3 Falls in Parkinson’s disease
3.1 Epidemiology
3URVSHFWLYHVWXGLHVRISDWLHQWVZLWK3'KDYHUHSRUWHGIDOOUDWHVEHWZHHQ DQG+RZHYHUWKHVHVWXGLHVZHUHFRQGXFWHGRYHUDVKRUWSHULRGRIWLPH OHVV WKDQ PRQWKV DQG LQFOXGHG VHOHFWHG SDWLHQW VDPSOHV 1HYHUWKHOHVV DERXWRISDWLHQWVZLWK3'UHSRUWLQJQRIDOOVLQWKHSUHYLRXV\HDUVHHPWR H[SHULHQFHIDOOLQJGXULQJPRQWKVRIIROORZXS
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
)LJXUH VKRZV SURVSHFWLYH VWXGLHV XVLQJ PRQWKO\ IDOO GLDULHV DORQH FRPELQHG ZLWK UHJXODU WHOHSKRQH WR YHULI\ GLDULHV EDVHG RQ LQFLGHQW UHSRUWVLQQXUVLQJKRPHVDQGILQDOO\ZHHNO\SRVWFDUGZLWKWHOHSKRQHIROORZ XS $QQXDO IDOO UDWHV YDULHG EHWZHHQ $OPHLGD DQG FROOHDJXHV DQG
$OODQDQGFROOHDJXHV2QHRIWKHPDLQUHDVRQVIRUGLIIHUHQFHVLQIDOO UDWHV LV EHWZHHQFRKRUW KHWHURJHQHLW\ :KHUHDV $OPHLGD DQG FROOHDJXHV LQFOXGHG SDWLHQWV ZLWK 3' PHDQ GLVHDVH GXUDWLRQ \HDUV ZLWKRXW IDOOLQJ ODVW PRQWKV RU FRQGLWLRQV RU FRPRUELGLWLHV WKDW ZRXOG DIIHFW ORFRPRWLRQRUEDODQFH$OODQDQGFROOHDJXHVLQFOXGHGSDWLHQWVPHDQDJH \HDUV ZLWK 3' GHPHQWLD PHGLDQ GXUDWLRQ RI GHPHQWLD \HDUV
Falls in Parkinson’s disease
Figure 1. Seventeen prospective studies of falling showing percentage of patients falling according to study duration. Dot sizes correspond to number of patients with PD (range 40-205).
Falls in Parkinson’s disease
6LQFHERWKFKDUDFWHULVWLFVRIWKHSDUWLFLSDQWVDQGVWXG\GXUDWLRQKDYHDPDMRU LPSDFW RQ IDOO SUHYDOHQFH ORQJLWXGLQDO REVHUYDWLRQDO VWXGLHV RI LQFLGHQW 3' FRKRUWVPD\SUREDEO\SURYLGHPRUHLQIRUPDWLYHGDWD,QDGGLWLRQIDOOVPD\
RFFXUVSRUDGLFDOO\DVRSSRVHGWRUHJXODUO\7KHUHIRUHORQJLWXGLQDOIDOOVGDWD FDQ GHWHFW FULWLFDO SHULRGV LQ WKH HYROXWLRQ RI IDOOV DQG WKHLU UHODWLRQVKLS WR GLVHDVH SURJUHVVLRQ DQG SRVVLEOH DPHQGDEOH IDOOV ULVN IDFWRUV (YHQWXDOO\
UDQGRPL]HGFRQWUROOHGFOLQLFDOWULDOVPD\EHGHVLJQHGWRH[DPLQHSUHYHQWLYH LQWHUYHQWLRQVFRYHULQJWKHPRVWLPSRUWDQWULVNIDFWRUV
3URVSHFWLYH SRSXODWLRQEDVHG VWXGLHV RI SDWLHQWV ZLWK LQFLGHQW 3' DUH OHVV FRPPRQDQGWKHHYROXWLRQRIIDOOVLQVXFKFRKRUWVLVODUJHO\XQNQRZQ)LJXUH VKRZV WKH RFFXUUHQFH RI IDOOV LQ LQFLGHQW VWXGLHV RI 3' LQFOXGLQJ ³7KH ,QFLGHQFHRI&RJQLWLYH,PSDLUPHQWLQ&RKRUWVZLWK/RQJLWXGLQDO(YDOXDWLRQ±
3'´ ,&,&/(3' IURP 1HZFDVWOH XSRQ 7\QH*DWHVKHDG DQG
&DPEULGJHVKLUH LQ 8. %HWZHHQ -XQH DQG 'HFHPEHU D WRWDO RI SDWLHQWV ZLWK 3' DQG DJHPDWFKHG FRQWUROV ZHUH UHFUXLWHG WR SDUWLFLSDWHLQWKH,&,&/(3'VWXG\2IWKHVHSDWLHQWVLQ1HZFDVWOHXSRQ 7\QH DQG *DWHVKHDG SURYLGHG GDWD RQ IDOOV ,QIRUPDWLRQ RQ UHWURVSHFWLYH IDOOVLQWKH SUHYLRXV \HDU ZDV EDVHG RQ LQWHUYLHZVZLWK SDWLHQWVDW EDVHOLQH DQG VKRZHG WKDW KDG IDOOHQ 7KHUHDIWHU IDOOV ZHUH SURVSHFWLYHO\
UHFRUGHGPRQWKO\XVLQJIDOOGLDU\DQGDWHOHSKRQHFDOOWRYHULI\LQIRUPDWLRQ DQGUHFWLI\DQ\PLVVLQJGDWD'XULQJWKHSUHFHGLQJPRQWKVRIWKH 3' SDWLHQWV UHSRUWHG RU PRUH IDOOV 2I WKH SDUWLFLSDQWV ZLWKRXW UHWURVSHFWLYHIDOOVDWEDVHOLQHKDGDQLQFLGHQWIDOOGXULQJWKHILUVW\HDU
2I VXEMHFWV UHFUXLWHG IURP D KRVSLWDOEDVHG PRYHPHQW GLVRUGHU FOLQLF EHWZHHQDQG&KLQHVHSDWLHQWVZLWKQHZO\GLDJQRVHG3'IURP WKH(DVWHUQDUHDRI+RQJ.RQJ,VODQGZHUHHYDOXDWHGDQQXDOO\IRU\HDUV 2I WKHVH KDG H[SHULHQFHG DW OHDVW VLJQLILFDQW IDOO UHTXLULQJ PHGLFDO DWWHQWLRQ0HDQDJHDWGLVHDVHRQVHWZDV\HDUVDQGGLVHDVHGXUDWLRQDWWKH HQGRIIROORZXSZDV\HDUV
7KH6\GQH\0XOWLFHQWUH6WXG\RI3DUNLQVRQVGLVHDVHUHFUXLWHGGHQRYR 3' SDWLHQWV EHWZHHQ DQG ZKR ZHUH UDQGRPO\ DVVLJQHG WR
Falls in Parkinson’s disease
Figure 2. Three incident PD cohort studies reporting falls. Dot sizes correspond to number of participants (range 30-171).
OHYRGRSD RU GRSDPLQH DJRQLVW ORZ GRVH WUHDWPHQW 2I ORQJLWXGLQDO DVVHVVPHQWV SHUIRUPHG DW DQG \HDUV RI IROORZ XS WKH RFFXUUHQFH RI IDOOV ZDV RQO\ UHSRUWHG DW DQG \HDUV )DOOV LQIRUPDWLRQ ZDV FROOHFWHG SURVSHFWLYHO\ DV SDUW RI WKH TXHVWLRQLQJ DERXW PRELOLW\ LQ DFWLYLWLHVRIGDLO\OLYLQJDQGZHUHUHFDOOHGVLQFHWKHODVWYLVLW\HDUVDJRDQG UHFRUGHGDVKDYLQJRFFXUUHGE\WKHWLPHRIWKHYLVLWWKH\ZHUHWKHQDWWHQGLQJE
b“The falls were recalled since the last visit and were recorded as having occurred by the time of the visit
they were then attending. We did not give patients diaries to fill out. The falls information was collected prospectively as part of the questioning about mobility in activities of daily living. Falls refers to hitting the ground, not merely overbalancing and saving oneself. The information collected was often from both an attending carer and the patient. As many were becoming frail, I think in all or nearly all cases they were with their carer who also helped answer questions.” 0DULHVH+HO\SHUVRQDOFRPPXQLFDWLRQ
Falls in Parkinson’s disease
)DOOVZHUHGHILQHGDVKLWWLQJWKHJURXQGQRWPHUHO\RYHUEDODQFLQJDQGVDYLQJ RQH VHOI $W \HDUV Q IDOOV RFFXUUHG LQ RI SDWLHQWV DQG VXVWDLQHGIUDFWXUHV)LYH\HDUVODWHUQ IDOOVRFFXUUHGLQDQG VXVWDLQHGIUDFWXUHV7KUHHDGGLWLRQDOLQFLGHQWVWXGLHVRI3'WKH&DP3D,*1 VWXG\IURPWKHFRXQW\RI&DPEULGJHVKLUH8. WKH1<380SURMHFWLQ QRUWKHUQ6ZHGHQDQGWKH3,1(VWXG\IURP$EHUGHHQKDYHWRWKHEHVWRI RXUNQRZOHGJHQRWUHSRUWHGIDOOVGDWD
3.2 Consequences
Fall-related injuries
$VXUYH\VWXG\UHSRUWHGWKDWRISDWLHQWVZLWK3'ZKRKDGDWOHDVWIDOO LQWKHSDVW\HDUVVXVWDLQHGDQLQMXU\2IWKHVHѿVXVWDLQHGDIUDFWXUHZKLFK UHTXLUHGVXUJHU\LQRIWKHFDVHV2YHUDOOôRIDOOIDOOUHODWHGLQMXULHVLQ WKLV VXUYH\ VWXG\ UHTXLUHG KHDOWK FDUH VHUYLFHV )XUWKHUPRUH D VWXG\ E\
6FKUDJ DQG FROOHDJXHV VKRZHG WKDW WKH SUHVHQFH RI IDOOV ZLWKLQ WKH SDVW PRQWKVZDVDVVRFLDWHGZLWKLQFUHDVHGFDUHJLYHUEXUGHQ
)LQGLQJVIURPDUHFHQWPHWDDQDO\VLVVXJJHVWWKDW3'LVDVVRFLDWHGZLWKD IROG LQFUHDVHG ULVN &, IRU IUDFWXUH $QRWKHU V\VWHPDWLF UHYLHZ DQG PHWDDQDO\VLV GHPRQVWUDWHG D &, FRPELQHG HIIHFWVL]HRIIUDFWXUHULVNDQGUHSRUWHGWKDW3'SDWLHQWVKDYHKLJKHUULVNRI RVWHRSRURVLV25&,FRPSDUHGZLWKKHDOWK\FRQWUROV ,QVXPPDU\WKHFRQVHTXHQFHRILQFUHDVHGULVNRIERWKIDOOVDQGRVWHRSRURVLV VHHPVWREHKLJKO\DVVRFLDWHGZLWKWKHLQFUHDVHGIUDFWXUHULVNDPRQJSDWLHQWV ZLWK 3' +LS IUDFWXUHLQWKH JHQHUDO SRSXODWLRQ LVDVVRFLDWHG ZLWK GLVDELOLW\
DQGKLJKDGPLVVLRQUDWHWRQXUVLQJKRPH)XUWKHUPRUHKLSIUDFWXUHSDWLHQWV KDYH D PRUWDOLW\ UDWH ZLWKLQ PRQWKV DQG ZLWKLQ \HDUV DIWHU VXUJHU\:KLOH\HDUPRUWDOLW\UDWHDIWHUVXUJLFDOWUHDWPHQWRIKLSIUDFWXUHV ZDV VLPLODU EHWZHHQ SDWLHQWV ZLWK DQG ZLWKRXW 3' LQ ERWK JURXSV D VWDWLVWLFDOO\VLJQLILFDQWLQFUHDVHLQPRUWDOLW\ZDVDSSDUHQWEH\RQG\HDUV 0RUHVSHFLILFDOO\WKH\HDUPRUWDOLW\UDWHZDVLQSDWLHQWVZLWK3'DQG LQFRQWUROV
$Q DXWRSV\ VWXG\ VXJJHVWHG WKDW IUHTXHQW IDOOLQJ UHPDUN D QRWDWLRQ LQ WKH FOLQLFDOUHFRUGWKDWPXOWLSOHIDOOVZHUHRFFXUULQJLQDGYDQFHG3'RFFXUOHVV WKDQ\HDUVEHIRUHWLPHRIGHDWKUHJDUGOHVVRIDJHDWGLVHDVHRQVHWDQGDJHDW
Falls in Parkinson’s disease
GHDWK,QHDUOLHUVWDJHVRI3'UHFXUUHQWIDOOLQJUHPDUNIDOOLQJWLPHVRU PRUHGXULQJD\HDUIROORZXSSHULRGZDVQRWDVVRFLDWHGZLWKLQFUHDVHGULVN RIPRUWDOLW\\HDUVDIWHUEDVHOLQH+HQFHWKHDVVRFLDWLRQEHWZHHQIUHTXHQW IDOOVDQGPRUWDOLW\LQDGYDQFHG3'PLJKWEHDSUR[\IRUFXPXODWLYHIUDLOW\LQ WKHVHSDWLHQWV
Fear of falling
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
DVVRFLDWHG ZLWK IHDU RI IDOOLQJ ZKHQ FRQWUROOLQJ IRU RWKHU H[SODQDWRU\
YDULDEOHV 2Q WKH RWKHU KDQG UHFXUUHQW IDOOV ZLWKLQ D PRQWK IROORZXS SHULRGZHUHDVVRFLDWHGZLWKIHDURIIDOOVDVVHVVHGZLWKWKHDFWLYLWLHVVSHFLILF EDODQFH FRQILGHQFH $%& VFDOH 7KHVH ILQGLQJV KLJKOLJKW WKH FRPSOH[
UHODWLRQVKLSEHWZHHQIDOOVIHDURIIDOOVDQGZDONLQJGLIILFXOWLHV
3.3 Activity and sedentary behaviors related to falls
/HYHOV RI SK\VLFDO DFWLYLW\ ZRUOGZLGH DUH ORZ DQG GHFOLQH ZLWK LQFUHDVLQJ DJH 3DWLHQWV ZLWK 3' ZLWK D PHDQ GLVHDVH GXUDWLRQ RI DERXW \HDUV DUH UHSRUWHG WR EH SK\VLFDOO\ OHVV DFWLYH FRPSDUHG ZLWK FRQWUROV &,
±DVPHDVXUHGZLWKDYDOLGDWHGSK\VLFDODFWLYLW\TXHVWLRQQDLUH7KLV GLIIHUHQFH LV DOVR HYLGHQW LQ SDWLHQWV ZLWK LQFLGHQW 3' ZKR SURGXFH IHZHUVWHSVSHUGD\FRPSDUHGZLWKFRQWUROV,QDGGLWLRQSDWLHQWVZLWK3' ZDONLQERXWVRIVKRUWHUGXUDWLRQDQGRQO\RISDUWLFLSDQWVZLWKHDUO\3'
Falls in Parkinson’s disease
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
Falls in Parkinson’s disease
FRPSDUHG ZLWK QRQIDOOHUV DQG SDWLHQWV ZKR UHSRUWHG WKDW IDOOV RFFXUUHG GXULQJ HYHU\GD\ ZDONLQJ DFWLYLWLHV LQFOXGLQJ VWDLU FOLPELQJ $OWRJHWKHU ZKHUHDVLQDFWLYLW\DQGHVSHFLDOO\LQMXULRXVIDOOVDUHFRUUHODWHGLQWKHJHQHUDO ROGHUSRSXODWLRQWKHFRPSOH[UHODWLRQVKLSEHWZHHQIDOOVDQGSK\VLFDODFWLYLW\
LHVHGHQWDU\EHKDYLRUVWDQGLQJDQGDPEXODWRU\DFWLYLW\UHPDLQVXQFOHDULQ 3'
3.4 Predicting risk of falling
&OLQLFDOSUHGLFWLRQPRGHOVPD\JXLGHFOLQLFLDQVWRLGHQWLI\SHUVRQVDWKLJKHU ULVNRIIXWXUHIDOOVVRWKDWPDQDJHPHQWFDQEHWDLORUHGHIIHFWLYHO\)DOOUDWHV IURP VWXGLHV XQGHUWDNHQ LQ FRPPXQLW\ VHWWLQJV VKRZ WKDW IDOO UDWHV LQ WKH JHQHUDOSRSXODWLRQLQFUHDVHZLWKDJHDERYH\HDUVDQGDUHKLJKHULQROGHU ZRPHQVXJJHVWLQJDJHDVRQHRIWKHNH\ULVNIDFWRUVIRUIDOOV7KLVULVNPD\
EH LQ SDUW GXH WR SK\VLFDO VHQVRU\ DQG FRJQLWLYH FKDQJHV DVVRFLDWHG ZLWK DJHLQJLQFRPELQDWLRQZLWKHQYLURQPHQWVWKDWFRXOGEHEHWWHUDGDSWHGIRUWKH DJLQJSRSXODWLRQ,QWKHIROORZLQJVHFWLRQIDFWRUVDVVRFLDWHGZLWKRUPRUH IDOOV LQ SDWLHQWV ZLWK 3' DUH SUHVHQWHG LQFOXGLQJ VWXGLHV XVLQJ SURVSHFWLYH IDOOVDVVHVVPHQWDQGPXOWLYDULDEOHULVNDQDO\VHV
3URVSHFWLYH VWXGLHV PRQWKV RI IROORZXS H[DPLQLQJ ULVN IDFWRUV LQ SDWLHQWVZLWK3'ZLWKRXWUHFHQWIDOOVKDYHLGHQWLILHGGLVHDVHVHYHULW\IHDU RIIDOOLQJLQFUHDVHGJDLWYDULDELOLW\SRVWXUDOLQVWDELOLW\DQGSRRUKHDOWK UHODWHGTXDOLW\RIOLIHDVSRWHQWLDOIDOOULVNIDFWRUV$OWKRXJKRQHVWXG\IRXQG QREHWZHHQJURXSGLIIHUHQFHVLQSRVWXUDOLQVWDELOLW\DQGJDLWGLIILFXOW\3,*' VFRUHPRWRUSKHQRW\SHVLQ3'DVULVNIDFWRUVIRUIDOOLQJKDYHUHFHLYHGOLWWOH DWWHQWLRQ
Previous fall DQG HYHQ QHDUIDOO LV D FRQVLVWHQW DQG VWURQJ SUHGLFWRU25UDQJLQJEHWZHHQDQGRIIXWXUHIDOOLQSURVSHFWLYHVWXGLHV
$ PHWDDQDO\VLV RI SURVSHFWLYH VWXGLHV FRQILUPHG WKDW VHOIUHSRUW RI RU PRUHIDOOVLQWKHSUHFHGLQJ\HDU\LHOGHGDVHQVLWLYLW\RIDQGVSHFLILFLW\RI ZKHQSUHGLFWLQJIDOOVRYHUPRQWKV$V\VWHPDWLFUHYLHZSXEOLVKHGLQ DOVRUHSRUWHGSUHYLRXVIDOODVDSUHGLFWRURIUHFXUUHQWIDOOV
Disease severity or progression DVPHDVXUHGE\WKH83'56 +RHKQ DQG <DKU + < VWDJH GLVHDVH GXUDWLRQ DQG 6FKZDE DQG (QJODQG
Falls in Parkinson’s disease
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
Freezing of gait LV DVVRFLDWHG ZLWK UHFXUUHQW IDOOV DQG RU PRUH IDOOV LQ SURVSHFWLYHVWXGLHV7KHUHODWLRQVKLSEHWZHHQIUHH]LQJRIJDLWDQGIDOOV ZDVUHYLHZHGE\1XWWDQGFROOHDJXHV7KH\VXJJHVWHGWKDWWKHLQFUHDVHGULVN RI IDOOLQJ PLJKW UHVXOW IURP WKH DVVRFLDWHG EDODQFH LPSDLUPHQWV DV WKHVH SDWLHQWVVKRZYDULDELOLW\LQJDLWPHWULFVEHWZHHQIUHH]LQJRIJDLWHSLVRGHVLQ DGGLWLRQWRDPDUNHGO\UHGXFWLRQLQVWHSOHQJWKZLWKIUHTXHQWWUHPEOLQJRIWKH OHJVGXULQJIUHH]LQJRIJDLWHSLVRGHV
Postural instability KDVEHHQLGHQWLILHGDVDQLQGHSHQGHQWULVNIDFWRUIRUIDOOV LQ 3' DV PHDVXUHG E\ SRVWXUDO VZD\ RQ D ILUP VXUIDFH RU D FRRUGLQDWHG VWDELOLW\WHVW,QDPHWDDQDO\VLVE\3LFNHULQJDQGFROOHDJXHVVSHHFKJDLW DQGSRVWXUDO LQVWDELOLW\ZHUHWKHPRVWLPSRUWDQW³ULVNLWHPV´LQWKH 83'56 PRWRUSDUWDIWHUFRQWUROOLQJIRURWKHU83'56PRWRULWHPV
Cognitive impairmentGHILQHGDV0LQL0HQWDO6WDWH([DPLQDWLRQ006(
RU006(RULHQWDWLRQDQGGHPHQWLDDUHFRQVLGHUHGLQGHSHQGHQW ULVN IDFWRUV IRU IDOOV LQ 3' ,Q SDUWLFXODU DWWHQWLRQDO G\VIXQFWLRQ VHHPV WR LQFUHDVH WKH ULVN RI IDOOV LQ 3' SHUKDSV GXH WR LQFUHDVHG GLVWUDFWLELOLW\ DQG LPSDLUHG WDVN VZLWFKLQJ ,QWHUHVWLQJO\ D UHFHQW SLORW VWXG\ KLJKOLJKWHG PRWRU GXDOWDVNLQJ DV D SRWHQWLDO SUHGLFWRU RI IDOOV LQ 3' DOWKRXJK WKHVH UHVXOWVVWLOOQHHGWREHYDOLGDWHGLQ3'SDWLHQWVZLWKRXWIDOOKLVWRU\
Falls in Parkinson’s disease
3.5 Physiotherapy interventions targeted to prevent falls
7KHUHLVOLPLWHGHYLGHQFHIRUUHFRPPHQGLQJDVSHFLILFLQWHUYHQWLRQWRUHGXFH WKH IUHTXHQF\RIIDOOVLQ3' 1RGLIIHUHQFHLQIDOOVZDVIRXQGEHWZHHQ WKH ³LQWHUYHQWLRQ´ DQG ³QR LQWHUYHQWLRQ´ DUP XVLQJ VWDQGDUG PHWDDQDO\VLV PHWKRGV 2I LQFOXGHG WULDOVLQ WKH &RFKUDQH PHWDDQDO\VLV SLORWVWXG\
UHSRUWHG D VLJQLILFDQW GHFUHDVH LQ IDOO IUHTXHQF\ ZLWK KRXU 7DL &KL FODVV WZLFHZHHNO\IRUFRQVHFXWLYHZHHNVFRPSDUHGZLWKWKH³QRLQWHUYHQWLRQ´
DUP7KH(XURSHDQ*XLGHOLQHVIRUSK\VLRWKHUDS\LQ3'KDYHDOVRQRWHGWKDW HYLGHQFH WR UHGXFH WKH IUHTXHQF\ RI IDOOV LV OLPLWHG 1RWHZRUWK\ D UDQGRPL]HGFRQWUROOHGWULDOFRPSDULQJ7DL&KLZLWKVWUHWFKLQJZDVLQFOXGHGLQ WKH JXLGHOLQHV DQG VKRZHG D GLIIHUHQFH RI IHZHU IDOOV LQ IDYRU RI 7DL
&KL
7ZR DGGLWLRQDO FOLQLFDO WULDOV KDYH H[SORUHG RWKHU IRUPV RI H[HUFLVH ZLWK SRVLWLYH ILQGLQJV 6PDQLD DQG FROOHDJXHV LQFOXGHG SDWLHQWV ZLWK 3' ZLWK + <VWDJHWRZKRUHFHLYHGLQWHUYHQWLRQIRUPLQXWHVGD\VDZHHNIRU FRQVHFXWLYH ZHHNV 7KH H[SHULPHQWDO JURXS UHFHLYHG EDODQFH WUDLQLQJ FRQVLVWLQJ RI H[HUFLVHV DLPHG DW LPSURYLQJ ERWK IHHGIRUZDUG DQG IHHGEDFN SRVWXUDOUHDFWLRQVDQGWKHFRQWUROJURXSSHUIRUPHGH[HUFLVHVQRWVSHFLILFDOO\
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
VXSHUYLVHGLQWHUYHQWLRQ
Aims of the study