{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T15:25:31Z","timestamp":1788621931094,"version":"build-2803163510"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Functional neurological symptom disorder, specifically, functional limb weakness, is a commonly seen condition in clinical neurological practice and requires careful examination for diagnosis. Specific and detailed examination techniques have been developed and validated over the past 100\u00a0years to help clinicians differentiate functional limb weakness from objective neurological weakness. These techniques vary in sensitivity, specificity, clinical application, and limitations. However, over time, the studied and\/or validated forms of these exam techniques may have been lost and often not performed or taught in the way it was originally studied, thus decreasing the reliability of the examiner\u2019s findings. With many new examination techniques for functional limb weakness having been studied in recent years, it is important to not only review the form of each of these examination techniques, but also discuss the clinical applications, limitations, and utility of each. To date, there has been no comprehensive review demonstrating the exact form of all the studied and\/or validated examination techniques for functional limb weakness and their proposed clinical utility. This review analyzes 9 examination techniques for functional limb weakness that have been studied for validity and provides readers with the exact technique of examination used to study each. It also outlines their sensitivity, specificity, clinical applications, and limitations to help clinicians accurately diagnose functional limb weakness.<\/jats:p>","DOI":"10.1007\/s00415-025-13139-4","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T10:02:53Z","timestamp":1748340173000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A practical guide to assessing functional motor weakness: a review of validated techniques"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1092-6432","authenticated-orcid":false,"given":"James","family":"Dolbow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheil","family":"El-Azzouni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Geiger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"issue":"9","key":"13139_CR1","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/j.clineuro.2010.05.011","volume":"112","author":"J Stone","year":"2010","unstructured":"Stone J, Carson A, Duncan R et al (2010) Who is referred to neurology clinics? The diagnoses made in 3781 new patients. Clin Neurol Neurosurg 112(9):747\u2013751. https:\/\/doi.org\/10.1016\/j.clineuro.2010.05.011","journal-title":"Clin Neurol Neurosurg"},{"issue":"5","key":"13139_CR2","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1111\/j.1600-0404.1990.tb03312.x","volume":"82","author":"T Lempert","year":"1990","unstructured":"Lempert T, Dieterich M, Huppert D, Brandt T (1990) Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 82(5):335\u2013340. https:\/\/doi.org\/10.1111\/j.1600-0404.1990.tb03312.x","journal-title":"Acta Neurol Scand"},{"issue":"5","key":"13139_CR3","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1111\/ene.14728","volume":"28","author":"J Beharry","year":"2021","unstructured":"Beharry J, Palmer D, Wu T et al (2021) Functional neurological disorders presenting as emergencies to secondary care. Eur J Neurol 28(5):1441\u20131445. https:\/\/doi.org\/10.1111\/ene.14728","journal-title":"Eur J Neurol"},{"key":"13139_CR4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.jocn.2015.11.020","volume":"28","author":"O Ahmad","year":"2016","unstructured":"Ahmad O, Ahmad KE (2016) Functional neurological disorders in outpatient practice: an Australian cohort. J Clin Neurosci 28:93\u201396","journal-title":"J Clin Neurosci"},{"issue":"4","key":"13139_CR5","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1136\/jnnp-2014-310181","volume":"87","author":"AE Merkler","year":"2016","unstructured":"Merkler AE, Parikh NS, Chaudhry S et al (2016) Hospital revisit rate after a diagnosis of conversion disorder. J Neurol Neurosurg Psychiatry 87(4):363\u2013366. https:\/\/doi.org\/10.1136\/jnnp-2014-310181","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"7","key":"13139_CR6","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1007\/s00415-011-6354-9","volume":"259","author":"A F\u00f6rster","year":"2012","unstructured":"F\u00f6rster A, Griebe M, Wolf ME, Szabo K, Hennerici MG, Kern R (2012) How to identify stroke mimics in patients eligible for intravenous thrombolysis? J Neurol 259(7):1347\u20131353. https:\/\/doi.org\/10.1007\/s00415-011-6354-9","journal-title":"J Neurol"},{"issue":"1","key":"13139_CR7","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/ene.14069","volume":"27","author":"AT Jones","year":"2020","unstructured":"Jones AT, O\u2019Connell NK, David AS (2020) Epidemiology of functional stroke mimic patients: a systematic review and meta-analysis. Eur J Neurol 27(1):18\u201326. https:\/\/doi.org\/10.1111\/ene.14069","journal-title":"Eur J Neurol"},{"issue":"8","key":"13139_CR8","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1001\/archpsyc.62.8.903","volume":"62","author":"AJ Barsky","year":"2005","unstructured":"Barsky AJ, Orav EJ, Bates DW (2005) Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 62(8):903\u2013910. https:\/\/doi.org\/10.1001\/archpsyc.62.8.903","journal-title":"Arch Gen Psychiatry"},{"key":"13139_CR9","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s11910-006-0015-x","volume":"6","author":"M Hallett","year":"2006","unstructured":"Hallett M (2006) Psychogenic movement disorders: a crisis for neurology. Curr Neurol Neurosci Rep 6:269\u2013271. https:\/\/doi.org\/10.1007\/s11910-006-0015-x","journal-title":"Curr Neurol Neurosci Rep"},{"key":"13139_CR10","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1001\/jamaneurol.2019.3043","volume":"76","author":"MJ Burke","year":"2019","unstructured":"Burke MJ (2019) \u201cIt\u2019s all in your head\u201d\u2014medicine\u2019s silent epidemic. JAMA Neurol 76:1417\u20131418. https:\/\/doi.org\/10.1001\/jamaneurol.2019.3043","journal-title":"JAMA Neurol"},{"key":"13139_CR11","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1016\/S2215-0366(17)30036-6","volume":"4","author":"RC Keynejad","year":"2017","unstructured":"Keynejad RC, Carson AJ, David AS, Nicholson TR (2017) Functionalneurological disorder: psychiatry\u2019s blind spot. Lancet Psychiatry 4:e2-3. https:\/\/doi.org\/10.1016\/S2215-0366(17)30036-6","journal-title":"Lancet Psychiatry"},{"issue":"06","key":"13139_CR12","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.jpsychores.2011.07.005","volume":"71","author":"J Stone","year":"2011","unstructured":"Stone J, LaFrance WC Jr, Brown R, Spiegel D, Levenson JL, Sharpe M (2011) Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res 71(06):369\u2013376","journal-title":"J Psychosom Res"},{"issue":"2","key":"13139_CR13","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1136\/jnnp-2012-304607","volume":"85","author":"C Daum","year":"2014","unstructured":"Daum C, Hubschmid M, Aybek S (2014) The value of \u201cpositive\u201d clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 85(2):180\u2013190. https:\/\/doi.org\/10.1136\/jnnp-2012-304607","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"06","key":"13139_CR14","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1176\/appi.ajp.2010.09101440","volume":"167","author":"J Stone","year":"2010","unstructured":"Stone J, LaFrance WC Jr, Levenson JL, Sharpe M (2010) Issues for DSM-5: conversion disorder. Am J Psychiatry 167(06):626\u2013627","journal-title":"Am J Psychiatry"},{"issue":"1","key":"13139_CR15","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1055\/s-0038-1676844","volume":"39","author":"JR Anderson","year":"2019","unstructured":"Anderson JR, Nakhate V, Stephen CD, Perez DL (2019) Functional (Psychogenic) neurological disorders: assessment and acute management in the Emergency Department. Semin Neurol 39(1):102\u2013114. https:\/\/doi.org\/10.1055\/s-0038-1676844","journal-title":"Semin Neurol"},{"issue":"04","key":"13139_CR16","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.psym.2017.12.006","volume":"59","author":"K McKee","year":"2018","unstructured":"McKee K, Glass S, Adams C et al (2018) The inpatient assessment and management of motor functional neurological disorders: an interdisciplinary perspective. Psychosomatics 59(04):358\u2013368","journal-title":"Psychosomatics"},{"key":"13139_CR17","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1159\/000475699","volume":"42","author":"S Galli","year":"2018","unstructured":"Galli S, Tatu L, Bogousslavsky J, Aybek S (2018) Conversion, factitious disorder and malingering: a distinct pattern or a continuum? Front Neurol Neurosci 42:72\u201380. https:\/\/doi.org\/10.1159\/000475699","journal-title":"Front Neurol Neurosci"},{"key":"13139_CR18","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1136\/practneurol-2017-001660","volume":"17","author":"J Stone","year":"2017","unstructured":"Stone J, Carson A (2017) \u2018Organic\u2019 and \u2018non-organic\u2019: a tale of two turnips. Pract Neurol 17:417\u2013418","journal-title":"Pract Neurol"},{"issue":"13","key":"13139_CR19","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1002\/mds.26035","volume":"29","author":"K LaFaver","year":"2014","unstructured":"LaFaver K, Hallett M (2014) Functional or psychogenic: what\u2019s the better name? Mov Disord. 29(13):1698\u20131699. https:\/\/doi.org\/10.1002\/mds.26035","journal-title":"Mov Disord."},{"key":"13139_CR20","doi-asserted-by":"publisher","first-page":"064","DOI":"10.1136\/bmj.o64","volume":"376","author":"S Aybek","year":"2022","unstructured":"Aybek S, Perez D (2022) Diagnosis and management of functional neurological disorder. BMJ 376:064. https:\/\/doi.org\/10.1136\/bmj.o64","journal-title":"BMJ"},{"key":"13139_CR21","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/B978-0-12-801772-2.00018-7","volume":"139","author":"J Stone","year":"2016","unstructured":"Stone J, Aybek S (2016) Functional limb weakness and paralysis. Handb Clin Neurol 139:213\u2013228","journal-title":"Handb Clin Neurol"},{"key":"13139_CR22","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.jpsychores.2011.09.003","volume":"71","author":"L McWhirter","year":"2011","unstructured":"McWhirter L, Stone J, Sandercock P et al (2011) Hoover\u2019s sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke. J Psychosom Res 71:384\u2013386","journal-title":"J Psychosom Res"},{"key":"13139_CR23","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1002\/mds.22268","volume":"23","author":"M Tinazzi","year":"2008","unstructured":"Tinazzi M, Simonetto S, Franco L et al (2008) Abduction finger sign: a new sign to detect unilateral functional paralysis of the upper limb. Mov Disord 23:2415\u20132419","journal-title":"Mov Disord"},{"key":"13139_CR24","first-page":"121","volume":"75","author":"M Sonoo","year":"2004","unstructured":"Sonoo M (2004) Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry 75:121\u2013125","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"Pt 5","key":"13139_CR25","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1093\/brain\/awq068","volume":"133","author":"J Stone","year":"2010","unstructured":"Stone J, Warlow C, Sharpe M (2010) The symptom of functional weakness: a controlled study of 107 patients. Brain 133(Pt 5):1537\u20131551","journal-title":"Brain"},{"key":"13139_CR26","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1007\/s004150050289","volume":"245","author":"I Ziv","year":"1998","unstructured":"Ziv I, Djaldetti R, Zoldan Y et al (1998) Diagnosis of \u2018\u201cnon-organic\u201d\u2019 limb paresis by a novel objective motor assessment: the quantitative Hoover\u2019s test. J Neurol 245:797\u2013802","journal-title":"J Neurol"},{"key":"13139_CR27","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/0924-9338(96)80314-2","volume":"10","author":"H Chabrol","year":"1995","unstructured":"Chabrol H, Peresson G, Clanet M (1995) Lack of specificity of the traditional criteria for conversion disorders. Eur Psychiatry 10:317\u2013319","journal-title":"Eur Psychiatry"},{"key":"13139_CR28","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1136\/jnnp.54.3.248","volume":"54","author":"RJ van der Ploeg","year":"1991","unstructured":"van der Ploeg RJ, Oosterhuis HJ (1991) The \u201cmake\/break test\u201d as a diagnostic tool in functional weakness. J Neurol Neurosurg Psychiatry 54:248\u2013251","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13139_CR29","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1097\/01.brs.0000137055.55350.37","volume":"29","author":"I Yugu\u00e9","year":"2004","unstructured":"Yugu\u00e9 I, Shiba K, Ueta T et al (2004) A new clinical evaluation for hysterical paralysis. Spine (Phila Pa 1976) 29:1910\u20131913","journal-title":"Spine (Phila Pa 1976)"},{"key":"13139_CR30","doi-asserted-by":"publisher","first-page":"100302","DOI":"10.1016\/j.ensci.2020.100302","volume":"21","author":"M Sonoo","year":"2021","unstructured":"Sonoo M (2021) Paradoxical wrist flexion: a new test to detect functional weakness in the upper limb. eNeurologicalSci 21:100302","journal-title":"eNeurologicalSci"},{"key":"13139_CR31","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1136\/jnnp-2012-304314","volume":"85","author":"TL Lombardi","year":"2014","unstructured":"Lombardi TL, Barton E, Wang J et al (2014) The elbow flex-ex: a new sign to detect unilateral upper extremity non-organic paresis. J Neurol Neurosurg Psychiatry 85:165\u2013167. https:\/\/doi.org\/10.1136\/jnnp-2012-304314","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13139_CR32","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1136\/jnnp.50.4.375","volume":"50","author":"JH Baker","year":"1987","unstructured":"Baker JH, Silver JR (1987) Hysterical paraplegia. J Neurol Neurosurg Psychiatry 50:375\u2013382","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13139_CR33","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/0013-4694(85)91027-2","volume":"61","author":"E Knutsson","year":"1985","unstructured":"Knutsson E, Martensson A (1985) Isokinetic measurements of muscle strength in hysterical paresis. Electroencephalogr Clin Neurophysiol 61:370\u2013374","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"13139_CR34","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1471-2377-13-31","volume":"13","author":"C Daum","year":"2013","unstructured":"Daum C, Aybek S (2013) Validity of the \u201cDrift without pronation\u201d sign in conversion disorder. BMC Neurol 13:31. https:\/\/doi.org\/10.1186\/1471-2377-13-31","journal-title":"BMC Neurol"},{"key":"13139_CR35","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1136\/jnnp-2013-307381","volume":"86","author":"C Daum","year":"2025","unstructured":"Daum C, Gheorghita F, Spatola M et al (2025) Interobserver agreement and validaty of bedside \u201cpositive signs\u201d for functional weakness, sensory and gait disorders in conversion disorders: a pilot study. J Neurol Neurosurg Psychiatry 86:425\u2013430","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13139_CR36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o64","author":"S Aybek","year":"2022","unstructured":"Aybek S, Perez DL (2022) Diagnosis and management of functional neurological disorders. BMJ. https:\/\/doi.org\/10.1136\/bmj.o64","journal-title":"BMJ"},{"key":"13139_CR37","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1001\/jama.1908.25410090028001h","volume":"51","author":"CF Hoover","year":"1908","unstructured":"Hoover CF (1908) A new sign for detection of malingering and functional paresis of the lower extremities. JAMA 51:746\u2013747","journal-title":"JAMA"},{"issue":"9","key":"13139_CR38","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1212\/01.wnl.0000142977.21104.94","volume":"63","author":"PJ Koehler","year":"2004","unstructured":"Koehler PJ, Okun MS (2004) Important observations prior to the description of the Hoover sign. Neurology 63(9):1693\u20131697. https:\/\/doi.org\/10.1212\/01.wnl.0000142977.21104.94","journal-title":"Neurology"},{"key":"13139_CR39","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1016\/S0140-6736(72)92286-6","volume":"ii","author":"AB Carter","year":"1972","unstructured":"Carter AB (1972) A physician\u2019s view of hysteria. Lancet ii:1241\u20131243","journal-title":"Lancet"},{"key":"13139_CR40","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.brainresrev.2005.03.005","volume":"49","author":"RG Carson","year":"2005","unstructured":"Carson RG (2005) Neural Pathways mediating bilateral interactions between the upper limbs. Brain Res Rev 49:641\u2013662","journal-title":"Brain Res Rev"},{"key":"13139_CR41","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1136\/jnnp.2004.043679","volume":"76","author":"NE Anderson","year":"2005","unstructured":"Anderson NE, Mason DF, Fink JN et al (2005) Detection of focal cerebral hemisphere lesions using the neurological examination. J Neurol Neurosurg Psychiatry 76:545\u2013549","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"13139_CR42","first-page":"755","volume":"15","author":"J Babinski","year":"1907","unstructured":"Babinski J (1907) De la pronation de la main dans l\u2019h\u00e9mipl\u00e9gie organique. Rev Neurol (Paris) 15:755","journal-title":"Rev Neurol (Paris)"},{"issue":"4","key":"13139_CR43","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1002\/mdc3.12492","volume":"4","author":"D Horn","year":"2017","unstructured":"Horn D, Galli S, Berney A, Vingerhoets F, Aybek S (2017) Testing head rotation and flexion is useful in functional limb weakness. Mov Disord Clin Pract 4(4):597\u2013602","journal-title":"Mov Disord Clin Pract"},{"key":"13139_CR44","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.jocn.2018.10.113","volume":"59","author":"O Aboud","year":"2019","unstructured":"Aboud O, Al-Salaimeh A, Raina K, Sahaya K, Hinduja A (2019) Positive clinical signs in neurological diseases\u2014an observational study. J Clin Neurosci. 59:141\u2013145","journal-title":"J Clin Neurosci."}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-025-13139-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-025-13139-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-025-13139-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T13:25:20Z","timestamp":1749907520000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-025-13139-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":44,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["13139"],"URL":"https:\/\/doi.org\/10.1007\/s00415-025-13139-4","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"assertion":[{"value":"17 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"On behalf of all authors, the corresponding author states that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"427"}}