Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-07T09:55:33.019Z Has data issue: false hasContentIssue false
  • English
  • Français

Do cognitively impaired patients benefit from rehabilitation?

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 February 2008

Lynn Poynter ,
Joseph Kwan ,
Avan Aihie Sayer  and
Michael Vassallo
Lynn Poynter*
Affiliation:
Royal Bournemouth Hospital and University of Southampton, UK
Joseph Kwan
Affiliation:
Royal Bournemouth Hospital and University of Southampton, UK
Avan Aihie Sayer
Affiliation:
Royal Bournemouth Hospital and University of Southampton, UK
Michael Vassallo
Affiliation:
Royal Bournemouth Hospital and University of Southampton, UK
*
Address for correspondence: Lynn Poynter, Royal Bournemouth Hospital, Castle Lane East Bournemouth, Dorset, BH7 7DW, UK.
Get access Rights & Permissions [Opens in a new window]

Extract

Rehabilitation in broad terms is a process aimed at restoring a person's functional capacity particularly in relation to activities of daily living. Studies have shown that hospitalization of older patients is a major risk factor for an often irreversible decline in function, and that functional decline from baseline occurs as early as day two of admission. Rehabilitation is therefore often required for older patients following an admission to an acute hospital. Older patients admitted for rehabilitation are more likely to be functionally impaired and are more medically complex than younger patients.

Type
Rehabilitation
Information
Reviews in Clinical Gerontology , Volume 18 , Issue 1 , February 2008 , pp. 53 - 64
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Cameron, ID, Kurrie, SE. Rehabilitation and older people. Med J Austr 2002; 177: 387–91.CrossRefGoogle ScholarPubMed
2Hoenig, H, Rubenstein, L. Hospital-associated deconditioning and dysfunction. (Editorial). J Am Soc Geriatr 1991; 39: 220–22.Google Scholar
3Creditor, M. Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118: 219–23.CrossRefGoogle ScholarPubMed
4Hirsch, C, Sommers, L, Olsen, A, Mullen, L, Winograd, C. The natural history of functional morbidity in hospitalized older patients. J Am Soc Geriatr 1990; 38: 1296–303.Google Scholar
5Knoefel, FD, Helliwell, B, Seabrook, JA et al. A comparison of the functional independence and medical complexity in geriatric and physical medicine and rehabilitation in-patients. Geriatr Today: J Can Geriatr Soc 2003; 6: 90–94Google Scholar
6Black, S, Rush, R. Cognitive and functional decline in adults aged 75 and older. J Am Geriatr Soc 2002; 50: 1978–86.CrossRefGoogle Scholar
7McIntosh-Michaelis, S, Roberts, M, Wilkinson, S et al. The prevalence of cognitive impairment in a community survey of multiple sclerosis. Br J Clin Psychol 1991; 30: 333–48.Google Scholar
8Landi, F, Russo, A, Barillaro, C et al. Physical activity and risk of cognitive impairment among older persons living in the community. Aging Clin Exp Res 2007; 19: 410–16.Google Scholar
9Cahill, S, Dooley, A. The historical context of rehabilitation and its application to dementia care. In Marshall, M ed. Perspectives on rehabilitation and dementia. London: Jessica Kingsley, 2005.Google Scholar
10Schuman, J, Beattie, E, Steed, D, Merry, G, Kraus, A. Geriatric patients with and without intellectual dysfunction: effectiveness of a standard rehabilitation program. Arch Phys Med Rehabil 1981; 62: 612–18.Google ScholarPubMed
11Billig, N, Ahmed, S, Kenmore, P, Amaral, D, Shakhashire, M. Assessment of depression and cognitive impairment after hip fracture. J Am Geriatr Soc 1986; 34: 499–503.Google Scholar
12Garrett, D, Cowdell, F. Physical rehabilitation for patients with dementia: reality and research – the missing links. CME Geriatr Med 2005; 7:38–44.Google Scholar
13Department of Health. National Service Framework for Older People. London. Department of Health, HMSO, 2001.Google Scholar
14Lindesay, J, Briggs, K, Murphy, E. The Guy's/Age Concern survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatry 1989; 155: 317–29.Google Scholar
15Audit Commission. Forget-me-not: mental health services for older people. London. Audit Commission 2000.Google Scholar
16Garcia, C, Tweedy, J, Blass, J. Underdiagnosis of cognitive impairment in a rehabilitation setting. J Am Geriatr Soc 1984; 32: 339–42.CrossRefGoogle Scholar
17Hinkka, K, Karppi, S, Aaltonen, T et al. A network-based geriatric rehabilitation programme: study design and baseline characteristics of the patients. Int J Rehabil Res 2006; 29: 97–103.Google Scholar
18Mast, B, Macneil, S, Lichtenberg, P. Geropsychological problems in medical rehabilitation: dementia and depression among stroke and lower-extremity fracture patients. J Gerontol Series A: Biol Sci Med Sci 1999; 54: M607–12.CrossRefGoogle ScholarPubMed
19Folstein, MF, Folstein SE, McHugh, PR. ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.Google Scholar
20Ruchinskas, R. Rehabilitation therapists recognition of cognitive and mood disorders in geriatric patients. Arch Phys Med Rehab 2002; 83: 609–12.Google Scholar
21Chodosh, J, Petitti, D, Elliott, M et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc 2004; 52: 1051–59.Google Scholar
22Bowler, C, Boyle, A, Branford, M. Detection of psychiatric disorders in elderly medical in-patients. Age Ageing 1994; 23: 307–11.Google Scholar
23Royall, D, Lauterbach, E, Kaufer, D et al. The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2007; 19: 249–65.CrossRefGoogle Scholar
24LaBuda, J, Lichtenberg, P. The role of cognition, depression and awareness of deficit in predicting geriatric rehabilitation patients IADL performance. Clin Neuropsychol 1999; 13: 258–67.CrossRefGoogle ScholarPubMed
25Mahoney, FI, Barthel, DW. Functional evaluation: the Barthel Index. Maryland State Med J 1965;14:61–65.Google ScholarPubMed
26Droes, R-M, Boelens-van der Knoop, E, Bos, J et al. An explorative study of variations in opinions among people with dementia and their professional caregivers and in literature. Dementia 2006; 5: 533–58.CrossRefGoogle Scholar
27Marengoni, A, Aguero-Torres, H, Timpini, A, Cossi, S, Fratiglioni, L. Rehabilitation and nursing-home admission after hospitalization for acute geriatric patients. J Am Med Dir Asssoc 2008; 9; 265–70.CrossRefGoogle ScholarPubMed
28Bellelli, G, Magnifico, F, Trabucchi, M. Outcomes at 12 months in a population of elderly patients discharged from a rehabilitation unit. J Am Med Dir Assoc 2008; 9: 55–64.CrossRefGoogle Scholar
29Rubenstein, L, Wieland, D et al. The Sepulveda VA Geriatric Rehabilitation Unit: data on 4-year outcomes and predictors of improved patient outcomes. J Am Geriatr Soc 1984; 32: 503–12.Google Scholar
30Friedman, PJ, Baskett, JJ, Richmond, DE. Cognitive jmpairment and its relationship to gait rehabilitation in the elderly. NZ Med J 1989; 102: 603–06.Google Scholar
31Caradoc-Davies, T. Medical profiles of patients admitted to a geriatric assessment and rehabilitation unit. NZ Med J 1987; 9: 557–59.Google Scholar
32Stahelin, H. Cognitive prerequisites of geriatric rehabilitation. Z Gerontol Geriatr 2000; 33: 24–27.Google Scholar
33Pomeroy, V, Warren, C, Honeycombe, C. Mobility and dementia: Is physiotherapy treatment during respite care effective? Int J Geriatr Psychiatry 1999; 14: 389–97.Google Scholar
34Resnick, B, Daly, M. Predictors of functional ability in geriatric rehabilitation patients. Rehabil Nurs 1998; 23: 21–29.CrossRefGoogle ScholarPubMed
35Landi, F, Bernabei, R, Russo, A et al. Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital. J Am Geriatr Soc 2002; 50: 679–84.Google Scholar
36Johnson, M, Kramer, A, Lin, M, Kowalsky, J, Steiner, J. Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke. J Am Geriatr Soc 2000; 48: 1389–97.Google Scholar
37Patrick, L, Leber, M, Johnstone, S. Aspects of cognitive status as predictors of mobility following geriatric rehabilitation. Aging (Milano) 1996; 8: 328–33.Google Scholar
38Coster, W, Haley, S, Jette, A, Tao, W, Siebens, H. Predictors of basic and instrumental activities of daily living performance in persons receiving rehabilitation services. Arch Phys Med Rehabil 2007; 88: 928–35.Google Scholar
39Gindin, J, Walter-Ginzburg, A, Geitzen, M et al. Predictors of rehabilitation outcomes: a comparison of Israeli and Italian geriatric postacute care (PAC) facilities using the minimum data set (MDS). J Am Med Dir Assoc 2007; 8: 233–42.Google Scholar
40Diamond, PT et al. Effect of cognitive impairment on rehabilitation outcome. Am J Phys Med Rehabil 1996; 75: 40–43.Google Scholar
41Heyn, P et al. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004; 85: 1694–704.Google Scholar
42Evans, F L, Sullivan-Marx, E. Functional outcomes for older adults with cognitive impairment in a comprehensive outpatient rehabilitation facility. J Nurs Schol J Am Geriatr Soc 2005; 53: 1599–606.Google Scholar
43Colombo, M, Guaita, A, Cottino, M et al. The impact of cognitive impairment on the rehabilitation process in geriatrics. Arch Gerontol Geriatr Suppl 2004; 9: 85–92.Google Scholar
44Resnick, B, Daly, MP. The effect of cognitive status on outcomes following rehabilitation. Fam Med 1997; 29: 400–05.Google ScholarPubMed
45Inagaki, T, Yamamoto, T, Nokura, K et al. Effect and prognosis of rehabilitation for cerebrovascular dementia in the elderly. Jpn J Geriatr 1990; 27: 33–39.Google Scholar
46Ghisla, MK, Cossi, S, Timpini, A, Baroni, F, Facchi, E, Marengoni, A. Predictors of successful rehabilitation in geriatric patients: a subgroup analysis of patients with cognitive impairment. Ageing Clin Exp Res 2007; 19: 417–23.Google Scholar
47Cartwright, DL, Madill, HM, Dennis, S. Cognitive impairment and functional performance of patients admitted to a geriatric assessment and rehabilitation centre. Phys Occ Ther Geriatr 1996; 14: 1–21.CrossRefGoogle Scholar
48Raj, G, Munir, J, Ball, L, Carr, D. An inpatient rehabilitation service for deconditioned older adults. Top Geriatr Rehabil Funct Cogn 2007; 23: 126–36.Google Scholar
49Meinck, M, Freigang, K, John, B, Keitel, C, Puls, E, Robra, B. Outpatient geriatric rehabilitation: an evaluation of two models assessing trends of medical outcomes. Die Rehabil 2003; 42: 45–51.Google Scholar
50Hershkovitz, A, Brill, S. The association between patient's cognitive status and rehabilitation outcome in a geriatric day hospital. Disabil Rehabil 2007; 29: 333–37.Google Scholar
51Yu, F, Richmond, T. Factors affecting outpatient rehabilitation outcomes in elders. J Nurs Schol 2005: 37: 229–36.Google Scholar
52Zekry, D, Herrmann, F, Grandjean, R et al. Demented versus non-demented very old inpatients: the same co-morbidities but poorer functional and nutritional status. Age Ageing 2008; 37: 83–89.Google Scholar
53Barnes, C, Conner, D, Legault, L, Reznickova, N, Harrison-Felix, C. Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community. Arch Phys Med Rehabil 2004; 85: 1602–07.Google Scholar
54Watanabe, Y. The long-term effect of day centre rehabilitation on individuals with dementia. Hokkaido Igaku Zasshi 1996; 71: 391–402.Google Scholar
55Nagaya, M, Endo, H, Kachi, T, Abe, Y, Ota, T. Recreational rehabilitation improved cognitive function in vascular dementia. J Am Geriatr Soc 2005; 53: 911–12.CrossRefGoogle ScholarPubMed
56Londos, E, Boschian, K, Linden, A, Persson, C, Minthon, L, Lexell, J. Effects of a goal-orientated rehabilitation program in mild cognitive impairment: a pilot study. Am J Alzheimer Dis other dementias 2008; 23: 177–83.Google Scholar
57Heyn, P, Johnson, K, Kramer, A. Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis. The J Nutr Health Ageing 2008; 12: 401–09.Google Scholar
58Baldelli, M, Boiardi, R, Ferrari, P, Bianchi, S, Bianchi, M. Dementia and occupational therapy. Arch Gerontol Geriatr 2007; 44: 45–48.CrossRefGoogle ScholarPubMed
59Davies, A, Gargaro, P, Dodd, A, Smith, C. Mental status and occupational therapy outcome in teaching dressing skills to the disabled elderly. Clin Rehabil 1989; 3:293–98.Google Scholar
60Graff, M, Vernooij-Dassen, M, Marjolein, et al. Effects of community occupational therapy on quality of life, mood and health status in dementia patients and their caregivers: a randomized control trial. J Gerontol Series A: Biol Sci Med Sci 2007; 62: 1002–09.Google Scholar
61Stott, D, Buttery, A, Bowman, A et al. Comprehensive geriatric assessment and home-based rehabilitation for elderly people with a history of recurrent non-elective hospital admissions. Age Ageing 2006; 35: 487–91.Google Scholar
62Ballard, C, Shaw, F, Lowery, K, McKeith, I, Kenney, R. The prevalence, assessment and association of falls in dementia with Lewy bodies and Alzheimer's disease. Dement Cogn Disord 1999; 10: 97–103.Google Scholar
63Gruber-Baldini, A, Zimmerman, S, Morrison, R et al. Cognitive impairment in hip- fracture patients: timing of detection and longitudinal follow up. J Am Geriatr Soc 2003; 51:1227–36.Google Scholar
64Goldstein, C, Strasser, D, Woodard, J, Roberts, V. Functional outcome of cognitively impaired hip-fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc 1997; 45: 35–42.Google Scholar
65Millis, S, Lichtenberg, P, Dijkers, M. Predicting bowel and bladder continence from cognitive status in geriatric rehabilitation patients. Arch Phys Med Rehabil 1994; 75: 590–93.Google Scholar
66Heruti, R, Lusky, A et al. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil 1999; 80: 432–36.CrossRefGoogle ScholarPubMed
67Lenze, E, Muni, M et al. Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture.Int J Geriatr Psychiatry 1994; 19: 472–78.CrossRefGoogle Scholar
68Mossey, J, Mutran, E et al. Determinants of recovery 12 months after hip fracture. The importance of psychological factors. Am J Pub Health 1989; 79: 279–86.Google Scholar
69Dorra, HH, Lenze, EJ, Yookyung, K et al. . Clinically relevant behaviours in hip fracture in elderly patients. Int J Psychiatry Med 2002; 32: 249–59.Google Scholar
70Beaupre, LA, Cinats, JG, Jones, CA et al. Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community? J Gerontol Series A: Biol Sci Med Sci 2007; 62A: 1127–33.Google Scholar
71Hakkinen, A, Heinonen, M, Kautiainen, H, Huusko, T, Sulkava, R, Karppi, P. Effect of cognitive impairment on basic activities of daily living in hip fracture patients: at 1-year follow-up. Ageing Clin Exp Res 2007; 19: 139–44.CrossRefGoogle Scholar
72Bellelli, G, Frisoni, GB, Pagani, M, Magnifico, F, Trabucchi, M. Does cognitive performance affect physical therapy regimen after hip fracture surgery? Ageing Clin Exp Res 2007; 19: 119–24.Google Scholar
73Magaziner, J, Simonsick, EM, Kashner, TM, Hebel, JR, Kenzora, JE. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 1990; 45: M101–M107.Google Scholar
74Parker, MJ, Palmer, CR. Prediction of rehabilitation after hip fracture. Age Ageing 1995; 24: 96–98.Google Scholar
75Rydholm-Hedman, AM, Grafstrom, M. Conditions for rehabilitation of older patients with dementia and hip fracture– the perspective of their next of kin. Scand J Caring Sci 2001; 15: 151–58.Google Scholar
76Givens, J, Sanft, T, Marcantonio, E. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment and delirium. J Am Geriatr Soc 2008; 56: 1075–79.Google Scholar
77Hershkovitz, A, Kalandariov, Z, Hermush, V, Weiss, R, Brill, S. Factors affecting the short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil 2007; 88: 916–21.Google Scholar
78Svensson, O, Stromberg, L, Ohlen, G, Lindgren, U. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg 1996; 78: 115–18.Google Scholar
79Lieberman, D, Fried, D, Castel, H, Weitzman, S, Lowenthal, M, Galinsky, D. Factors related to successful rehabilitation after hip fracture: a case control study. Disabil Rehabil 1996; 5: 224–30.Google Scholar
80Ensberg, MD, Paletta, MJ, Galecki, AT, Dacko, CL, Fries, BE. Identifying elderly patients for early discharge after hospitalization for hip fracture. J Gerontol Med Sci 1993; 48: M187–M195.Google Scholar
81McCracken, AL, Gilster, SD. Outcomes of people with a fractured hip and dementia who reside in a specialized nursing home. Top Geriatr Rehabil 1995; 11: 2029.Google Scholar
82McGilton, K, Wells, J, Davis, A et al. Rehabilitating patients with dementia who have had a hip fracture. Part II: Cognitive symptoms that influence care. Top Geriatr Rehabil Funct Cogn 2007; 23: 174–82.Google Scholar
83Huusko, TM et al. Randomised, clinically controlled trial of extensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000; 321:1107–1111.Google Scholar
84Lenze, E, Skidmore, E et al. Does depression, apathy or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip-fracture patients? Gen Hosp Psychiatry 2007; 29: 141–46.Google Scholar
85Rolland, Y, Pillard, F, Lauwers-Cances, V, Busquere, F, Vellas, B, Lafont, C. Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment. Disabil Rehabil 2004; 26: 425–31.Google Scholar
86Goldstein, FC, Strasser, DC, Woodard, JL, Roberts, VJ. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc 1997; 45: 1406–07.Google Scholar
87Beloosesky, Y, Grinblat, J, Epelboym, B, Hendel, D. Dementia does not significantly affect complications and functional gain in elderly patients operated on for intracapsular hip fracture. Arch Orthopaed Trauma Surg 2001; 121: 257–60>.Google Scholar
88Hamman, R. Rehabilitation following hip fracture in patients with Alzheimer's disease and related disorders. Am J Alzheimer's Dis 1997; 12: 209–11.Google Scholar
89Schulz, M. Intensive geriatric rehabilitation reduced hospital stay and time to independent living in hip-fracture patients with mild to moderate dementia. Evid Based Nurs 2001; 4: 54.Google Scholar
90Logters, T, Hakimi, M, Linhart, W et al. Early interdisciplinary geriatric rehabilitation after hip fracture: Effective concept or just transfer of costs? Der Unfallchirurg 2008 (in press).Google Scholar
91Barnes, B. Ambulation outcomes after hip fracture. Phys Ther 1984; 64: 317–20.Google Scholar
92Giusti, A, Barone, A, Pioli, G. Rehabilitation after hip fracture in patients with dementia. J Am Geriatr Soc 2007; 55: 1309–10.Google Scholar
93Hegener, K, Krause, T, von Renteln-Kruse, W. Patient characteristics and factors associated with unfavourable in-hospital rehabilitation therapy outcome in very old geriatric patients with first-ever ischemic stroke: a retrospective case-control study. Z Gerontol Geriatrie 2007; 40: 457–62.Google Scholar
94Becker, G, Kruse, A, Tronnier, J et al. Rehabilitation processes and sustainability–first results of a rehabilitation study of geriatric stoke patients. Z Gerontol Geriatrie 2006; 39: 365–70.Google Scholar
95Milinaviciene, E, Rastenyte, D, Krisciunas, A. Factors influencing the functional state recovery in cerebral stroke patients during the second rehabilitation stage. Medicina (Kaunas) 2008; 44: 500–09.Google Scholar
96Lehman, J, DeLateur, B, Fowler, R et al. Stroke rehabilitation: outcome and prediction. Arch Phys Med Rehab 1975; 56: 383–89.Google Scholar
97Zinn, S, Dudley, T, Bosworth, H, Hoenig, H, Duncan, P, Horner, R. The effect of post-stroke cognitive impairment on rehabilitation process and functional outcome. Arch Phys Med Rehab 2004; 85: 1084–90.Google Scholar
98Heruti, R, Lusky, A, Dankner, R et al. Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome. Arch Phys Med Rehab 2002; 83: 742–49.Google Scholar
99Patel, M, Coshall, C, Rudd, A, Wolfe, C. Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes. J Am Geriatr Soc 2002; 50: 700–06.Google Scholar
100Schut, L. Dementia following stroke. Clin Geriatr Med 1988; 4: 767–84.Google Scholar
101Galski, T, Bruno, R, Zorowitz, R, Walker, J. Predicting length of stay, functional outcome and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition. Stroke 1993; 24: 1794–1800.Google Scholar
102Saxena, S, Ng, T, Yong, D, Fong, N, Koh, G. Sub-threshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation. Acta Neurol Scand 2008; 117: 133–40.Google Scholar
103Saxena, S. Prevalence and correlates of cognitive impairment in stroke patients in a rehabilitation setting. Int J Psychosoc Rehabil 2006; 10:37–47.Google Scholar
104Nas, K, Gur, A, Cevik, R, Sarac, A. The relationship between physical impairment and disability during stroke rehabilitation: effect of cognitive status. Int J Rehabil Res 2004; 27: 181–84.CrossRefGoogle ScholarPubMed
105Rabadi, M, Rabadi, F, Edelstein, L, Peterson, M. Cognitively impaired stroke patients do benefit from admission to an acute rehabilitation unit. Arch Phys Med Rehab 2008; 89: 441–48.Google Scholar
106Dalwood, N, Morris, M, Stillman, B. Relationship between cognitive impairment and physical function in acute stroke patients without communication deficits. Physiother Singapore 2005; 8:13–17.Google Scholar
107Paradee, C, Rapport, L, Hanks, R, Levy, J. Circadian preference and cognitive functioning among rehabilitation inpatients. Clin Neuropsychol 2005; 19: 55–72.CrossRefGoogle ScholarPubMed