽  
Monotherapy Group ◽  
Randomized Controlled ◽  
Micturition Frequency ◽  
Micturition Volume

Objective: This review aimed to evaluate the efficacy and safety of mirabegron as monotherapy and its combination with solifenacin for patients with overactive bladder (OAB). Material & Methods: A systematic search was conducted in PubMed, Google Scholar, and Science Direct using the keywords Overactive bladder or OAB and mirabegron or beta-3 agonist or β3 adrenoreceptor agonist and solifenacin or antimuscarinic based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline to include relevant randomized controlled trials (RCT)s. The included studies were assessed for their risks of bias using the Cochrane risk of bias tool for randomized controlled trials. Quantitative analysis using forest plot was performed in Review Manager 5.4. Results: A total of 4 RCTs were included from 227 studies. A fixed-effects model was chosen due to the low level of heterogeneity between the studies (I2 = 0%). The average micturition volume of patients in the combination group is higher compared to the monotherapy group (MD 17.13, 95% CI 12.78 - 21.48, p < 0.00001). The mean micturition frequency (MD - 0.54, 95% CI - 0.73 - -0.34, p < 0.00001) and incontinence incidence (MD -0.30, 95% CI -0.48 - -0.12, p = 0.001) in the combined group are significantly lower compared to the monotherapy group. Conclusion: The combination of mirabegron and solifenacin has better efficacy compared to mirabegron as monotherapy for OAB patients with a therapy duration of less than 12 weeks based on the micturition volume, micturition frequency, and incontinence incidence. The administration of combination therapy would not increase adverse event incidence compared to monotherapy.

scholarly journals Platelet inhibition and clinical outcomes of low dose ticagrelor in patients with coronary artery disease: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Cheng Xie ◽  
Xiaoliang Ding ◽  
Qiong Qin ◽  
Jia Lin ◽  
Yuzhen Zhang
Keyword(s):  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Fixed Effects ◽  
Low Dose ◽  
Platelet Reactivity ◽  
Standard Dose ◽  
Meta Analysis ◽  
Platelet Inhibition ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Although current guidelines recommend ticagrelor 90 mg twice daily in ACS patients for 12 months and 60 mg twice daily in stable patients 1 to 3 years after MI with additional high-risk features, the bleeding complication was actually higher than clopidogrel. This meta-analysis was performed to assess the platelet inhibition and clinical outcomes of low dose ticagrelor in patients with CAD. Methods Medline, EMBASE and Cochrane Databases were systematically searched from inception to March, 2021 for randomized controlled trials (RCTs) comparing low dose ticagrelor with standard dose clopidogrel or standard dose ticagrelor in patients with CAD. Pooled estimates were calculated using fixed-effects or random-effects model as appropriate. Results 15 RCTs that included 15357 patients were identified. Low dose ticagrelor had no statistical differences of the risks of MACE and major bleeding compared with standard dose ticagrelor and standard dose clopidogrel (RR 0.98, 95%CI 0.87 − 1.11, P = 0.80; RR 1.35, 95%CI 0.46 − 4.00, P = 0.59; RR 0.86, 95%CI 0.68 − 1.10, P = 0.23; RR 1.46, 95%CI 0.45 − 4.76, P = 0.53, respectively). Compared with standard dose clopidogrel, low dose ticagrelor showed significantly lower platelet reaction units (PRU) (MD -118.48, 95%CI -144.33−-92.63, P ༜0.00001), rates of high on-treatment platelet reactivity (HTPR) (RR 0.10, 95%CI 0.04 − 0.21, P ༜ 0.00001) and minor or minimal bleeding (RR 0.73, 95%CI 0.55 − 0.96, P = 0.03), but increased the incidence of dyspnea (RR 6.48, 95%CI 1.78 − 23.54, P = 0.005). Compared with standard dose ticagrelor, low dose ticagrelor showed significantly higher PRU (MD 15.45, 95%CI 5.45 − 25.44, P = 0.002) and risk of dyspnea (RR 0.81, 95%CI 0.75 − 0.88, P ༜ 0.00001), but similar rates of HTPR (RR 1.63, 95%CI 0.40 − 6.70, P = 0.50) and minor or minimal bleeding (RR 1.36, 95%CI 0.78 − 2.38, P = 0.28). Conclusion Low dose ticagrelor may provide an additional choice for secondary prevention in CAD patients. However, the specific dose of ticagrelor should be selected according to the patients’ clinical characteristics.

scholarly journals Efficacy and safety of interleukin-17A inhibitors in patients with ankylosing spondylitis: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Peng Wang ◽  
Shuo Zhang ◽  
Binwu Hu ◽  
Weijian Liu ◽  
Xiao Lv ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Response Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Interleukin 17A ◽  
Mean Differences

AbstractTo assess the efficacy and safety of interleukin (IL)-17A inhibitors in patients with ankylosing spondylitis (AS). PubMed, EMBASE, and Web of Science were searched up to 5 February 2020 for randomized controlled trials (RCTs) that assessed the efficacy and safety of IL-17A inhibitors in patients with AS. We used a meta-analytic approach to perform a random effects analysis or fixed effects analysis according to heterogeneity. Subgroup analyses between studies included medication, time to primary endpoint, and data source. Odds ratios (ORs) or mean differences (MDs) were used to assess the efficacy and safety of IL-17A inhibitors in AS. A total of ten RCTs with 2613 patients were eligible for inclusion in the analysis (six for secukinumab, two for ixekizumab, one for netakimab, and one for bimekizumab). Compared to placebo, IL-17A inhibitors improved ASAS20 response rate (OR = 2.58; p < 0.01) and ASAS40 response rate (OR = 2.80; p < 0.01), and significantly increased the risk of AEs (OR = 1.23; p = 0.03) and nasopharyngitis (OR = 1.72; p < 0.01), but not SAEs (OR = 0.87; p = 0.60). IL-17A inhibitors demonstrated better efficacy in patients with AS in several evaluation indicators. However, the safety of IL-17A inhibitors remains to be further studied in studies with larger sample size and longer follow-up times.

scholarly journals Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials (Preprint)

2020 ◽  
Author(s):  
Su-Hang Xie ◽  
Qian Wang ◽  
Li-Qiong Wang ◽  
Lin Wang ◽  
Kang-Ping Song ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Physical Function ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Rehabilitation Programs ◽  
Significant Difference

BACKGROUND Osteoarthritis (OA) is a chronic, debilitating, and degenerative joint disease. However, it is difficult for patients with knee OA to access conventional rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies to provide a means combining monitoring, guidance, and treatment for patients with knee OA. OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based rehabilitation programs on pain and physical function in patients with knee OA. METHODS Keywords related to knee OA and internet-based rehabilitation were systematically searched in the Web of Science, MEDLINE, EMBASE, CENTRAL, Scopus, PEDro (Physiotherapy Evidence Database), CNKI, SinoMed, and WANFANG databases from January 2000 to April 2020. Only randomized controlled trials were included. The authors independently screened the literature. The main outcome measures were focused on pain and physical function. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. RESULTS The systematic review identified 6 randomized controlled trials, 4 of which were included in the meta-analysis, comprising a total of 791 patients with knee OA. The meta-analysis with the fixed-effects model showed that the internet-based rehabilitation programs could significantly alleviate the osteoarthritic pain for patients compared with conventional rehabilitation (standardized mean difference [SMD] –0.21, 95% CI  −0.4 to –0.01, <i>P</i>=.04). No significant difference was found in the improvement of physical function in patients with knee OA compared with conventional rehabilitation within 2 to 12 months (SMD –0.08, 95% CI −0.27 to 0.12, <i>P</i>=.43). CONCLUSIONS This systematic review shows that internet-based rehabilitation programs could improve the pain but not physical function for patients with knee OA. However, there was a very small number of studies that could be included in the review and meta-analysis. Thus, further studies with large sample sizes are warranted to promote the effectiveness of internet-based rehabilitation and to develop its personalized design.

scholarly journals Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Guangjie Liu ◽  
Xingyu Yang ◽  
Tao Xue ◽  
Shujun Chen ◽  
Xin Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Compulsive Disorder ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Subacute Stroke

Background and Purpose: Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive–compulsive disorder, and some studies have shown that fluoxetine can improve motor and function recovery after stroke. Therefore, we performed a meta-analysis to investigate the efficacy and safety of fluoxetine in the treatment of post-stroke neurological recovery.Methods: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) that were performed to assess the efficacy and safety of fluoxetine for functional and motor recovery in subacute stroke patients up to October 2020. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) and standardized mean difference (SMD) were analyzed and calculated with a fixed effects model.Results: We pooled 6,788 patients from nine RCTs. The primary endpoint was modified Rankin Scale (mRS). Fluoxetine did not change the proportion of mRS ≤ 2 (P = 0.47). The secondary endpoints were Fugl-Meyer Motor Scale (FMMS), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS). Fluoxetine improved the FMMS (P &lt; 0.00001) and BI(P &lt; 0.0001) and showed a tendency of improving NIHSS (P = 0.08). In addition, we found that fluoxetine reduced the rate of new-onset depression (P &lt; 0.0001) and new antidepressants (P &lt; 0.0001).Conclusion: In post-stroke treatment, fluoxetine did not improve participants' mRS and NIHSS but improved FMMS and BI. This difference could result from heterogeneities between the trials: different treatment duration, clinical scales sensitivity, patient age, delay of inclusion, and severity of the deficit.

scholarly journals Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials

10.2196/21542 ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. e21542
Author(s):  
Su-Hang Xie ◽  
Qian Wang ◽  
Li-Qiong Wang ◽  
Lin Wang ◽  
Kang-Ping Song ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Physical Function ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Rehabilitation Programs ◽  
Significant Difference

Background Osteoarthritis (OA) is a chronic, debilitating, and degenerative joint disease. However, it is difficult for patients with knee OA to access conventional rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies to provide a means combining monitoring, guidance, and treatment for patients with knee OA. Objective The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based rehabilitation programs on pain and physical function in patients with knee OA. Methods Keywords related to knee OA and internet-based rehabilitation were systematically searched in the Web of Science, MEDLINE, EMBASE, CENTRAL, Scopus, PEDro (Physiotherapy Evidence Database), CNKI, SinoMed, and WANFANG databases from January 2000 to April 2020. Only randomized controlled trials were included. The authors independently screened the literature. The main outcome measures were focused on pain and physical function. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. Results The systematic review identified 6 randomized controlled trials, 4 of which were included in the meta-analysis, comprising a total of 791 patients with knee OA. The meta-analysis with the fixed-effects model showed that the internet-based rehabilitation programs could significantly alleviate the osteoarthritic pain for patients compared with conventional rehabilitation (standardized mean difference [SMD] –0.21, 95% CI  −0.4 to –0.01, P=.04). No significant difference was found in the improvement of physical function in patients with knee OA compared with conventional rehabilitation within 2 to 12 months (SMD –0.08, 95% CI −0.27 to 0.12, P=.43). Conclusions This systematic review shows that internet-based rehabilitation programs could improve the pain but not physical function for patients with knee OA. However, there was a very small number of studies that could be included in the review and meta-analysis. Thus, further studies with large sample sizes are warranted to promote the effectiveness of internet-based rehabilitation and to develop its personalized design.

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