{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T21:30:56Z","timestamp":1793568656193,"version":"4.5.0"},"reference-count":63,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Special Program","award":["23Y11921700"],"award-info":[{"award-number":["23Y11921700"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Knee osteoarthritis (KOA), a common degenerative joint disease, affects a large patient population and poses significant challenges in early diagnosis and rehabilitation. Achieving precise assessment of knee function and efficient home-based intelligent rehabilitation is crucial for alleviating pain, slowing disease progression, and improving patients\u2019 quality of life. This study proposes a smart wearable knee function assessment based on multimodal physiological signals and a rehabilitation system. The system integrates surface electromyography (sEMG), pressure sensors, and an inertial measurement unit (IMU) to synchronously capture gait, posture, and muscle activity. It quantifies knee function by extracting gait and EMG features. Additionally, a wearable massage device driven by airbags was designed and implemented to simulate the traditional Chinese medicine \u201cseated knee-adjustment method\u201d and deliver precise intelligent rehabilitation interventions. Experimental results validated the system\u2019s accuracy in functional assessment and reliability in rehabilitation assistance. The average relative error in gait feature extraction was below 8%, while the massage head displacement error remained within clinically acceptable ranges. By integrating multimodal sensing technology with intelligent rehabilitation devices, this system offers KOA patients a convenient, efficient, and sustainable home-based rehabilitation solution with strong clinical application potential and promotional value.<\/jats:p>","DOI":"10.3390\/s25237334","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:42:02Z","timestamp":1764960122000},"page":"7334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A Wearable System for Knee Osteoarthritis: Based on Multimodal Physiological Signal Assessment and Intelligent Rehabilitation"],"prefix":"10.3390","volume":"25","author":[{"given":"Jingyi","family":"Hu","sequence":"first","affiliation":[{"name":"School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyi","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichun","family":"Shen","sequence":"additional","affiliation":[{"name":"Institute of Robotics and Intelligent System, Dalian University of Technology, Dalian 116024, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinrong","family":"Miao","sequence":"additional","affiliation":[{"name":"School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106349","DOI":"10.1016\/j.envint.2020.106349","article-title":"The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: A systematic review and meta-analysis from the WHO\/ILO Joint Estimates of the Work-related Burden of Disease and Injury","volume":"150","author":"Hulshof","year":"2021","journal-title":"Environ. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.7812\/TPP\/16-183","article-title":"Knee Osteoarthritis: A Primer","volume":"21","author":"Lespasio","year":"2017","journal-title":"Perm. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lv, Y., Sui, L., Lv, H., Zheng, J., Feng, H., and Jing, F. (2025). Burden of knee osteoarthritis in China and globally from 1992 to 2021, and projections to 2030: A systematic analysis from the Global Burden of Disease Study 2021. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1543180"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1186\/s13018-025-06270-5","article-title":"Prevalence of knee osteoarthritis in the Chinese population, 2013\u20132023: A systematic review and meta-analysis","volume":"20","author":"Chen","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1001\/jama.2020.22171","article-title":"Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review","volume":"325","author":"Katz","year":"2021","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zeng, L., Zhou, G., Yang, W., and Liu, J. (2023). Guidelines for the diagnosis and treatment of knee osteoarthritis with integrative medicine based on traditional Chinese medicine. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1260943"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S1063-4584(03)00082-7","article-title":"Response relationship of VAS and Likert scales in osteoarthritis efficacy measurement","volume":"11","author":"Bolognese","year":"2023","journal-title":"Osteoarthr. Cartil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/acr.22415","article-title":"Measurement properties of the Western Ontario and McMaster Universities Osteoarthritis Index: A systematic review","volume":"67","author":"Gandek","year":"2015","journal-title":"Arthritis Care Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.joca.2021.04.018","article-title":"Imaging in osteoarthritis","volume":"30","author":"Roemer","year":"2022","journal-title":"Osteoarthr. Cartil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"KELLGREN","year":"1957","journal-title":"Ann. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1148\/radiology.187.2.8475293","article-title":"Abnormalities of articular cartilage in the knee: Analysis of available MR techniques","volume":"187","author":"Recht","year":"1993","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tiulpin, A., Thevenot, J., Rahtu, E., Lehenkari, P., and Saarakkala, S. (2018). Automatic Knee Osteoarthritis Diagnosis from Plain Radiographs: A Deep Learning-Based Approach. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-20132-7"},{"key":"ref_13","first-page":"5586529","article-title":"An Automatic Knee Osteoarthritis Diagnosis Method Based on Deep Learning: Data from the Osteoarthritis Initiative","volume":"2021","author":"Wang","year":"2021","journal-title":"J. Healthc. Eng."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/BOR.0b013e32833bd81f","article-title":"Lower limb osteoarthritis: Biomechanical alterations and implications for therapy","volume":"22","author":"Block","year":"2010","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.jelekin.2005.07.014","article-title":"Neuromuscular alterations during walking in persons with moderate knee osteoarthritis","volume":"16","author":"Deluzio","year":"2006","journal-title":"J. Electromyogr. Kinesiol. Off. J. Int. Soc. Electrophysiol. Kinesiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Taniguchi, T., Tanaka, S., Nishigami, T., Imai, R., Mibu, A., and Yoshimoto, T. (2024). Relationship between Fear-Avoidance Beliefs and Muscle Co-Contraction in People with Knee Osteoarthritis. Sensors, 24.","DOI":"10.3390\/s24165137"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kobsar, D., Masood, Z., Khan, H., Khalil, N., Kiwan, M.Y., Ridd, S., and Tobis, M. (2020). Wearable Inertial Sensors for Gait Analysis in Adults with Osteoarthritis\u2014A Scoping Review. Sensors, 20.","DOI":"10.3390\/s20247143"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.3390\/s120202255","article-title":"Gait analysis using wearable sensors","volume":"12","author":"Tao","year":"2012","journal-title":"Sensors"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sun, J., Liu, G., Sun, Y., Lin, K., Zhou, Z., and Cai, J. (2022). Application of Surface Electromyography in Exercise Fatigue: A Review. Front. Syst. Neurosci., 16.","DOI":"10.3389\/fnsys.2022.893275"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5755\/j01.eee.19.3.3697","article-title":"Mean and median frequency of EMG signal to determine muscle force based on time-dependent power spectrum","volume":"19","author":"Thongpanja","year":"2013","journal-title":"Elektron. Ir Elektrotechnika"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/BF02441600","article-title":"Monitoring surface EMG spectral changes by the zero crossing rate","volume":"24","author":"Inbar","year":"1986","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s13534-018-0078-z","article-title":"Electromyography-signal-based muscle fatigue assessment for knee rehabilitation monitoring systems","volume":"8","author":"Kim","year":"2018","journal-title":"Biomed. Eng. Lett."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.cmpb.2017.10.024","article-title":"Surface electromyography based muscle fatigue detection using high-resolution time-frequency methods and machine learning algorithms","volume":"154","author":"Karthick","year":"2018","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Shtroblia, V., Petakh, P., Kamyshna, I., Halabitska, I., and Kamyshnyi, O. (2025). Recent advances in the management of knee osteoarthritis: A narrative review. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1523027"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.2147\/JPR.S154002","article-title":"Knee osteoarthritis: Pathophysiology and current treatment modalities","volume":"11","author":"Mora","year":"2018","journal-title":"J. Pain Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Guo, W., Katiyar, S.A., Davis, S., and Nefti-Meziani, S. (2025). Overview: A Comprehensive Review of Soft Wearable Rehabilitation and Assistive Devices, with a Focus on the Function, Design and Control of Lower-Limb Exoskeletons. Machines, 13.","DOI":"10.3390\/machines13111020"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.5535\/arm.250093","article-title":"Wearable Robots for Rehabilitation and Assistance of Gait: A Narrative Review","volume":"49","author":"Cha","year":"2025","journal-title":"Ann. Rehabil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zhu, Z., Liu, L., Zhang, W., Jiang, C., Wang, X., and Li, J. (2024). Design and motion control of exoskeleton robot for paralyzed lower limb rehabilitation. Front. Neurosci., 18.","DOI":"10.3389\/fnins.2024.1355052"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1080\/10400435.2021.1887400","article-title":"Evaluation of a lower-extremity robotic exoskeleton for people with knee osteoarthritis","volume":"34","author":"McGibbon","year":"2022","journal-title":"Assist. Technol. Off. J. RESNA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.artd.2022.03.007","article-title":"A Novel Mobile App-Based Neuromuscular Electrical Stimulation Therapy for Improvement of Knee Pain, Stiffness, and Function in Knee Osteoarthritis: A Randomized Trial","volume":"15","author":"Sax","year":"2022","journal-title":"Arthroplast. Today"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bruce-Brand, R.A., Walls, R.J., Ong, J.C., Emerson, B.S., O\u2019Byrne, J.M., and Moyna, N.M. (2012). Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: A randomized controlled trial. BMC Musculoskelet. Disord., 13.","DOI":"10.1186\/1471-2474-13-118"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pan, J., Xie, Z., Shen, H., Luan, J., Zhang, X., and Liao, B. (2025). Three-Dimensional gait biomechanics in patients with mild knee osteoarthritis. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-17398-z"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.gaitpost.2017.08.009","article-title":"Clinical gait evaluation of patients with knee osteoarthritis","volume":"58","author":"Sun","year":"2017","journal-title":"Gait Posture"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Liu, Y., Li, Y., and Hao, Q. (2020). Development and Application of Resistance Strain Force Sensors. Sensors, 20.","DOI":"10.3390\/s20205826"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.compbiomed.2018.04.010","article-title":"Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis","volume":"97","author":"Zhang","year":"2018","journal-title":"Comput. Biol. Med."},{"key":"ref_36","first-page":"687","article-title":"Analysis of the plantar pressure distribution of the normal Chinese adult","volume":"16","author":"Wang","year":"2008","journal-title":"Orthop. J. China"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12984-020-00685-3","article-title":"Validity and reliability of wearable inertial sensors in healthy adult walking: A systematic review and meta-analysis","volume":"17","author":"Kobsar","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101662","DOI":"10.1016\/j.rehab.2022.101662","article-title":"Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis","volume":"66","author":"Tayfur","year":"2023","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jelekin.2004.06.003","article-title":"Reliability of surface EMG during sustained contractions of the quadriceps","volume":"15","author":"Mathur","year":"2005","journal-title":"J. Electromyogr. Kinesiol. Off. J. Int. Soc. Electrophysiol. Kinesiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.2147\/JPR.S247827","article-title":"Mechanism of Traditional Chinese Medicine in Treating Knee Osteoarthritis","volume":"13","author":"Wang","year":"2020","journal-title":"J. Pain Res."},{"key":"ref_41","first-page":"106","article-title":"Advances in Traditional Chinese Medicine Treatment for Knee Osteoarthritis","volume":"50","author":"Zhang","year":"2022","journal-title":"Acta Chin. Med. Pharmacol."},{"key":"ref_42","first-page":"98","article-title":"Preliminary exploration on therapeutic ideas and principals of the method for adjusting knee joint in a sitting position in the treatment of knee osteoarthritis","volume":"34","author":"Kang","year":"2020","journal-title":"Acad. J. Shanghai Univ. Tradit. Chin. Med."},{"key":"ref_43","first-page":"14","article-title":"Review of Gait Analysis","volume":"43","author":"Zhang","year":"2022","journal-title":"Packag. Eng."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Liu, M., Kang, N., Wang, D., Mei, D., Wen, E., Qian, J., and Chen, G. (2023). Analysis of Lower Extremity Motor Capacity and Foot Plantar Pressure in Overweight and Obese Elderly Women. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043112"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.gaitpost.2016.08.024","article-title":"Accelerometer-based determination of gait variability in older adults with knee osteoarthritis","volume":"50","author":"Clermont","year":"2016","journal-title":"Gait Posture"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"102983","DOI":"10.1016\/j.msksp.2024.102983","article-title":"Gait speed in knee osteoarthritis: A simple 10-meter walk test predicts the distance covered in the 6-minute walk test","volume":"72","year":"2024","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Bandara, A., Shimizu, H., Watanabe, D., Misa, T., Suzuki, S., Tanigawa, K., Nagai-Tanima, M., and Aoyama, T. (2025). Diurnal variations in gait parameters among older adults with early-stage knee osteoarthritis: Insights from wearable sensor technology. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-91617-5"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13018-025-05484-x","article-title":"Factors, characteristics and influences of the changes of muscle activation patterns for patients with knee osteoarthritis: A review","volume":"20","author":"Liu","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Chen, W., Li, C., Wang, Y., Shen, X., Wu, Z., Li, J., Ye, Z., Xiang, R., and Xu, X. (2023). Comparison of the asymmetries in muscle mass, biomechanical property and muscle activation asymmetry of quadriceps femoris between patients with unilateral and bilateral knee osteoarthritis. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1126116"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Zeng, Z., Shan, J., Zhang, Y., Wang, Y., Li, C., Li, J., Chen, W., Ye, Z., Ye, X., and Chen, Z. (2022). Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.922832"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"V\u00e5rbakken, K., Lor\u00e5s, H., Nilsson, K.G., Engdal, M., and Stensdotter, A.K. (2019). Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: An exploratory cross-sectional study. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2957-6"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.clinbiomech.2009.01.010","article-title":"Surface EMG based muscle fatigue evaluation in biomechanics","volume":"24","author":"Cifrek","year":"2009","journal-title":"Clin. Biomech."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1743-0003-7-21","article-title":"Study of stability of time-domain features for electromyographic pattern recognition","volume":"7","author":"Tkach","year":"2010","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Liu, S.H., Lin, C.B., Chen, Y., Chen, W., Huang, T.S., and Hsu, C.Y. (2019). An EMG Patch for the Real-Time Monitoring of Muscle-Fatigue Conditions During Exercise. Sensors, 19.","DOI":"10.3390\/s19143108"},{"key":"ref_55","first-page":"4115","article-title":"Gait comparison between normal young people and knee osteoarthritis patients","volume":"15","author":"Fu","year":"2011","journal-title":"J. Clin. Rehabil. Tissue Eng. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.joca.2013.12.015","article-title":"Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis","volume":"22","author":"Elbaz","year":"2014","journal-title":"Osteoarthr. Cartil."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/MRR.0000000000000242","article-title":"Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: A clinical and electrophysiological study","volume":"40","author":"Benedetti","year":"2017","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"20552076241311940","DOI":"10.1177\/20552076241311940","article-title":"Digital assessment of muscle adaptation in obese patients with osteoarthritis: Insights from surface electromyography (sEMG)","volume":"11","author":"Luo","year":"2025","journal-title":"Digit. Health"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Kim, H., Kang, Y., Valencia, D.R., and Kim, D. (February, January 31). An integrated system for gait analysis using FSRs and an IMU. Proceedings of the 2018 Second IEEE International Conference on Robotic Computing (IRC), Laguna Hills, CA, USA.","DOI":"10.1109\/IRC.2018.00073"},{"key":"ref_60","first-page":"135","article-title":"Study on the curative effects and gait analysis of knee osteoarthritis treated by the method for adjusting knee joint in a sitting position","volume":"37","author":"Liang","year":"2018","journal-title":"Beijing J. Tradit. Chin. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1177\/0040517517716907","article-title":"Application of air bladders for medical compression hosieries","volume":"88","author":"Hakala","year":"2018","journal-title":"Text. Res. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"113708","DOI":"10.1016\/j.isci.2025.113708","article-title":"A systematic review of computer-aided acupoint localization","volume":"28","author":"Zhai","year":"2025","journal-title":"iScience"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jams.2018.10.009","article-title":"Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review","volume":"12","author":"Godson","year":"2019","journal-title":"J. Acupunct. Meridian Stud."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/23\/7334\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:47:01Z","timestamp":1764960421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/23\/7334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":63,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["s25237334"],"URL":"https:\/\/doi.org\/10.3390\/s25237334","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,2]]}}}