{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:55:31Z","timestamp":1785938131455,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists\u2019 clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist\u2013interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke\u2019s framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework.<\/jats:p>","DOI":"10.3390\/jcm15156099","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:16:29Z","timestamp":1785935789000},"page":"6099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physiotherapists\u2019 Clinical Reasoning and Therapeutic Strategies in Fibromyalgia: A Qualitative Interpretative Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6423-2319","authenticated-orcid":false,"given":"Daniel","family":"Sanju\u00e1n-S\u00e1nchez","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad San Jorge, Villanueva de G\u00e1llego, 50830 Zaragoza, Spain"},{"name":"Departament d\u2019Infermeria i Fisioter\u00e0pia, Universitat de Lleida, 25198 Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Cordova-Alegre","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad San Jorge, Villanueva de G\u00e1llego, 50830 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9245-3207","authenticated-orcid":false,"given":"Jos\u00e9 Lesmes","family":"Poveda-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad San Jorge, Villanueva de G\u00e1llego, 50830 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0493-8229","authenticated-orcid":false,"given":"Oriol","family":"Mart\u00ednez-Navarro","sequence":"additional","affiliation":[{"name":"Departament d\u2019Infermeria i Fisioter\u00e0pia, Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca Societat, Salut, Educaci\u00f3 i Cultura (GESEC), Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca de Cures en Salut (GRECS), IRBLleida (Institut de Recerca Biom\u00e8dica de Lleida, Fundaci\u00f3 Dr. Pifarr\u00e9), 25198 Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0162-3950","authenticated-orcid":false,"given":"Francesc","family":"Rub\u00ed-Carnacea","sequence":"additional","affiliation":[{"name":"Departament d\u2019Infermeria i Fisioter\u00e0pia, Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca Societat, Salut, Educaci\u00f3 i Cultura (GESEC), Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca de Cures en Salut (GRECS), IRBLleida (Institut de Recerca Biom\u00e8dica de Lleida, Fundaci\u00f3 Dr. Pifarr\u00e9), 25198 Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8437-2781","authenticated-orcid":false,"given":"Erica","family":"Briones-Vozmediano","sequence":"additional","affiliation":[{"name":"Departament d\u2019Infermeria i Fisioter\u00e0pia, Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca Societat, Salut, Educaci\u00f3 i Cultura (GESEC), Universitat de Lleida, 25198 Lleida, Spain"},{"name":"Grup de Recerca de Cures en Salut (GRECS), IRBLleida (Institut de Recerca Biom\u00e8dica de Lleida, Fundaci\u00f3 Dr. Pifarr\u00e9), 25198 Lleida, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mengshoel, A.M., Skarb\u00f8, \u00c5., Hasselknippe, E., Petterson, T., Brandsar, N.L., Askmann, E., Ildstad, R., L\u00f8seth, L., and Sallinen, M.H. (2021). Enabling personal recovery from fibromyalgia\u2014Theoretical rationale, content and meaning of a person-centred, recovery-oriented programme. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06295-6"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103290","DOI":"10.1016\/j.ctim.2025.103290","article-title":"The role of yoga as mind-body exercise in fibromyalgia management: A systematic review","volume":"95","author":"Durusoy","year":"2025","journal-title":"Complement. Ther. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jurado-Priego, L.N., Cueto-Ure\u00f1a, C., Ram\u00edrez-Exp\u00f3sito, M.J., and Mart\u00ednez-Martos, J.M. (2024). Fibromyalgia: A Review of the Pathophysiological Mechanisms and Multidisciplinary Treatment Strategies. Biomedicines, 12.","DOI":"10.3390\/biomedicines12071543"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"105966","DOI":"10.1016\/j.jbspin.2025.105966","article-title":"Non-invasive auricular vagus nerve stimulation in fibromyalgia: Impacts on autonomic function, central sensitization and pain catastrophizing","volume":"93","author":"Lommano","year":"2026","journal-title":"Jt. Bone Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s11916-013-0356-5","article-title":"Worldwide epidemiology of fibromyalgia","volume":"17","author":"Queiroz","year":"2013","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.36076\/ppj.2020\/23\/461","article-title":"Efficacy of Manual Therapy on Pain, Impact of Disease, and Quality of Life in the Treatment of Fibromyalgia: A Systematic Review","volume":"23","author":"Schulze","year":"2020","journal-title":"Pain Physician"},{"key":"ref_7","first-page":"957","article-title":"Fibromyalgia: One year in review 2025","volume":"43","author":"Iannuccelli","year":"2025","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1097\/j.pain.0000000000002324","article-title":"Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system","volume":"162","author":"Kosek","year":"2021","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1001\/jama.2014.3266","article-title":"Fibromyalgia: A clinical review","volume":"311","author":"Clauw","year":"2014","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Siracusa, R., Paola, R.D., Cuzzocrea, S., and Impellizzeri, D. (2021). Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22083891"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"515","DOI":"10.2147\/JPR.S128508","article-title":"Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma","volume":"10","author":"Tanum","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jpain.2018.10.008","article-title":"AAPT Diagnostic Criteria for Fibromyalgia","volume":"20","author":"Arnold","year":"2019","journal-title":"J. Pain"},{"key":"ref_13","first-page":"1668","article-title":"\u201cFibromyalgia\u201d and the medicalization of misery","volume":"30","author":"Hadler","year":"2003","journal-title":"J. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40945-018-0044-1","article-title":"The necessary conditions of engagement for the therapeutic relationship in physiotherapy: An interpretive description study","volume":"8","author":"Miciak","year":"2018","journal-title":"Arch. Physiother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1080\/09593985.2016.1194663","article-title":"Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature","volume":"32","author":"Puentedura","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref_16","first-page":"689","article-title":"The experience of meaningful rehabilitation as perceived by people with chronic pain: A phenomenological study","volume":"75","author":"Liddiard","year":"2023","journal-title":"Work"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.reuma.2022.01.001","article-title":"Investigation of effectiveness of reformer pilates in individuals with fibromyalgia: A randomized controlled trial","volume":"19","author":"Caglayan","year":"2023","journal-title":"Reumatol. Clin. (Engl. Ed.)"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/annrheumdis-2016-209724","article-title":"EULAR revised recommendations for the management of fibromyalgia","volume":"76","author":"Macfarlane","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7550108","DOI":"10.1155\/prm\/7550108","article-title":"Pain Neuroscience Education and Resistance Training in Women with Fibromyalgia: A Randomized Control Pilot Study","volume":"2025","year":"2025","journal-title":"Pain Res. Manag."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cuenca-Mart\u00ednez, F., Suso-Mart\u00ed, L., Calatayud, J., Ferrer-Sargues, F.J., Mu\u00f1oz-Alarcos, V., Alba-Quesada, P., and Bivi\u00e1-Roig, G. (2023). Pain neuroscience education in patients with chronic musculoskeletal pain: An umbrella review. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1272068"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1111\/1756-185X.14223","article-title":"Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial","volume":"24","author":"Saracoglu","year":"2021","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"180","DOI":"10.34172\/hpp.2020.31","article-title":"Psychological interventions for depression and anxiety: A systematic review and meta-analysis of Iranian chronic pain trials","volume":"10","author":"Jandaghi","year":"2020","journal-title":"Health Promot. Perspect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e70013","DOI":"10.1002\/brb3.70013","article-title":"Pain neuroscience education and motor imagery-based exercise protocol for patients with fibromyalgia: A randomized controlled trial","volume":"14","author":"Kircali","year":"2024","journal-title":"Brain Behav."},{"key":"ref_24","first-page":"255","article-title":"Multidisciplinary Biopsychosocial Program for Chronic Musculoskeletal Pain at the Dead Sea","volume":"21","author":"Dramsdahl","year":"2019","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_25","first-page":"1156","article-title":"A multicomponent physical activity home-based intervention for fibromyalgia patients: Effects on clinical and skin biopsy features","volume":"42","author":"Gentile","year":"2024","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.socscimed.2008.03.003","article-title":"Illness experience in fibromyalgia syndrome: A metasynthesis of qualitative studies","volume":"67","author":"Sim","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/1742395317718035","article-title":"Diagnostic experience of patients with fibromyalgia\u2014A meta-ethnography","volume":"14","author":"Mengshoel","year":"2018","journal-title":"Chronic Illn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1046\/j.1365-2702.2002.00606.x","article-title":"The meaning of fatigue and tiredness as narrated by women with fibromyalgia and healthy women","volume":"11","author":"Lundman","year":"2002","journal-title":"J. Clin. Nurs."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e008847","DOI":"10.1136\/bmjopen-2015-008847","article-title":"Beliefs underlying pain-related fear and how they evolve: A qualitative investigation in people with chronic back pain and high pain-related fear","volume":"5","author":"Bunzli","year":"2015","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/msc.162","article-title":"Women\u2019s narratives on experiences of work ability and functioning in fibromyalgia","volume":"8","author":"Sallinen","year":"2010","journal-title":"Musculoskelet. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1080\/09638288.2019.1632939","article-title":"Physiotherapists\u2019 accounts of fibromyalgia: Role-uncertainty and professional shortcomings","volume":"43","author":"Roitenberg","year":"2021","journal-title":"Disabil. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1517\/14656566.2014.925446","article-title":"Treatment of central sensitization in patients with \u201cunexplained\u201d chronic pain: An update","volume":"15","author":"Nijs","year":"2014","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ashcraft, L.E., Hamm, M.E., Omowale, S.S., Hruschak, V., Miller, E., Eack, S.M., and Merlin, J.S. (2024). The perpetual evidence-practice gap: Addressing ongoing barriers to chronic pain management in primary care in three steps. Front. Pain Res., 5.","DOI":"10.3389\/fpain.2024.1376462"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"609","DOI":"10.2522\/ptj.20150240","article-title":"What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis","volume":"96","author":"Cullinane","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.semarthrit.2016.08.012","article-title":"2016 Revisions to the 2010\/2011 fibromyalgia diagnostic criteria","volume":"46","author":"Wolfe","year":"2016","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1002\/art.24922","article-title":"Understanding the lack of understanding: Invalidation from the perspective of the patient with fibromyalgia","volume":"61","author":"Kool","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2522\/ptj.20130118","article-title":"Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: An experimental controlled study","volume":"94","author":"Fuentes","year":"2014","journal-title":"Phys. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1080\/09593985.2018.1431343","article-title":"The role of the therapeutic alliance on pain relief in musculoskeletal rehabilitation: A systematic review","volume":"34","year":"2018","journal-title":"Physiother. Theory Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10669817.2021.1873259","article-title":"Can we just talk our patients out of pain? Should pain neuroscience education be our only tool?","volume":"29","author":"Shala","year":"2021","journal-title":"J. Man. Manip. Ther."},{"key":"ref_42","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_43","doi-asserted-by":"crossref","first-page":"15022","DOI":"10.1038\/nrdp.2015.22","article-title":"Fibromyalgia","volume":"1","author":"Ablin","year":"2015","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1207\/S15324796ABM2601_01","article-title":"Self-management education: History, definition, outcomes, and mechanisms","volume":"26","author":"Lorig","year":"2003","journal-title":"Ann. Behav. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1002\/ejp.1253","article-title":"The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis","volume":"22","author":"Elbers","year":"2018","journal-title":"Eur. J. Pain"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1140.e1","DOI":"10.1016\/j.jpain.2019.02.011","article-title":"Pain Neuroscience Education for Adults with Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis","volume":"20","author":"Watson","year":"2019","journal-title":"J. Pain"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1016\/j.apmr.2011.07.198","article-title":"The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain","volume":"92","author":"Louw","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Geraghty, A.W.A., Maund, E., Newell, D., Santer, M., Everitt, H., Price, C., Pincus, T., Moore, M., Little, P., and West, R. (2021). Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254642"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/bja\/aet129","article-title":"Psychosocial interventions for managing pain in older adults: Outcomes and clinical implications","volume":"111","author":"Keefe","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"D\u00edaz-Fern\u00e1ndez, \u00c1., Cort\u00e9s-P\u00e9rez, I., Obrero-Gait\u00e1n, E., Ortega-Mart\u00ednez, A.R., Osuna-P\u00e9rez, M.C., Zagalaz-Anula, N., and Lomas-Vega, R. (2024). Chronic Pain Management Approaches among Spanish Physiotherapists: Influences, Practices, Barriers, and Challenges. J. Pers. Med., 14.","DOI":"10.3390\/jpm14090903"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"van Dijk, H., K\u00f6ke, A.J.A., Elbers, S., Mollema, J., Smeets, R.J.E.M., and Wittink, H. (2023). Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators-A Scoping Review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021634"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e70201","DOI":"10.1002\/ejp.70201","article-title":"Associations Between Genetic Polymorphisms and Psychological Variables in Women with Fibromyalgia: A Cross-Sectional Study","volume":"30","year":"2026","journal-title":"Eur. J. Pain"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1080\/09593985.2016.1194646","article-title":"The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature","volume":"32","author":"Louw","year":"2016","journal-title":"Physiother. Theory Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6099\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:38:45Z","timestamp":1785937125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":53,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156099"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156099","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}