{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T18:19:06Z","timestamp":1764181146837,"version":"3.46.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"VIA University College"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurol Belg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to evaluate the responsiveness of the Six-Spot Step Test (SSST) in people with multiple sclerosis to assess its capability as a measure for detecting changes in gait and balance capacity following a 10-week training intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The SSST, Timed 25-Foot Walk, and mini-BESTest were administered to 71 individuals with MS, ranging from mild to severe disability, before and after a 10-week program of progressive resistance and balance training. However, 16 patients were lost to follow-up. This study adhered to the COSMIN framework for reporting and evaluating the psychometric properties of health-related outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Spearman's analyses revealed a moderate negative correlation between changes in the SSST and the mini-BESTest (r\n                      <jats:sub>s<\/jats:sub>\n                      \u2009=\u2009-0.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and changes in the SSST and the Timed 25-Foot Walk (r\n                      <jats:sub>s<\/jats:sub>\n                      \u2009=\u2009-0.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Significant median (min;max) changes and corresponding effect sizes (ES) were observed in the SSST (-1.4 (-11.4;4.7),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, ES\u2009=\u2009-0.84), the Mini-BESTest (3 (-3;13),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, ES\u2009=\u20090.89), and the Timed 25-Foot Walk (0.09 (-0.21;0.54),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, ES\u2009=\u20090.71).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The SSST serves as a sensitive measure for changes in gait and balance capacity. Furthermore, the consistently large effect sizes observed across all three gait and balance assessments following the exercise intervention suggest that these measures reflect a shared underlying construct\u2014functional mobility\u2014which is essential for independent community living.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s13760-025-02887-9","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T01:00:01Z","timestamp":1756947601000},"page":"1567-1574","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A study of the responsiveness of the Six-Spot Step Test in people with multiple sclerosis"],"prefix":"10.1007","volume":"125","author":[{"given":"Esben","family":"K\u00f8hler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Callsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Kodal","family":"Brincks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"issue":"11","key":"2887_CR1","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1212\/WNL.0000000000000768","volume":"83","author":"P Browne","year":"2014","unstructured":"Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, Thompson AJ (2014) Atlas of Multiple Sclerosis 2013: a growing global problem with widespread inequity. Neur 83(11):1022\u20131024. https:\/\/doi.org\/10.1212\/WNL.0000000000000768","journal-title":"Neur"},{"key":"2887_CR2","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/B978-0-444-63916-5.00015-X","volume":"159","author":"MH Cameron","year":"2018","unstructured":"Cameron MH, Nilsagard Y (2018) Balance, gait, and falls in multiple sclerosis. Handb Clini Neur 159:237\u2013250. https:\/\/doi.org\/10.1016\/B978-0-444-63916-5.00015-X","journal-title":"Handb Clini Neur"},{"key":"2887_CR3","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1191\/1352458506ms1293oa","volume":"12","author":"MM Nieuwenhuis","year":"2006","unstructured":"Nieuwenhuis MM, Van Tongeren H, S\u00f8rensen PS, Ravnborg M (2006) The six spot step test: a new measurement for walking ability in multiple sclerosis. Mult Scler J 12:495\u2013500. https:\/\/doi.org\/10.1191\/1352458506ms1293oa","journal-title":"Mult Scler J"},{"key":"2887_CR4","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.apmr.2015.10.100","volume":"97","author":"NE Fritz","year":"2016","unstructured":"Fritz NE, Jiang A, Keller J, Zackowski KM (2016) Utility of the Six-Spot Step Test as a measure of walking performance in ambulatory individuals with multiple sclerosis. Arch Phy Med Rehab 97:507\u2013512. https:\/\/doi.org\/10.1016\/j.apmr.2015.10.100","journal-title":"Arch Phy Med Rehab"},{"key":"2887_CR5","doi-asserted-by":"publisher","unstructured":"Horak FB (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 35 Suppl 2: ii7-ii11. https:\/\/doi.org\/10.1093\/ageing\/afl077","DOI":"10.1093\/ageing\/afl077"},{"key":"2887_CR6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.2340\/16501977-0537","volume":"42","author":"F Franchignoni","year":"2010","unstructured":"Franchignoni F, Horak F, Godi M, Nardone A, Giordano A (2010) Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med 42:323\u2013331. https:\/\/doi.org\/10.2340\/16501977-0537","journal-title":"J Rehabil Med"},{"key":"2887_CR7","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/MRR.0000000000000153","volume":"39","author":"S Di Carlo","year":"2016","unstructured":"Di Carlo S, Bravini E, Vercelli S, Massazza G, Ferriero G (2016) The Mini-BESTest: a review of psychometric properties. Int J Rehabil Res 39:97\u2013105. https:\/\/doi.org\/10.1097\/MRR.0000000000000153","journal-title":"Int J Rehabil Res"},{"key":"2887_CR8","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1177\/02692155241236609","volume":"38","author":"EB Aakrann","year":"2024","unstructured":"Aakrann EB, Brincks J (2024) The psychometric properties of the Six-Spot Step Test - a systematic review using the COSMIN guidelines. Clin Rehabil 38:932\u2013943. https:\/\/doi.org\/10.1177\/02692155241236609","journal-title":"Clin Rehabil"},{"key":"2887_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ptj\/pzaa227","volume":"101","author":"BM Sandroff","year":"2021","unstructured":"Sandroff BM, Silveira SL, Baird JF, Huynh T, Motl RW (2021) Cognitive processing speed impairment does not influence the construct validity of Six-Spot Step Test performance in people with multiple sclerosis. Phys Therapy & J Rehabil 101:1\u201310. https:\/\/doi.org\/10.1093\/ptj\/pzaa227","journal-title":"Phys Therapy & J Rehabil"},{"key":"2887_CR10","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.gaitpost.2014.10.011","volume":"41","author":"BM Sandroff","year":"2015","unstructured":"Sandroff BM, Motl RW, Sosnoff JJ, Pula JH (2015) Further validation of the Six-Spot Step Test as a measure of ambulation in multiple sclerosis. Gait Posture 41:222\u2013227. https:\/\/doi.org\/10.1016\/j.gaitpost.2014.10.011","journal-title":"Gait Posture"},{"key":"2887_CR11","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1177\/0269215519833016","volume":"33","author":"J Brincks","year":"2019","unstructured":"Brincks J, Callesen J, Johnsen E, Dalgas U (2019) A study of the validity of the six-spot step test in ambulatory people with Parkinson\u2019s disease. Clin Rehabil 33:1206\u20131213","journal-title":"Clin Rehabil"},{"key":"2887_CR12","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1177\/02692155211010278","volume":"35","author":"J Brincks","year":"2021","unstructured":"Brincks J, Callesen J (2021) Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems. Clin Rehabil 35:1478\u20131487. https:\/\/doi.org\/10.1177\/02692155211010278","journal-title":"Clin Rehabil"},{"key":"2887_CR13","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/jns.12210","volume":"22","author":"M Kreutzfeldt","year":"2017","unstructured":"Kreutzfeldt M, Jensen HB, Ravnborg M, Markvardsen LH, Andersen H, Sindrup SH (2017) The six-spot-step test - a new method for monitoring walking ability in patients with chronic inflammatory polyneuropathy. J Perip Nerv Sys 22:131\u2013138. https:\/\/doi.org\/10.1111\/jns.12210","journal-title":"J Perip Nerv Sys"},{"key":"2887_CR14","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1080\/09593985.2018.1482511","volume":"36","author":"M Arvidsson Lindvall","year":"2020","unstructured":"Arvidsson Lindvall M, Anderz\u00e9n-Carlsson A, Appelros P, Forsberg A (2020) Validity and test-retest reliability of the six-spot step test in persons after stroke. Physioth Theory Pra 36:211\u2013218. https:\/\/doi.org\/10.1080\/09593985.2018.1482511","journal-title":"Physioth Theory Pra"},{"key":"2887_CR15","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s13760-022-01991-4","volume":"122","author":"UM Pommerich","year":"2022","unstructured":"Pommerich UM, Brincks J, Skjerb\u00e6k AG, Dalgas U (2022) Acta neurologica Belgic 122:893\u2013901. https:\/\/doi.org\/10.1007\/s13760-022-01991-4","journal-title":"Acta neurologica Belgic"},{"key":"2887_CR16","doi-asserted-by":"publisher","unstructured":"Gr\u010di\u0107 PF, Matijaca M, Lu\u0161i\u0107 I, \u010capkun V (2011) Responsiveness of walking-based outcome measures after multiple sclerosis relapses following steroid pulses. Medical Science Monitor 17:CR704-CR710. https:\/\/doi.org\/10.12659\/MSM.882130","DOI":"10.12659\/MSM.882130"},{"key":"2887_CR17","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1177\/15459683241273402","volume":"38","author":"A Wallin","year":"2024","unstructured":"Wallin A, Johansson S, Brincks J, Dalgas U, Franz\u00e9n E, Callesen J (2024) Effects of balance exercise interventions on balance-related performance in people with multiple sclerosis: a systematic review and a meta-analysis of randomized controlled trials. Neurorehabil Neural Repair 38:775\u2013790. https:\/\/doi.org\/10.1177\/15459683241273402","journal-title":"Neurorehabil Neural Repair"},{"key":"2887_CR18","doi-asserted-by":"publisher","first-page":"2854130","DOI":"10.1155\/2019\/2854130","volume":"2019","author":"K Novotna","year":"2019","unstructured":"Novotna K, Janatova M, Hana K, Svestkova O, PreiningerovaLizrova J, KubalaHavrdova E (2019) Biofeedback based home balance training can improve balance but not gait in people with multiple sclerosis. Mult Scler Int 2019:2854130. https:\/\/doi.org\/10.1155\/2019\/2854130","journal-title":"Mult Scler Int"},{"key":"2887_CR19","doi-asserted-by":"publisher","unstructured":"Straudi S, De Marco G, Martinuzzi C, Baroni A, Lamberti N, Brondi L, Da Roit M, Pizzongolo L, Basaglia N, Manfredini F (2022) Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial. Multiple Sclerosis and Related Disorders 60: 103721. https:\/\/doi.org\/10.1016\/j.msard.2022.103721","DOI":"10.1016\/j.msard.2022.103721"},{"key":"2887_CR20","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1177\/1352458515579442","volume":"22","author":"P Hoang","year":"2016","unstructured":"Hoang P, Schoene D, Gandevia S, Smith S, Lord SR (2016) Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis\u2013a randomized controlled trial. J Multi Sclerosis 22:94\u2013103. https:\/\/doi.org\/10.1177\/1352458515579442","journal-title":"J Multi Sclerosis"},{"key":"2887_CR21","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/1352458512450088","volume":"19","author":"YE Nilsag\u00e5rd","year":"2013","unstructured":"Nilsag\u00e5rd YE, Forsberg AS, von Koch L (2013) Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. J Multi Sclerosis 19:209\u2013216. https:\/\/doi.org\/10.1177\/1352458512450088","journal-title":"J Multi Sclerosis"},{"key":"2887_CR22","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1177\/1545968313478484","volume":"27","author":"L Prosperini","year":"2013","unstructured":"Prosperini L, Fortuna D, Giann\u00ec C, Leonardi L, Marchetti MR, Pozzilli C (2013) Home-based balance training using the Wii balance board: a randomized, crossover pilot study in multiple sclerosis. Neurorehabilitaion and Neural Repair 27:516\u2013525. https:\/\/doi.org\/10.1177\/1545968313478484","journal-title":"Neurorehabilitaion and Neural Repair"},{"key":"2887_CR23","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1212\/WNL.0b013e3181bf98b4","volume":"73","author":"U Dalgas","year":"2009","unstructured":"Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen J, Knudsen C, Overgaard K, Ingemann-Hansen T (2009) Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neur 73:1478\u20131484. https:\/\/doi.org\/10.1212\/WNL.0b013e3181bf98b4","journal-title":"Neur"},{"key":"2887_CR24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jclinepi.2021.06.002","volume":"140","author":"L Mokkink","year":"2021","unstructured":"Mokkink L, Terwee C, de Vet H, Key, (2021) Concepts in clinical epidemiology: Responsiveness, the longitudinal aspect of validity. J Clini Epidem 140:159\u2013162. https:\/\/doi.org\/10.1016\/j.jclinepi.2021.06.002","journal-title":"J Clini Epidem"},{"key":"2887_CR25","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/wnl.33.11.144","volume":"33","author":"JF Kurtzke","year":"1983","unstructured":"Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neur 33:1444\u20131452. https:\/\/doi.org\/10.1212\/wnl.33.11.144","journal-title":"Neur"},{"key":"2887_CR26","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.1177\/1352458519865740","volume":"26","author":"J Callesen","year":"2020","unstructured":"Callesen J, Cattaneo D, Brincks J, KjeldgaardJ\u00f8rgensen ML, Dalgas U (2020) How do resistance training and balance and motor control training affect gait performance and fatigue impact in people with multiple sclerosis? A randomized controlled multi-center study. J Multi Sclerosis 26:1420\u20131432. https:\/\/doi.org\/10.1177\/1352458519865740","journal-title":"J Multi Sclerosis"},{"key":"2887_CR27","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3233\/NRE-172238","volume":"42","author":"J Callesen","year":"2018","unstructured":"Callesen J, Cattaneo D, Brincks J, Dalgas U (2018) How does strength training and balance training affect gait and fatigue in patients with Multiple Sclerosis? A study protocol of a randomized controlled trial. Neuro Rehabil 42:131\u2013142. https:\/\/doi.org\/10.3233\/NRE-172238","journal-title":"Neuro Rehabil"},{"key":"2887_CR28","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s11136-018-1798-3","volume":"27","author":"CAC Prinsen","year":"2018","unstructured":"Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HVW, Terwee CB (2018) COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 27:1147\u20131157. https:\/\/doi.org\/10.1007\/s11136-018-1798-3","journal-title":"Qual Life Res"},{"key":"2887_CR29","doi-asserted-by":"publisher","first-page":"2428","DOI":"10.1016\/j.apmr.2014.06.016","volume":"95","author":"YE Nilsag\u00e5rd","year":"2014","unstructured":"Nilsag\u00e5rd YE, von Koch LK, Nilsson M, Forsberg AS (2014) Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial. Arc of Phys Med Rehabil 95:2428\u20132434. https:\/\/doi.org\/10.1016\/j.apmr.2014.06.016","journal-title":"Arc of Phys Med Rehabil"},{"key":"2887_CR30","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1177\/0269215507077602","volume":"21","author":"D Cattaneo","year":"2007","unstructured":"Cattaneo D, Jonsdottir J, Zocchi M, Regola A (2007) Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil 21:771\u2013781. https:\/\/doi.org\/10.1177\/0269215507077602","journal-title":"Clin Rehabil"},{"key":"2887_CR31","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1177\/0269215514546770","volume":"29","author":"A Halvarsson","year":"2015","unstructured":"Halvarsson A, Dohrn IM, St\u00e5hle A (2015) Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme. Clin Rehabil 29:417\u2013425. https:\/\/doi.org\/10.1177\/0269215514546770","journal-title":"Clin Rehabil"},{"key":"2887_CR32","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.2522\/ptj.20100399","volume":"91","author":"JR Hebert","year":"2011","unstructured":"Hebert JR, Corboy JR, Manago MM, Schenkman M (2011) Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upright postural control: a randomized controlled trial. J Phys Therapy & Rehabil 91:1166\u20131183. https:\/\/doi.org\/10.2522\/ptj.20100399","journal-title":"J Phys Therapy & Rehabil"},{"key":"2887_CR33","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1177\/135245859900500409","volume":"5","author":"JS Fischer","year":"1999","unstructured":"Fischer JS, Rudick RA, Cutter GR, Reingold SC (1999) The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. J Multi Sclerosis 5:244\u2013250. https:\/\/doi.org\/10.1177\/135245859900500409","journal-title":"J Multi Sclerosis"},{"key":"2887_CR34","unstructured":"COSMIN (2019) Study Design checklist for Patient-reported outcome measurement instruments. COSMIN. https:\/\/www.cosmin.nl\/tools\/checklists-assessing-methodological-study-qualities\/. Accessed 16 June 2025"},{"key":"2887_CR35","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2025.2456602","author":"AB Meseguer-Henarejos","year":"2025","unstructured":"Meseguer-Henarejos AB, L\u00f3pez-Pina JA, L\u00f3pez-Garc\u00eda JJ, Mart\u00ednez-Gonz\u00e1lez-Moro I (2025) Psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) among multiple populations: a COSMIN systematic review and meta-analysis. Disabil Rehabil. https:\/\/doi.org\/10.1080\/09638288.2025.2456602","journal-title":"Disabil Rehabil"},{"key":"2887_CR36","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.2522\/ptj.20150334","volume":"96","author":"MB Wall\u00e9n","year":"2016","unstructured":"Wall\u00e9n MB, Sorjonen K, L\u00f6fgren N, Franz\u00e9n E (2016) Structural Validity of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in People With Mild to Moderate Parkinson\u2019s Disease. J Phys Therapy & Rehabil 96:1799\u20131806. https:\/\/doi.org\/10.2522\/ptj.20150334","journal-title":"J Phys Therapy & Rehabil"}],"container-title":["Acta Neurologica Belgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02887-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13760-025-02887-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-025-02887-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T18:15:08Z","timestamp":1764180908000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13760-025-02887-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2887"],"URL":"https:\/\/doi.org\/10.1007\/s13760-025-02887-9","relation":{},"ISSN":["0300-9009","2240-2993"],"issn-type":[{"type":"print","value":"0300-9009"},{"type":"electronic","value":"2240-2993"}],"subject":[],"published":{"date-parts":[[2025,9,4]]},"assertion":[{"value":"16 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}