{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T21:46:36Z","timestamp":1781732796624,"version":"3.54.5"},"reference-count":57,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"K. C. Wong Magna Fund in Ningbo University","award":["2020"],"award-info":[{"award-number":["2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This systematic review and meta-analysis aimed to identify the effect of multi-modal therapies that combined physical and psychological therapies for kinesiophobia caused by musculoskeletal disorders compared with uni-modal therapy of only phycological therapy or psychological therapy. The search terms and their logical connector were as following: (1) \u201ckinesiophobia\u201d at the title or abstract; and (2) \u201crandomized\u201d OR \u201crandomized\u201d at title or abstract; not (3) \u201ddesign\u201d OR \u201cprotocol\u201d at the title. They were typed into the databases of Medline (EBSCO), PubMed, and Ovid, following the different input rules of these databases. The eligibility criteria were: (1) Adults with musculoskeletal disorders or illness as patients; (2) Multi-modal therapies combined physical and psychological therapy as interventions; (3) Uni-modal therapy of only physical or psychological therapy as a comparison; (4) The scores of the 17-items version of the Tampa Scale of Kinesiophobia as the outcome; (5) Randomized controlled trials as study design. As a result, 12 studies were included with a statistically significant polled effect of 6.99 (95% CI 4.59 to 9.38). Despite a large heterogeneity within studies, multi-modal therapies might be more effective in reducing kinesiophobia than the unimodal of only physical or psychological therapy both in the total and subdivision analysis. The effect might decrease with age. What\u2019s more, this review\u2019s mathematical methods were feasible by taking test-retest reliability of the Tampa Scale of Kinesiophobia into consideration.<\/jats:p>","DOI":"10.3390\/ijerph17249439","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T09:21:15Z","timestamp":1608110475000},"page":"9439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Effect of Multi-Modal Therapies for Kinesiophobia Caused by Musculoskeletal Disorders: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9710","authenticated-orcid":false,"given":"Yining","family":"Xu","sequence":"first","affiliation":[{"name":"Faculty of Sports Science, Ningbo University, Ningbo 315211, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7438-6290","authenticated-orcid":false,"given":"Yang","family":"Song","sequence":"additional","affiliation":[{"name":"Doctoral School of Safety and Security Sciences, Obuda University, 1034 Budapest, Hungary"},{"name":"Faculty of Engineering, University of Szeged, 6724 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Sun","sequence":"additional","affiliation":[{"name":"Faculty of Sports Science, Ningbo University, Ningbo 315211, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-8382","authenticated-orcid":false,"given":"Guszt\u00e1v","family":"Fekete","sequence":"additional","affiliation":[{"name":"Savaria Institute of Technology, E\u00f6tv\u00f6s Lor\u00e1nd University, 9700 Szombathely, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-9440","authenticated-orcid":false,"given":"Yaodong","family":"Gu","sequence":"additional","affiliation":[{"name":"Faculty of Sports Science, Ningbo University, Ningbo 315211, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.berh.2010.01.012","article-title":"Epidemiology of chronic musculoskeletal pain","volume":"25","author":"Cimmino","year":"2011","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990\u20132010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Vos","year":"2012","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Artus, M., Campbell, P., Mallen, C.D., Dunn, K.M., and van der Windt, D.A. (2017). Generic prognostic factors for musculoskeletal pain in primary care: A systematic review. BMJ Open, 7.","DOI":"10.1136\/bmjopen-2016-012901"},{"key":"ref_4","first-page":"195","article-title":"Psychological aspects of persistent pain: Current state of the science","volume":"5","author":"Keefe","year":"2004","journal-title":"J. Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s11916-010-0094-x","article-title":"Fear of pain as a prognostic factor in chronic pain: Conceptual models, assessment, and treatment implications","volume":"14","author":"Turk","year":"2010","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S0304-3959(99)00242-0","article-title":"Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art","volume":"85","author":"Vlaeyen","year":"2000","journal-title":"Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10865-006-9085-0","article-title":"The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence","volume":"30","author":"Leeuw","year":"2007","journal-title":"J. Behav. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.pain.2011.12.009","article-title":"Fear-avoidance model of chronic musculoskeletal pain: 12 years on","volume":"153","author":"Vlaeyen","year":"2012","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lundberg, M., Grimby-Ekman, A., Verbunt, J., and Simmonds, M.J. (2011). Pain-related fear: A critical review of the related measures. Pain Res. Treat., 2011.","DOI":"10.1155\/2011\/494196"},{"key":"ref_10","first-page":"35","article-title":"Kinesiophobia: A new view of chronic pain behavior","volume":"3","author":"Kori","year":"1990","journal-title":"Pain Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3389\/fnhum.2015.00424","article-title":"Fear avoidance beliefs in back pain-free subjects are reflected by amygdala-cingulate responses","volume":"9","author":"Meier","year":"2015","journal-title":"Front. Hum. Neurosci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1002\/ejp.1044","article-title":"Fear of pain changes movement: Motor behaviour following the acquisition of pain-related fear","volume":"21","author":"Karos","year":"2017","journal-title":"Eur. J. Pain"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.pain.2007.01.008","article-title":"Fear of movement and (re)injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples","volume":"131","author":"Roelofs","year":"2007","journal-title":"Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1080\/16501970510041253","article-title":"Kinesiophobia among patients with musculoskeletal pain in primary healthcare","volume":"38","author":"Lundberg","year":"2006","journal-title":"J. Rehabil. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1097\/AJP.0b013e31827fef7e","article-title":"Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: Results of a randomized controlled trial","volume":"29","author":"Monticone","year":"2013","journal-title":"Clin. J. Pain"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Barnhoorn, K.J., Staal, J.B., van Dongen, R.T.M., Fr\u00f6lke, J.P.M., Klomp, F.P., van de Meent, H., Samwel, H., and Nijhuis-van der Sanden, M.W.G. (2015). Are pain-related fears mediators for reducing disability and pain in patients with complex regional pain syndrome type 1? An explorative analysis on pain exposure physical therapy. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123008"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.pain.2008.11.006","article-title":"Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain\u2014A randomized controlled trial","volume":"141","author":"Wicksell","year":"2009","journal-title":"Pain"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Valenzuela-Pascual, F., Molina, F., Corbi, F., Blanco-Blanco, J., Gil, R.M., and Soler-Gonzalez, J. (2015). The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: A mixed methods approach. BMC Med. Inform. Decis. Mak., 15.","DOI":"10.1186\/s12911-015-0220-0"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Klaassen, G., Zelle, D.M., Navis, G.J., Dijkema, D., Bemelman, F.J., Bakker, S.J.L., and Corpeleijn, E. (2017). Lifestyle intervention to improve quality of life and prevent weight gain after renal transplantation: Design of the Active Care after Transplantation (ACT) randomized controlled trial. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0709-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1177\/0269215516651979","article-title":"Group-based multi-modal exercises integrated with cognitive-behavioural therapy improve disability, pain and quality of life of subjects with chronic neck pain: A randomized controlled trial with one-year follow-up","volume":"31","author":"Monticone","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1007\/s00586-014-3478-5","article-title":"A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: Results of a randomised controlled pilot study","volume":"23","author":"Monticone","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Serrat, M., Almirall, M., Muste, M., Sanabria-Mazo, J.P., Feliu-Soler, A., Mendez-Ulrich, J.L., Luciano, J.V., and Sanz, A. (2020). Effectiveness of a multicomponent treatment for fibromyalgia based on pain neuroscience education, exercise therapy, psychological support, and nature exposure (NAT-FM): A pragmatic randomized controlled trial. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103348"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1080\/09593985.2017.1331481","article-title":"Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia\/chronic fatigue syndrome: An explorative study","volume":"33","author":"Malfliet","year":"2017","journal-title":"Physiother. Theory Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.pain.2008.11.016","article-title":"Examination of the photograph series of daily activities (PHODA) scale in chronic low back pain patients with high and low kinesiophobia","volume":"141","author":"Trost","year":"2009","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/09593980490453002","article-title":"A psychometric evaluation of the Tampa Scale for Kinesiophobia\u2014From a physiotherapeutic perspective","volume":"20","author":"Mari","year":"2004","journal-title":"Physiother. Theory Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.jpain.2010.08.004","article-title":"Psychometric properties of the Spanish version of the Tampa Scale for Kinesiophobia (TSK)","volume":"12","year":"2011","journal-title":"J. Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.physio.2013.11.007","article-title":"Test-retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia","volume":"100","author":"Koho","year":"2014","journal-title":"Physiotherapy"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gotzsche, P.C., Ioannidis, J.P., Clarke, M., Devereaux, P.J., Kleijnen, J., and Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med., 6.","DOI":"10.2427\/5768"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Borenstein, M., Hedges, L.V., Higgins, J.P.T., and Rothstein, H.R. (2009). Introduction to Meta-Analysis, John Wiley and Sons, Ltd.","DOI":"10.1002\/9780470743386"},{"key":"ref_30","unstructured":"Higgins, J.P.T., and Green, S. (2020, December 16). Cochrane Handbook for Systematic, Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available online: www.cochrane-handbook.org."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Atkins, D., Eccles, M., Flottorp, S., Guyatt, G.H., Henry, D., Hill, S., Liberati, A., O\u2019Connell, D., Oxman, A.D., and Phillips, B. (2004). Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv. Res., 4.","DOI":"10.1186\/1472-6963-4-38"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/16501970510044025","article-title":"Applied relaxation in the treatment of long-lasting neck pain: A randomized controlled pilot study","volume":"38","author":"Gustavsson","year":"2006","journal-title":"J. Rehabil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.math.2014.06.008","article-title":"Cervical kinematic training with and without interactive VR training for chronic neck pain\u2014A randomized clinical trial","volume":"20","author":"Takasaki","year":"2015","journal-title":"Man. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1136\/bjsports-2018-100080","article-title":"Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: A randomised controlled trial","volume":"53","author":"Gardner","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1007\/s00420-006-0098-3","article-title":"Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: A randomized, controlled trial with one-year follow-up","volume":"79","author":"Meijer","year":"2006","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.math.2016.08.004","article-title":"Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up","volume":"26","author":"Ris","year":"2016","journal-title":"Man. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.physio.2015.04.008","article-title":"Does adding cognitive-behavioural physiotherapy to exercise improve outcome in patients with chronic neck pain? A randomised controlled trial","volume":"102","author":"Thompson","year":"2016","journal-title":"Physiotherapy"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Gulsen, C., Soke, F., Eldemir, K., Apaydin, Y., Ozkul, C., Guclu-Gunduz, A., and Akcali, D.T. (2020). Effect of fully immersive virtual reality treatment combined with exercise in fibromyalgia patients: A randomized controlled trial. Assist. Technol., 1\u20138.","DOI":"10.1080\/10400435.2020.1772900"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1177\/0269215514558567","article-title":"Effectiveness of a cognitive-behavioural group intervention for knee osteoarthritis pain: A randomized controlled trial","volume":"29","author":"Helminen","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Saracoglu, I., Arik, M.I., Afsar, E., and Gokpinar, H.H. (2020). The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial. Physiother. Theory Pract., 1\u201311.","DOI":"10.1080\/09593985.2020.1809046"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s00586-016-4892-7","article-title":"Is physiotherapy integrated virtual walking effective on pain, function, and kinesiophobia in patients with non-specific low-back pain? Randomised controlled trial","volume":"26","author":"Demir","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Javdaneh, N., Letafatkar, A., Shojaedin, S., and Hadadnezhad, M. (2020). Scapular exercise combined with cognitive functional therapy is more effective at reducing chronic neck pain and kinesiophobia than scapular exercise alone: A randomized controlled trial. Clin. Rehabil.","DOI":"10.1177\/0269215520941910"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Nambi, G., Abdelbasset, W.K., Alrawaili, S.M., Abodonya, A.M., and Saleh, A.K. (2020). Virtual reality or Isokinetic training; its effect on pain, kinesiophobia and serum stress hormones in chronic low back pain: A randomized controlled trial. Technol. Health Care Off. J. Eur. Soc. Eng. Med.","DOI":"10.3233\/THC-202301"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/occmed\/kqh070","article-title":"Active or passive treatment for neck-shoulder pain in occupational health care? A randomized controlled trial","volume":"54","author":"Savolainen","year":"2004","journal-title":"Occup. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0022-3999(03)00078-3","article-title":"The stress of musculoskeletal pain: A comparison between primary care patients in various ages","volume":"56","author":"Soares","year":"2004","journal-title":"J. Psychosom. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"887","DOI":"10.2340\/16501977-2159","article-title":"Longer term follow-up on effects of Tailored Physical Activity or Chronic Pain Self-Management Programme on return-to-work: A randomized controlled trial","volume":"48","author":"Andersen","year":"2016","journal-title":"J. Rehabil. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1093\/ptj\/72.3.166","article-title":"The aged and the aging of physical therapy","volume":"72","author":"Rothstein","year":"1992","journal-title":"Phys. Ther."},{"key":"ref_48","first-page":"323","article-title":"Special problems of physical therapy in the aged","volume":"41","author":"Gunther","year":"1986","journal-title":"Z. Alternsforsch."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/s00586-004-0671-y","article-title":"Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: A randomized trial","volume":"13","author":"Helmhout","year":"2004","journal-title":"Eur. Spine J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1097\/01.brs.0000216443.46783.4d","article-title":"The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: A pragmatic randomized controlled trial","volume":"31","author":"Heymans","year":"2006","journal-title":"Spine"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"La Touche, R., Pardo-Montero, J., Cuenca-Martinez, F., Visscher, C.M., Paris-Alemany, A., and Lopez-de-Uralde-Villanueva, I. (2020). Cross-cultural adaptation and psychometric properties of the Spanish version of the Tampa Scale for Kinesiophobia for temporomandibular disorders. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092831"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.pain.2005.05.029","article-title":"Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia","volume":"117","author":"Steve","year":"2005","journal-title":"Pain"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1002\/ejp.795","article-title":"Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13)","volume":"20","author":"Neblett","year":"2016","journal-title":"Eur. J. Pain"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Valiente-Castrillo, P., Mart\u00edn-Pintado-Zugasti, A., Calvo-Lobo, C., Beltran-Alacreu, H., and Fern\u00e1ndez-Carnero, J. (2020). Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: A randomized clinical trial. Acupunct. Med. J. Br. Med Acupunct. Soc.","DOI":"10.1177\/0964528420920300"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jpain.2018.02.004","article-title":"Randomized controlled trial of online acceptance and commitment therapy for fibromyalgia","volume":"19","author":"Simister","year":"2018","journal-title":"J. Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1016\/j.jpain.2018.06.010","article-title":"Randomized trial of a low-literacy chronic pain self-management program: Analysis of secondary pain and psychological outcome measures","volume":"19","author":"Turner","year":"2018","journal-title":"J. Pain"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.apmr.2019.12.016","article-title":"Chronic pain self-management support with pain science education and Exercise (COMMENCE) for people with chronic pain and multiple comorbidities: A randomized controlled trial","volume":"101","author":"Miller","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/24\/9439\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:45:51Z","timestamp":1760179551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/24\/9439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,16]]},"references-count":57,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["ijerph17249439"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17249439","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,16]]}}}