{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:55:11Z","timestamp":1789185311142,"version":"build-2803163510"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"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":["Spinal Cord Ser Cases"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Shoulder pain mostly due to high biomechanical load of the anterior-shoulder musculature is prevalent among manual wheelchair users with spinal cord injury or disorder (SCI\/D). This case study showcases a novel pull-function attachment to the wheelchair that reverses the propulsion motion by pulling rather than pushing the wheelchair. Additionally, the study reports its preliminary usability and impact on shoulder pain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>Four individuals with SCI\/D (median age: 33; 1 female) used the novel pull-function attachment to the manual wheelchair for six weeks. Usability (System Usability Scale; ranging from 1\u2009=\u2009\u2019strongly disagree\u2019 to 5\u2009=\u2009\u2019strongly agree\u2019) and daily usage time were assessed. Shoulder pain intensity was explored before and after the six weeks using the Wheelchair User\u2019s Shoulder Pain Index. Median usability scores were \u22653.0 for 5\/6 items, indicating high usability of the assistive technology. Shoulder pain intensity was reduced in all participants at the post-test (median change: \u22126.3), with the change in shoulder pain exceeding the minimal detectable change for 2\/3 participants.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>The results of this case study suggest high usability of the pull-function attachment to the wheelchair. The decreases in shoulder pain intensity reported following six weeks of use were noticeable and may have clinical relevance. This novel assistive technology that enables forward propulsion by pulling rather than pushing the wheelchair may therefore have the potential to reduce shoulder pain in manual wheelchair users with SCI\/D.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1038\/s41394-025-00704-2","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T15:33:44Z","timestamp":1745854424000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A pull function attachment to manual wheelchairs: a case report on usability and shoulder pain in people with spinal cord injury"],"prefix":"10.1038","volume":"11","author":[{"given":"Mikkel","family":"Krogshede","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"Holgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim Alexander","family":"Valk\u00e6r","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2164-234X","authenticated-orcid":false,"given":"Pascal","family":"Madeleine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8515-8779","authenticated-orcid":false,"given":"Rasmus Kopp","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"704_CR1","volume-title":"Wheelchair service training package - fact sheet on wheelchairs","author":"World Health Organization (WHO","year":"2014","unstructured":"Wheelchair service training package - fact sheet on wheelchairs. Geneva: WHO; 2014World Health Organization (WHO)."},{"key":"704_CR2","volume-title":"Mobility device use in the United States. Disability statistics report, 14","author":"HS Kaye","year":"2000","unstructured":"Kaye HS, Kang T, LaPlante MP Mobility device use in the United States. Disability statistics report, 14. Washington, D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research; 2000."},{"key":"704_CR3","doi-asserted-by":"publisher","first-page":"676","DOI":"10.2106\/00004623-198769050-00006","volume":"69","author":"JC Bayley","year":"1987","unstructured":"Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder. the impingement syndrome in paraplegics. J Bone Jt Surg Am. 1987;69:676\u20138.","journal-title":"J Bone Jt Surg Am"},{"key":"704_CR4","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.apmr.2014.09.032","volume":"96","author":"M Akbar","year":"2015","unstructured":"Akbar M, Brunner M, Ewerbeck V, Wiedenh\u00f6fer B, Grieser T, Bruckner T, et al. Do overhead sports increase risk for rotator cuff tears in wheelchair users?. Arch Phys Med Rehabil. 2015;96:484\u20138. https:\/\/doi.org\/10.1016\/j.apmr.2014.09.032.","journal-title":"Arch Phys Med Rehabil"},{"key":"704_CR5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/03009740310004667","volume":"33","author":"JJ Luime","year":"2004","unstructured":"Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73\u201381. https:\/\/doi.org\/10.1080\/03009740310004667.","journal-title":"Scand J Rheumatol"},{"key":"704_CR6","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1038\/s41393-020-00594-1","volume":"59","author":"CM Larsen","year":"2021","unstructured":"Larsen CM, Juul-Kristensen B, Kasch H, Hartvigsen J, Frich LH, Boyle E, et al. The danish spinal cord injury shoulder (DanSCIS) cohort: methodology and primary results. Spinal Cord. 2021;59:821\u201331. https:\/\/doi.org\/10.1038\/s41393-020-00594-1.","journal-title":"Spinal Cord"},{"key":"704_CR7","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1053\/apmr.2000.18216","volume":"81","author":"DA Ballinger","year":"2000","unstructured":"Ballinger DA, Rintala DH, Hart KA. The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study. Arch Phys Med Rehabil. 2000;81:1575\u201381. https:\/\/doi.org\/10.1053\/apmr.2000.18216.","journal-title":"Arch Phys Med Rehabil"},{"key":"704_CR8","doi-asserted-by":"publisher","unstructured":"Stirane D, Kiukucane E, Vetra A, Nulle A. The consequences of shoulder pain intensity on quality of life and community participation in paraplegic wheelchair users. SHS web of conferences. In 3rd International Interdisciplinary Scientific Conference SOCIETY. HEALTH. WELFARE \u20131st Congress of Rehabilitation Doctors of Latvia, vol 2, 2012. https:\/\/doi.org\/10.1051\/shsconf\/20120200033.","DOI":"10.1051\/shsconf\/20120200033"},{"key":"704_CR9","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1080\/10790268.2007.11753933","volume":"30","author":"DD Gutierrez","year":"2007","unstructured":"Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. J Spinal Cord Med. 2007;30:251\u20135. https:\/\/doi.org\/10.1080\/10790268.2007.11753933Physical Therapy Clinical Research Network, Rehabilitation Research and Training Center on Aging-Related Changes in Impairment for Persons Living with Physical Disabilities.","journal-title":"J Spinal Cord Med"},{"key":"704_CR10","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1038\/sc.1995.65","volume":"33","author":"KA Curtis","year":"1995","unstructured":"Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, et al. Development of the wheelchair user\u2019s shoulder pain index (WUSPI). Paraplegia. 1995;33:290\u20133. https:\/\/doi.org\/10.1038\/sc.1995.65.","journal-title":"Paraplegia"},{"key":"704_CR11","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1038\/sc.1991.75","volume":"29","author":"WE Pentland","year":"1991","unstructured":"Pentland WE, Twomey LT. The weight-bearing upper extremity in women with long term paraplegia. Paraplegia. 1991;29:521\u201330. https:\/\/doi.org\/10.1038\/sc.1991.75.","journal-title":"Paraplegia"},{"key":"704_CR12","doi-asserted-by":"crossref","unstructured":"Gellman H, Sie I, Waters RL. Late complications of the weight-bearing upper extremity in the paraplegic patient. Clin Orthop Relat Res. 1988;132\u20135.","DOI":"10.1097\/00003086-198808000-00016"},{"key":"704_CR13","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1310\/sci1304-86","volume":"13","author":"PS Requejo","year":"2008","unstructured":"Requejo PS, Mulroy SJ, Haubert LL, Newsam CJ, Gronley JK, Perry J. Evidence-based strategies to preserve shoulder function in manual wheelchair users with spinal cord injury. Top Spinal Cord Inj Rehabil. 2008;13:86\u2013119. https:\/\/doi.org\/10.1310\/sci1304-86.","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"704_CR14","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1097\/00003086-199809000-00016","volume":"354","author":"K Kulig","year":"1998","unstructured":"Kulig K, Rao SS, Mulroy SJ, Newsam CJ, Gronley JK, Bontrager EL, et al. Shoulder joint kinetics during the push phase of wheelchair propulsion. Clin Orthop Relat Res. 1998;354:132\u201343. https:\/\/doi.org\/10.1097\/00003086-199809000-00016.","journal-title":"Clin Orthop Relat Res"},{"key":"704_CR15","first-page":"22","volume":"16","author":"SJ Fleck","year":"1994","unstructured":"Fleck SJ. Detraining: its effects on endurance and strength. Strength Cond. 1994;16:22\u201328.","journal-title":"Strength Cond"},{"key":"704_CR16","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1177\/036354659302100213","volume":"21","author":"RS Burnham","year":"1993","unstructured":"Burnham RS, May L, Nelson E, Steadward R, Reid DC. Shoulder pain in wheelchair athletes. the role of muscle imbalance. Am J Sports Med. 1993;21:238\u201342. https:\/\/doi.org\/10.1177\/036354659302100213.","journal-title":"Am J Sports Med"},{"key":"704_CR17","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/s0003-9993(96)90166-5","volume":"77","author":"SJ Mulroy","year":"1996","unstructured":"Mulroy SJ, Gronley JK, Newsam CJ, Perry J. Electromyographic activity of shoulder muscles during wheelchair propulsion by paraplegic persons. Arch Phys Med Rehabil. 1996;77:187\u201393. https:\/\/doi.org\/10.1016\/s0003-9993(96)90166-5.","journal-title":"Arch Phys Med Rehabil"},{"key":"704_CR18","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1310\/sci2201-60","volume":"22","author":"SR Wilbanks","year":"2016","unstructured":"Wilbanks SR, Bickel CS. Scapular stabilization and muscle strength in manual wheelchair users with spinal cord injury and subacromial impingement. Top Spinal Cord Inj Rehabil. 2016;22:60\u201370. https:\/\/doi.org\/10.1310\/sci2201-60.","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"704_CR19","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1038\/sj.sc.3100860","volume":"37","author":"KA Curtis","year":"1999","unstructured":"Curtis KA, Tyner TM, Zachary L, Lentell G, Brink D, Didyk T, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal Cord. 1999;37:421\u20139. https:\/\/doi.org\/10.1038\/sj.sc.3100860.","journal-title":"Spinal Cord"},{"key":"704_CR20","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.2522\/ptj.20060001","volume":"86","author":"DA Nawoczenski","year":"2006","unstructured":"Nawoczenski DA, Ritter-Soronen JM, Wilson CM, Howe BA, Ludewig PM. Clinical trial of exercise for shoulder pain in chronic spinal injury. Phys Ther. 2006;86:1604\u201318. https:\/\/doi.org\/10.2522\/ptj.20060001.","journal-title":"Phys Ther"},{"key":"704_CR21","doi-asserted-by":"publisher","first-page":"305","DOI":"10.2522\/ptj.20100182","volume":"91","author":"SJ Mulroy","year":"2011","unstructured":"Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther. 2011;91:305\u201324. https:\/\/doi.org\/10.2522\/ptj.20100182.","journal-title":"Phys Ther"},{"key":"704_CR22","unstructured":"Nasser S, Rincon DM, Ye S. Rowheel pulling wheel system: an innovative approach to wheelchair propulsion. Second LACCEI International Latin American and Caribbean Conference for Engineering and Technology (LACCEI\u20192004) \u201cChallenges and Opportunities for Engineering Education, Research and Development\u201d 2-4 June 2004, Miami, Florida, USA"},{"key":"704_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2165\/00007256-199826010-00001","volume":"26","author":"G Kentt\u00e4","year":"1998","unstructured":"Kentt\u00e4 G, Hassm\u00e9n P. Overtraining and recovery. A conceptual model. Sports Med. 1998;26:1\u201316. https:\/\/doi.org\/10.2165\/00007256-199826010-00001.","journal-title":"Sports Med"},{"key":"704_CR24","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/s0140-6736(74)90884-8","volume":"2","author":"EC Huskisson","year":"1974","unstructured":"Huskisson EC. Measurement of pain. Lancet. 1974;2:1127\u201331. https:\/\/doi.org\/10.1016\/s0140-6736(74)90884-8.","journal-title":"Lancet"},{"key":"704_CR25","doi-asserted-by":"publisher","first-page":"400","DOI":"10.2519\/jospt.2009.2930","volume":"39","author":"JC MacDermid","year":"2009","unstructured":"MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39:400\u201317. https:\/\/doi.org\/10.2519\/jospt.2009.2930.","journal-title":"J Orthop Sports Phys Ther"},{"key":"704_CR26","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1179\/204577211X13207446293695","volume":"34","author":"SC Kirshblum","year":"2011","unstructured":"Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535\u201346. https:\/\/doi.org\/10.1179\/204577211X13207446293695.","journal-title":"J Spinal Cord Med"},{"key":"704_CR27","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1080\/15391523.2020.1867938","volume":"54","author":"P Vlachogianni","year":"2021","unstructured":"Vlachogianni P, Tselios N. Perceived usability evaluation of educational technology using the system usability scale (SUS): a systematic review. J Res Technol Educ. 2021;54:392\u2013409. https:\/\/doi.org\/10.1080\/15391523.2020.1867938.","journal-title":"J Res Technol Educ"},{"key":"704_CR28","unstructured":"Larsen CM, Bruun P, Hansen SS, Hansen LH, & Juul-Kristensen B. Translation and cross-cultural adaptation of the danish version: wheelchair users shoulder pain index (WUSPI). University of Southern Denmark. The abstract was presented on the annual meeting of the 'Danish Society for surgery of the shoulder and the elbow', Herlev, Denmark, April 2015."},{"key":"704_CR29","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1038\/sc.1995.126","volume":"33","author":"KA Curtis","year":"1995","unstructured":"Curtis KA, Roach KE, Applegate EB, Amar T, Benhow CS, Genecoo TD, et al. Reliability and validity of the wheelchair user\u2019s shoulder pain index (WUSPI). Paraplegia. 1995;33:595\u2013601. https:\/\/doi.org\/10.1038\/sc.1995.126.","journal-title":"Paraplegia"},{"key":"704_CR30","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.apmr.2020.09.384","volume":"102","author":"RK Hansen","year":"2021","unstructured":"Hansen RK, Larsen RG, Laessoe U, Samani A, Cowan RE. Physical activity barriers in danish manual wheelchair users: a cross-sectional study. Arch Phys Med Rehabil. 2021;102:687\u201393. https:\/\/doi.org\/10.1016\/j.apmr.2020.09.384.","journal-title":"Arch Phys Med Rehabil"},{"key":"704_CR31","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1080\/17437199.2016.1198240","volume":"10","author":"KA Martin Ginis","year":"2016","unstructured":"Martin Ginis KA, Ma JK, Latimer-Cheung AE, Rimmer JH. A systematic review of review articles addressing factors related to physical activity participation among children and adults with physical disabilities. Health Psychol Rev. 2016;10:478\u201394. https:\/\/doi.org\/10.1080\/17437199.2016.1198240.","journal-title":"Health Psychol Rev"},{"key":"704_CR32","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1038\/s41393-021-00673-x","volume":"60","author":"M Wellisch","year":"2022","unstructured":"Wellisch M, Lovett K, Harrold M, Juhl C, Juul-Kristensen B, McKenna L, et al. Treatment of shoulder pain in people with spinal cord injury who use manual wheelchairs: a systematic review and meta-analysis. Spinal Cord. 2022;60:107\u201314. https:\/\/doi.org\/10.1038\/s41393-021-00673-x.","journal-title":"Spinal Cord"},{"key":"704_CR33","unstructured":"Brooke J. SUS: A \u2018Quick and Dirty\u2019 Usability Scale. In Book Usability Evaluation In Industry. 1st ed. vol 189, CRC Press; 1996. pp. 4\u20137."},{"key":"704_CR34","doi-asserted-by":"publisher","first-page":"48.","DOI":"10.1038\/s41394-022-00518-6","volume":"8","author":"RK Hansen","year":"2022","unstructured":"Hansen RK, de Wit JLJ, Samani A, Laessoe U, Figlewski K, Larsen RG. Wheelchair-modified ergometer rowing exercise in individuals with spinal cord injury: a feasibility, acceptability, and preliminary efficacy study. Spinal Cord Ser Cases.2022;8:48. https:\/\/doi.org\/10.1038\/s41394-022-00518-6.","journal-title":"Spinal Cord Ser Cases."},{"key":"704_CR35","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1016\/j.apmr.2003.08.090","volume":"85","author":"SJ Mulroy","year":"2004","unstructured":"Mulroy SJ, Farrokhi S, Newsam CJ, Perry J. Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study. Arch Phys Med Rehabil. 2004;85:925\u201334. https:\/\/doi.org\/10.1016\/j.apmr.2003.08.090.","journal-title":"Arch Phys Med Rehabil"},{"key":"704_CR36","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3109\/17483107.2010.509883","volume":"6","author":"KL Troy","year":"2011","unstructured":"Troy KL. Biomechanical validation of upper extremity exercise in wheelchair users: design considerations and improvements in a prototype device. Disabil Rehabil Assist Technol. 2011;6:22\u20138. https:\/\/doi.org\/10.3109\/17483107.2010.509883.","journal-title":"Disabil Rehabil Assist Technol"},{"key":"704_CR37","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1080\/10790268.2005.11753840","volume":"28","author":"F Ambrosio","year":"2005","unstructured":"Ambrosio F, Boninger ML, Souza AL, Fitzgerald SG, Koontz AM, Cooper RA. Biomechanics and strength of manual wheelchair users. J Spinal Cord Med. 2005;28:407\u201314. https:\/\/doi.org\/10.1080\/10790268.2005.11753840.","journal-title":"J Spinal Cord Med"},{"key":"704_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1748-1716.2010.02145.x","volume":"199","author":"P Madeleine","year":"2010","unstructured":"Madeleine P. On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region. Acta Physiol. 2010;199:1\u201346. https:\/\/doi.org\/10.1111\/j.1748-1716.2010.02145.x.","journal-title":"Acta Physiol"},{"key":"704_CR39","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/j.apmr.2007.07.045","volume":"88","author":"MA Finley","year":"2007","unstructured":"Finley MA, Rodgers MM. Effect of 2-speed geared manual wheelchair propulsion on shoulder pain and function. Arch Phys Med Rehabil. 2007;88:1622\u20137. https:\/\/doi.org\/10.1016\/j.apmr.2007.07.045.","journal-title":"Arch Phys Med Rehabil"}],"container-title":["Spinal Cord Series and Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41394-025-00704-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41394-025-00704-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41394-025-00704-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T15:33:48Z","timestamp":1745854428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41394-025-00704-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["704"],"URL":"https:\/\/doi.org\/10.1038\/s41394-025-00704-2","relation":{},"ISSN":["2058-6124"],"issn-type":[{"value":"2058-6124","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,28]]},"assertion":[{"value":"30 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"MK is a co-owner of the company Pull & GO I\/S responsible for the pull function device used in the research. Accordingly, MK was excluded from data collection and analysis.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was approved by the North Denmark Region Committee on Health Research Ethics (J.nr. 2-1-02-1167-24). We confirm that all applicable institutional and government regulations on the ethical handling of human subjects were followed during the course of this research. All procedures were in accordance with the ethical standards of the relevant committee on human experimentation and the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed written consent was obtained from all participants in the study. A separate written informed consent was obtained for publication of images of human research participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"12"}}