{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:19:44Z","timestamp":1779376784039,"version":"3.53.1"},"reference-count":56,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Clinical interventions in expressive and neuromuscular medicine have become increasingly precise at the local level, targeting specific muscles, doses, or anatomical sites. At the same time, the outcomes used to judge clinical success are frequently global, encompassing expression, pain, function, or behaviour. This mismatch between localised inputs and system\u2010level outcomes reflects a common clinical reality that remains insufficiently addressed by conceptual models grounded primarily in local corrective logic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and objectives<\/jats:title>\n                    <jats:p>The aim of this article is to clarify the conceptual level at which many existing clinical practices are already operating by examining whether routine interventions are more accurately interpreted as forms of systemic modulation rather than isolated local correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Conceptual analysis is conducted using the literature on clinical reasoning, systems\u2010oriented health research, motor control, and evaluation science. The convergence of independently developed clinical frameworks is examined to identify shared organisational principles underlying adaptive clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis shows that clinicians routinely titrate interventions, monitor patterns over time, and adjust decisions based on evolving system states. These practices implicitly acknowledge non\u2010linearity, context dependence, delayed effects, and interindividual variability, even when described using locally focused terminology. Interpreting such actions as modulatory inputs acting on distributed expressive\u2013neuromuscular systems provides a coherent account of observed clinical phenomena without invoking methodological failure or inconsistency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reframing clinical interventions as systemic modulation offers a descriptive framework that aligns more closely with observed clinical reasoning and outcomes, while remaining compatible with established standards of precision and evidence\u2010based practice. This perspective supports testable system\u2010level evaluation through longitudinal designs and pattern\u2010based outcome assessment, facilitating clearer interpretation and comparison across expressive and neuromuscular domains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70415","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T18:58:24Z","timestamp":1773946704000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From Local Interventions to Systemic Modulation in Expressive and Neuromuscular Medicine: A Conceptual Reframing of Clinical Action"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8139-9169","authenticated-orcid":false,"given":"Andrea Felice","family":"Armenti","sequence":"first","affiliation":[{"name":"LA VISION Training Institute Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.10.1182"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2007.26"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1089-4"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1258\/jhsrp.2010.009158"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31818131e7"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2016.12.041"},{"key":"e_1_2_16_8_1","volume-title":"The Reflective Practitioner: How Professionals Think in Action","author":"Sch\u00f6n D. 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