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Duhn PH, Christensen R, Locht H, Henriksen M, Ginnerup-Nielsen E, Bliddal H, Wæhrens EE, Thielen K, Amris K. Phenotypic characteristics of patients with chronic widespread pain and fibromyalgia: a cross-sectional cluster analysis. Scand J Rheumatol 2024:1-10. [PMID: 38275145 DOI: 10.1080/03009742.2023.2297514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE This study aimed to explore whether phenotypic characteristics of patients with chronic widespread pain (CWP) and fibromyalgia (FM) can be aggregated into definable clusters that may help to tailor treatments. METHOD Baseline variables (sex, age, education, marital/employment status, pain duration, prior CWP/FM diagnosis, concomitant rheumatic disease, analgesics, tender point count, and disease variables derived from standardized questionnaires) collected from 1099 patients (93.4% females, mean age 44.6 years) with a confirmed CWP or FM diagnosis were evaluated by hierarchical cluster analysis. The number of clusters was based on coefficients in the agglomeration schedule, supported by dendrograms and silhouette plots. Simple and multiple regression analyses using all variables as independent predictors were used to assess the likelihood of cluster assignment, reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Only one cluster emerged (Cluster 1: 455 patients). Participants in this cluster were characterized as working (OR 66.67, 95% CI 7.14 to 500.00), with a medium-term/higher education (OR 16.80, 95% CI 1.94 to 145.41), married/cohabiting (OR 14.29, 95% CI 1.26 to 166.67), and using mild analgesics (OR 25.64, 95% CI 0.58 to > 999.99). The odds of being an individual in Cluster 1 were lower when having a worse score on the PDQ (score ≥ 18) (OR < 0.001, 95% CI < 0.001 to 0.02). CONCLUSION We identified one cluster, where participants were characterized by a potentially favourable clinical profile. More studies are needed to evaluate whether these characteristics could be used to guide the management of patients with CWP and FM.
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Affiliation(s)
- P H Duhn
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - R Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - H Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - E Ginnerup-Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-Based Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - K Thielen
- Department of Social Medicine, Institute of Public Health Science, Copenhagen University, Copenhagen, Denmark
| | - K Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
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Ghaziani E, Christensen SS, Arens CH, Wæhrens EE. Addressing ADL ability in people with poststroke cognitive impairments: A Danish survey of clinical practice. Scand J Occup Ther 2024; 31:2318204. [PMID: 38382558 DOI: 10.1080/11038128.2024.2318204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Denmark, stroke represents a leading disability cause. While people with difficulties in performing activities of daily living (ADL) due to poststroke cognitive impairments are often referred to occupational therapy, limited knowledge is available on the nature of these services. AIM/OBJECTIVE To explore how Danish occupational therapists describe their practice when addressing decreased ADL ability in people with poststroke cognitive impairments in hospital and municipality settings. MATERIAL AND METHODS National, cross-sectorial, web-based public survey. RESULTS 244 occupational therapists accessed the survey; 172 were included in the analysis. Most respondents could indicate the theory guiding their reasoning; half used standardised assessments. Regarding intervention, restorative and acquisitional models were preferred; specific strategies were identified. Intensity: 30-45 min 3-4 times/week in hospitals; 30-60 min 1-2 times/week in municipalities. CONCLUSIONS Therapists report to be guided by theory in their reasoning. Standardised assessments are used to a higher extend than previously reported. Still, the results invite critical reflections on correct use of assessment instruments, content and intensity of interventions, and how therapists keep themselves updated. SIGNIFICANCE The results document the need for practice improvements and may inform the definition of standard care in future trials.
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Affiliation(s)
- E Ghaziani
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S S Christensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - C H Arens
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - E E Wæhrens
- Occupation-Centered Occupational Therapy, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Ginnerup-Nielsen E, Bandak E, Bartholdy C, Henriksen M, Wæhrens EE. Validity of the Brief Illness Perception Questionnaire in people with knee pain: a Rasch analysis. Scand J Rheumatol 2024; 53:63-71. [PMID: 37751331 DOI: 10.1080/03009742.2023.2256089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The Brief Illness Perception Questionnaire (B-IPQ) is a frequently used measure of illness perception (IP). The aim of this study was to explore the psychometric properties of the questionnaire when used in elderly people with knee pain. METHOD Based on data from the Frederiksberg Cohort on elderly people reporting knee pain (N = 836), the psychometric properties of the eight B-IPQ items (1 'Consequences', 2 'Timeline', 3 'Personal control', 4 'Treatment control', 5 'Identity', 6 'Concern', 7 'Coherence', and 8 'Emotions') were analysed using Rasch analysis to establish whether the questionnaire provides reliable and valid measures of IP. RESULTS Threshold disordering was found on the 1-10 rating scale in all items. When rescaling to a 0-2 rating scale, disordering was resolved in six items. Item goodness-of-fit analyses revealed that two items displayed underfit misfit and four items overfit misfit; hence, the B-IPQ does not present unidimensionality. The person separation index indicated that items separate respondents into only two IP levels. Finally, floor and ceiling effects were found, indicating that the B-IPQ may not fully describe the extent of IP in this population. CONCLUSION The 1-10 rating scale used in the Danish B-IPQ targeting knee pain is suboptimal, while a 0-2 scale improves the psychometric properties of the scale. The B-IPQ does not present unidimensionality and the use of a sum score is therefore not recommended when assessing IP. The B-IPQ may not cover the extent of IP in elderly people with knee pain.
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Affiliation(s)
- E Ginnerup-Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - E Bandak
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Duhn PH, Wæhrens EE, Pedersen MB, Nielsen SM, Locht H, Bliddal H, Christensen R, Amris K. Effectiveness of patient education as a stand-alone intervention for patients with chronic widespread pain and fibromyalgia: a systematic review and meta-analysis of randomized trials. Scand J Rheumatol 2023; 52:654-663. [PMID: 37162478 DOI: 10.1080/03009742.2023.2192450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Patient education is recommended as an integral component of the therapeutic plan for the management of chronic widespread pain (CWP) and fibromyalgia (FM). The key purpose of patient education is to increase the patient's competence to manage his or her own health requirements, encouraging self-management and a return to desired everyday activities and lifestyle. The aim of this systematic review was to evaluate the evidence for the benefits and potential harms associated with the use of patient education as a stand-alone intervention for individuals with CWP and FM through randomized controlled trials (RCTs). METHOD On 24 November 2021 a systematic search of PubMed, MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, ClinicalTrials.gov, American College of Rheumatology, European League Against Rheumatism, and the World Health Organization International Clinical Trials Registry Platform identified 2069 studies. After full-text screening, five RCT studies were found to be eligible for the qualitative evidence synthesis. RESULTS Patient education as a stand-alone intervention presented an improvement in patients' global assessment (standardized mean difference 0.79, 95% confidence interval 0.13 to 1.46). When comparing patient education with usual care, no intervention, or waiting list, no differences were found for functioning, level of pain, emotional distress in regard to anxiety and depression, or pain cognition. CONCLUSION This review reveals the need for RCTs investigating patient education as a stand-alone intervention for patients with FM, measuring outcomes such as disease acceptance, health-related quality of life, enhancement of patients' knowledge of pain, pain coping skills, and evaluation of prioritized learning outcomes.
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Affiliation(s)
- P H Duhn
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science and Occupational Therapy, User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M B Pedersen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Orthopaedic Research Unit at Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - H Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
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Duhn PH, Amris K, Bliddal H, Wæhrens EE. The validity of the Danish version of the Fibromyalgia Impact Questionnaire - Revised applied in a clinical setting: a Rasch analysis. Scand J Rheumatol 2022:1-10. [PMID: 35924595 DOI: 10.1080/03009742.2022.2098631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the psychometric properties of the Danish version of the Fibromyalgia Impact Questionnaire - Revised (FIQR), when used to quantify the severity of disease burden in a Danish population of patients with chronic widespread pain (CWP), including fibromyalgia (FM). METHOD A total of 924 participants diagnosed with CWP and/or FM completed an electronic version of the FIQR via touchscreens in the clinic at referral for specialist care. Data were collected from 1 January 2018 to 3 September 2020. Rasch measurement methods were applied. RESULTS Rating scale analysis suggested multiple threshold disordering in the 0-10 category rating scale. A principal component analysis suggested assessment of a multidimensional construct. Thus, the Rasch analysis of the full FIQR was discontinued. Instead, Rasch analyses were performed on the two subscales: 'function' and 'symptoms'. By collapsing the rating scale to a 0-4 category scale, the remaining threshold disordering of both subscale was solved. Only the symptom subscale indicated multidimensionality. There was underfitting misfit of item 21 and overfitting misfit of item 12. No significant differential item functioning, defined by sex, ethnicity, or education, was found. CONCLUSION The FIQR should be considered as an instrument consisting of three separate subscales representing 'function', 'overall impact', and 'symptoms'. We recommend calculating and reporting on both a 0-10 and a 0-4 category scale. Also, if using the total FIQR score as an outcome measure, this should be done with caution, until revision of the rating scale.
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Affiliation(s)
- P H Duhn
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.,Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - K Amris
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.,Department of Rheumatology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Denmark
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E E Wæhrens
- The Parker Institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Denmark.,Occupational Science, User Perspectives and Community-Based Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Amris K, Bandak E, Kristensen LE, Wæhrens EE. Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study. Scand J Rheumatol 2021; 51:452-460. [PMID: 34596488 DOI: 10.1080/03009742.2021.1952755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue.Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman's rho correlation and regression modelling were applied.Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA.Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.
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Affiliation(s)
- K Amris
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - L E Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - E E Wæhrens
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Occupational Science & Occupational Therapy, User Perspectives and Community-Based Interventions, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Bülow C, Amris K, Bandak E, Danneskiold-Samsøe B, Wæhrens E. Improving activities of daily living ability in women with fibromyalgia: An exploratory, quasi-randomized, phase-two study, IMPROvE trial. J Rehabil Med 2017; 49:241-250. [DOI: 10.2340/16501977-2198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Amris K, Omerovic E, Danneskiold-Samsøe B, Bliddal H, Wæhrens EE. The validity of self-rating depression scales in patients with chronic widespread pain: a Rasch analysis of the Major Depression Inventory. Scand J Rheumatol 2015; 45:236-46. [DOI: 10.3109/03009742.2015.1067712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- K Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - E Omerovic
- Department of Rheumatology, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark
| | - B Danneskiold-Samsøe
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - EE Wæhrens
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Research Initiative for Activity Studies and Occupational Therapy, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Wæhrens EE, Amris K, Bartels EM, Christensen R, Danneskiold-Samsøe B, Bliddal H, Gudbergsen H. Agreement between touch-screen and paper-based patient-reported outcomes for patients with fibromyalgia: a randomized cross-over reproducibility study. Scand J Rheumatol 2015; 44:503-10. [DOI: 10.3109/03009742.2015.1029517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wæhrens EE, Bliddal H, Danneskiold-Samsøe B, Lund H, Fisher AG. Differences between questionnaire- and interview-based measures of activities of daily living (ADL) ability and their association with observed ADL ability in women with rheumatoid arthritis, knee osteoarthritis, and fibromyalgia. Scand J Rheumatol 2012; 41:95-102. [DOI: 10.3109/03009742.2011.632380] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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