{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:59:30Z","timestamp":1782262770881,"version":"3.54.5"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000377","name":"dunhill medical trust","doi-asserted-by":"publisher","award":["RTF2006\\14"],"award-info":[{"award-number":["RTF2006\\14"]}],"id":[{"id":"10.13039\/501100000377","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>An observational cohort study was conducted using data from the British Spine Registry (2017\u20132018) of adults (\u2265\u200950\u00a0years) with LSS, who underwent\u2009\u2264\u20092 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor\/good outcome. Multivariable regression models were performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12\u00a0months follow-up. Predictors associated with poor walking ability at 12\u00a0months were: increasing age (\u2265\u200975\u00a0years OR 1.54, 95% CI 1.07, 2.18), BMI\u2009\u2265\u200935\u00a0kg\/m<jats:sup>2<\/jats:sup> (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25)\u00a0and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12\u00a0months; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking\u00a0ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking\u00a0ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-021-06938-6","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T14:02:38Z","timestamp":1628172158000},"page":"3307-3318","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Prediction of walking ability following posterior decompression for lumbar spinal stenosis"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1863-9473","authenticated-orcid":false,"given":"Suzanne","family":"McIlroy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feroz","family":"Jadhakhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8114-7669","authenticated-orcid":false,"given":"Alison","family":"Rushton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"6938_CR1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1097\/BRS.0000000000001476","volume":"41","author":"C Tomkins-Lane","year":"2016","unstructured":"Tomkins-Lane C, Melloh M, Lurie J et al (2016) ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international delphi study. Spine (Phila Pa 1976) 41:1239\u20131246 (PubMed PMID: 26839989; PubMed Central PMCID: PMCPMC4966995)","journal-title":"Spine (Phila Pa 1976)"},{"key":"6938_CR2","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/1471-2474-11-233","volume":"11","author":"CC Winter","year":"2010","unstructured":"Winter CC, Brandes M, M\u00fcller C, Schubert T, Ringling M, Hillmann A, Rosenbaum D, Schulte TL (2010) Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study. BMC Musculoskelet Disord 11:233. https:\/\/doi.org\/10.1186\/1471-2474-11-233","journal-title":"BMC Musculoskelet Disord"},{"key":"6938_CR3","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1080\/09638288.2016.1177611","volume":"39","author":"S Lyle","year":"2017","unstructured":"Lyle S, Williamson E, Darton F, Griffiths F, Lamb SE (2017) A qualitative study of older people\u2019s experience of living with neurogenic claudication to inform the development of a physiotherapy intervention. Disabil Rehabil 39:1009\u20131017. https:\/\/doi.org\/10.1080\/09638288.2016.1177611","journal-title":"Disabil Rehabil"},{"key":"6938_CR4","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1007\/s00586-014-3262-6","volume":"23","author":"C Ammendolia","year":"2014","unstructured":"Ammendolia C, Stuber K, Tomkins-Lane C, Schneider M, Rampersaud YR, Furlan AD, Kennedy CA (2014) What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review. Eur Spine J 23:1282\u20131301. https:\/\/doi.org\/10.1007\/s00586-014-3262-6 (PubMed PMID: 24633719)","journal-title":"Eur Spine J"},{"key":"6938_CR5","unstructured":"NHS Digital Hospital Admitted Patient Care Activity, 2017\u201318. 2018"},{"key":"6938_CR6","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.spinee.2013.12.010","volume":"14","author":"YR Rampersaud","year":"2014","unstructured":"Rampersaud YR, Lewis SJ, Davey JR, Gandhi R, Mahomed NN (2014) Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee\u2013part 1: long-term change in health-related quality of life. Spine J 14:234\u2013243. https:\/\/doi.org\/10.1016\/j.spinee.2013.12.010","journal-title":"Spine J"},{"key":"6938_CR7","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1186\/1471-2474-15-348","volume":"15","author":"P Kuittinen","year":"2014","unstructured":"Kuittinen P, Sipola P, Saari T, Aalto TJ, Sinikallio S, Savolainen S, Kr\u00f6ger H, Turunen V, Leinonen V, Airaksinen O (2014) Visually assessed severity of lumbar spinal canal stenosis is paradoxically associated with leg pain and objective walking ability. BMC Musculoskelet Disord 15:348. https:\/\/doi.org\/10.1186\/1471-2474-15-348","journal-title":"BMC Musculoskelet Disord"},{"key":"6938_CR8","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1097\/BRS.0b013e3181e0f04d","volume":"35","author":"JN Weinstein","year":"2010","unstructured":"Weinstein JN, Tosteson TD et al (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 35:1329\u20131338. https:\/\/doi.org\/10.1097\/BRS.0b013e3181e0f04d","journal-title":"Spine (Phila Pa 1976)"},{"key":"6938_CR9","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.spinee.2017.08.262","volume":"18","author":"M Smuck","year":"2018","unstructured":"Smuck M, Muaremi A, Zheng P, Norden J, Sinha A, Hu R, Tomkins-Lane C (2018) Objective measurement of function following lumbar spinal stenosis decompression reveals improved functional capacity with stagnant real-life physical activity. Spine J 18:15\u201321. https:\/\/doi.org\/10.1016\/j.spinee.2017.08.262","journal-title":"Spine J"},{"key":"6938_CR10","doi-asserted-by":"publisher","first-page":"E648","DOI":"10.1097\/01.brs.0000231727.88477.da","volume":"31","author":"TJ Aalto","year":"2006","unstructured":"Aalto TJ, Malmivaara A et al (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976) 31:E648\u2013E663. https:\/\/doi.org\/10.1097\/01.brs.0000231727.88477.da","journal-title":"Spine (Phila Pa 1976)"},{"key":"6938_CR11","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1007\/s00586-010-1324-y","volume":"19","author":"TL Schulte","year":"2010","unstructured":"Schulte TL, Schubert T et al (2010) Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J 19:1855\u20131864. https:\/\/doi.org\/10.1007\/s00586-010-1324-y","journal-title":"Eur Spine J"},{"key":"6938_CR12","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453\u20131457. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X","journal-title":"Lancet"},{"key":"6938_CR13","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","volume":"25","author":"JCT Fairbank","year":"2000","unstructured":"Fairbank JCT, Pynsent PB (2000) The oswestry disability index. Spine 25:2940\u20132953","journal-title":"Spine"},{"key":"6938_CR14","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s11136-012-0322-4","volume":"22","author":"MF Janssen","year":"2013","unstructured":"Janssen MF, Pickard AS et al (2013) Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res 22:1717\u20131727","journal-title":"Qual Life Res"},{"key":"6938_CR15","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s00586-007-0511-y","volume":"17","author":"JA Cleland","year":"2008","unstructured":"Cleland JA, Fritz JM, Brennan GP (2008) Predictive validity of initial fear avoidance beliefs in patients with low back pain receiving physical therapy: is the FABQ a useful screening tool for identifying patients at risk for a poor recovery? Eur Spine J 17:70\u201379. https:\/\/doi.org\/10.1007\/s00586-007-0511-y","journal-title":"Eur Spine J"},{"key":"6938_CR16","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1001\/archpsyc.1965.01720310065008","volume":"12","author":"WW Zung","year":"1965","unstructured":"Zung WW (1965) A self-rating depession scale. Arch Gen Psychiatry 12:63\u201370. https:\/\/doi.org\/10.1001\/archpsyc.1965.01720310065008","journal-title":"Arch Gen Psychiatry"},{"key":"6938_CR17","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1016\/j.spinee.2019.04.004","volume":"19","author":"DB Anderson","year":"2019","unstructured":"Anderson DB, Mathieson S, Eyles J, Maher CG, Van Gelder JM, Tomkins-Lane CC, Ammendolia C, Bella V, Ferreira ML (2019) Measurement properties of walking outcome measures for neurogenic claudication: a systematic review and meta analysis. Spine J 19:1378\u20131396. https:\/\/doi.org\/10.1016\/j.spinee.2019.04.004","journal-title":"Spine J"},{"key":"6938_CR18","doi-asserted-by":"publisher","first-page":"E2","DOI":"10.3171\/2017.10.FOCUS17554","volume":"441","author":"AL Asher","year":"2018","unstructured":"Asher AL et al (2018) Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus 441:E2","journal-title":"Neurosurg Focus"},{"key":"6938_CR19","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/mpr.329","volume":"20","author":"MJ Azur","year":"2011","unstructured":"Azur MJ, Stuart EA, Frangakis C, Leaf PJ (2011) Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psychiatr Res 20:40\u201349. https:\/\/doi.org\/10.1002\/mpr.329","journal-title":"Int J Methods Psychiatr Res"},{"key":"6938_CR20","doi-asserted-by":"publisher","first-page":"536","DOI":"10.3109\/17453674.2012.733915","volume":"83","author":"FG Sigmundsson","year":"2012","unstructured":"Sigmundsson FG, Kang XP, Jonsson B, Stromqvist B (2012) Prognostic factors in lumbar spinal stenosis surgery. Acta Orthop 83:536\u2013542","journal-title":"Acta Orthop"},{"key":"6938_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journalpone.0207126","author":"U Held","year":"2018","unstructured":"Held U, Burgstaller JM et al (2018) Prognostic function to estimate the probability of meaningful clinical improvement after surgery - Results of a prospective multicenter observational cohort study on patients with lumbar spinal stenosis. PLoS ONE. https:\/\/doi.org\/10.1371\/journalpone.0207126","journal-title":"PLoS ONE"},{"key":"6938_CR22","doi-asserted-by":"publisher","DOI":"10.1007\/s13670-013-0059-0","author":"JS Brach","year":"2013","unstructured":"Brach JS, Vanswearingen JM (2013) Interventions to improve walking in older adults. Curr Transl Geriatr Exp Gerontol Rep. https:\/\/doi.org\/10.1007\/s13670-013-0059-0","journal-title":"Curr Transl Geriatr Exp Gerontol Rep"},{"key":"6938_CR23","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.apmr.2011.09.023","volume":"93","author":"CC Tomkins-Lane","year":"2012","unstructured":"Tomkins-Lane CC, Holz SC, Yamakawa KS, Phalke VV, Quint DJ, Miner J, Haig AJ (2012) Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls. Arch Phys Med Rehabil 93:647\u2013653. https:\/\/doi.org\/10.1016\/j.apmr.2011.09.023","journal-title":"Arch Phys Med Rehabil"},{"key":"6938_CR24","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1097\/BRS.0b013e3182634b04","volume":"37","author":"A Pearson","year":"2012","unstructured":"Pearson A, Lurie J, Tosteson T, Zhao WY, Abdu W, Weinstein JN (2012) Who should have surgery for spinal stenosis? Treatment effect predictors in SPORT. Spine 37:1791\u20131802. https:\/\/doi.org\/10.1097\/BRS.0b013e3182634b04","journal-title":"Spine"},{"key":"6938_CR25","doi-asserted-by":"publisher","unstructured":"McIlroy S, Walsh E, Sothinathan C, Stovold E, Norwitz D, Norton S, Weinman J, Bearne L (2021) Pre-operative prognostic factors for walking capacity after surgery for lumbar spinal stenosis: a systematic review. Age Ageing.\u00a0https:\/\/doi.org\/10.1093\/ageing\/afab150","DOI":"10.1093\/ageing\/afab150"},{"key":"6938_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30480-X","author":"J Hartvigsen","year":"2018","unstructured":"Hartvigsen J, Hancock MJ et al (2018) What low back pain is and why we need to pay attention. Lancet. https:\/\/doi.org\/10.1016\/S0140-6736(18)30480-X","journal-title":"Lancet"},{"key":"6938_CR27","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1123\/japa.16.1.69","volume":"16","author":"MN Galea","year":"2008","unstructured":"Galea MN, Bray SR, Ginis KA (2008) Barriers and facilitators for walking in individuals with intermittent claudication. J Aging Phys Act 16:69\u201383","journal-title":"J Aging Phys Act"},{"key":"6938_CR28","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/NPT.0000000000000143","volume":"40","author":"KA Danks","year":"2016","unstructured":"Danks KA, Pohlig RT, Roos M, Wright TR, Reisman DS (2016) Relationship between walking capacity, biopsychosocial factors, self-efficacy, and walking activity in persons poststroke. J Neurol Phys Ther 40:232\u2013238. https:\/\/doi.org\/10.1097\/NPT.0000000000000143","journal-title":"J Neurol Phys Ther"},{"key":"6938_CR29","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/0895-4356(95)00054-2","volume":"48","author":"G Stucki","year":"1995","unstructured":"Stucki G, Liang MH, Fossel AH, Katz JN (1995) Relative responsiveness of condition-specific and generic health-status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48:1369\u20131378","journal-title":"J Clin Epidemiol"},{"key":"6938_CR30","doi-asserted-by":"publisher","first-page":"E425","DOI":"10.1097\/BRS.0000000000001845","volume":"42","author":"JM Burgstaller","year":"2017","unstructured":"Burgstaller JM, Wertli MM, Steurer J, Kessels AG, Held U, Gramke HF, Group LS (2017) The Influence of Pre- and postoperative fear avoidance beliefs on postoperative pain and disability in patients with lumbar spinal stenosis: analysis of the lumbar spinal outcome study (LSOS) data. Spine 42:E425\u2013E432","journal-title":"Spine"},{"key":"6938_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2019.105481","volume":"185","author":"Y Kobayashi","year":"2019","unstructured":"Kobayashi Y, Ogura Y et al (2019) The influence of preoperative mental health on clinical outcomes after laminectomy in patients with lumbar spinal stenosis. Clin Neurol Neurosurg 185:105481. https:\/\/doi.org\/10.1016\/j.clineuro.2019.105481","journal-title":"Clin Neurol Neurosurg"},{"key":"6938_CR32","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1097\/BRS.0b013e3181dcaf4a","volume":"36","author":"S Sinikallio","year":"2011","unstructured":"Sinikallio S, Aalto T, Airaksinen O, Lehto SM, Kroger H, Viinamaki H (2011) Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study. Spine 36:677\u2013682","journal-title":"Spine"},{"key":"6938_CR33","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.jpain.2015.09.013","volume":"17","author":"KR Archer","year":"2016","unstructured":"Archer KR, Devin CJ et al (2016) Cognitive-behavioral-based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial. J Pain 17:76\u201389. https:\/\/doi.org\/10.1016\/j.jpain.2015.09.013","journal-title":"J Pain"},{"key":"6938_CR34","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1186\/s12891-019-2850-3","volume":"20","author":"M Fors","year":"2019","unstructured":"Fors M, Enthoven P, Abbott A, Oberg B (2019) Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: secondary outcomes of the PREPARE randomised controlled trial. BMC Musculoskelet Disord 20:468","journal-title":"BMC Musculoskelet Disord"},{"key":"6938_CR35","doi-asserted-by":"crossref","unstructured":"Sterne JA, White IR, Carlin JB et al (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393","DOI":"10.1136\/bmj.b2393"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-021-06938-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-021-06938-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-021-06938-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T12:50:30Z","timestamp":1635252630000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-021-06938-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,5]]},"references-count":35,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["6938"],"URL":"https:\/\/doi.org\/10.1007\/s00586-021-06938-6","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,5]]},"assertion":[{"value":"7 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The corresponding author has completed the disclosure of potential conflicts of interest and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}