scholarly journals A Supervised Exercise Intervention During Cancer Treatment for Adolescents and Young Adults - FiGHTING F!T: Study Protocol of a Randomised Controlled Trial.

2021 ◽  
Author(s):  
Claire Munsie ◽  
Jay Ebert ◽  
Joanne Collins ◽  
Megan Plaster ◽  
David Joske ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Program ◽  
Adolescent And Young Adult ◽  
Trial Registry ◽  
Supervised Exercise ◽  
Wide Range ◽  
Patient Reported ◽  
Randomised Controlled

Abstract BackgroundHigh quality evidence supports the integration of exercise to mitigate treatment- related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured and progressive exercise program can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. Methods/DesignA total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise program will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10 and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning and self-reported quality of life measurements. Patient reported treatment-related toxicities will be recorded on a weekly basis. DiscussionThe FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise program in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort.Trial registrationThis trial was registered retrospectively with the Australia New Zealand Clinical Trial registry(ACTRN12620000663954;https://www.anzctr.org.au/ACTRN12620000663954.aspx). Trial registry date: 10th June 2020.

scholarly journals A supervised exercise intervention during cancer treatment for adolescents and young adults—FiGHTING F!T: study protocol of a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Claire Munsie ◽  
Jay Ebert ◽  
Joanne Collins ◽  
Megan Plaster ◽  
David Joske ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Programme ◽  
Adolescent And Young Adult ◽  
Exercise Tests ◽  
Supervised Exercise ◽  
Wide Range ◽  
Patient Reported ◽  
Randomised Controlled

Abstract Background High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. Methods/design A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0–10 weeks) or following an interim assessment to 20 weeks (10–20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis. Discussion The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort. Trial registration This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry (ACTRN12620000663954). Registered on 10 June 2020

scholarly journals El ejercicio físico supervisado durante el embarazo mejora la percepción de la salud. Ensayo clínico aleatorizado (Supervised physical exercise during pregnancy improves health perception. Randomised controlled trial)

Retos ◽  
2015 ◽  
pp. 36-38
Author(s):  
Mireia Peláez ◽  
Soraya Casla ◽  
María Perales ◽  
Yaiza Cordero ◽  
Rubén Barakat
Keyword(s):  
Urinary Incontinence ◽  
Randomised Controlled Trial ◽  
Physical Exercise ◽  
Controlled Trial ◽  
Exercise Program ◽  
Health Perception ◽  
Control Group ◽  
Supervised Exercise ◽  
Randomised Controlled ◽  
Ensayo Clínico

Objetivo; Investigar la influencia de un programa de ejercicio físico de intensidad moderada realizado durante toda la gestación sobre la percepción de salud de la gestante. Material y métodos; Se desarrolló un ensayo clínico aleatorizado controlado. 101 mujeres primíparas fueron distribuidas aleatoriamente en dos grupos (grupo control (GC) n=51, grupo intervención (GI) n=50, muestra perdida 13, 11.4%). El GI participó en un programa de ejercicio físico desde la semana de gestación 10-14 hasta el final de la gestación (70-75 sesiones de 55-60 min, tres veces por semana). El GC recibió la atención médica regular. Todas las gestantes rellenaron dos cuestionarios validados sobre salud percibida e incontinencia urinaria, antes y después de la intervención. Resultados; Se encontraron diferencias estadísticamente significativas entre grupos en la salud percibida al final de la intervención [muy buena: GI 35, 70% vs. GC 5, 9.8%; buena: GI 15, 30% vs. GC 16, 31%; regular GI 0, 0.0% vs. GC 26, 51%; mala GI 0, 0.0% vs. GC 3, 5.9%; muy mala: GI 0, 0.0% vs. GC 1, 2% (p<.001)]. Además el GI padeció menos incontinencia urinaria [Puntuación ICIQ-SF GI 0.30 (SD1.3) vs. GC 3.1 (SD4.1), p<.001]. Conclusiones; Un programa de ejercicio físico supervisado, de intensidad moderada realizado durante toda la gestación que incluya ejercicios de fortalecimiento del suelo pélvico, mejora la percepción  de la salud en las gestantes y es efectivo en la prevención primaria de la incontinencia urinaria.Palabras clave: ejercicio físico; embarazo; percepción salud; incontinencia urinaria.Abstract: Aim: To investigate the influence of a moderate exercise program during pregnancy on the maternal health perception. Methods. A randomised controlled trial was performed. 101 primiparous women were allocated into the control group (CG, n=51) and the exercise group (EG, n=50), lost to follow-up 13, 11.4%. Women on the EC were asked to participate in a supervised exercise program during from 10-14 to 36 weeks of gestation (70-75 sessions, 55-60 min/session, three times per week). Women in the CG received usual care. All women were asked to fill in validated questionnaires about health perception and urinary incontinence before and after the intervention. Results. At the end of the intervention there were statistically significant differences between groups on health perception [very good: EG 35, 70% vs. CG 5, 9.8%; good: EG 15, 30% vs. CG 16, 31%; average EG 0, 0.0% vs. CG 26, 51%; poor EG 0, 0.0% vs. CG 3, 5.9%; very poor: EG 0, 0.0% vs. CG 1, 2% (p<.001)]. What is more, women in the EG showed less urinary incontinence [ICIQ-SF Score EG 0.30 (SD1.3) vs. CG 3.1 (SD4.1), p<.001]. Conclusions. A supervised physical exercise program during pregnancy which includes pelvic floor muscle training, improves health perception and it is effective on primary prevention of urinary incontinence.Keywords: physical exercise; pregnancy; health perception; urinary incontinence; quality of life.

scholarly journals Bladder cancer and exeRcise trAining during intraVesical thErapy—the BRAVE trial: a study protocol for a prospective, single-centre, phase II randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e055782
Author(s):  
Fernanda Z. Arthuso ◽  
Adrian S. Fairey ◽  
Normand G. Boulé ◽  
Kerry S. Courneya
Keyword(s):  
Bladder Cancer ◽  
Randomised Controlled Trial ◽  
Exercise Training ◽  
Patient Reported Outcomes ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Intravesical Therapy ◽  
Patient Reported ◽  
Health Related ◽  
Randomised Controlled

IntroductionNon-muscle invasive bladder cancer (NMIBC) accounts for about 75% of newly diagnosed bladder cancers. The treatment for NMIBC involves surgical removal of the tumour followed by 6 weekly instillations of immunotherapy or chemotherapy directly into the bladder (ie, intravesical therapy). NMIBC has a high rate of recurrence (31%–78%) and progression (15%). Moreover, bladder cancer and its treatment may affect patient functioning and quality of life. Exercise is a safe and effective intervention for many patient with cancer groups, however, no studies have examined exercise during intravesical therapy for NMIBC. The primary objective of the Bladder cancer and exeRcise trAining during intraVesical thErapy (BRAVE) trial is to examine the safety and feasibility of an exercise intervention in patients with bladder cancer undergoing intravesical therapy. The secondary objectives are to investigate the preliminary efficacy of exercise on health-related fitness and patient-reported outcomes; examine the social cognitive predictors of exercise adherence; and explore the potential effects of exercise on tumour recurrence and progression.Methods and analysisBRAVE is a phase II randomised controlled trial that aims to include 66 patients with NMIBC scheduled to receive intravesical therapy. Participants will be randomly assigned to the exercise intervention or usual care. The intervention consists of three supervised, high-intensity interval training sessions per week for 12 weeks. Feasibility will be evaluated by eligibility, recruitment, adherence and attrition rates. Preliminary efficacy will focus on changes in cardiorespiratory fitness and patient-reported outcomes from baseline (prior to intravesical therapy) to pre-cystoscopy (3 months). Cancer outcomes will be tracked at 3 months, and 1-year follow-up by cystoscopy. Analysis of covariance will compare between-group differences at post-intervention (pre-cystoscopy) for all health-related fitness and patient-reported outcomes.Ethics and disseminationThe study was approved by the Health Research Ethics Board of Alberta-Cancer Committee (#20–0184). Dissemination will include publication and presentations at scientific conferences and public channels.Trial registration numberNCT04593862; Pre-results.

scholarly journals Evaluating a Web- and Telephone-based Personalised Exercise Intervention for Individuals Living With Metastatic Prostate Cancer (Exerciseguide): Protocol for a Pilot Randomised Controlled Trial

2020 ◽  
Author(s):  
Holly EL Evans ◽  
Cynthia C Forbes ◽  
Daniel A Galvão ◽  
Corneel Vandelanotte ◽  
Robert U Newton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Behavioural Change ◽  
Controlled Study ◽  
Remote Supervision ◽  
Supervised Exercise ◽  
Randomised Controlled ◽  
Pilot Intervention

Abstract Introduction:Preliminary research has shown the effectiveness of supervised exercise-based interventions in alleviating sequela resulting from metastatic prostate cancer. Despite this, many individuals do not engage in sufficient exercise to gain the benefits. There are many barriers which limit the uptake of face-to-face exercise in this population including lack of suitable facilities, remoteness, access to experts, significant fatigue, urinary incontinence, and motivation. Technology-enabled interventions offer a distance-based alternative. This protocol describes a pilot two-armed randomised controlled study that will investigate the feasibility and preliminary efficacy of an online exercise and behavioural change tool (ExerciseGuide) among individuals with metastatic prostate cancer.Methods:Sixty-six participants with histologically diagnosed metastatic prostate cancer will be randomised into either the eight-week intervention or a wait-list control. The intervention arm will have access to a tailored website, remote supervision, and three tele-coaching sessions to enhance support and adherence. Algorithms will individually prescribe resistance and aerobic exercise based upon factors such as metastasis location, pain, fatigue, confidence, and current exercise levels. Behavioural change strategies and education on exercise benefits, safety and lifestyle are also tailored through the website. The primary outcome will be intervention feasibility (safety, usability, acceptability, adherence). Secondary exploratory outcomes include changes in physical activity, quality of life, sleep, and physical function. Outcomes will be measured at baseline and week 9.Discussion:The study aims to determine the potential feasibilityof an online remotely-monitored exercise intervention developed for individuals with metastatic prostate cancer. If feasible, this pilot intervention will inform the design and implementation of further distance-based interventions.Trial registration: ANZCTR, ACTRN12614001268639. Registered 10th December 2018, https://anzctr.org.au/ACTRN12618001979246.aspx

scholarly journals Evaluating a web- and telephone-based personalised exercise intervention for individuals living with metastatic prostate cancer (ExerciseGuide): protocol for a pilot randomised controlled trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Holly E. L. Evans ◽  
Cynthia C. Forbes ◽  
Daniel A. Galvão ◽  
Corneel Vandelanotte ◽  
Robert U. Newton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Behavioural Change ◽  
Trial Registration ◽  
Controlled Study ◽  
Link Type ◽  
Supervised Exercise ◽  
Randomised Controlled

Abstract Introduction Preliminary research has shown the effectiveness of supervised exercise-based interventions in alleviating sequela resulting from metastatic prostate cancer. Despite this, many individuals do not engage in sufficient exercise to gain the benefits. There are many barriers, which limit the uptake of face-to-face exercise in this population including lack of suitable facilities, remoteness, and access to experts, significant fatigue, urinary incontinence and motivation. Technology-enabled interventions offer a distance-based alternative. This protocol describes a pilot two-armed randomised controlled study that will investigate the feasibility and preliminary efficacy of an online exercise and behavioural change tool (ExerciseGuide) amongst individuals with metastatic prostate cancer. Methods Sixty-six participants with histologically diagnosed metastatic prostate cancer will be randomised into either the 8-week intervention or a wait-list control. The intervention arm will have access to a tailored website, remote supervision, and tele-coaching sessions to enhance support and adherence. Algorithms will individually prescribe resistance and aerobic exercise based upon factors such as metastasis location, pain, fatigue, confidence and current exercise levels. Behavioural change strategies and education on exercise benefits, safety and lifestyle are also tailored through the website. The primary outcome will be intervention feasibility (safety, usability, acceptability, and adherence). Secondary exploratory outcomes include changes in physical activity, quality of life, sleep, and physical function. Outcomes will be measured at baseline and week 9. Discussion The study aims to determine the potential feasibility of an online remotely monitored exercise intervention developed for individuals with metastatic prostate cancer. If feasible, this pilot intervention will inform the design and implementation of further distance-based interventions. Trial registration ANZCTR, ACTRN12614001268639. Registered 10 December 2018, https://anzctr.org.au/ACTRN12618001979246.aspx

scholarly journals i-Move, a personalised exercise intervention for patients with advanced melanoma receiving immunotherapy: a randomised feasibility trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e036059
Author(s):  
Amelia Hyatt ◽  
Karla Gough ◽  
Andrew Murnane ◽  
George Au-Yeung ◽  
Tamara Dawson ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Controlled Trial ◽  
Single Agent ◽  
Exercise Programme ◽  
Advanced Melanoma ◽  
Retention Rates ◽  
Feasibility Trial ◽  
Cancer Centre ◽  
Supervised Exercise ◽  
Patient Reported

IntroductionThere is increasing evidence demonstrating the benefits of exercise in counteracting cancer treatment-related fatigue. Immunotherapy is an established treatment for advanced melanoma, and is associated with fatigue in a third of patients. The safety and efficacy of exercise in counteracting treatment-related fatigue in patients with advanced melanoma receiving immunotherapy are yet to be determined. This study aims to assess the safety, adherence to and acceptability of a mixed-methods parallel-group, pilot randomised controlled trial of a personalised, 12-week semi-supervised exercise programme prescribed by an exercise physiologist (iMove) in 30 patients with stage IV melanoma scheduled to commence immunotherapy: single agent ipilimumab, nivolumab or pembrolizumab, or combination ipilimumab and nivolumab. The trial will be used to provide preliminary evidence of the potential efficacy of exercise for managing fatigue.Methods and analysisThirty participants will be recruited from a specialist cancer centre between May and September, 2019. Participants will be randomised 1:1 to receive iMove, or usual care (an information booklet about exercise for people with cancer). Feasibility data comprise: eligibility; recruitment and retention rates; adherence to and acceptability of exercise consultations, personalised exercise programme and study measures; and exercise-related adverse events. Patient-reported outcome measures assess potential impact of the exercise intervention on: fatigue, role functioning, symptoms and quality of life. Follow-up will comprise five time points over 24 weeks. Physical assessments measure physical fitness and functioning.Ethics and disseminationThis study was reviewed and approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/48927/PMCC-2019). The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with clinicians, media, government and consumers. In particular, we will promote the outcomes of this work among the oncology community should this pilot indicate benefit for patients.Trial registration numberACTRN12619000952145; Pre-results.

scholarly journals Evaluating a web- and telephone-based personalised exercise intervention for individuals living with metastatic prostate cancer (ExerciseGuide): protocol for a pilot randomised controlled trial

2020 ◽  
Author(s):  
Holly EL Evans ◽  
Cynthia C Forbes ◽  
Daniel A Galvão ◽  
Corneel Vandelanotte ◽  
Robert U Newton ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Behavioural Change ◽  
Controlled Study ◽  
Remote Supervision ◽  
Supervised Exercise ◽  
Randomised Controlled ◽  
Pilot Intervention

Abstract Introduction:Preliminary research has shown the effectiveness of supervised exercise-based interventions in alleviating sequela resulting from metastatic prostate cancer. Despite this, many individuals do not engage in sufficient exercise to gain the benefits. There are many barriers which limit the uptake of face-to-face exercise in this population including lack of suitable facilities, remoteness, access to experts, significant fatigue, urinary incontinence, and motivation. Technology-enabled interventions offer a distance-based alternative. This protocol describes a pilot two-armed randomised controlled study that will investigate the feasibility and preliminary efficacy of an online exercise and behavioural change tool (ExerciseGuide) among individuals with metastatic prostate cancer.Methods:Sixty-six participants with histologically diagnosed metastatic prostate cancer will be randomised into either the eight-week intervention or a wait-list control. The intervention arm will have access to a tailored website, remote supervision, and three tele-coaching sessions to enhance support and adherence. Algorithms will individually prescribe resistance and aerobic exercise based upon factors such as metastasis location, pain, fatigue, confidence, and current exercise levels. Behavioural change strategies and education on exercise benefits, safety and lifestyle are also tailored through the website. The primary outcome will be intervention feasibility (safety, usability, acceptability, adherence). Secondary exploratory outcomes include changes in physical activity, quality of life, sleep, and physical function. Outcomes will be measured at baseline and week 9.Discussion:The study aims to determine the potential feasibility of an online remotely-monitored exercise intervention developed for individuals with metastatic prostate cancer. If feasible, this pilot intervention will inform the design and implementation of further distance-based interventions.Trial registration: ANZCTR, ACTRN12614001268639. Registered 10th December 2018, https://anzctr.org.au/ACTRN12618001979246.aspxProtocol issue: Version 1 (9th March 2020).

scholarly journals OP0159 EFFICACY OF COMPREHENSIVE TECHNOLOGY-ASSISTED HOME-BASED EXERCISE IN ANKYLOSING SPONDYLITIS: A RANDOMIZED, CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Group Differences ◽  
Control Group ◽  
Home Based ◽  
The Mean

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared

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