Feasibility of a blended therapy approach in the treatment of patients with inflammatory myopathies
Tóm tắt
Inflammatory myopathies (IMs) are a group of rare conditions characterized by proximal and often symmetrical muscle weakness and reduced muscle endurance. The recommended medical treatment is based on corticosteroids in combination with immunosuppressants. This anti-inflammatory therapy serves to inhibit and prevent inflammation but does not influence impaired muscle strength. Exercise, particularly progressive resistance training, plays therefore an important role in IMs management. Blended therapy, a combination of face-to-face treatment and telerehabilitation, may be a powerful therapy option in improving exercise program adherence in these patients. The feasibility of a 12-week interactive tablet-based home exercise program combined with face-to-face therapy sessions – a ‘blended therapy’ approach - was evaluated using a quasi-experimental one-group pre-post comparison design. Primary outcomes were recruitment, attrition and adherence rates, plus measures of acceptance (Technology Acceptance Model Questionnaire (TAM)) and satisfaction (satisfaction questionnaire). Secondary outcomes comprised potential effects of the intervention on muscle strength and function, activity limitation, disability and health-related quality of life. Thirteen of the included 14 participants completed the study without any related adverse events. Mean adherence to exercise program was 84% (range: 25–100%) and participants indicated high acceptance of the intervention with mean TAM scores between 6.1 and 6.5 points. Overall satisfaction with the therapy sessions, the home program, and the technology was good. Approximately half the participants wished for longer training periods and more training sessions per week. There were inconsistent effects on muscle strength, muscle function, activity limitation, disability, and health-related quality of life. Blended therapy combining the use of an interactive tablet-based resistance training program with face-to-face therapy sessions is feasible and safe and participants` acceptance with this approach was high. Furthermore, results were obtained that might be useful in selecting appropriate assessments and sample sizes in future trials. NCT03713151 .
Tài liệu tham khảo
citation_journal_title=N Engl J Med; citation_title=Polymyositis, dermatomyositis and inclusion-body myositis; citation_author=MC Dalakas; citation_volume=325; citation_issue=21; citation_publication_date=1991; citation_pages=1487-1498; citation_doi=10.1056/NEJM199111213252107; citation_id=CR1
citation_journal_title=N Engl J Med; citation_title=Polymyositis and dermatomyositis (first of two parts); citation_author=A Bohan, JB Peter; citation_volume=292; citation_issue=7; citation_publication_date=1975; citation_pages=344-347; citation_doi=10.1056/NEJM197502132920706; citation_id=CR2
citation_journal_title=Cochrane Database Syst Rev; citation_title=Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis; citation_author=PA Gordon, JB Winer, JE Hoogendijk, EH Choy; citation_volume=8; citation_issue=8; citation_publication_date=2012; citation_id=CR3
citation_journal_title=Curr Opin Rheumatol; citation_title=Therapy of myositis: biological and physical; citation_author=IE Lundberg, J Vencovsky, H Alexanderson; citation_volume=26; citation_issue=6; citation_publication_date=2014; citation_pages=704-711; citation_doi=10.1097/BOR.0000000000000109; citation_id=CR4
citation_journal_title=Rheumatology.; citation_title=Safety and efficacy of exercise training in patients with an idiopathic inflammatory myopathy--a systematic review; citation_author=GE Habers, T Takken; citation_volume=50; citation_issue=11; citation_publication_date=2011; citation_pages=2113-2124; citation_doi=10.1093/rheumatology/ker292; citation_id=CR5
citation_journal_title=Curr Treatm Opt Rheumatol; citation_title=Exercise in myositis; citation_author=H Alexanderson; citation_volume=4; citation_issue=4; citation_publication_date=2018; citation_pages=289-298; citation_doi=10.1007/s40674-018-0113-3; citation_id=CR6
citation_journal_title=J Intern Med; citation_title=Physical exercise as a treatment for adult and juvenile myositis; citation_author=H Alexanderson; citation_volume=280; citation_issue=1; citation_publication_date=2016; citation_pages=75-96; citation_doi=10.1111/joim.12481; citation_id=CR7
citation_journal_title=Br J Sports Med; citation_title=Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis; citation_author=SH Sveaas, G Smedslund, KB Hagen, H Dagfinrud; citation_volume=51; citation_issue=14; citation_publication_date=2017; citation_pages=1065-1072; citation_doi=10.1136/bjsports-2016-097149; citation_id=CR8
citation_journal_title=J Rheumatol; citation_title=Patients' experience of myositis and further validation of a myositis-specific patient reported outcome measure - establishing Core domains and expanding patient input on clinical assessment in myositis. Report from OMERACT 12; citation_author=M Regardt, P Basharat, L Christopher-Stine, C Sarver, A Bjorn, IE Lundberg; citation_volume=42; citation_issue=12; citation_publication_date=2015; citation_pages=2492-2495; citation_doi=10.3899/jrheum.141243; citation_id=CR9
citation_journal_title=Rheumatol Int; citation_title=Disability in idiopathic inflammatory myopathies: questionnaire-based study; citation_author=AH Opinc, OE Brzezinska, JS Makowska; citation_volume=39; citation_issue=7; citation_publication_date=2019; citation_pages=1213-1220; citation_doi=10.1007/s00296-019-04302-y; citation_id=CR10
citation_journal_title=J Intern Med; citation_title=Can muscle regeneration fail in chronic inflammation: a weakness in inflammatory myopathies?; citation_author=I Loell, IE Lundberg; citation_volume=269; citation_issue=3; citation_publication_date=2011; citation_pages=243-257; citation_doi=10.1111/j.1365-2796.2010.02334.x; citation_id=CR11
citation_journal_title=Curr Opin Rheumatol; citation_title=Exercise effects in patients with adult idiopathic inflammatory myopathies; citation_author=H Alexanderson; citation_volume=21; citation_issue=2; citation_publication_date=2009; citation_pages=158-163; citation_doi=10.1097/BOR.0b013e328324e700; citation_id=CR12
citation_journal_title=Nat Clin Pract Rheumatol; citation_title=Molecular effects of exercise in patients with inflammatory rheumatic disease; citation_author=IE Lundberg, GA Nader; citation_volume=4; citation_issue=11; citation_publication_date=2008; citation_pages=597-604; citation_doi=10.1038/ncprheum0929; citation_id=CR13
citation_journal_title=Curr Opin Rheumatol; citation_title=Exercise as an anti-inflammatory intervention to combat inflammatory diseases of muscle; citation_author=GA Nader, IE Lundberg; citation_volume=21; citation_issue=6; citation_publication_date=2009; citation_pages=599-603; citation_doi=10.1097/BOR.0b013e3283319d53; citation_id=CR14
citation_journal_title=Rheumatol Int; citation_title=The relevance of applying exercise training principles when designing therapeutic interventions for patients with inflammatory myopathies: a systematic review; citation_author=P Baschung Pfister, E Bruin, B Tobler-Ammann, B Maurer, R Knols; citation_volume=35; citation_issue=10; citation_publication_date=2015; citation_pages=1641-1654; citation_doi=10.1007/s00296-015-3343-9; citation_id=CR15
citation_journal_title=Curr Opin Rheumatol; citation_title=Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies; citation_author=H Alexanderson, IE Lundberg; citation_volume=24; citation_issue=2; citation_publication_date=2012; citation_pages=201-207; citation_doi=10.1097/BOR.0b013e32834f19f5; citation_id=CR16
citation_journal_title=BMC Fam Pract; citation_title=A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial; citation_author=R Verwey, S Weegen, M Spreeuwenberg, H Tange, T Weijden, L Witte; citation_volume=15; citation_issue=1; citation_publication_date=2014; citation_pages=93; citation_doi=10.1186/1471-2296-15-93; citation_id=CR17
citation_journal_title=BMC Musculoskelet Disord; citation_title=Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis: study protocol of a randomized controlled trial; citation_author=CJ Kloek, D Bossen, C Veenhof, JM Dongen, J Dekker, DH Bakker; citation_volume=15; citation_issue=1; citation_publication_date=2014; citation_pages=269; citation_doi=10.1186/1471-2474-15-269; citation_id=CR18
citation_journal_title=J Telemed Telecare; citation_title=Physical rehabilitation using telemedicine; citation_author=TG Russell; citation_volume=13; citation_issue=5; citation_publication_date=2007; citation_pages=217-220; citation_doi=10.1258/135763307781458886; citation_id=CR19
citation_journal_title=Int J Telerehabil; citation_title=Telerehabilitation: policy issues and research tools; citation_author=KD Seelman, LM Hartman; citation_volume=1; citation_issue=1; citation_publication_date=2009; citation_pages=47-58; citation_doi=10.5195/ijt.2009.6013; citation_id=CR20
citation_journal_title=JMIR Hum Factors; citation_title=Supporting older adults in exercising with a tablet: a usability study; citation_author=S Mehra, B Visser, N Cila, J Helder, RH Engelbert, PJ Weijs; citation_volume=6; citation_issue=1; citation_publication_date=2019; citation_doi=10.2196/11598; citation_id=CR21
citation_journal_title=BMC Musculoskelet Disord; citation_title=Acceptability of a digital health intervention alongside physiotherapy to support patients following anterior cruciate ligament reconstruction; citation_author=E Dunphy, FL Hamilton, I Spasic, K Button; citation_volume=18; citation_issue=1; citation_publication_date=2017; citation_pages=471; citation_doi=10.1186/s12891-017-1846-0; citation_id=CR22
citation_journal_title=Phys Ther; citation_title=Effectiveness of a blended physical therapist intervention in people with hip osteoarthritis, knee osteoarthritis, or both: a cluster-randomized controlled trial; citation_author=CJJ Kloek, D Bossen, PM Spreeuwenberg, J Dekker, DH Bakker, C Veenhof; citation_volume=98; citation_issue=7; citation_publication_date=2018; citation_pages=560-570; citation_doi=10.1093/ptj/pzy045; citation_id=CR23
citation_journal_title=Physioscience; citation_title=Entwicklung eines Trainingsleitfadens für Patienten mit entzündlicher Muskelerkrankung; citation_author=P Baschung Pfister, I Sterkele, C Keller Trevisan, ED Bruin; citation_volume=16; citation_issue=01; citation_publication_date=2020; citation_pages=16-25; citation_doi=10.1055/a-1075-3963; citation_id=CR24
Research NIfH. Feasibility 2020. Available from:
https://www.nihr.ac.uk/about-us/glossary.htm?letter=F&postcategory=-1
.
citation_journal_title=Am J Occup Ther; citation_title=Nuts and bolts of conducting feasibility studies; citation_author=L Tickle-Degnen; citation_volume=67; citation_issue=2; citation_publication_date=2013; citation_pages=171-176; citation_doi=10.5014/ajot.2013.006270; citation_id=CR26
citation_journal_title=Clin Transl Sci; citation_title=Recommendations for planning pilot studies in clinical and translational research; citation_author=CG Moore, RE Carter, PJ Nietert, PW Stewart; citation_volume=4; citation_issue=5; citation_publication_date=2011; citation_pages=332-337; citation_doi=10.1111/j.1752-8062.2011.00347.x; citation_id=CR27
citation_journal_title=Pharm Stat; citation_title=Sample size of 12 per group rule of thumb for a pilot study; citation_author=SA Julious; citation_volume=4; citation_issue=4; citation_publication_date=2005; citation_pages=287-291; citation_doi=10.1002/pst.185; citation_id=CR28
citation_journal_title=Rheumatology.; citation_title=Distribution and severity of weakness among patients with polymyositis, dermatomyositis and juvenile dermatomyositis; citation_author=MO Harris-Love, JA Shrader, D Koziol, N Pahlajani, M Jain, M Smith, HL Cintas, CL McGarvey, L James-Newton, A Pokrovnichka, B Moini, I Cabalar, DJ Lovell, R Wesley, PH Plotz, FW Miller, JE Hicks, LG Rider; citation_volume=48; citation_issue=2; citation_publication_date=2009; citation_pages=134-139; citation_doi=10.1093/rheumatology/ken441; citation_id=CR29
citation_journal_title=Arthritis Care Res (Hoboken); citation_title=Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies; citation_author=LG Rider, D Koziol, EH Giannini, MS Jain, MR Smith, K Whitney-Mahoney, BM Feldman, SJ Wright, CB Lindsley, LM Pachman, ML Villalba, DJ Lovell, SL Bowyer, PH Plotz, FW Miller, JE Hicks; citation_volume=62; citation_issue=4; citation_publication_date=2010; citation_pages=465-472; citation_doi=10.1002/acr.20035; citation_id=CR30
citation_journal_title=Med Sci Sports Exerc; citation_title=Psychophysical bases of perceived exertion; citation_author=GA Borg; citation_volume=14; citation_issue=5; citation_publication_date=1982; citation_pages=377-381; citation_doi=10.1249/00005768-198205000-00012; citation_id=CR31
citation_journal_title=Technology.; citation_title=Technology acceptance model and e-learning; citation_author=M Masrom; citation_volume=21; citation_publication_date=2007; citation_pages=24; citation_id=CR32
citation_journal_title=Ann Rheum Dis; citation_title=Survey of satisfaction with care in a rheumatology outpatient clinic; citation_author=J Hill, HA Bird, R Hopkins, C Lawton, V Wright; citation_volume=51; citation_issue=2; citation_publication_date=1992; citation_pages=195-197; citation_doi=10.1136/ard.51.2.195; citation_id=CR33
citation_journal_title=Rheumatology.; citation_title=Two simple, reliable and valid tests of proximal muscle function, and their application to the management of idiopathic inflammatory myositis; citation_author=S Agarwal, PD Kiely; citation_volume=45; citation_issue=7; citation_publication_date=2006; citation_pages=874-879; citation_doi=10.1093/rheumatology/kel017; citation_id=CR34
citation_journal_title=PLoS One; citation_title=Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: an intra- and interrater reliability and validity study; citation_author=P Baschung Pfister, ED Bruin, I Sterkele, B Maurer, RA Bie, RH Knols; citation_volume=13; citation_issue=3; citation_publication_date=2018; citation_doi=10.1371/journal.pone.0194531; citation_id=CR35
citation_journal_title=J Rehabil Res Dev; citation_title=The timed get-up-and-go test revisited: measurement of the component tasks; citation_author=JC Wall, C Bell, S Campbell, J Davis; citation_volume=37; citation_issue=1; citation_publication_date=2000; citation_pages=109-113; citation_id=CR36
citation_journal_title=Arthritis Rheum; citation_title=Functional index-2: validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis; citation_author=H Alexanderson, L Broman, A Tollback, A Josefson, IE Lundberg, CH Stenstrom; citation_volume=55; citation_issue=1; citation_publication_date=2006; citation_pages=114-122; citation_doi=10.1002/art.21715; citation_id=CR37
citation_journal_title=J Rheumatol; citation_title=The myositis activities profile -- initial validation for assessment of polymyositis/dermatomyositis in the USA; citation_author=H Alexanderson, AM Reed, SR Ytterberg; citation_volume=39; citation_issue=11; citation_publication_date=2012; citation_pages=2134-2141; citation_doi=10.3899/jrheum.120504; citation_id=CR38
citation_journal_title=J Rheumatol; citation_title=Development of the myositis activities profile--validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis; citation_author=H Alexanderson, IE Lundberg, CH Stenstrom; citation_volume=29; citation_issue=11; citation_publication_date=2002; citation_pages=2386-2392; citation_id=CR39
citation_journal_title=Arthritis Rheum; citation_title=Measurement of patient outcome in arthritis; citation_author=JF Fries, P Spitz, RG Kraines, HR Holman; citation_volume=23; citation_issue=2; citation_publication_date=1980; citation_pages=137-145; citation_doi=10.1002/art.1780230202; citation_id=CR40
citation_journal_title=Soc Sci Med (1982); citation_title=German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment; citation_author=M Bullinger; citation_volume=41; citation_issue=10; citation_publication_date=1995; citation_pages=1359-1366; citation_doi=10.1016/0277-9536(95)00115-N; citation_id=CR41
citation_journal_title=Front Physiol; citation_title=Exergame-driven high-intensity interval training in untrained community dwelling older adults: a formative one group quasi- experimental feasibility trial; citation_author=S Rebsamen, RH Knols, PB Pfister, ED Bruin; citation_volume=10; citation_publication_date=2019; citation_pages=1019; citation_doi=10.3389/fphys.2019.01019; citation_id=CR42
citation_title=Measurement in medicine : a practical guide; citation_publication_date=2011; citation_id=CR43; citation_publisher=Cambridge University Press
citation_journal_title=J Exp Psychol Gen; citation_title=Effect size estimates: current use, calculations, and interpretation; citation_author=CO Fritz, PE Morris, JJ Richler; citation_volume=141; citation_issue=1; citation_publication_date=2012; citation_pages=2-18; citation_doi=10.1037/a0024338; citation_id=CR44
citation_journal_title=J Strength Cond Res.; citation_title=Determining the magnitude of treatment effects in strength training research through the use of the effect size; citation_author=MR Rhea; citation_volume=18; citation_issue=4; citation_publication_date=2004; citation_pages=918-920; citation_doi=10.1519/14403.1; citation_id=CR45
citation_title=Statistical power analysis for the behavioral sciences; citation_publication_date=1988; citation_id=CR46; citation_author=J Cohen; citation_publisher=L. Erlbaum Associates
citation_journal_title=Rheumatology.; citation_title=Incidence and prevalence of inflammatory myopathies: a systematic review; citation_author=A Meyer, N Meyer, M Schaeffer, JE Gottenberg, B Geny, J Sibilia; citation_volume=54; citation_issue=1; citation_publication_date=2015; citation_pages=50-63; citation_doi=10.1093/rheumatology/keu289; citation_id=CR47
citation_journal_title=Rheumatol Adv Pract; citation_title=Increasing incidence of adult idiopathic inflammatory myopathies in the City of Salford, UK: a 10-year epidemiological study; citation_author=MJS Parker, A Oldroyd, ME Roberts, WE Ollier, RP New, RG Cooper; citation_volume=2; citation_issue=1; citation_publication_date=2018; citation_pages=rky035; citation_doi=10.1093/rap/rky035; citation_id=CR48
citation_journal_title=J Rheumatol; citation_title=Resistive home exercise in patients with recent-onset polymyositis and dermatomyositis -- a randomized controlled single-blinded study with a 2-year followup; citation_author=H Alexanderson, LA Munters, M Dastmalchi, I Loell, M Heimburger, CH Opava; citation_volume=41; citation_issue=6; citation_publication_date=2014; citation_pages=1124-1132; citation_doi=10.3899/jrheum.131145; citation_id=CR49
citation_journal_title=Scand J Rheumatol; citation_title=The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis; citation_author=H Alexanderson, CH Stenstrom, G Jenner, I Lundberg; citation_volume=29; citation_issue=5; citation_publication_date=2000; citation_pages=295-301; citation_doi=10.1080/030097400447679; citation_id=CR50
citation_title=Persuasive Technology: Using Computers to Change What We Think and Do. Morgan Kaufmann Series in Interactive Technologies B, USA (2008); citation_publication_date=2008; citation_id=CR51; citation_author=BJ Fogg; citation_publisher=Morgan Kaufmann Series in Interactive Technologies
citation_journal_title=JMIR Res Protoc; citation_title=Translating behavior change principles into a blended exercise intervention for older adults: design study; citation_author=S Mehra, B Visser, T Dadema, J Helder, RH Engelbert, PJ Weijs; citation_volume=7; citation_issue=5; citation_publication_date=2018; citation_doi=10.2196/resprot.9244; citation_id=CR52
citation_journal_title=Telemed J E Health; citation_title=Determinants of adherence to the online component of a blended intervention for patients with hip and/or knee osteoarthritis: a mixed methods study embedded in the e-exercise trial; citation_author=HJ Vries, CJJ Kloek, DH Bakker, J Dekker, D Bossen, C Veenhof; citation_volume=23; citation_issue=12; citation_publication_date=2017; citation_pages=1002-1010; citation_doi=10.1089/tmj.2016.0264; citation_id=CR53
citation_journal_title=Med Sci Sports Exerc; citation_title=American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise; citation_author=CE Garber, B Blissmer, MR Deschenes, BA Franklin, MJ Lamonte, IM Lee, DC Nieman, DP Swain; citation_volume=43; citation_issue=7; citation_publication_date=2011; citation_pages=1334-1359; citation_doi=10.1249/MSS.0b013e318213fefb; citation_id=CR54
citation_journal_title=J Strength Cond Res; citation_title=Applications of the dose-response for muscular strength development: a review of meta-analytic efficacy and reliability for designing training prescription; citation_author=MD Peterson, MR Rhea, BA Alvar; citation_volume=19; citation_issue=4; citation_publication_date=2005; citation_pages=950-958; citation_doi=10.1519/R-16874.1; citation_id=CR55
citation_journal_title=Med Sci Sports Exerc; citation_title=A meta-analysis to determine the dose response for strength development; citation_author=MR Rhea, BA Alvar, LN Burkett, SD Ball; citation_volume=35; citation_issue=3; citation_publication_date=2003; citation_pages=456-464; citation_doi=10.1249/01.MSS.0000053727.63505.D4; citation_id=CR56
citation_journal_title=Games Health J; citation_title=Usability and effects of an Exergame-based balance training program; citation_author=S Wuest, NA Borghese, M Pirovano, R Mainetti, R Langenberg, ED Bruin; citation_volume=3; citation_issue=2; citation_publication_date=2014; citation_pages=106-114; citation_doi=10.1089/g4h.2013.0093; citation_id=CR57
citation_journal_title=BMC Med Res Methodol; citation_title=A tutorial on pilot studies: the what, why and how; citation_author=L Thabane, J Ma, R Chu, J Cheng, A Ismaila, LP Rios, R Robson, M Thabane, L Giangregorio, CH Goldsmith; citation_volume=10; citation_issue=1; citation_publication_date=2010; citation_pages=1; citation_doi=10.1186/1471-2288-10-1; citation_id=CR58
citation_journal_title=Eur Rev Aging Phys Act; citation_title=Preliminary inconclusive results of a randomised double blinded cross-over pilot trial in long-term-care dwelling elderly assessing the feasibility of stochastic resonance whole-body vibration; citation_author=S Rogan, L Radlinger, D Schmidtbleicher, RA Bie, ED Bruin; citation_volume=12; citation_issue=1; citation_publication_date=2015; citation_pages=5; citation_doi=10.1186/s11556-015-0150-y; citation_id=CR59
citation_journal_title=Med Sci Sports Exerc; citation_title=Fundamentals of resistance training: progression and exercise prescription; citation_author=WJ Kraemer, NA Ratamess; citation_volume=36; citation_issue=4; citation_publication_date=2004; citation_pages=674-688; citation_doi=10.1249/01.MSS.0000121945.36635.61; citation_id=CR60
citation_title=Assessments in der muskuloskelettalen Rehabilitation: Bern : Hans Huber; citation_publication_date=2007; citation_id=CR61; citation_author=P Oesch
citation_journal_title=J Rheumatol; citation_title=Proposal for a candidate Core set of fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies; citation_author=DK Stap, LG Rider, H Alexanderson, AM Huber, B Gualano, P Gordon; citation_volume=43; citation_issue=1; citation_publication_date=2016; citation_pages=169-176; citation_doi=10.3899/jrheum.150270; citation_id=CR62
citation_journal_title=Rheumatology.; citation_title=Safety of a home exercise programme in patients with polymyositis and dermatomyositis: a pilot study; citation_author=H Alexanderson, CH Stenstrom, I Lundberg; citation_volume=38; citation_issue=7; citation_publication_date=1999; citation_pages=608-611; citation_doi=10.1093/rheumatology/38.7.608; citation_id=CR63
citation_journal_title=Arthritis Care Res (Hoboken).; citation_title=Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: a multicenter randomized controlled trial with a 1-year open extension followup; citation_author=L Alemo Munters, M Dastmalchi, V Andgren, C Emilson, J Bergegard, M Regardt; citation_volume=65; citation_issue=12; citation_publication_date=2013; citation_pages=1959-1968; citation_doi=10.1002/acr.22068; citation_id=CR64
citation_journal_title=Pilot Feasibility Stud; citation_title=Should treatment effects be estimated in pilot and feasibility studies?; citation_author=J Sim; citation_volume=5; citation_issue=1; citation_publication_date=2019; citation_pages=107; citation_doi=10.1186/s40814-019-0493-7; citation_id=CR65