{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:03:14Z","timestamp":1789041794943,"version":"build-2803163510"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"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":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Individuals with temporomandibular disorder (TMD) experience autonomic dysfunction, which disrupts the balance between the sympathetic and parasympathetic nervous systems. This imbalance can result in altered heart rate variability (HRV) and other physiological disturbances. However, it is important to note that, to date, no research has investigated the inter- and intra-rater reliability of HRV measurements in individuals with TMD. The objective of this investigation was to analyze the intra- and inter-examiner reliability of HRV captured by a polar heart rate monitor in individuals with TMD. The RR interval, the time elapsed between two successive R-waves of the QRS signal on the electrocardiogram (RRi), were recorded during a 10\u00a0min period in a supine position using a portable heart rate monitor (Polar\u00ae\u00a0V800 model). The data were transferred into Kubios\u00ae\u00a0HRV standard analysis software and analyzed within the stable sessions containing 5\u00a0min sequential RRi. The intraclass correlation coefficient (ICC) ranged from 0.907 to 0.998 according to the intra-examiner analysis by Examiner 1 and 0.875 to 0.998 according to the intra-examiner by Examiner 2. The inter-examiner ICC ranged from 0.796 to 0.996. The coefficient of variation was up to 9.60 for Examiner 1 intra-examiner analysis, 11.95 for Examiner 2 intra-examiner analysis and 14.88 for inter-examiner analysis. The HRV analysis captured by a Polar cardio frequency meter presented adequate reliability when considering different times and examiners. Intra-examiner reliability showed ICC values ranging from 0.842 to 0.999, and inter-examiner reliability ranged from 0.796 to 0.994. Bland\u2013Altman plots indicated good agreement with minimal bias. Coefficients of variation were below 10% for most variables.<\/jats:p>","DOI":"10.1038\/s41598-025-00560-y","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T09:39:40Z","timestamp":1747906780000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reliability of short-term measurement of heart rate variability on rest in individuals with temporomandibular disorder"],"prefix":"10.1038","volume":"15","author":[{"given":"Rodrigo","family":"Costa Cutrim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldair Darlan","family":"Santos-de-Ara\u00fajo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassius Iury","family":"Anselmo-e-Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janaina","family":"de Oliveira Brito Monzani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudys Rodolfo","family":"de Jesus Tavarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cl\u00e1udia","family":"Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etevaldo","family":"Matos Maia-Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Borghi-Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almir","family":"Vieira Dibai-Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Bassi-Dibai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"560_CR1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1038\/s41415-020-1250-2","volume":"228","author":"P Riley","year":"2020","unstructured":"Riley, P. et al. Oral splints for temporomandibular disorder or bruxism: A systematic review. Br. Dent. J. 228, 191\u2013197 (2020).","journal-title":"Br. Dent. J."},{"key":"560_CR2","doi-asserted-by":"publisher","first-page":"225","DOI":"10.11607\/ofph.1719","volume":"31","author":"AC Fernandes","year":"2017","unstructured":"Fernandes, A. C., Duarte Moura, D. M., Da Silva, L. G. D., De Almeida, E. O. & Barbosa, G. A. S. Acupuncture in temporomandibular disorder myofascial pain treatment: A systematic review. J Facial Pain Headache 31, 225\u2013232 (2017).","journal-title":"J Facial Pain Headache"},{"key":"560_CR3","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1111\/joor.13331","volume":"49","author":"PHF Reis","year":"2022","unstructured":"Reis, P. H. F., Laxe, L. A. C., Lacerda-Santos, R. & M\u00fcnchow, E. A. Distribution of anxiety and depression among different subtypes of temporomandibular disorder: A systematic review and meta-analysis. J. Oral Rehabil. 49, 754\u2013767 (2022).","journal-title":"J. Oral Rehabil."},{"key":"560_CR4","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/joor.12321","volume":"42","author":"LB Calixtre","year":"2015","unstructured":"Calixtre, L. B., Moreira, R. F. C., Franchini, G. H., Alburquerque-Send\u00edn, F. & Oliveira, A. B. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: A systematic review of randomised controlled trials. J. Oral Rehabil. 42, 847\u2013861 (2015).","journal-title":"J. Oral Rehabil."},{"key":"560_CR5","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.archoralbio.2018.03.011","volume":"90","author":"S Chinthakanan","year":"2018","unstructured":"Chinthakanan, S. et al. Reduced heart rate variability and increased saliva cortisol in patients with TMD. Arch. Oral Biol. 90, 125\u2013129 (2018).","journal-title":"Arch. Oral Biol."},{"key":"560_CR6","doi-asserted-by":"publisher","first-page":"103190","DOI":"10.1016\/j.autrev.2022.103190","volume":"21","author":"AD Santos-de-Ara\u00fajo","year":"2022","unstructured":"Santos-de-Ara\u00fajo, A. D., Shida-Marinho, R. & Pontes-Silva, A. Heart rate variability (HRV): Checklist for observational and experimental studies. Autoimmunity Rev. 21, 103190. https:\/\/doi.org\/10.1016\/j.autrev.2022.103190 (2022).","journal-title":"Autoimmunity Rev."},{"key":"560_CR7","doi-asserted-by":"publisher","first-page":"1070327","DOI":"10.3389\/fcvm.2023.1070327","volume":"10","author":"JS Alqahtani","year":"2023","unstructured":"Alqahtani, J. S. et al. A systematic review and meta-analysis of heart rate variability in COPD. Front. Cardiovasc. Med. 10, 1070327. https:\/\/doi.org\/10.3389\/fcvm.2023.1070327 (2023).","journal-title":"Front. Cardiovasc. Med."},{"key":"560_CR8","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","volume":"93","author":"M Malik","year":"1996","unstructured":"Malik, M. et al. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation 93, 1043\u20131065 (1996).","journal-title":"Circulation"},{"key":"560_CR9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","volume":"5","author":"F Shaffer","year":"2017","unstructured":"Shaffer, F. & Ginsberg, J. P. An overview of heart rate variability metrics and norms. Front. Public Heal. 5, 258 (2017).","journal-title":"Front. Public Heal."},{"key":"560_CR10","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1161\/01.CIR.102.11.1239","volume":"102","author":"JM Dekker","year":"2000","unstructured":"Dekker, J. M. et al. Low heart rate variability in a 2-min rhythm strip predicts risk of coronary heart disease and mortality from several causes: The ARIC Study. Atherosclerosis risk in communities.. Circulation 102, 1239\u20131244 (2000).","journal-title":"Circulation"},{"key":"560_CR11","first-page":"232","volume":"25","author":"CM Eze-Nliam","year":"2011","unstructured":"Eze-Nliam, C. M., Quartana, P. J., Quain, A. M. & Smith, M. T. Nocturnal heart rate variability is lower in temporomandibular disorder patients tvhan in healthy, pain-free individuals. J. Oral Facial Pain Headache 25, 232\u2013239 (2011).","journal-title":"J. Oral Facial Pain Headache"},{"key":"560_CR12","doi-asserted-by":"publisher","first-page":"6559","DOI":"10.1007\/s00784-023-05261-2","volume":"27","author":"RC Cutrim","year":"2023","unstructured":"Cutrim, R. C. et al. Short-term heart rate variability at rest in individuals with temporomandibular disorder: A comparative analysis. Clin. Oral Investig. 27, 6559\u20136566 (2023).","journal-title":"Clin. Oral Investig."},{"key":"560_CR13","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1186\/s12874-020-01179-5","volume":"20","author":"LB Mokkink","year":"2020","unstructured":"Mokkink, L. B. et al. COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: A Delphi study. BMC Med. Res. Methodol. 20, 293 (2020).","journal-title":"BMC Med. Res. Methodol."},{"key":"560_CR14","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.jclinepi.2010.03.002","volume":"64","author":"J Kottner","year":"2011","unstructured":"Kottner, J. et al. Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J. Clin. Epidemiol. 64, 96\u2013106 (2011).","journal-title":"J. Clin. Epidemiol."},{"key":"560_CR15","doi-asserted-by":"publisher","first-page":"325","DOI":"10.3390\/jcm9020325","volume":"9","author":"JMA Alcantara","year":"2020","unstructured":"Alcantara, J. M. A. et al. Impact of using different levels of threshold-based artefact correction on the quantification of heart rate variability in three independent human cohorts. J. Clin. Med. 9, 325 (2020).","journal-title":"J. Clin. Med."},{"issue":"3","key":"560_CR16","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/S42600-024-00368-1\/FIGURES\/3","volume":"40","author":"AD Santos-de-Ara\u00fajo","year":"2024","unstructured":"Santos-de-Ara\u00fajo, A. D. et al. Impact of different corrective filters on heart rate variability in chronic obstructive pulmonary disease: Conclusions and recommendations for future research. Res. Biomed. Eng. 40(3), 579\u2013592. https:\/\/doi.org\/10.1007\/S42600-024-00368-1\/FIGURES\/3 (2024).","journal-title":"Res. Biomed. Eng."},{"key":"560_CR17","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.bjpt.2019.02.006","volume":"24","author":"AM Catai","year":"2020","unstructured":"Catai, A. M. et al. Heart rate variability: Are you using it properly? Standardisation checklist of procedures. Brazil. J. Phys. Ther. 24, 91\u2013102 (2020).","journal-title":"Brazil. J. Phys. Ther."},{"key":"560_CR18","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.cmpb.2013.07.024","volume":"113","author":"MP Tarvainen","year":"2014","unstructured":"Tarvainen, M. P., Niskanen, J. P., Lipponen, J. A., Ranta-aho, P. O. & Karjalainen, P. A. Kubios HRV - Heart rate variability analysis software. Comput. Methods Progr. Biomed. 113, 210\u2013220 (2014).","journal-title":"Comput. Methods Progr. Biomed."},{"key":"560_CR19","unstructured":"Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93, 1043\u20131065 (1996)."},{"key":"560_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-020-68197-7","volume":"10","author":"A Plaza-Florido","year":"2020","unstructured":"Plaza-Florido, A. et al. Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts. Sci. Rep. 10, 1\u201311 (2020).","journal-title":"Sci. Rep."},{"key":"560_CR21","first-page":"210","volume":"5","author":"PK Stein","year":"2005","unstructured":"Stein, P. K. & Reddy, A. Non-linear heart rate variability and risk stratification in cardiovascular disease. Indian Pacing Electrophysiol. J. 5, 210 (2005).","journal-title":"Indian Pacing Electrophysiol. J."},{"key":"560_CR22","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1093\/europace\/euv015","volume":"17","author":"R Sassi","year":"2015","unstructured":"Sassi, R. et al. Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace 17, 1341\u20131353 (2015).","journal-title":"Europace"},{"key":"560_CR23","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo, T. K. & Li, M. Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J. Chiropr. Med. 15, 155 (2016).","journal-title":"J. Chiropr. Med."},{"key":"560_CR24","first-page":"231","volume":"19","author":"JP Weir","year":"2005","unstructured":"Weir, J. P. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J. Strength Cond. Res. 19, 231\u2013240 (2005).","journal-title":"J. Strength Cond. Res."},{"key":"560_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10916-018-1101-8","volume":"42","author":"D Bassi","year":"2018","unstructured":"Bassi, D. et al. Inter and intra-rater reliability of short-term measurement of heart rate variability on rest in diabetic type 2 patients. J. Med. Syst. 42, 1\u20137 (2018).","journal-title":"J. Med. Syst."},{"key":"560_CR26","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2165\/00007256-199826040-00002","volume":"26","author":"G Atkinson","year":"2012","unstructured":"Atkinson, G. & Nevill, A. M. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sport. Med. 26, 217\u2013238 (2012).","journal-title":"Sport. Med."},{"key":"560_CR27","doi-asserted-by":"publisher","first-page":"141","DOI":"10.11613\/BM.2015.015","volume":"25","author":"D Giavarina","year":"2015","unstructured":"Giavarina, D. Understanding bland altman analysis. Biochem. Medica 25, 141 (2015).","journal-title":"Biochem. Medica"},{"key":"560_CR28","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.tjem.2018.09.001","volume":"18","author":"N\u00d6 Do\u011fan","year":"2018","unstructured":"Do\u011fan, N. \u00d6. Bland-Altman analysis: A paradigm to understand correlation and agreement. Turkish J. Emerg. Med. 18, 139 (2018).","journal-title":"Turkish J. Emerg. Med."},{"key":"560_CR29","unstructured":"Fleiss, J. L. Design and analysis of clinical experiments. (1986)."},{"key":"560_CR30","first-page":"378","volume":"91","author":"RL Gauer","year":"2015","unstructured":"Gauer, R. L. & Semidey, M. J. Diagnosis and treatment of temporomandibular disorders. Am. Fam. Physician 91, 378\u2013386 (2015).","journal-title":"Am. Fam. Physician"},{"key":"560_CR31","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1179\/crn.2007.018","volume":"25","author":"BC Cooper","year":"2007","unstructured":"Cooper, B. C. & Kleinberg, I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio 25, 114\u2013126 (2007).","journal-title":"Cranio"},{"key":"560_CR32","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1515\/sjpain-2020-0132","volume":"21","author":"ACS Chaves","year":"2021","unstructured":"Chaves, A. C. S., Reis, F. J. J., Bandeira, P. M., Fernandes, O. & Arruda Sanchez, T. Autonomic dysregulation and impairments in the recognition of facial emotional expressions in patients with chronic musculoskeletal pain. Scand. J. Pain 21, 530\u2013538 (2021).","journal-title":"Scand. J. Pain"},{"key":"560_CR33","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.cden.2013.04.006","volume":"57","author":"F Liu","year":"2013","unstructured":"Liu, F. & Steinkeler, A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent. Clin. North Am. 57, 465\u2013479 (2013).","journal-title":"Dent. Clin. North Am."},{"key":"560_CR34","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s10194-015-0586-5","volume":"16","author":"M Wieckiewicz","year":"2015","unstructured":"Wieckiewicz, M., Boening, K., Wiland, P., Shiau, Y.-Y. & Paradowska-Stolarz, A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J. Headache Pain 16, 106 (2015).","journal-title":"J. Headache Pain"},{"issue":"2","key":"560_CR35","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3390\/brainsci12020153","volume":"12","author":"G Forte","year":"2022","unstructured":"Forte, G., Troisi, G., Pazzaglia, M., Pascalis, V. D. & Casagrande, M. Heart rate variability and pain: A systematic review. Brain Sci. 12(2), 153 (2022).","journal-title":"Brain Sci."},{"key":"560_CR36","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1111\/papr.13294","volume":"24","author":"\u00c9P Rampazo","year":"2024","unstructured":"Rampazo, \u00c9. P., Rehder-Santos, P., Catai, A. M. & Liebano, R. E. Heart rate variability in adults with chronic musculoskeletal pain: A systematic review. Pain Pract. 24, 211\u2013230 (2024).","journal-title":"Pain Pract."},{"key":"560_CR37","doi-asserted-by":"publisher","first-page":"104907","DOI":"10.1016\/j.neubiorev.2022.104907","volume":"143","author":"MN Jarczok","year":"2022","unstructured":"Jarczok, M. N. et al. Heart rate variability in the prediction of mortality: A systematic review and meta-analysis of healthy and patient populations. Neurosci. Biobehav. Rev. 143, 104907 (2022).","journal-title":"Neurosci. Biobehav. Rev."},{"key":"560_CR38","doi-asserted-by":"publisher","DOI":"10.1016\/J.JCM.2023.03.007","author":"LMB Penha","year":"2023","unstructured":"Penha, L. M. B. et al. Reliability of the heart rate variability registered through polar cardio frequency meter in individuals with chronic low back pain. J. Chiropr. Med. https:\/\/doi.org\/10.1016\/J.JCM.2023.03.007 (2023).","journal-title":"J. Chiropr. Med."},{"key":"560_CR39","doi-asserted-by":"publisher","first-page":"13587","DOI":"10.3390\/ijerph192013587","volume":"19","author":"LV de Almeida","year":"2022","unstructured":"de Almeida, L. V. et al. Intra- and interrater reliability of short-term measurement of heart rate variability on rest in individuals post-COVID-19. Int. J. Environ. Res. Public Health 19, 13587 (2022).","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"560_CR40","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.hrtlng.2023.06.004","volume":"62","author":"AD Santos-de-Ara\u00fajo","year":"2023","unstructured":"Santos-de-Ara\u00fajo, A. D. et al. Inter- and intrarater reliability of short-term measurement of heart rate variability on rest in chronic obstructive pulmonary disease (COPD). Heart Lung 62, 64\u201371 (2023).","journal-title":"Heart Lung"},{"key":"560_CR41","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1590\/1806-9282.20220406","volume":"68","author":"A Pontes-Silva","year":"2022","unstructured":"Pontes-Silva, A. et al. Comparison of the autonomic nervous system dysfunction between different chronic spine disorders: Neck pain versus low back pain. Rev. Assoc. Med. Bras. 68, 1288\u20131296 (2022).","journal-title":"Rev. Assoc. Med. Bras."},{"key":"560_CR42","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.jmpt.2018.11.010","volume":"42","author":"AD Santos-de-Ara\u00fajo","year":"2019","unstructured":"Santos-de-Ara\u00fajo, A. D. et al. Correlation between chronic neck pain and heart rate variability indices at rest: A cross-sectional study. J. Manipulative Physiol. Ther. 42, 219\u2013226 (2019).","journal-title":"J. Manipulative Physiol. Ther."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00560-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00560-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00560-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T09:39:46Z","timestamp":1747906786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-00560-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["560"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-00560-y","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]},"assertion":[{"value":"31 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 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 interest"}},{"value":"(This study was approved by the Research Ethics Committee of Ceuma University (report n. 5.674.373). All individuals who voluntarily agreed to participate signed a consent form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}}],"article-number":"17779"}}