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Method
The present study was approved by the ethics committee of our hospital and adhered to the tenets of the Declaration of Helsinki. Additionally, all the parents of patients signed the consent form before participating in the study.
PMC10782327
Research design
congenital heart disease, congenital malformations, gastrointestinal abnormalities, intestinal obstruction
SKIN DISEASE, PREMATURE, COMPLICATIONS, INTESTINAL OBSTRUCTION
This study was a prospective randomized controlled study conducted in the Department of Neonatology in a hospital on the southeast coast of China from June 2019 to October 2020. Based on the difference in the incidence of feeding intolerance (13% vs 35%) between the two groups from the pre-experiment, and assuming that...
PMC10782327
Recruitment
Participants were recruited according to the inclusion criteria and given written information regarding the study. Informed consent was obtained from all parents of patients. Withdrawal from the study was possible at any time without any negative consequences.
PMC10782327
Randomization
Simple randomization was done according to a software-generated random number sequence posted on a dedicated and secure website available on a 24/7 basis. The website generated the randomization, but the sequence was concealed from investigators. Participants who were eligible were randomized to either the intervention...
PMC10782327
Standard care
ml/kg/
In all preterm infants, orogastric tubes were inserted. A 6 Fr orogastric tube is generally inserted in these infants. Bolus feedings were given by gravity drainage after priming the tubing every three hours in the two groups. Continuous feeds were given using an automatic syringe pump. Gastric residuals were checked e...
PMC10782327
Chinese pediatric Tuina
The intervention group was treated with Chinese pediatric Tuina on the basis of standard care. Two professionals pediatric Tuina doctors who had 5 years of experience in Chinese pediatric
PMC10782327
Data collection
gastrointestinal bleeding, liver insufficiency, abdominal distension, bloody, intolerance,
BILE REFLUX, NECROTIZING ENTEROCOLITIS, GASTRIC RETENTION, COMPLICATIONS
Before the intervention, the following data were collected: gestational age, age, sex, body weight, head circumference, albumin and prealbumin. After one week of intervention, the following data were collected: body weight, head circumference, albumin, prealbumin and complications including feeding intolerance, gastroi...
PMC10782327
Statistical Analysis
We used SPSS 25.0 software for statistical analysis. Continuous data are presented as the mean ± standard deviation and range. Clinical parameters between the two groups were compared with an independent-sample t-test. The χ
PMC10782327
Result
gastrointestinal bleeding, liver insufficiency
GASTROINTESTINAL BLEEDING, NECROTIZING ENTEROCOLITIS, COMPLICATIONS
Before intervention, there were no statistically significant differences in gestational age, age, sex, body weight, head circumference, albumin or prealbumin between the two groups, which indicated that the two groups were homogenous and comparable (Comparison of general data between the two groupsAfter 1 week of inter...
PMC10782327
Discussion
oral).Studies
Many premature infants are transferred to the neonatal intensive care unit after birth and are fed via a tube (nasal or oral).Studies have shown that direct stimulation of the vagus nerve can regulate gastric peristalsis, enhance food digestion, and increase nutrient utilization.Chinese pediatric This study has some li...
PMC10782327
Conclusion
Chinese pediatric
PMC10782327
Acknowledgements
We appreciated the help of all doctors and nurses in our center.
PMC10782327
Ethics approval and consent to participate
The present study was approved by the ethics committee of our hospital and adhered to the tenets of the Declaration of Helsinki. Additionally, all the parents of patients signed the consent form before participating in the study.
PMC10782327
Authors' contributions
Su-xian Lai and Shao-Shu Li designed the study, collected the clinical data, performed the statistical analysis, drafted the manuscript and revised the article. Xiu-Yao Lin, Xin Li, Ya-Di Zhang and Li-Qiong Wang participated in the statistical analysis and drafted the manuscript. All authors read and approved the final...
PMC10782327
Consent for publication
All authors read and approved the final manuscript and publication.
PMC10782327
Competing interests
The authors declare that they have no competing interests.
PMC10782327
Funding
Our research was funded by the “Quanzhou Science and Technology Plan Project (2018N065S)”.
PMC10782327
ABSTRACT
PMC10413913
Background
depressive disorder, ’, ’ depressive symptoms
Globally, an estimated five percent of adults have major depressive disorder. However, little is known about the relationship between these individuals’ depressive symptoms and their household members’ mental health and well-being.
PMC10413913
Objectives
depressive disorder, depressive symptoms
We aimed to investigate the prevalence and predictors of depressive symptoms among adult household members of patients living with major depressive disorder in Neno District, Malawi.
PMC10413913
Methods
depressive disorder, depression
As part of a cluster randomized controlled trial providing depression care to adults with major depressive disorder, we conducted surveys with patients’ household members (
PMC10413913
Results
depressive disorder, greater disability, depressed, Elevated depression
We observed that roughly one in five household members (19%) screened positive for a depressive disorder (PHQ-9 > 9). More than half of household members endorsed six or more of the nine symptoms, with 68% reporting feeling ‘down, depressed, or hopeless’ in the prior two weeks. Elevated depression symptom severity was ...
PMC10413913
Conclusions
depressive disorder, depression
In the Malawian context, we find that depressive disorder and depression symptoms are shared attributes among household members. This has implications for both screening and treatment, and it suggests that mental health should be approached from the vantage point of the broader social ecology of the household and famil...
PMC10413913
Trial Registration
ClinicalTrials.gov (NCT04777006) - March 2, 2021.
PMC10413913
Background
Human Immunodeficiency Virus (HIV), diabetes, depressive disorder, depressive symptoms, MDD, depression, hypertension
HYPERTENSION
Mental health conditions affect approximately one billion people around the globe [Individuals with chronic health conditions – such as Human Immunodeficiency Virus (HIV), diabetes, and hypertension – are more likely to be affected by mental health conditions [Common forms of behavioral therapy that address MDD in high...
PMC10413913
Methods
PMC10413913
Setting and study design
epilepsy, type-2 diabetes, asthma, depression disorder, depression
HYPERTENSION, DISEASES, ASTHMA, EPILEPSY
This study is a part of a randomized controlled trial investigating an evidence-based model of depression care at IC3 in 14 health facilities throughout Neno District, Malawi. The IC3 paradigm represents an expansion of a care delivery system that was historically focused on HIV services alone. Since its inception, pat...
PMC10413913
Participants
depression
RECRUITMENT
At the stage of study participant recruitment, participants were asked if they would be open to a household member being interviewed, provided the household member was not informed of the study participant’s diagnosis. Of 487 study participants, 427 (88%) verbally consented to have a household member interviewed. Of th...
PMC10413913
Measures
depressive disorder, Depressive, [Functional impairment
The household interview comprised six instruments, the first of which gathered an overview of the household member’s sociodemographic characteristics – such as sex, age, marital status, and source of income. The remaining instruments are described below.Depressive symptoms and depressive disorder were evaluated using t...
PMC10413913
Statistical methods
depressive disorder, depression, depressive
REGRESSION
Based on our sample size, the present study had 80% power to detect relationships between patient and household member measures that were ≥ 0.19. As a first step in analysis, we drew from baseline interviews to generate descriptive statistics that characterized patients and household members. This included frequencies ...
PMC10413913
Results
PMC10413913
Prevalence estimates
depressive disorder, depressed, depressive symptoms
Overall, 16% of household members were classified as moderately depressed and three percent as severely depressed, based on PHQ-9 scores. This represents a 19% prevalence of depressive disorder. Greater than nine in 10 household members endorsed one or more depressive symptoms (see Prevalence of depressive symptoms and...
PMC10413913
Discussion
depressive disorder, ’ depressive symptoms, depressive symptoms, MDD, depression
DISEASES, DISORDERS
To our knowledge, this is one of the first studies to assess the prevalence and correlates of depressive symptoms and depressive disorder among household members of patients with MDD. We found a high prevalence of depressive symptoms: 91% of household respondents endorsed one or more symptoms, a figure similar to that ...
PMC10413913
Conclusion
depressive disorder, depressive symptoms, MDD, depression, disability
We found a high prevalence of depressive symptoms and depression among household members of chronic care patients with MDD. The overall paucity of resources presently available to households – coupled with difficulties in social support, overall health, and disability – make a collective case for the importance of inte...
PMC10413913
Acknowledgments
We would like to thank the clinicians, data collectors, and other staff at Partners In Health/APZU who spend their days making Integrated Chronic Care a reality throughout Neno District. Zikomo.
PMC10413913
Author contributions
KM, OM, and RM contributed to the study conception and design. KM, OM, and MK performed data collection. R M, KM, and TeR performed data preparation and analysis. RM, KM, and TeR wrote the first draft of the manuscript. All authors reviewed, commented, and provided feedback on all versions of the manuscripts. All autho...
PMC10413913
Consent for participation and publication
We obtained written informed consent from all participants to participate in the study. Patients signed informed consent regarding publishing their data. The research was carried out in accordance with the RAND Human Subjects Protection Committee guidelines.
PMC10413913
Disclosure statement
No potential conflict of interest was reported by the author(s).
PMC10413913
Ethics
The study has received ethics approval from the RAND Human Subjects Protection Committee as well as the National Health Science Research Committee of Malawi (20/11/2626). The research was carried out in accordance with the RAND Human Subjects Protection Committee guidelines.
PMC10413913
Paper context
depressive disorder, depressive disorders, depressive symptoms
Among household members of adults living with major depressive disorder, we find a high prevalence of depressive symptoms and moderate-to-severe depressive disorders. The findings shed new light on the social ecology of major depressive disorder, including the correspondence of elevated depressive symptoms among co-hab...
PMC10413913
Data availability statement
Deidentified data and code are available upon request (email: rmcbain@bwh.harvard.edu).
PMC10413913
References
PMC10413913
Background
malignant pancreatobiliary strictures
Endoscopic retrograde cholangiopancreatography (ERCP) with biliary brush cytology is commonly used to diagnose malignant pancreatobiliary strictures. This trial compared the sensitivity of two intraductal brush cytology devices.
PMC10234858
Methods
extrahepatic biliary strictures
A randomized controlled trial in which consecutive patients with suspected malignant, extrahepatic biliary strictures were randomized (1:1) to a dense or conventional brush cytology device. Primary endpoint was sensitivity. Interim analysis was conducted after 50% of the patients completed follow-up. Results were inter...
PMC10234858
Results
benign disease, Malignancy
MALIGNANCY, SENSITIVITY
Between June 2016 and June 2021, 64 patients were randomized to the dense (27 patients, 42%) or conventional brush (37 patients, 58%). Malignancy was diagnosed in 60 patients (94%) and benign disease in 4 patients (6%). Diagnoses were confirmed by histopathology in 34 patients (53%), cytopathology in 24 patients (38%),...
PMC10234858
Discussion
The results of this randomized controlled trial showed that the sensitivity of a dense brush is not superior to a conventional brush for diagnosing malignant extrahepatic pancreatobiliary strictures. This trial was prematurely ended for reasons of futility.
PMC10234858
Trial registration
Netherlands Trial Register number; NTR5458.
PMC10234858
Supplementary Information
The online version contains supplementary material available at 10.1007/s00464-023-09916-9.
PMC10234858
Keywords
Malignant pancreatobiliary strictures, PDAC, cholangiocarcinoma, pancreatic ductal adenocarcinoma
PANCREATIC DUCTAL ADENOCARCINOMA, DISEASE, CHOLANGIOCARCINOMA
Malignant pancreatobiliary strictures are most commonly caused by pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (CCA). Due to the late presentation in advanced stages of disease, only 20% of the patients can be treated with curative intent. Chemotherapy is the mainstay of treatment as it prolong...
PMC10234858
Materials and methods
PMC10234858
Study design
extrahepatic biliary strictures
We performed a single-blinded, randomized controlled trial to prove superior sensitivity of the dense Infinity® brush (US Endoscopy, Northeast Ohio, USA. CE 02,112) over the conventional RX cytology® brush (Boston scientific Corporation, Marlborough, MA, USA. CE 616,288) for diagnosing malignant, extrahepatic biliary s...
PMC10234858
Participants
extrahepatic biliary stricture, malignant stricture, pancreatitis, biliary stricture, biliary obstruction
BILIARY OBSTRUCTION, PANCREATITIS
All consecutive patients ≥ 18 years with a suspected malignant, extrahepatic biliary stricture who underwent ERCP and had an indication to obtain a cytological sample via biliary brush cytology were eligible for inclusion. Patients provided written informed consent prior to the procedure. Exclusion criteria were: Intra...
PMC10234858
Randomization and masking
After biliary cannulation was obtained, patients were randomly assigned (1:1) by the coordinating investigator to either the intervention group (dense brush) or the control group (conventional brush) with the use of sealed opaque envelopes. The randomization sequence was computer-generated before trial commencement by ...
PMC10234858
Procedures
STRICTURE
ERCP procedures were performed by or under direct supervision of a dedicated interventional endoscopist using standard techniques. Because of the diameter (9 French) of the dense brush, all patients in the intervention group underwent concomitant sphincterotomy. In the control group, sphincterotomy was performed at the...
PMC10234858
Outcomes
cholangitis, malignancy, benign disease, perforation, gastro-intestinal bleeding
METASTASIS, CHOLANGITIS, ADVERSE EVENTS, ADVERSE EVENT, PANCREATITIS
The primary outcome was sensitivity, defined as brush cytology specimen showing at least suspicion of malignancy (Bethesda ≥ 4) in patients with malignant diagnosis, as confirmed by histopathology results (surgical specimen or biopsy of either the primary mass or distant metastasis) or cytopathology results (ultrasound...
PMC10234858
Statistical analysis
Sample size calculation was based on the results of a meta-analysis which evaluated the sensitivity of conventional brush cytology in 1556 patients from 16 studies [
PMC10234858
Early termination
ADVERSE EVENTS
According to protocol, the trial would be terminated after the interim analysis in case of a statistically significant higher rate of adverse events in the intervention group without a clinically relevant increase in sensitivity. Furthermore, rules for efficacy (according to the Haybittle-Peto rule) and futility (based...
PMC10234858
Discussion
malignant extrahepatic biliary strictures
This randomized controlled trial compared the sensitivity of two intraductal brush cytology devices and showed that the dense brush was not superior to the conventional brush in diagnosing malignant extrahepatic biliary strictures. Following the recommendation from the DSMB, this study was interrupted after the interim...
PMC10234858
Supplementary Information
Below is the link to the electronic supplementary material.Supplementary file1 (DOCX 22 KB)
PMC10234858
Acknowledgements
We would like to acknowledge and thank the members of the data safety monitoring board (Robert C. Verdonk [chair; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands], Lydi M.J.W. van Driel [Department of Gastroenterology and Hepatology Erasmus Medical Center, Rotterdam, th...
PMC10234858
Author contributions
SL, NvH and MG coordinated the trial during the inclusion period and JEvH supervised the study. MG performed the statistical analysis, JEvH checked the statistical analysis. SL, MG and NvH had access to the data and MG and NvH verified the data. MG drafted the manuscript. All authors critically assessed the study desig...
PMC10234858
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
PMC10234858
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request. Individual patient data will be shared after de-identification and approval by the study team. Furthermore, a data transfer agreement has to be set up prior to data sharing.
PMC10234858
Declarations
PMC10234858
Disclosures
Jeanin E. van Hooft has received research support from Cook Medical and acted as consultant for Cook Medical, Boston Scientific, Medtronics, Olympus, and Abbvie. Rogier Voermans received a research grant and acted as consultant for Boston Scientific. Paul Fockens acted as a consultant for Cook Endoscopy and Olympus. Ro...
PMC10234858
References
PMC10234858
Introduction
T1DM, HF, cardiovascular death, myocardial and skeletal muscles, hypoxia, Diabetes mellitus, T2DM, Type 2 Diabetes, heart failure, type 2 diabetes, insulin-dependent diabetes, diabetes
VOLUME OVERLOAD, TYPE 1 DIABETES, INFLAMMATION, HYPOXIA, EVENTS, DIABETES MELLITUS, CHRONIC METABOLIC DISEASE, INCREASING INSULIN, INSULIN RESISTANCE, INSULIN RESISTANCE, TYPE 2 DIABETES, HEART FAILURE, TYPE 2 DIABETES, INSULIN-DEPENDENT DIABETES, DIABETES
Diabetes mellitus is a chronic metabolic disease, in which there is a marked elevation in the blood glucose level. This elevation is associated with damaging effects on nerves, eyes, blood vessels, heart, and kidney. There are 2 main subtypes of diabetes: Type 1 Diabetes (T1DM), in which the pancreas is producing littl...
PMC10113266
Aim of the work
This study aims to compare the effect of dapagliflozin versus glimepiride on glycemic control, HOMA-IR, and on markers like IRAPe, IL-34, and NT-proBNP, and to establish relationship between these parameters.Primary outcomes: change in the glycemic control and IRAPe.Secondary outcomes: change in the levels of IL-34 and...
PMC10113266
Patients and methods
PMC10113266
Study design and participation
diabetic, Diabetes
BLIND, DIABETES
This is a 3-month prospective double blind parallel randomized study, that involve 60 type 2 diabetic patients of both sexes recruited from outpatient clinics of Diabetes and Endocrinology Unit, Department of Internal Medicine, Tanta University hospitals, Tanta, Egypt. The study took place from January 2021 to February...
PMC10113266
Inclusion criteria
diabetic
The selected patients were with uncontrolled type 2 diabetic with age ranging from 18 to 70 year and having glycated hemoglobin A1c% (HbA1c%) level ≥ 7. There were no limits to the duration of DM and gender.
PMC10113266
Exclusion criteria
malignancy, abnormal liver function, hypersensitivity, renal impairment
RENAL IMPAIRMENT, ISCHEMIC HEART DISEASE, TYPE 1 DIABETES, BLADDER CANCER, HEART FAILURE, HYPERSENSITIVITY
Patients excluded from the study were those with type 1 diabetes, hepatic impairment, malignancy, heart failure, history of ischemic heart disease, planned surgical intervention, and both pregnant and nursing women, hypersensitivity to the study drugs, abnormal liver function, renal impairment (eGFR ≤ 60 ml/min) or his...
PMC10113266
Demographic data and baseline evaluation
Complete medical examination was performed for each subject to evaluate their health status. Data on weight, height, sex, age, medical history, and medication were collected. BMI was calculated for each patient using the formula BMI = weight (kg)/height
PMC10113266
Study procedure and biomarker measurement
BLOOD, INSULIN RESISTANCE
The blood samples were collected from each patient after overnight 12 hours (h) fasting period, a drop of blood was used to determine the fasting blood glucose using the glucometer. Patients were allowed to have breakfast, then after 2 h, the glucometer was used to determine the 2 h post prandial glucose. All these sam...
PMC10113266
Follow up and adherence
All the study participants were followed up during the 3-month interval of the study, and all have confirmed adherence to their medications and their usual dietary and activity habits during the study.
PMC10113266
Sample size calculation
Heinrich Heine Universität
The required sample size was calculated using G*Power software version 3.1.0 (Institut für Experimentelle Psychologie, Heinrich Heine Universität, Dusseldorf, Germany). It was estimated that a total sample size of 60 patients would have a power of 95.4% to detect a medium to large effect size of 0.87 in the outcome mea...
PMC10113266
Statistical analysis
Statistical analysis of the data was performed, and box plots were created using IBM SPSS statistics software version 24 (IBM, Armonk, New York). Continuous variables are expressed as mean ± SD. Unpaired t-test was used to compare between the 2 groups, while paired t-test was used to detect the difference within the gr...
PMC10113266
Effects of glimepiride vs. dapagliflozin on insulin resistance as indicated by HOMA-IR
Table
PMC10113266
Discussion
inflammation, heart failure, hypoxia, type 2 diabetes
HYPOXIA, INFLAMMATION, INSULIN RESISTANCE, HEART FAILURE, TYPE 2 DIABETES
To our knowledge this is the first study that compares the effects of dapagliflozin and glimepiride on glycemic control, insulin resistance and different biomarkers as IRAPe, IL-34, and NT-pro BNP.Our results show that both glimepiride and dapagliflozin have significantly improved the glycemic control in the study pati...
PMC10113266
Conclusion
diabetic
CVD, INSULIN RESISTANCE, INSULIN SENSITIVITY, CARDIOVASCULAR DISEASES
Both glimepiride or dapagliflozin significantly improved glycemic control, insulin resistance (as indicated by HOMA-IR), and NT-proBNP with no significant difference between them in type 2 diabetic patients. However, dapagliflozin has a borderline significant effect on IRAPe, and did not affect IL-34 significantly, whi...
PMC10113266
Study limitations
The main limitation of this study is relatively small sample size and short time of follow-up period. Hence, further large-scale studies seem necessary. Another limitation of our study is that it did not assess post prandial insulin resistance.
PMC10113266
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-023-33417-3.
PMC10113266
Acknowledgements
Diabetes
DIABETES
The authors are so thankful to all participants and to the physicians in Endocrinology and Diabetes unit at Tanta University Hospitals for their help and valuable recommendations.
PMC10113266
Author contributions
R.Z., G.A.O. and R.H.W. reviewed the literature, constructed the study design, and performed laboratory investigation of collected samples. Eligibility assessment, participant selection, enrolment and collection of clinical data were performed by N.M.E.-G. All authors shared in statistical analysis of collected data, w...
PMC10113266
Funding
Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).
PMC10113266
Data availability
All data generated or analysed during this study are included in this published article [and its
PMC10113266
Competing interests
The authors declare no competing interests.
PMC10113266
References
PMC10113266
Background
pain, Knee osteoarthritis, OA, arthritis
KNEE OSTEOARTHRITIS, ARTHRITIS, DEGENERATION
Knee osteoarthritis (OA) is the most common kind of arthritis that occurs due to degeneration of the joint articular cartilage, producing pain, stiffness, and impaired movement. The objective of the study was to evaluate the short-term effectiveness of Kinesio taping (KT) plus conventional physical therapy (CPT) and CP...
PMC10522526
Materials and methods
pain
OSTEOARTHRITIS
Forty male subjects were divided into two groups at random using a parallel assignment, double-blinded study design, viz., KT with CPT (transcutaneous electrical nerve stimulation and exercise therapy), and CPT alone for the period of 6 weeks of treatment. At baseline, third, and sixth weeks, the following outcome meas...
PMC10522526
Statistical analysis
To reveal the patient’s demographic profile concerning the outcome parameters, a descriptive statistic was applied. Furthermore, two-way mixed ANOVA and Tukey HSD post hoc tests were used to analyze within and between-group comparisons in SPSS 20.0.
PMC10522526
Results
pain
In both groups, pain and knee flexion were significantly improved during the 6-week period of interventions (
PMC10522526
Conclusion
pain
KT combined with CPT was found to be more effective than CPT alone in the third and sixth weeks of the treatment. In knee OA, this combination of treatments was found to reduce pain, enhance range of motion, and improve physical functioning.
PMC10522526
Keywords
PMC10522526
Introduction
knee OA, Knee osteoarthritis, OA, pain
OSTEOARTHRITIS OF THE KNEE, KNEE OSTEOARTHRITIS, JOINT DISEASE
Knee osteoarthritis (OA) joint disease most commonly occurs in the elderly population, and it causes significant pain and functional limitations [Kinesio taping (KT) is a therapeutic technique commonly used to treat knee OA [Exercise therapy (ET) is an important component of the treatment for osteoarthritis of the knee...
PMC10522526
Methodology
PMC10522526
Study design
knee osteoarthritis
KNEE OSTEOARTHRITIS
The effectiveness of Kinesio taping and transcutaneous electrical nerve stimulation with exercises on knee osteoarthritis was evaluated using a parallel assignment; a double-blinded study design was used in this study.
PMC10522526
Protocol registration
The study was approved by the Ethics committee (IRB), University of Tabuk and is registered with ClinicalTrial.gov (NCT05151627).
PMC10522526
Subjects and Randomization
osteoarthritis, OA, knee pain
OSTEOARTHRITIS
The study included all male subjects with knee pain who visited two government hospitals. All the subjects were referred to the physical therapy clinic by an orthopedic surgeon with a diagnosis of osteoarthritis (OA) in the knee. Both radiography and a clinical examination showed that they had OA changes in the knee jo...
PMC10522526
Inclusion and exclusion criteria
degenerative knee arthritis, pain, knee pain, knee injuries, loss of active and passive ROM
HAND SWELLING
The participants in the study had to meet the following requirements: complaining of knee pain that has lasted longer than 3 months, and a pain level that is medium (pain score greater than or equal to 4) with no knee injuries, treatment not received in another physical therapy clinic in the past three months, painful ...
PMC10522526