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B
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C
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:
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Ma
n
af
C
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Ph
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Stu
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Facu
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s
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9
4
@
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.
ed
u
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
Hig
h
-
lev
el
m
o
b
ilit
y
(
HL
M)
e
n
co
m
p
ass
es
co
m
p
lex
m
o
v
em
en
ts
s
u
ch
as
r
u
n
n
in
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,
ju
m
p
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,
an
d
s
tair
clim
b
in
g
,
wh
ich
ex
ten
d
b
e
y
o
n
d
b
asic
walk
in
g
an
d
ar
e
cr
u
cial
f
o
r
d
aily
ac
tiv
ities
lik
e
cr
o
s
s
in
g
s
tr
ee
ts
,
m
an
ag
in
g
h
o
u
s
eh
o
ld
c
h
o
r
es,
ch
ild
ca
r
e,
an
d
f
aster
m
o
v
em
e
n
t
d
u
r
i
n
g
tr
a
n
s
p
o
r
tatio
n
[
1
]
.
T
h
ese
s
k
ills
ar
e
also
ess
en
tial
f
o
r
p
ar
ticip
atin
g
in
l
eisu
r
e
ac
ti
v
ities
,
en
g
ag
in
g
in
ac
tiv
e
s
p
o
r
ts
,
an
d
m
ain
tain
in
g
em
p
lo
y
a
b
ilit
y
[
2
]
,
[
3
]
.
HL
M
p
lay
s
a
k
ey
r
o
le
in
r
ein
teg
r
atin
g
in
d
iv
id
u
als
in
to
co
m
m
u
n
ity
life
an
d
s
u
s
tain
in
g
p
h
y
s
ical
ac
tiv
ity
th
at
ca
n
p
r
ev
e
n
t
lo
n
g
-
ter
m
h
ea
lth
d
ec
lin
e.
Desp
ite
its
s
ig
n
if
ican
ce
,
HL
M
is
f
r
eq
u
e
n
tly
o
v
er
lo
o
k
ed
i
n
r
eh
ab
ilit
atio
n
p
r
o
g
r
am
s
,
wh
ic
h
o
f
ten
p
r
io
r
itize
lo
wer
-
lev
el
m
o
b
ilit
y
s
k
ills
l
ik
e
b
e
d
m
o
b
ilit
y
,
tr
an
s
f
er
s
,
an
d
b
asic
walk
in
g
[
4
]
.
W
h
ile
m
u
c
h
o
f
th
e
r
esear
ch
an
d
clin
ical
f
o
cu
s
h
as
b
ee
n
o
n
im
p
r
o
v
in
g
g
ait
a
n
d
b
alan
ce
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
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8
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
1
8
9
-
1
2
0
0
1190
th
er
e
is
lim
ited
atten
tio
n
o
n
h
o
w
th
ese
g
ain
s
tr
an
s
late
in
to
ad
v
an
ce
d
m
o
b
ilit
y
s
k
ills
[
1
]
,
l
ea
v
in
g
a
g
a
p
in
th
e
ev
id
en
ce
n
ee
d
ed
to
g
u
id
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ef
f
e
ctiv
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r
eh
ab
ilit
atio
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f
o
r
tr
au
m
atic
b
r
ain
in
ju
r
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(
T
B
I
)
s
u
r
v
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s
.
Sev
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s
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d
ies
em
p
h
asize
th
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im
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o
r
tan
ce
o
f
HL
M
f
o
r
f
u
ll
p
ar
ticip
atio
n
in
life
,
in
clu
d
in
g
wo
r
k
a
n
d
s
o
cial
r
ein
t
eg
r
atio
n
.
Sp
e
n
ce
r
e
t
a
l.
[
1
]
r
ev
iewe
d
HL
M
t
r
ain
i
n
g
in
in
d
iv
id
u
als
with
n
e
u
r
o
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o
g
ical
im
p
air
m
en
ts
,
in
clu
d
in
g
T
B
I
.
T
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f
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at
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ile
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tio
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tar
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g
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e
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en
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f
icial,
m
o
r
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well
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d
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s
tu
d
ies
with
lar
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s
am
p
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s
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to
co
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f
ir
m
th
ese
f
in
d
in
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s
.
T
h
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r
k
h
ig
h
lig
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th
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n
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d
f
o
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f
u
r
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er
r
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to
b
etter
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tan
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th
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p
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d
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s
o
f
HL
M
an
d
th
e
ef
f
ec
tiv
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f
d
i
f
f
er
en
t
r
e
h
ab
ilit
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s
tr
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Ker
s
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et
a
l.
[
2
]
also
n
o
ted
th
at
HL
M
p
lay
s
a
cr
itical
r
o
le
in
co
m
m
u
n
ity
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teg
r
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f
o
r
in
d
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with
T
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,
em
p
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asizin
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th
at
it
is
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t
m
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p
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ical
m
iles
to
n
e
b
u
t
a
v
ital
f
ac
to
r
f
o
r
s
o
cial
an
d
f
u
n
ctio
n
al
r
ec
o
v
er
y
.
Ho
wev
e
r
,
th
e
v
ar
io
u
s
p
er
s
o
n
al,
e
n
v
ir
o
n
m
en
tal,
an
d
in
ju
r
y
-
r
elate
d
f
ac
to
r
s
th
at
af
f
ec
t
HL
M
o
u
tco
m
es
r
em
ain
p
o
o
r
ly
u
n
d
er
s
to
o
d
,
m
ak
i
n
g
p
er
s
o
n
alize
d
r
eh
a
b
ilit
atio
n
p
lan
s
ch
allen
g
in
g
.
Mo
r
e
r
ec
en
tly
,
Gallo
w
et
a
l.
[
4
]
e
x
p
lo
r
ed
wh
en
in
d
iv
id
u
als with
T
B
I
ca
n
s
af
ely
r
esu
m
e
HL
M
ac
tiv
ities
.
T
h
eir
s
tu
d
y
r
ev
ea
led
th
e
ab
s
en
ce
o
f
clea
r
g
u
id
elin
es,
lea
v
in
g
clin
ician
s
u
n
ce
r
tain
a
b
o
u
t
h
o
w
a
n
d
w
h
en
to
in
co
r
p
o
r
at
e
HL
M
in
to
r
eh
a
b
ilit
atio
n
.
T
h
is
h
ig
h
lig
h
ts
th
e
n
ee
d
f
o
r
m
o
r
e
r
esear
c
h
to
d
ev
elo
p
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
f
ac
to
r
s
i
n
f
lu
en
cin
g
HL
M
in
T
B
I
r
ec
o
v
er
y
.
T
h
is
h
i
g
h
lig
h
ts
th
e
n
ee
d
f
o
r
m
o
r
e
r
esear
ch
t
o
d
ev
elo
p
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
f
ac
to
r
s
in
f
lu
en
cin
g
HL
M
in
T
B
I
r
ec
o
v
er
y
.
Giv
en
th
ese
g
ap
s
,
th
is
s
co
p
in
g
r
ev
iew
a
d
d
r
ess
es
th
e
f
o
llo
win
g
r
esear
ch
q
u
est
io
n
:
W
h
at
ar
e
th
e
k
ey
f
ac
to
r
s
in
f
lu
en
ci
n
g
h
ig
h
-
lev
el
m
o
b
ilit
y
o
u
tco
m
es in
in
d
iv
id
u
als with
T
B
I
?
B
u
ild
in
g
o
n
th
ese
in
s
ig
h
ts
,
th
is
s
co
p
in
g
r
ev
iew
aim
s
to
in
v
esti
g
ate
th
e
f
ac
to
r
s
th
at
af
f
ec
t
HL
M
in
in
d
iv
id
u
als
with
T
B
I
.
W
h
ile
p
r
ev
io
u
s
s
tu
d
ies
h
av
e
ac
k
n
o
w
led
g
ed
th
e
im
p
o
r
tan
ce
o
f
HL
M,
th
er
e
r
em
ain
s
a
lack
o
f
clar
ity
o
n
th
e
k
ey
f
ac
t
o
r
s
th
at
in
f
lu
en
ce
m
o
b
ilit
y
o
u
tco
m
es.
A
p
r
elim
in
ar
y
s
ea
r
ch
o
f
m
ed
ical
liter
atu
r
e
an
aly
s
is
an
d
r
etr
iev
al
s
y
s
tem
o
n
lin
e
(
ME
DL
I
NE
)
,
th
e
C
o
ch
r
an
e
d
atab
ase
o
f
s
y
s
tem
atic
r
e
v
iews
,
an
d
J
o
an
n
a
B
r
ig
g
s
I
n
s
titu
te
(
JBI
)
E
v
id
e
n
ce
Sy
n
th
esis
r
ev
ea
led
n
o
cu
r
r
en
t
o
r
o
n
g
o
in
g
s
co
p
i
n
g
r
ev
i
ews
o
n
th
is
to
p
ic.
T
h
er
ef
o
r
e,
th
is
s
co
p
in
g
r
ev
ie
w
s
ee
k
s
to
f
il
l
th
ese
g
ap
s
b
y
s
y
s
tem
atica
lly
ex
p
lo
r
in
g
th
e
f
ac
to
r
s
in
f
lu
en
cin
g
HL
M
in
in
d
iv
i
d
u
als
with
T
B
I
an
d
i
d
en
t
if
y
in
g
th
e
o
u
tco
m
e
m
ea
s
u
r
es
u
s
ed
to
e
v
alu
ate
HL
M
in
r
eh
a
b
ilit
atio
n
s
ettin
g
s
.
T
h
is
r
ev
iew
aim
s
to
c
o
n
tr
ib
u
te
to
th
e
f
ield
in
two
s
ig
n
if
ican
t w
ay
s
: f
ir
s
t,
b
y
illu
m
in
atin
g
th
e
co
m
p
lex
in
ter
ac
tio
n
s
b
etwe
en
f
ac
to
r
s
t
h
at
in
f
lu
e
n
ce
HL
M
o
u
tco
m
es
in
T
B
I
,
an
d
s
ec
o
n
d
,
b
y
p
r
o
p
o
s
in
g
f
u
tu
r
e
r
esear
ch
d
ir
ec
tio
n
s
an
d
r
eh
a
b
ilit
atio
n
s
tr
ateg
ies.
Ultim
ately
,
th
ese
f
in
d
in
g
s
will
ass
i
s
t
clin
ician
s
an
d
r
esear
ch
er
s
in
o
p
tim
izin
g
r
e
h
ab
ilit
atio
n
ap
p
r
o
ac
h
es f
o
r
i
n
d
iv
id
u
als with
T
B
I
,
ad
v
an
cin
g
th
e
f
ield
o
f
n
eu
r
o
r
eh
ab
ilit
atio
n
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
Giv
en
th
e
lim
ited
r
esear
ch
av
ailab
le
o
n
HL
M
in
T
B
I
,
a
s
c
o
p
in
g
r
ev
iew
was
ch
o
s
en
to
ex
p
lo
r
e
th
e
ex
is
tin
g
liter
atu
r
e,
id
en
tify
p
atter
n
s
,
an
d
h
ig
h
lig
h
t
ar
ea
s
th
at
n
ee
d
f
u
r
th
e
r
s
tu
d
y
.
T
h
is
r
ev
iew
f
o
llo
wed
a
s
tr
u
ctu
r
ed
ap
p
r
o
ac
h
u
s
in
g
t
h
e
P
r
ef
er
r
ed
R
ep
o
r
tin
g
I
tem
s
f
o
r
Sy
s
tem
atic
R
ev
iews
a
n
d
Me
ta
-
An
aly
s
es
ex
ten
s
io
n
f
o
r
Sco
p
in
g
R
ev
iews
(
PR
I
SM
A
-
ScR
)
ch
ec
k
lis
t
[
5
]
.
Ad
d
itio
n
ally
,
to
f
u
r
th
e
r
e
n
s
u
r
e
tr
an
s
p
ar
e
n
cy
an
d
ac
co
u
n
tab
ilit
y
,
th
e
r
ev
iew
p
r
o
to
co
l
was
r
e
g
is
ter
ed
with
th
e
o
p
en
s
cien
ce
f
r
am
ewo
r
k
(
OSF)
(
h
ttp
s
://o
s
f
.
io
/x
m
z8
j
)
[
6
]
.
T
h
e
r
ev
iew
was
co
n
d
u
cted
i
n
f
o
u
r
k
e
y
s
tag
es:
i
)
d
eter
m
in
e
s
ea
r
ch
s
tr
ateg
y
,
ii
)
s
p
ec
if
y
elig
ib
ilit
y
cr
iter
ia
,
iii
)
s
tu
d
y
s
elec
tio
n
,
an
d
iv
)
d
ata
c
h
ar
tin
g
an
d
ex
tr
ac
tio
n
.
2
.
2
.
Sea
rc
h str
a
t
eg
y
An
ex
ten
s
iv
e
s
ea
r
ch
was
c
o
n
d
u
cted
ac
r
o
s
s
f
iv
e
m
ajo
r
d
ata
b
ases
:
Sco
p
u
s
,
W
eb
o
f
Scien
ce
(
W
o
S),
C
o
ch
r
an
e
L
ib
r
a
r
y
,
Scien
ce
Di
r
ec
t
,
an
d
Pu
b
Me
d
.
T
h
is
co
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
ai
m
ed
to
ca
p
tu
r
e
all
r
elev
an
t
s
tu
d
ies o
n
HL
M
in
in
d
iv
i
d
u
als with
T
B
I
.
No
d
ate
r
estrictio
n
s
wer
e
ap
p
lied
,
r
ec
o
g
n
izin
g
th
e
lim
ited
am
o
u
n
t
o
f
r
esear
ch
s
p
ec
if
ically
ad
d
r
ess
in
g
HL
M
in
T
B
I
p
o
p
u
latio
n
s
an
d
en
s
u
r
in
g
all
p
er
tin
en
t
e
v
i
d
en
ce
was
in
clu
d
ed
.
Me
d
ical
Su
b
ject
Hea
d
in
g
s
(
Me
SH)
ter
m
s
f
r
o
m
th
e
C
o
ch
r
an
e
D
atab
ase
wer
e
u
tili
ze
d
to
ac
co
u
n
t
f
o
r
all
po
s
s
ib
le
s
y
n
o
n
y
m
s
,
an
d
B
o
o
lean
o
p
er
ato
r
s
(
AND,
OR
)
wer
e
u
s
ed
to
co
m
b
in
e
s
ea
r
c
h
ter
m
s
ef
f
ec
tiv
ely
.
Qu
o
tatio
n
m
a
r
k
s
wer
e
a
p
p
lied
ar
o
u
n
d
s
p
ec
i
f
ic
p
h
r
ases
,
an
d
p
ar
en
th
eses
wer
e
u
s
ed
to
g
r
o
u
p
s
im
ilar
co
n
ce
p
ts
.
T
h
e
p
r
im
ar
y
s
ea
r
ch
ter
m
s
i
n
clu
d
ed
(
“
tr
a
u
m
atic
b
r
ain
i
n
ju
r
y
*
”
OR
“
T
B
I
*
”
O
R
“
b
r
ain
tr
au
m
a*
”
OR
“
tr
au
m
atic
en
ce
p
h
alo
p
ath
y
*
”
)
AND
(
“
h
ig
h
-
lev
el
m
o
b
ilit
y
”
)
.
A
d
etailed
lis
t
o
f
th
e
s
ea
r
ch
q
u
er
ies
an
d
th
e
n
u
m
b
er
o
f
a
r
ticles r
etr
iev
ed
f
r
o
m
ea
ch
d
atab
ase
is
p
r
o
v
id
e
d
in
T
ab
le
1
.
2
.
3
.
E
lig
ibi
lity
cr
it
er
ia
T
o
en
s
u
r
e
th
e
r
e
v
iew
f
o
cu
s
ed
o
n
h
ig
h
-
q
u
ality
r
esear
ch
,
s
p
ec
i
f
ic
in
clu
s
io
n
an
d
e
x
clu
s
io
n
cr
i
ter
ia
wer
e
s
et.
T
h
e
r
e
v
iew
in
clu
d
ed
s
tu
d
ies
in
v
o
lv
in
g
p
e
o
p
le
with
T
B
I
,
r
e
g
ar
d
less
o
f
th
e
s
ev
er
ity
,
a
s
lo
n
g
as
th
e
s
tu
d
y
lo
o
k
ed
at
f
ac
to
r
s
o
r
p
r
e
d
icto
r
s
af
f
ec
tin
g
HL
M
an
d
u
s
ed
at
least
o
n
e
p
er
f
o
r
m
an
ce
-
b
ased
o
u
tco
m
e
m
ea
s
u
r
e
.
Ob
s
er
v
atio
n
al
s
tu
d
ies,
lik
e
co
h
o
r
t,
ca
s
e
-
co
n
tr
o
l,
an
d
c
r
o
s
s
-
s
ec
tio
n
al
d
esig
n
s
,
wer
e
also
co
n
s
id
er
ed
.
Me
an
wh
ile,
ar
ticles
with
o
u
t
f
u
ll
tex
t,
th
o
s
e
n
o
t
in
E
n
g
lis
h
,
in
ter
v
en
tio
n
s
tu
d
ies,
an
d
r
esear
ch
th
at
o
n
ly
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
F
a
cto
r
s
imp
a
ctin
g
h
ig
h
-
leve
l
mo
b
ilit
y
in
tr
a
u
ma
tic
b
r
a
in
in
j
u
r
y:
a
s
co
p
in
g
r
ev
iew
…
(
S
ya
z
lin
A
z
mi
)
1191
v
al
id
ated
o
u
tco
m
e
m
ea
s
u
r
es
with
o
u
t
r
ep
o
r
tin
g
ac
tu
al
p
e
r
f
o
r
m
an
ce
d
ata
wer
e
e
x
clu
d
ed
.
I
n
ter
v
en
tio
n
s
tu
d
ies
wer
e
ex
clu
d
e
d
b
ec
au
s
e
th
e
ai
m
was
to
id
en
tify
f
ac
to
r
s
im
p
ac
tin
g
HL
M,
r
at
h
er
th
a
n
ass
ess
th
e
ef
f
icac
y
o
f
s
p
ec
if
ic
tr
ea
tm
en
ts
.
Similar
ly
,
s
tu
d
ies
f
o
cu
s
ed
o
n
v
alid
atin
g
o
u
tc
o
m
e
m
ea
s
u
r
es
with
o
u
t
p
er
f
o
r
m
a
n
ce
d
ata
wer
e
ex
clu
d
ed
to
e
n
s
u
r
e
th
e
r
ev
iew
co
n
ce
n
tr
ated
o
n
r
ea
l
-
w
o
r
ld
p
er
f
o
r
m
a
n
ce
o
u
tco
m
es.
Seco
n
d
ar
y
s
o
u
r
ce
s
,
s
u
ch
as r
ev
iews o
r
b
o
o
k
c
h
ap
t
er
s
,
wer
e
also
lef
t o
u
t to
f
o
cu
s
o
n
o
r
i
g
in
al,
r
elev
a
n
t f
in
d
i
n
g
s
r
elate
d
to
HL
M.
T
ab
le
1
.
Sear
ch
q
u
er
ies u
s
ed
i
n
th
e
s
co
p
in
g
r
ev
iew
o
f
f
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r
s
im
p
ac
tin
g
HL
M
am
o
n
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B
I
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t
a
b
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e
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c
e
p
t
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t
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c
o
p
u
s
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TI
TLE
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A
B
S
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EY
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b
r
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r
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ma
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h
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l
e
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m
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38
W
e
b
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f
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e
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=
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27
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54
#2
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b
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h
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[
T
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A
b
s
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“
T
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I
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[
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[
Ti
t
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5
5
,
3
3
8
#2
“
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[
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(
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1
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2
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]
31
To
t
a
l
1
0
9
2
.
4
.
Study
s
elec
t
io
n
Fo
llo
win
g
th
e
PR
I
SMA
-
ScR
g
u
id
elin
es,
th
e
s
ea
r
ch
s
tr
ateg
y
co
m
p
r
is
ed
f
o
u
r
k
ey
s
tag
es:
id
en
tific
atio
n
,
s
cr
ee
n
in
g
,
elig
ib
ilit
y
,
an
d
in
clu
s
io
n
,
as
d
ep
icted
in
Fig
u
r
e
1
.
T
h
e
in
itial
s
ea
r
ch
ac
r
o
s
s
f
iv
e
d
atab
ases
y
ield
ed
a
to
tal
o
f
1
0
9
a
r
ticles.
Af
ter
th
e
r
em
o
v
al
o
f
6
8
d
u
p
licates,
4
1
r
ec
o
r
d
s
p
r
o
ce
ed
e
d
to
t
h
e
s
cr
ee
n
in
g
s
tag
e.
T
w
o
in
d
e
p
en
d
en
t
r
ev
iewe
r
s
ass
ess
ed
th
e
titl
es
an
d
ab
s
tr
ac
ts
o
f
t
h
ese
ar
t
icles
to
d
eter
m
in
e
th
eir
r
elev
an
ce
,
lead
in
g
t
o
th
e
ex
clu
s
io
n
o
f
an
a
d
d
itio
n
al
s
e
v
en
ar
ticles.
A
to
tal
o
f
3
4
f
u
l
l
-
tex
t
ar
ticles
wer
e
th
en
ass
ess
ed
f
o
r
elig
ib
ilit
y
.
Fo
llo
win
g
th
is
m
o
r
e
th
o
r
o
u
g
h
r
ev
iew,
2
6
ar
ticles
wer
e
ex
clu
d
ed
b
ased
o
n
th
e
p
r
e
-
estab
lis
h
ed
cr
iter
ia.
R
ea
s
o
n
s
f
o
r
ex
clu
s
io
n
in
cl
u
d
ed
ar
tic
les
n
o
t
in
E
n
g
lis
h
,
ar
ticles
lack
in
g
f
u
ll
tex
t
(
e.
g
.
,
ab
s
tr
ac
ts
o
r
ed
ito
r
ials
)
,
a
n
d
s
t
u
d
ies
f
o
cu
s
ed
s
o
lely
o
n
v
alid
a
tin
g
o
u
tc
o
m
e
m
ea
s
u
r
es.
Fin
all
y
,
eig
h
t
s
tu
d
ies
m
et
th
e
elig
ib
ilit
y
cr
iter
ia
an
d
wer
e
in
clu
d
ed
in
th
e
f
in
al
s
y
n
th
esis
f
o
r
d
ata
ex
tr
ac
tio
n
.
An
y
d
is
a
g
r
ee
m
en
ts
b
etwe
en
th
e
r
ev
iewe
r
s
d
u
r
i
n
g
th
e
s
el
ec
tio
n
p
r
o
ce
s
s
wer
e
r
eso
lv
e
d
th
r
o
u
g
h
d
is
cu
s
s
io
n
,
en
s
u
r
i
n
g
a
r
ig
o
r
o
u
s
an
d
u
n
b
iased
s
elec
tio
n
o
f
s
tu
d
ies f
o
r
in
clu
s
io
n
i
n
th
e
r
e
v
iew.
2
.
5
.
Da
t
a
cha
rt
ing
a
nd
ex
t
ra
ct
io
n
T
h
e
s
tep
-
by
-
s
tep
d
ata
ex
tr
ac
ti
o
n
en
s
u
r
ed
c
o
n
s
is
ten
cy
in
th
e
in
f
o
r
m
atio
n
co
llected
an
d
m
in
im
ized
th
e
r
is
k
o
f
o
m
itti
n
g
cr
itical
d
etails.
Da
ta
wer
e
ex
tr
ac
ted
u
s
in
g
a
s
tan
d
ar
d
ized
f
o
r
m
,
wh
ich
was
iter
ativ
ely
r
ef
in
ed
to
en
s
u
r
e
ac
cu
r
ac
y
an
d
co
m
p
r
eh
en
s
iv
e
n
ess
.
T
wo
r
ev
ie
wer
s
in
d
ep
en
d
e
n
tly
ch
ar
te
d
th
e
d
ata,
an
d
an
y
d
is
cr
ep
an
cies
wer
e
d
is
cu
s
s
ed
u
n
til
a
co
n
s
en
s
u
s
wa
s
r
ea
c
h
ed
.
T
h
is
p
r
o
ce
s
s
en
s
u
r
ed
th
e
r
o
b
u
s
tn
ess
an
d
r
eliab
ilit
y
o
f
th
e
d
ata.
T
h
e
f
o
l
lo
win
g
k
ey
in
f
o
r
m
atio
n
was
ex
tr
ac
ted
f
r
o
m
ea
c
h
s
tu
d
y
;
i
)
s
tu
d
y
ch
ar
ac
ter
is
tics
(
au
th
o
r
(
s
)
,
p
u
b
licatio
n
y
ea
r
,
an
d
s
tu
d
y
d
esig
n
)
;
ii
)
p
ar
ticip
an
t
d
etails
(
p
o
p
u
latio
n
,
s
am
p
le
s
ize,
ag
e,
an
d
g
en
d
er
)
;
iii
)
p
r
ed
icto
r
s
/f
ac
to
r
s
(
v
ar
iab
les
an
aly
ze
d
as
f
ac
t
o
r
s
im
p
ac
tin
g
HL
M)
;
iv
)
o
u
t
co
m
e
m
ea
s
u
r
es
o
f
HL
M;
v
)
co
r
r
elatio
n
s
(
s
tatis
tical
r
elatio
n
s
h
ip
s
b
etwe
en
p
r
e
d
icto
r
s
an
d
HL
M
o
u
tco
m
es
if
av
ailab
le)
;
a
n
d
vi
)
k
ey
f
in
d
in
g
s
(
s
u
m
m
ar
y
o
f
th
e
m
ain
r
esu
lts
r
elate
d
to
HL
M
in
T
B
I
p
o
p
u
latio
n
s
)
.
T
ab
le
2
(
s
ee
in
ap
p
en
d
ix
)
p
r
o
v
id
es th
e
ex
tr
ac
ted
d
ata
f
r
o
m
th
e
in
clu
d
e
d
s
tu
d
y
.
2
.
6
.
Da
t
a
a
na
ly
s
is
T
h
e
d
ata
wer
e
an
aly
ze
d
u
s
in
g
b
o
th
d
escr
ip
tiv
e
a
n
d
th
em
atic
m
eth
o
d
s
.
T
h
em
atic
an
al
y
s
is
was a
p
p
lied
to
ca
teg
o
r
ize
d
if
f
e
r
en
t
p
r
e
d
icto
r
s
an
d
f
ac
to
r
s
af
f
ec
tin
g
HL
M,
wh
ile
d
escr
ip
tiv
e
an
aly
s
is
s
u
m
m
ar
ized
th
e
ch
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
ies
an
d
p
o
p
u
latio
n
s
in
v
o
lv
ed
.
W
h
er
e
q
u
an
titativ
e
d
ata
wer
e
a
v
ailab
le,
co
r
r
elatio
n
s
an
d
s
tatis
tical
as
s
o
ciatio
n
s
b
etwe
en
f
ac
to
r
s
an
d
HL
M
o
u
tco
m
es we
r
e
r
ep
o
r
te
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
1
8
9
-
1
2
0
0
1192
Fig
u
r
e
1
.
T
h
e
PR
I
SMA
-
ScR
f
l
o
w
d
iag
r
am
o
f
th
is
r
e
v
iew
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Cha
ra
c
t
er
is
t
ics o
f
s
t
ud
ies
Of
th
e
eig
h
t
s
tu
d
ies
in
clu
d
e
d
i
n
th
is
r
e
v
iew,
s
ev
en
wer
e
p
u
b
l
is
h
ed
b
etwe
en
2
0
1
0
an
d
2
0
1
6
,
with
o
n
e
m
o
r
e
r
ec
e
n
t
s
tu
d
y
p
u
b
lis
h
ed
in
2
0
2
2
.
T
h
e
s
tu
d
ies
u
tili
ze
d
two
m
ain
o
b
s
er
v
atio
n
al
d
esig
n
s
:
cr
o
s
s
-
s
ec
tio
n
al
(n
=
2
)
an
d
c
o
h
o
r
t
(
n
=
6
)
.
Sam
p
le
s
izes
v
ar
ied
,
r
an
g
in
g
f
r
o
m
5
6
to
1
3
6
p
ar
ticip
an
ts
.
T
h
e
s
tu
d
ies
in
clu
d
ed
in
d
iv
id
u
als
with
v
ar
y
in
g
lev
e
ls
o
f
tr
au
m
atic
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r
ain
i
n
ju
r
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(
T
B
I
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s
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ity
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ild
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I
(
n
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m
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d
m
o
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e
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n
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wev
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f
iv
e
s
tu
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ies
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id
n
o
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s
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ec
if
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I
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ev
er
ity
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d
o
n
l
y
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o
u
r
s
tu
d
ies
m
ea
s
u
r
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in
ju
r
y
s
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ity
u
s
in
g
a
v
alid
ated
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etr
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s
u
ch
as
p
o
s
t
-
tr
au
m
atic
am
n
esia
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PTA)
d
u
r
atio
n
.
B
ased
o
n
d
em
o
g
r
ap
h
ics,
th
e
p
ar
ticip
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ts
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en
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all
y
r
ef
lecte
d
th
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b
r
o
ad
er
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I
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o
p
u
latio
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m
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ei
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m
ale
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d
p
r
e
d
o
m
in
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tly
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o
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n
g
,
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m
ea
n
ag
e
r
an
g
e
b
etwe
en
2
9
an
d
3
2
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2
y
ea
r
s
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Six
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f
th
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eig
h
t stu
d
ies id
en
tifie
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co
r
r
ela
tio
n
s
b
etwe
en
f
ac
to
r
s
an
d
HL
M
o
u
tco
m
es.
3
.
2
.
O
utc
o
m
e
m
ea
s
ures o
f
h
ig
h
-
lev
el
m
o
bil
it
y
I
n
th
is
s
co
p
in
g
r
ev
iew,
f
o
u
r
o
u
tco
m
e
m
ea
s
u
r
es
wer
e
u
s
ed
t
o
ass
es
s
HL
M:
th
e
Hig
h
-
L
ev
e
l
Mo
b
ilit
y
Ass
es
s
m
en
t
T
o
o
l
(
HiMA
T
)
(
n
=
8
)
,
th
e
R
ev
is
ed
HiMA
T
(
HiMA
T
-
R
)
(
n
=
2
)
,
th
e
m
o
d
i
f
ied
I
llin
o
is
Ag
ilit
y
T
est
(
m
I
AT
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(
n
=
2
)
,
an
d
t
h
e
ab
ilit
y
to
r
u
n
(
n
=
1
)
.
Hi
MA
T
was
th
e
m
o
s
t
co
m
m
o
n
ly
u
tili
ze
d
m
ea
s
u
r
e
o
r
ig
in
ally
d
ev
el
o
p
ed
to
ass
ess
m
o
b
ilit
y
lim
itatio
n
s
in
ad
o
lesc
en
ts
an
d
ad
u
lts
with
T
B
I
.
T
h
e
to
o
l c
o
n
s
is
ts
o
f
1
3
task
s
,
in
clu
d
in
g
walk
in
g
b
ac
k
war
d
,
r
u
n
n
in
g
,
ju
m
p
i
n
g
,
s
k
i
p
p
in
g
,
h
o
p
p
in
g
,
a
n
d
clim
b
in
g
s
tair
s
[
7
]
.
Usi
n
g
s
tan
d
ar
d
ized
o
u
tco
m
e
m
ea
s
u
r
es
li
k
e
HiMA
T
is
e
s
s
en
tial
f
o
r
s
ettin
g
m
ea
n
in
g
f
u
l
a
n
d
ac
h
ie
v
ab
le
r
eh
ab
ilit
atio
n
g
o
als.
T
h
ese
m
ea
s
u
r
es
p
r
o
v
id
e
a
clea
r
b
aselin
e,
en
a
b
lin
g
clin
ician
s
an
d
p
atien
ts
to
tr
ac
k
p
r
o
g
r
ess
an
d
tailo
r
tr
ea
tm
en
t
p
lan
s
b
ased
o
n
th
e
in
d
iv
id
u
al'
s
ab
ilit
ies
an
d
f
u
n
ctio
n
al
d
ef
i
cits
[
8
]
.
R
eg
u
lar
ass
ess
m
en
t
with
to
o
ls
lik
e
HiMA
T
h
elp
s
g
u
id
e
clin
ical
d
ec
is
io
n
-
m
ak
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g
,
allo
win
g
f
o
r
ev
id
en
c
e
-
b
ased
ad
ju
s
tm
e
n
ts
to
r
eh
ab
ilit
atio
n
p
r
o
g
r
a
m
s
[
9
]
.
Mo
r
e
o
v
er
,
s
tan
d
ar
d
ized
o
u
tc
o
m
e
m
ea
s
u
r
es
f
ac
ilit
ate
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
b
etwe
en
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
,
p
atien
ts
,
an
d
o
th
e
r
s
tak
eh
o
ld
er
s
,
e
n
s
u
r
in
g
a
s
h
ar
ed
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
atie
n
t's
p
r
o
g
r
ess
[
1
0
]
.
I
n
r
esear
c
h
,
th
e
co
n
s
is
ten
t
ap
p
licatio
n
o
f
th
ese
to
o
ls
en
ab
les
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ata
co
m
p
a
r
is
o
n
ac
r
o
s
s
s
tu
d
ies
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d
p
o
p
u
latio
n
s
,
f
ac
ilit
atin
g
t
h
e
id
en
tific
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n
o
f
b
est
p
r
ac
t
ices
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d
th
e
ev
alu
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n
o
f
r
eh
ab
ilit
atio
n
p
r
o
to
co
l
ef
f
ec
tiv
en
ess
.
T
h
ese
m
ea
s
u
r
es
ar
e
ess
en
tial
f
o
r
o
p
tim
izin
g
p
atien
t
ca
r
e
b
y
p
r
o
v
id
i
n
g
a
s
tr
u
ctu
r
ed
f
r
a
m
ewo
r
k
to
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ess
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ea
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en
t o
u
tco
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es a
n
d
p
r
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m
o
te
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atien
t e
n
g
ag
em
en
t in
th
eir
r
ec
o
v
er
y
p
r
o
c
ess
[
1
1
]
.
3
.
3
.
F
a
ct
o
rs
im
pa
c
t
ing
hig
h
-
lev
el
m
o
bil
it
y
Af
ter
th
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r
o
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d
ata
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t
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tio
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we
i
d
en
tifie
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a
r
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g
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o
f
f
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s
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at
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to
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f
l
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HL
M
in
p
eo
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le
with
T
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I
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T
h
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ac
to
r
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wer
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ca
teg
o
r
ized
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n
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r
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d
if
f
er
en
t
asp
ec
ts
th
at
c
o
n
tr
ib
u
te
t
o
HL
M
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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lth
Sci
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N:
2252
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8
8
0
6
F
a
cto
r
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imp
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ig
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ch
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u
r
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a
n
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tain
f
in
d
in
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r
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m
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e
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r
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im
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g
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astl
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air
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ical
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ay
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o
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s
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en
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e
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T
ab
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p
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id
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m
m
ar
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th
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o
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elev
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ig
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ab
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r
s
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p
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H
L
M
D
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i
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P
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e
d
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c
t
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f
a
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R
e
f
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e
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s)
P
e
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n
a
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f
a
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A
g
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t
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e
x
B
o
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s i
n
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B
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u
m
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s
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me
a
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A
c
t
i
v
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t
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e
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l
[
1
2
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[
1
2
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[
1
3
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[
1
3
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[
1
3
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I
n
j
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r
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r
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t
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c
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[
1
2
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1
2
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[
1
2
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1
2
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[
1
2
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I
mp
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1
4
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1
6
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[
1
3
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,
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1
7
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[
1
2
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1
2
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1
8
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7
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,
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9
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5
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,
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3
.
3
.
1
.
P
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s
o
na
l
f
a
ct
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rs
T
wo
s
tu
d
ies
ex
am
in
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th
e
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o
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etwe
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f
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r
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d
HL
M
o
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tc
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o
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s
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g
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ag
e
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ex
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o
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ass
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ex
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B
MI
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,
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e
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u
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o
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n
in
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ity
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els
(
PALs)
.
Acc
o
r
d
in
g
to
Mo
e
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et
a
l.
[
1
2
]
,
a
g
e
at
in
ju
r
y
a
p
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ed
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av
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tio
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ea
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f
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wh
ich
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e
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d
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R
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eter
m
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ed
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r
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ize
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r
eg
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ess
io
n
co
e
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f
icien
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(
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3
3
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0
0
1
;
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0
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2
3
7
,
p
<
.
0
0
1
)
,
r
esp
ec
tiv
ely
.
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h
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in
d
i
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g
s
ar
e
co
n
s
is
ten
t
with
p
r
ev
io
u
s
s
tu
d
ies
[
2
0
]
–
[
2
2
]
wh
ich
s
u
g
g
est
th
at
y
o
u
n
g
er
i
n
d
i
v
id
u
als
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d
t
o
r
ec
o
v
er
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o
b
ili
ty
m
o
r
e
ef
f
ec
tiv
ely
d
u
e
to
e
n
h
an
ce
d
n
eu
r
o
p
last
icity
.
Sex
also
ap
p
ea
r
ed
to
h
av
e
a
s
ig
n
if
ican
t
u
n
iq
u
e
co
n
tr
ib
u
ti
o
n
to
HiMA
T
an
d
HiMA
T
-
R
(
B
=
4
.
9
4
3
,
p
<.
0
5
;
B
=
3
.
6
8
6
,
p
<.
0
5
)
[
1
2
]
.
Acc
o
r
d
in
g
to
Han
et
a
l
.
[
2
3
]
an
d
H
am
ilto
n
et
a
l.
[
2
4
]
,
m
ales
o
f
ten
d
em
o
n
s
tr
ate
b
ett
er
r
ec
o
v
er
y
,
p
o
ten
tially
b
ec
a
u
s
e
o
f
g
r
ea
ter
m
u
s
cle
m
ass
an
d
h
ig
h
e
r
b
aselin
e
p
h
y
s
ical
f
itn
ess
.
Ho
wev
er
,
t
h
e
in
f
lu
en
ce
o
f
p
er
s
o
n
al
f
a
cto
r
s
m
ay
in
ter
ac
t
with
o
th
er
v
ar
iab
les,
an
d
in
co
n
s
is
ten
cies
in
th
e
liter
atu
r
e
h
ig
h
lig
h
t
th
e
n
e
e
d
f
o
r
ad
d
itio
n
al
r
esear
ch
,
p
ar
ticu
lar
ly
o
n
h
o
r
m
o
n
al
f
ac
to
r
s
an
d
g
en
d
er
d
if
f
er
en
ce
s
[
2
5
]
,
[
2
6
]
.
T
h
e
in
ter
ac
tio
n
o
f
th
ese
p
er
s
o
n
al
f
ac
to
r
s
with
in
ju
r
y
s
ev
er
ity
an
d
p
s
y
ch
o
s
o
cial
f
ac
to
r
s
f
u
r
th
er
co
m
p
licates
th
e
u
n
d
e
r
s
tan
d
in
g
o
f
HL
M
o
u
tco
m
es
[
2
3
]
,
[
2
7
]
.
T
h
u
s
,
f
u
t
u
r
e
r
esear
c
h
is
n
ec
ess
ar
y
to
in
v
est
ig
ate
th
ese
in
ter
ac
tio
n
s
a
n
d
d
e
v
elo
p
m
o
r
e
p
er
s
o
n
alize
d
r
eh
a
b
ilit
atio
n
s
tr
ateg
ies
th
at
ac
co
u
n
t f
o
r
in
d
iv
id
u
al
d
if
f
er
en
ce
s
in
r
ec
o
v
er
y
p
o
ten
tial.
B
MI
an
d
th
e
s
u
m
o
f
n
in
e
s
k
in
f
o
ld
m
ea
s
u
r
es
d
em
o
n
s
tr
ated
o
n
ly
a
n
e
g
lig
ib
le
r
elatio
n
s
h
ip
w
ith
HL
M,
wh
ile
PALs
s
h
o
wed
a
m
o
d
er
a
te
co
r
r
elatio
n
(
r
=
0
.
5
0
8
,
p
<.
0
5
)
with
HL
M
[
1
3
]
.
Petk
ev
icien
e
et
a
l.
[
2
8
]
f
o
u
n
d
th
at
in
d
iv
id
u
als
with
T
B
I
o
f
t
en
h
ad
PALs
well
b
elo
w
r
ec
o
m
m
en
d
e
d
g
u
id
elin
es,
h
i
g
h
li
g
h
tin
g
t
h
e
n
ee
d
f
o
r
in
cr
ea
s
ed
d
aily
p
h
y
s
ical
ac
tiv
ity
th
r
o
u
g
h
m
o
d
e
r
ate
to
v
ig
o
r
o
u
s
ex
er
cise.
T
h
e
r
ec
o
m
m
en
d
ed
g
u
id
elin
es
f
o
r
PALs
in
clu
d
e
3
0
m
in
u
tes
o
f
m
o
d
er
ate
-
in
te
n
s
ity
ex
er
cise
f
iv
e
d
ay
s
p
er
wee
k
o
r
6
0
-
7
5
m
in
u
tes
p
er
wee
k
o
f
v
ig
o
r
o
u
s
-
in
ten
s
ity
ex
er
cise
[
2
4
]
.
T
h
e
s
ig
n
if
ican
ce
o
f
PALs
in
p
r
ed
ictin
g
HL
M
o
u
tco
m
es
a
lig
n
s
wit
h
p
r
ev
io
u
s
r
esear
ch
in
d
icatin
g
th
at
h
ig
h
e
r
lev
els
o
f
p
h
y
s
ical
ac
tiv
ity
a
r
e
ass
o
ciate
d
with
b
etter
r
ec
o
v
er
y
tr
ajec
to
r
ies
i
n
in
d
iv
id
u
als
with
T
B
I
[
2
9
]
.
P
AL
s
ar
e
an
im
p
o
r
tan
t
p
r
ed
ict
o
r
o
f
HL
M,
t
h
eir
in
ter
ac
tio
n
with
o
th
er
f
ac
to
r
s
s
u
g
g
ests
th
at
a
m
u
ltid
im
en
s
io
n
al
ap
p
r
o
ac
h
is
n
ec
ess
ar
y
to
i
m
p
r
o
v
e
m
o
b
ilit
y
o
u
tco
m
es.
3
.
3
.
2
.
I
njury
-
re
la
t
ed
cha
ra
ct
er
is
t
ics
Mo
en
et
a
l.
[
1
2
]
ex
p
lo
r
e
d
th
e
ass
o
ciatio
n
b
etwe
en
in
ju
r
y
-
r
el
ated
ch
ar
ac
ter
is
tics
an
d
HL
M
o
u
tco
m
es,
f
o
cu
s
in
g
o
n
in
ju
r
y
s
ev
er
ity
,
m
ec
h
an
is
m
o
f
in
ju
r
y
,
d
u
r
atio
n
o
f
PTA,
an
d
m
ag
n
etic
r
eso
n
an
ce
im
ag
in
g
(
MRI)
f
in
d
in
g
s
(
c
o
r
tical
co
n
t
u
s
io
n
an
d
d
if
f
u
s
e
ax
o
n
al
in
ju
r
y
.
T
h
e
r
o
le
o
f
in
ju
r
y
-
r
elate
d
f
ac
t
o
r
s
,
s
u
ch
as
m
o
t
o
r
v
eh
icle
ac
ci
d
en
ts
(
MV
As)
a
n
d
PTA
d
u
r
atio
n
,
a
d
d
s
co
m
p
lex
ity
to
m
o
b
ilit
y
r
ec
o
v
er
y
.
T
h
e
m
ec
h
an
is
m
o
f
in
ju
r
y
,
p
ar
tic
u
lar
ly
MV
As,
h
ad
a
s
ig
n
if
ican
t
im
p
ac
t
o
n
b
o
th
HiMA
T
(
B
=
4
.
5
5
9
,
p
<.
0
5
)
an
d
HiMA
T
-
R
(B
=
4
.
0
3
4
,
p
<.
0
5
)
s
co
r
es.
I
n
ter
esti
n
g
ly
,
p
atien
ts
in
v
o
lv
ed
in
MV
As
te
n
d
ed
to
h
av
e
b
ett
er
HL
M
o
u
tc
o
m
es,
p
o
s
s
ib
ly
d
u
e
t
o
d
em
o
g
r
a
p
h
ic
f
ac
to
r
s
s
u
ch
as
y
o
u
n
g
er
a
g
e
a
n
d
b
etter
ac
ce
s
s
to
r
eh
ab
ilit
at
io
n
.
L
ik
ewise,
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
1
8
9
-
1
2
0
0
1194
d
u
r
atio
n
o
f
PTA
was
a
s
tr
o
n
g
p
r
ed
icto
r
o
f
HiMA
T
o
u
tco
m
es
(
B
=
4
.
3
6
8
,
p
<.
0
5
)
,
alth
o
u
g
h
it
d
id
n
o
t
af
f
ec
t
HiMA
T
-
R
s
c
o
r
es.
PTA
d
u
r
atio
n
was
also
a
s
tr
o
n
g
p
r
ed
ict
o
r
o
f
p
o
o
r
er
o
u
tco
m
es,
with
ea
ch
ad
d
itio
n
al
wee
k
o
f
PTA
r
ed
u
ci
n
g
th
e
lik
elih
o
o
d
o
f
r
e
g
ain
in
g
p
r
o
d
u
ctiv
it
y
b
y
1
4
%
[
3
0
]
.
Sh
o
r
ter
PT
A
d
u
r
atio
n
s
wer
e
ass
o
ciate
d
with
b
etter
r
ec
o
v
er
y
an
d
a
h
ig
h
er
ch
an
ce
o
f
r
etu
r
n
in
g
to
p
r
e
-
in
ju
r
y
f
u
n
ctio
n
in
g
.
As
a
r
esu
lt,
th
e
r
ec
o
v
er
y
p
r
o
ce
s
s
f
o
r
m
o
d
er
ate
to
s
ev
er
e
T
B
I
is
o
f
ten
p
r
o
lo
n
g
ed
,
with
o
u
tc
o
m
es
r
an
g
in
g
f
r
o
m
f
u
ll
r
ec
o
v
er
y
to
lo
n
g
-
ter
m
d
e
p
en
d
e
n
ce
,
m
ak
in
g
it
d
if
f
icu
lt
t
o
p
r
ed
ict
m
o
b
il
ity
o
u
tco
m
es
an
d
p
la
n
r
eh
ab
i
litatio
n
s
tr
ateg
ies.
Oth
er
in
ju
r
y
-
r
elate
d
f
ac
t
o
r
s
,
s
u
ch
as
co
r
tic
al
co
n
tu
s
io
n
s
a
n
d
d
if
f
u
s
e
ax
o
n
al
in
ju
r
y
,
s
h
o
wed
n
o
s
ig
n
if
ican
t
ass
o
ciatio
n
with
HL
M
[
1
2
]
.
3
.
3
.
3
.
I
m
pa
irm
ent
s
I
m
p
air
m
en
ts
h
ad
a
s
u
b
s
tan
tial
in
f
lu
en
ce
o
n
HL
M.
Sev
en
s
tu
d
ies
ex
am
in
ed
th
e
r
elatio
n
s
h
ip
b
etwe
en
im
p
air
m
en
ts
an
d
HL
M
o
u
tco
m
es,
with
f
iv
e
s
tu
d
ies
id
en
tify
in
g
s
ig
n
if
ican
t
co
r
r
elatio
n
s
.
W
alk
in
g
s
p
ee
d
an
d
en
d
u
r
a
n
ce
wer
e
th
e
m
o
s
t
cr
itical
f
ac
to
r
s
in
th
is
d
o
m
ain
.
T
w
o
s
tu
d
ies
[
1
3
]
,
[
1
7
]
r
e
p
o
r
ted
a
s
tr
o
n
g
co
r
r
elatio
n
b
etwe
en
walk
in
g
s
p
ee
d
an
d
HL
M,
with
o
n
e
s
tu
d
y
s
h
o
win
g
a
s
ig
n
if
ican
t
co
n
tr
ib
u
tio
n
to
th
e
ab
ilit
y
to
r
u
n
(B
=
6
.
4
2
,
p
<
.
0
0
1
)
[
1
7
]
.
E
n
d
u
r
an
ce
also
s
h
o
wed
a
r
o
b
u
s
t
co
r
r
elatio
n
with
HL
M
(
r
=
0
.
9
3
2
)
[
1
3
]
,
h
ig
h
li
g
h
tin
g
th
e
n
ee
d
to
i
n
clu
d
e
g
ait
tr
ai
n
in
g
,
ca
r
d
io
v
ascu
lar
f
itn
ess
,
an
d
en
d
u
r
a
n
ce
ex
er
cises
in
r
eh
a
b
ilit
atio
n
s
tr
ateg
ies
to
en
h
an
ce
m
o
b
ilit
y
r
ec
o
v
er
y
.
Sp
asti
city
was
f
r
eq
u
en
tly
as
s
ess
ed
b
u
t
s
h
o
wed
o
n
l
y
a
wea
k
co
r
r
elatio
n
with
HL
M
(
r
=
0
.
1
3
,
p
=
0
.
2
2
)
[
1
5
]
,
s
u
g
g
esti
n
g
th
at
its
im
p
ac
t
o
n
m
o
b
ilit
y
r
ec
o
v
e
r
y
m
ay
b
e
less
s
ig
n
if
ican
t
th
an
m
o
to
r
co
n
tr
o
l
an
d
en
d
u
r
a
n
ce
.
Alth
o
u
g
h
l
o
wer
lim
b
s
p
asti
city
was
ass
o
ciate
d
with
g
r
ea
ter
m
o
b
ilit
y
lim
it
atio
n
s
(
t9
1
=
2
.
1
5
,
p
=
0
.
0
3
)
[
1
6
]
,
th
e
lack
o
f
s
p
e
cif
ic
tim
elin
es
in
th
e
ass
ess
m
en
ts
m
ak
es
it
d
if
f
icu
lt
to
d
eter
m
in
e
its
lo
n
g
-
ter
m
ef
f
ec
ts
.
As
th
e
f
i
n
d
in
g
s
s
h
o
wed
a
wea
k
co
r
r
elatio
n
b
etwe
en
s
p
asti
city
an
d
HL
M,
th
is
r
a
is
es
th
e
q
u
esti
o
n
o
f
wh
eth
er
lo
wer
lim
b
s
p
asti
city
is
a
p
r
im
ar
y
p
h
y
s
ical
im
p
air
m
en
t
th
at
r
e
q
u
ir
es
m
an
a
g
em
en
t
to
im
p
r
o
v
e
m
o
b
ilit
y
o
r
wh
et
h
er
it
is
p
r
im
ar
ily
a
b
ar
r
ier
to
ef
f
ec
tiv
el
y
tr
ea
tin
g
o
th
er
p
h
y
s
ical
im
p
air
m
en
ts
,
s
u
ch
as
m
u
s
cle
wea
k
n
ess
in
p
eo
p
le
with
T
B
I
.
T
h
e
r
ef
o
r
e
,
s
p
asti
city
m
ay
s
ig
n
if
ican
tly
im
p
ac
t
m
o
b
ilit
y
o
u
tco
m
es
d
u
e
to
ad
d
itio
n
al
im
p
air
m
en
ts
,
s
u
ch
a
s
m
u
s
cle
wea
k
n
ess
an
d
r
ed
u
ce
d
p
o
wer
g
en
er
atio
n
[
1
5
]
.
An
k
le
p
o
wer
g
en
e
r
atio
n
(
APG)
d
em
o
n
s
tr
ated
a
m
o
d
er
ate
c
o
r
r
elatio
n
with
HL
M
(
r
a
n
g
in
g
f
r
o
m
0
.
4
8
to
0
.
6
3
)
b
u
t
d
id
n
o
t
s
h
o
w
a
s
ig
n
if
ican
t
u
n
iq
u
e
co
n
tr
i
b
u
tio
n
t
o
m
o
b
ilit
y
o
u
tco
m
e
s
[
1
5
]
,
[
1
7
]
.
Oth
e
r
im
p
air
m
en
ts
,
s
u
ch
as
v
esti
b
u
l
ar
f
u
n
ctio
n
an
d
b
alan
ce
,
s
h
o
w
ed
m
o
d
e
r
ate
co
r
r
elatio
n
s
with
HL
M
b
u
t
wer
e
n
o
t
as
s
tr
o
n
g
ly
lin
k
ed
to
r
ec
o
v
e
r
y
as
walk
in
g
s
p
ee
d
an
d
en
d
u
r
a
n
ce
.
Static
b
alan
ce
an
d
later
al
ce
n
ter
o
f
m
ass
(
C
OM
)
d
is
p
lace
m
en
t
wer
e
m
o
d
er
ately
co
r
r
elate
d
with
HL
M
(
r
=
0
.
5
7
a
n
d
r
=
0
.
5
1
,
r
esp
ec
tiv
ely
)
,
ex
p
lain
in
g
3
2
%
an
d
2
6
%
o
f
th
e
v
a
r
ian
ce
in
HiMA
T
s
co
r
es
[
1
9
]
.
Vestib
u
lar
f
u
n
ctio
n
r
ef
lecte
d
b
y
th
e
Vestib
u
lar
Ocu
lar
Mo
to
r
Scr
ee
n
in
g
(
VOM
S)
an
d
n
ea
r
p
o
in
t
co
n
v
er
g
e
n
ce
(
NPC
)
d
is
tan
ce
was
also
f
o
u
n
d
to
h
av
e
a
v
er
y
wea
k
co
r
r
elatio
n
with
HL
M
r
an
g
in
g
f
r
o
m
0
.
0
2
to
0
.
0
6
an
d
0
.
1
4
to
0
.
2
1
,
r
esp
ec
tiv
ely
[
1
8
]
,
s
u
g
g
esti
n
g
th
at
it
m
ay
n
o
t b
e
a
p
r
im
ar
y
f
o
c
u
s
in
m
o
b
ilit
y
r
ec
o
v
er
y
f
o
r
T
B
I
p
atien
ts
.
O
v
e
r
a
l
l
,
w
a
l
k
i
n
g
s
p
e
e
d
a
n
d
en
d
u
r
a
n
c
e
e
m
e
r
g
e
d
a
s
t
h
e
m
o
s
t
i
n
f
l
u
e
n
t
i
a
l
f
a
c
t
o
r
s
i
n
t
h
e
im
p
a
i
r
m
e
n
t
d
o
m
a
i
n
.
T
h
e
s
e
f
i
n
d
i
n
g
s
e
m
p
h
a
s
i
z
e
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
t
a
r
g
et
i
n
g
t
h
e
s
e
c
a
p
a
ci
t
ie
s
i
n
r
e
h
a
b
i
l
it
a
t
io
n
s
t
r
a
t
e
g
i
es
.
W
h
i
le
s
p
a
s
t
i
c
it
y
m
a
n
a
g
e
m
e
n
t
is
o
f
t
e
n
e
m
p
h
a
s
i
z
e
d
,
i
m
p
r
o
v
i
n
g
m
o
t
o
r
c
o
n
t
r
o
l
a
n
d
e
n
d
u
r
a
n
c
e
m
a
y
l
ea
d
t
o
b
e
t
t
e
r
m
o
b
i
li
t
y
o
u
t
c
o
m
e
s
.
A
d
d
it
i
o
n
a
ll
y
,
i
n
c
o
r
p
o
r
a
t
i
n
g
a
c
ti
v
i
t
y
-
m
o
n
i
t
o
r
i
n
g
t
o
o
l
s
,
s
u
c
h
as
p
e
d
o
m
e
t
e
r
s
,
ca
n
h
e
lp
p
a
t
i
e
n
ts
m
ai
n
t
a
i
n
r
e
g
u
l
a
r
p
h
y
s
i
c
a
l
a
ct
i
v
i
t
y
,
s
u
p
p
o
r
t
i
n
g
l
o
n
g
-
t
e
r
m
m
o
b
i
l
i
t
y
r
e
c
o
v
e
r
y
.
T
h
e
v
a
r
i
a
b
i
l
i
t
y
i
n
s
t
u
d
y
r
e
s
u
l
t
s
m
a
y
b
e
a
t
t
r
i
b
u
t
e
d
t
o
d
i
f
f
e
r
e
n
c
es
i
n
T
B
I
c
h
a
r
a
c
t
e
r
is
t
i
cs
,
t
h
e
i
m
p
a
i
r
m
e
n
ts
s
t
u
d
i
e
d
,
a
n
d
t
h
e
e
x
t
e
n
t
o
f
n
e
u
r
o
l
o
g
i
c
a
l
r
e
c
o
v
e
r
y
.
T
h
e
s
e
d
is
c
r
e
p
a
n
c
i
es
h
i
g
h
l
i
g
h
t
th
e
n
e
e
d
f
o
r
p
e
r
s
o
n
a
l
i
z
e
d
,
c
l
ie
n
t
-
c
e
n
t
e
r
e
d
r
e
h
a
b
i
li
t
a
ti
o
n
a
p
p
r
o
a
c
h
e
s
t
o
a
c
c
o
u
n
t
f
o
r
d
i
v
e
r
s
e
r
ec
o
v
e
r
y
p
a
t
t
e
r
n
s
a
m
o
n
g
T
B
I
p
at
i
e
n
ts
.
F
u
r
t
h
e
r
r
es
ea
r
c
h
,
p
a
r
t
i
c
u
la
r
l
y
t
h
r
o
u
g
h
i
n
ter
v
e
n
t
i
o
n
a
l
t
r
i
a
ls
,
is
n
e
e
d
e
d
t
o
d
e
t
e
r
m
i
n
e
t
h
e
m
o
s
t
s
i
g
n
i
f
i
c
a
n
t
i
m
p
ai
r
m
e
n
t
s
a
f
f
e
c
t
i
n
g
m
o
b
i
l
i
t
y
o
u
t
c
o
m
e
s
.
3
.
4
.
I
m
pli
ca
t
i
o
ns
o
f
s
t
ud
y
T
h
is
s
tu
d
y
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
p
er
s
o
n
alize
d
r
eh
ab
i
litatio
n
ap
p
r
o
ac
h
es
tailo
r
ed
to
in
d
iv
id
u
al
p
atien
t
ch
ar
ac
te
r
is
tics
,
in
clu
d
i
n
g
a
g
e,
s
ex
,
d
u
r
atio
n
o
f
PTA,
an
d
walk
in
g
s
p
ee
d
.
R
ec
o
g
n
izi
n
g
th
e
v
a
r
iab
ilit
y
in
r
ec
o
v
er
y
tr
ajec
to
r
ies
is
cr
u
ci
al
f
o
r
d
e
v
el
o
p
in
g
e
f
f
ec
tiv
e
r
eh
ab
ilit
atio
n
s
tr
ateg
ies
[
3
1
]
,
[
3
2
]
.
Per
s
o
n
alize
d
in
ter
v
en
tio
n
s
ca
n
lead
to
im
p
r
o
v
ed
o
u
tco
m
es
b
y
ad
d
r
ess
in
g
th
e
s
p
ec
if
ic
n
ee
d
s
an
d
g
o
a
ls
o
f
ea
ch
p
atien
t,
th
er
eb
y
f
ac
ilit
atin
g
a
m
o
r
e
e
f
f
icien
t
r
ec
o
v
er
y
p
r
o
ce
s
s
[
3
3
]
,
[
3
4
]
.
T
h
e
ac
k
n
o
wled
g
m
e
n
t
o
f
t
h
ese
f
ac
to
r
s
allo
ws
clin
ician
s
to
d
esig
n
r
eh
ab
ilit
a
tio
n
p
r
o
g
r
am
s
th
at
ar
e
n
o
t
o
n
ly
in
d
iv
id
u
alize
d
b
u
t
also
m
o
r
e
lik
ely
to
y
ield
p
o
s
itiv
e
r
esu
lts
in
ter
m
s
o
f
m
o
b
ilit
y
an
d
o
v
er
all
r
eh
a
b
ilit
atio
n
s
u
cc
ess
[
3
5
]
.
Stan
d
a
r
d
ized
ass
ess
m
en
t
to
o
l
s
,
s
u
ch
as
th
e
HiMA
T
,
p
lay
a
p
iv
o
tal
r
o
le
i
n
ev
al
u
atin
g
a
n
d
tr
ac
k
in
g
p
r
o
g
r
ess
in
T
B
I
r
eh
ab
ilit
atio
n
.
T
h
e
co
n
s
is
ten
t
u
s
e
o
f
HiMA
T
ac
r
o
s
s
v
ar
io
u
s
s
tu
d
ies
d
em
o
n
s
tr
ates
its
ef
f
ec
tiv
en
ess
in
estab
lis
h
in
g
r
ea
lis
tic
an
d
m
ea
s
u
r
ab
le
g
o
als
f
o
r
p
atien
ts
r
ec
o
v
er
in
g
f
r
o
m
T
B
I
[
3
6
]
,
[
3
7
]
.
B
y
em
p
lo
y
in
g
s
tan
d
ar
d
ized
o
u
tc
o
m
e
m
ea
s
u
r
es,
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
ca
n
b
etter
ass
ess
im
p
r
o
v
em
en
ts
in
HL
M,
m
ak
e
in
f
o
r
m
ed
a
d
ju
s
tm
en
ts
to
tr
ea
tm
en
t
p
lan
s
,
a
n
d
en
h
an
c
e
co
m
m
u
n
icatio
n
am
o
n
g
clin
i
cian
s
,
p
atien
ts
,
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
F
a
cto
r
s
imp
a
ctin
g
h
ig
h
-
leve
l
mo
b
ilit
y
in
tr
a
u
ma
tic
b
r
a
in
in
j
u
r
y:
a
s
co
p
in
g
r
ev
iew
…
(
S
ya
z
lin
A
z
mi
)
1195
f
am
ilies
[
3
8
]
.
T
h
is
a
p
p
r
o
ac
h
n
o
t
o
n
ly
aid
s
in
m
o
n
ito
r
in
g
p
r
o
g
r
ess
b
u
t
also
e
n
s
u
r
es
th
at
r
eh
ab
ilit
atio
n
ef
f
o
r
ts
ar
e
alig
n
ed
with
b
est p
r
ac
tices in
th
e
f
ield
[
3
9
]
,
[
4
0
]
.
T
h
e
s
tu
d
y
also
lay
s
a
f
o
u
n
d
atio
n
f
o
r
f
u
t
u
r
e
r
esear
ch
b
y
id
en
t
if
y
in
g
g
ap
s
in
th
e
cu
r
r
en
t
u
n
d
er
s
tan
d
in
g
o
f
h
o
w
p
er
s
o
n
al,
en
v
ir
o
n
m
en
tal,
an
d
in
ju
r
y
-
r
elate
d
f
ac
to
r
s
in
ter
ac
t
to
in
f
lu
en
ce
m
o
b
ilit
y
o
u
tco
m
es.
Ad
d
r
ess
in
g
th
ese
g
ap
s
is
ess
en
tial
f
o
r
r
ef
i
n
in
g
r
eh
a
b
i
litatio
n
p
r
o
to
co
ls
a
n
d
en
h
a
n
cin
g
cli
n
ical
p
r
ac
tice
[
4
1
]
.
Fu
tu
r
e
in
v
esti
g
atio
n
s
co
u
ld
ex
p
lo
r
e
th
e
c
o
m
p
lex
in
ter
p
l
ay
o
f
th
ese
f
ac
to
r
s
to
d
e
v
e
lo
p
m
o
r
e
n
u
an
ce
d
r
eh
ab
ilit
atio
n
s
tr
ateg
ies
th
at
c
ater
to
th
e
d
iv
er
s
e
n
ee
d
s
o
f
T
B
I
p
atien
ts
[
4
2
]
,
[
4
3
]
.
T
h
is
r
e
s
ea
r
ch
tr
ajec
to
r
y
is
v
ital
f
o
r
o
p
tim
izin
g
r
e
h
ab
ilit
atio
n
o
u
tco
m
es
an
d
e
n
s
u
r
in
g
th
at
in
ter
v
en
tio
n
s
ar
e
b
o
th
ef
f
ec
tiv
e
an
d
r
elev
an
t
to
th
e
p
atien
t p
o
p
u
latio
n
.
L
astl
y
,
th
e
im
p
licatio
n
s
o
f
th
i
s
s
tu
d
y
ex
te
n
d
t
o
r
e
h
ab
ilit
atio
n
p
o
licies
an
d
g
u
id
elin
es.
T
h
e
o
b
s
er
v
e
d
v
ar
iab
ilit
y
in
HL
M
o
u
tco
m
es
s
u
g
g
ests
th
at
ex
is
t
in
g
r
eh
ab
il
itatio
n
p
r
o
to
co
ls
m
ay
b
en
e
f
it
f
r
o
m
in
co
r
p
o
r
ati
n
g
ad
v
an
ce
d
m
o
b
ilit
y
tar
g
ets.
Po
licy
m
ak
er
s
an
d
r
e
h
ab
ilit
atio
n
ce
n
ter
s
s
h
o
u
ld
co
n
s
id
er
r
e
v
is
in
g
g
u
id
elin
es
to
in
clu
d
e
in
ter
v
en
tio
n
s
s
p
ec
if
ically
aim
ed
at
en
h
an
cin
g
HL
M
,
wh
ich
co
u
ld
im
p
r
o
v
e
th
e
ch
an
ce
s
o
f
s
u
cc
ess
f
u
l
co
m
m
u
n
ity
r
ein
te
g
r
atio
n
an
d
lo
n
g
-
ter
m
r
ec
o
v
er
y
f
o
r
in
d
iv
id
u
als
with
T
B
I
[
4
4
]
,
[
4
5
]
.
B
y
alig
n
in
g
r
eh
ab
ilit
atio
n
p
r
ac
tices
with
th
e
latest
r
e
s
ea
r
ch
f
in
d
in
g
s
,
s
tak
eh
o
ld
er
s
ca
n
f
o
s
ter
a
n
en
v
ir
o
n
m
en
t
th
at
s
u
p
p
o
r
ts
th
e
h
o
lis
tic
r
ec
o
v
er
y
o
f
T
B
I
p
atien
ts
,
u
ltima
tely
en
h
an
ci
n
g
th
ei
r
q
u
ality
o
f
life
.
I
n
s
u
m
m
ar
y
,
th
e
s
tu
d
y
p
r
o
v
id
es
cr
u
cial
in
s
ig
h
ts
in
to
t
h
e
f
ac
to
r
s
in
f
lu
en
cin
g
h
i
g
h
-
le
v
el
m
o
b
ilit
y
in
in
d
i
v
id
u
als
wit
h
T
B
I
.
I
t
a
d
v
o
ca
tes
f
o
r
p
er
s
o
n
alize
d
r
eh
a
b
ilit
atio
n
s
tr
ateg
ies,
th
e
u
s
e
o
f
s
tan
d
ar
d
ized
ass
ess
m
en
t
to
o
ls
,
an
d
a
s
tr
o
n
g
er
f
o
cu
s
o
n
HL
M
tr
ain
in
g
.
Ad
d
itio
n
ally
,
it
em
p
h
asizes
th
e
n
ee
d
f
o
r
f
u
r
th
er
r
esear
ch
an
d
p
o
te
n
tial
p
o
licy
ch
a
n
g
es
t
o
im
p
r
o
v
e
r
e
h
ab
ilit
atio
n
o
u
tco
m
es a
n
d
th
e
o
v
er
all
q
u
ality
o
f
lif
e
f
o
r
in
d
iv
id
u
als r
ec
o
v
er
in
g
f
r
o
m
T
B
I
.
3
.
5
.
Str
eng
t
h
a
nd
l
im
it
a
t
io
n
Ho
wev
er
,
th
is
r
ev
iew
h
as
s
ev
er
al
lim
itatio
n
s
th
at
m
u
s
t
b
e
ac
k
n
o
wled
g
ed
.
Ma
n
y
o
f
th
e
in
clu
d
e
d
s
tu
d
ies
h
ad
s
m
all
s
am
p
le
s
ize
s
,
lim
itin
g
th
e
g
e
n
er
aliza
b
ilit
y
o
f
th
e
f
in
d
i
n
g
s
.
A
d
d
itio
n
ally
,
th
e
o
b
s
er
v
atio
n
al
n
atu
r
e
o
f
m
o
s
t
s
tu
d
ies
m
ak
es
it
d
if
f
icu
lt
to
estab
lis
h
ca
u
s
a
lity
b
etwe
en
th
e
id
en
tifie
d
f
a
cto
r
s
an
d
m
o
b
ilit
y
o
u
tco
m
es.
T
h
e
v
ar
iab
ilit
y
i
n
o
u
tco
m
e
m
ea
s
u
r
es,
s
u
ch
as
t
h
e
u
s
e
o
f
d
if
f
er
e
n
t
v
er
s
io
n
s
o
f
th
e
HiMA
T
,
also
co
n
tr
ib
u
ted
t
o
in
co
n
s
is
ten
cies
ac
r
o
s
s
s
tu
d
ies.
An
o
th
er
s
ig
n
if
ican
t
lim
itatio
n
is
th
e
lack
o
f
co
n
s
id
er
atio
n
f
o
r
en
v
ir
o
n
m
en
tal
f
ac
to
r
s
,
s
u
ch
as
ac
ce
s
s
to
co
m
m
u
n
ity
r
eso
u
r
c
es
o
r
s
o
cial
s
u
p
p
o
r
t,
wh
ich
ar
e
lik
ely
to
in
f
lu
en
ce
m
o
b
ilit
y
r
ec
o
v
er
y
.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
ad
d
r
ess
th
ese
lim
itatio
n
s
b
y
co
n
d
u
cti
n
g
lar
g
e
r
,
m
o
r
e
r
ig
o
r
o
u
s
s
tu
d
i
es
th
at
u
s
e
s
tan
d
ar
d
ized
o
u
tc
o
m
e
m
ea
s
u
r
es,
allo
win
g
f
o
r
b
etter
co
m
p
ar
ab
ilit
y
ac
r
o
s
s
d
iv
er
s
e
p
o
p
u
latio
n
s
.
I
t
is
also
ess
en
tial
to
ex
p
lo
r
e
th
e
r
o
le
o
f
en
v
i
r
o
n
m
e
n
tal
f
ac
to
r
s
an
d
th
eir
in
ter
ac
tio
n
with
p
er
s
o
n
a
l
an
d
in
ju
r
y
-
r
elate
d
ch
ar
ac
ter
is
tics
in
in
f
lu
en
cin
g
HL
M.
Ad
d
itio
n
ally
,
f
u
r
th
er
in
v
esti
g
atio
n
in
to
th
e
ef
f
ec
tiv
e
n
ess
o
f
in
ter
v
en
tio
n
s
tar
g
etin
g
e
n
d
u
r
an
ce
,
b
alan
ce
,
an
d
m
u
s
cle
s
tr
en
g
th
will
b
e
c
r
itical
in
o
p
t
im
izin
g
r
e
h
ab
ilit
a
tio
n
s
tr
ateg
ies
an
d
im
p
r
o
v
in
g
o
u
tco
m
es
f
o
r
in
d
i
v
id
u
als
with
T
B
I
.
T
h
ese
in
s
i
g
h
ts
will
h
elp
g
u
id
e
th
e
d
ev
elo
p
m
en
t
o
f
m
o
r
e
tailo
r
ed
r
eh
a
b
ilit
atio
n
p
r
o
g
r
am
s
,
u
ltima
tely
en
h
an
cin
g
th
e
q
u
ality
o
f
life
f
o
r
T
B
I
s
u
r
v
iv
o
r
s
.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
f
o
u
n
d
s
ig
n
if
ica
n
t
v
ar
iatio
n
s
in
th
e
r
ep
o
r
ted
a
s
s
o
ciatio
n
s
am
o
n
g
f
ac
to
r
s
in
d
if
f
er
e
n
t
d
o
m
ain
s
th
at
m
ay
p
r
ed
ict
HL
M
in
p
e
o
p
le
with
T
B
I
.
Ag
e
a
t
in
ju
r
y
,
s
ex
,
m
o
to
r
v
eh
icle
a
cc
id
en
t,
d
u
r
atio
n
o
f
PTA,
walk
in
g
s
p
ee
d
,
an
d
en
d
u
r
an
ce
wer
e
id
en
tifie
d
as
th
e
m
o
s
t
in
f
l
u
en
tial
f
ac
to
r
s
o
f
HL
M
o
u
tco
m
es.
Ho
wev
er
,
f
u
r
th
er
in
v
esti
g
atio
n
is
n
ee
d
e
d
to
b
etter
u
n
d
e
r
s
tan
d
th
o
s
e
f
ac
to
r
s
'
in
ter
ac
tio
n
s
an
d
p
o
ten
tial
m
o
d
er
ato
r
s
'
in
ter
ac
tio
n
s
with
HL
M
in
p
eo
p
le
with
T
B
I
.
T
h
is
wo
u
ld
h
elp
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
d
ev
elo
p
ap
p
r
o
p
r
iate
in
te
r
v
en
tio
n
s
an
d
ef
f
ec
tiv
e
r
eh
ab
ilit
atio
n
p
r
o
g
r
am
s
f
o
cu
s
in
g
o
n
m
o
d
if
iab
le
f
ac
to
r
s
to
im
p
r
o
v
e
HL
M.
Ultim
ately
,
th
o
s
e
in
ter
v
en
tio
n
s
ar
e
cr
u
cial
f
o
r
e
n
h
an
ci
n
g
th
e
q
u
ality
o
f
life
f
o
r
in
d
iv
i
d
u
als with
T
B
I
.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
ap
p
r
ec
iate
th
e
co
n
tr
i
b
u
tio
n
o
f
r
e
v
i
ewe
r
s
wh
o
s
e
in
s
ig
h
ts
s
ig
n
if
ican
tly
s
u
p
p
o
r
ted
th
is
s
tu
d
y
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
wo
r
k
was
s
u
p
p
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b
y
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Un
iv
er
s
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T
ek
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g
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MA
R
A
th
r
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Ger
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Min
is
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Hig
h
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th
r
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Fu
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)
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
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I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
1
8
9
-
1
2
0
0
1196
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
e
co
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Sy
az
lin
Azm
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
No
r
Azlin
Mo
h
d
No
r
d
in
✓
✓
✓
✓
✓
✓
Alia
Alg
h
wir
i
✓
✓
✓
✓
✓
✓
Haid
zir
Ma
n
af
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
I
NF
O
RM
E
D
CO
NS
E
N
T
No
t a
p
p
licab
le
.
E
T
H
I
CAL AP
P
RO
V
AL
No
t a
p
p
licab
le
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
ts
th
e
f
i
n
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
av
ailab
le
f
r
o
m
th
e
c
o
r
r
esp
o
n
d
in
g
au
t
h
o
r
,
[
HM
]
,
u
p
o
n
r
ea
s
o
n
ab
le
r
eq
u
est.
RE
F
E
R
E
NC
E
S
[
1
]
T.
S
p
e
n
c
e
r
,
S
.
A
l
d
o
u
s
,
G
.
W
i
l
l
i
a
m
s,
a
n
d
M
.
F
a
h
e
y
,
“
S
y
s
t
e
m
a
t
i
c
r
e
v
i
e
w
o
f
h
i
g
h
-
l
e
v
e
l
mo
b
i
l
i
t
y
t
r
a
i
n
i
n
g
i
n
p
e
o
p
l
e
w
i
t
h
a
n
e
u
r
o
l
o
g
i
c
a
l
i
mp
a
i
r
m
e
n
t
,
”
Br
a
i
n
I
n
j
u
r
y
,
v
o
l
.
3
2
,
n
o
.
4
,
p
p
.
4
0
3
–
4
1
5
,
M
a
r
.
2
0
1
8
,
d
o
i
:
1
0
.
1
0
8
0
/
0
2
6
9
9
0
5
2
.
2
0
1
8
.
1
4
2
9
6
5
6
.
[
2
]
J.
K
e
r
s
e
y
,
L
.
Te
r
h
o
r
s
t
,
C
.
-
Y
.
W
u
,
a
n
d
E.
S
k
i
d
mo
r
e
,
“
A
s
c
o
p
i
n
g
r
e
v
i
e
w
o
f
p
r
e
d
i
c
t
o
r
s
o
f
c
o
mm
u
n
i
t
y
i
n
t
e
g
r
a
t
i
o
n
f
o
l
l
o
w
i
n
g
t
r
a
u
m
a
t
i
c
b
r
a
i
n
i
n
j
u
r
y
:
A
se
a
r
c
h
f
o
r
me
a
n
i
n
g
f
u
l
a
ss
o
c
i
a
t
i
o
n
s
,
”
J
o
u
r
n
a
l
o
f
H
e
a
d
T
r
a
u
m
a
R
e
h
a
b
i
l
i
t
a
t
i
o
n
,
v
o
l
.
3
4
,
n
o
.
4
,
p
p
.
E
3
2
–
E4
1
,
Ju
l
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
9
7
/
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Sep
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20
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:
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9
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1
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4
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]
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4
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]
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[
4
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[
4
4
]
C.
-
L.
M
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r
,
T.
Li
n
g
a
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d
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.
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[
4
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AP
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ex
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t
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(
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c
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n
[
1
2
]
LF
-
UP
M
o
d
e
r
a
t
e
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n
d
sev
e
r
e
T
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I
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[
1
3
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C
S
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v
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[
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C
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