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e&#46;g&#46;&#44; walking impairments&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Fatigue&#44; primary or secondary&#44; appears in the early stages&#44; can be present for years&#44; and is the most frequent and severe MS-related symptom&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Depressive disorders are a rather prevalent comorbidity in the context of fatigue<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> and may interfere with independence and ability to work&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Between 50&#37; to 80&#37; of people with MS&#44; even those with mild levels of disability&#44; report their walking performance &#40;endurance&#44; biomechanics&#44; and variability&#41; is impaired&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> All this together negatively impacts on the quality of life &#40;QOL&#41; and the ability to participate in everyday activities&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">Management of MS is complex&#46; Medical treatment with disease-modifying therapies can reduce disability and the frequency of annual relapse rates&#44; but it is also associated with adverse effects&#44; e&#46;g&#46;&#44; infections&#44; headache&#44; and diarrhea&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Hence&#44; current approach needs to be multimodal and include lifestyle changes&#44; psychological support&#44; and rehabilitation interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Rehabilitation aims to decrease the impact of fatigue and enhance function and participation&#44; with current evidence suggesting the positive effects of exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; most commonly used treatments have shown limited or inconclusive effect&#44;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> and people with MS tend to seek alternative therapies&#44; despite those alternative options rarely being recommended in clinical guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Peripheral low-frequency pulsed electromagnetic field &#40;PEMF&#41; therapy is a non-thermal&#44; non-invasive technique that has become popular as adjuvant for treating musculoskeletal disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">10&#8211;12</span></a> In people with neurological diseases&#44; research about PEMF treatment is scant and limited to adults with MS&#44;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> stroke&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> and Parkinson&#39;s or Alzheimer&#39;s disease<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> to determine effects on fatigue&#44; depression&#44; functional status&#44; and QOL&#46; The limited data available&#44; together with the variety of current parameters reported in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> and the placebo effect&#44;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> can explain the conflicting findings reported to date&#46; Electromagnetic field treatment has shown a potential neuroprotective role and seems to modulate the inflammatory and immune responses&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> which can help to accelerate sensorimotor and neurological recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Several studies have provided a molecular basis to support the clinical use of PEMF&#44;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> although the underlying mechanisms of action are not well understood&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> The primary objective was to investigate the effects of PEMF therapy&#44; compared with placebo&#44; on the self-reported level of fatigue in people with RRMS&#46; As a secondary objective&#44; we explored the effects of PEMF therapy on walking performance&#44; severity of depression&#44; and QOL&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Study design</span><p id="para0012" class="elsevierStylePara elsevierViewall">This is a randomized placebo-controlled trial&#46; The study design complied with the ethical guidelines of the Helsinki Declaration and the Consolidated Standards of Reporting Trials &#40;CONSORT&#41; requirements&#46; The protocol was approved by the Research Ethics Committee of the Hospital Universitario Virgen Macarena&#44; Sevilla&#44; Spain &#40;code&#58; CP&#46;CI-2077&#41; and prospectively registered in the Australian and New Zealand Clinical Trials Registry &#40;ACTRN12618000515291&#41;&#46; All participants provided verbal and written informed consent prior to enrollment&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Participants</span><p id="para0013" class="elsevierStylePara elsevierViewall">Patients with a confirmed diagnosis of RRMS&#44; according to the 2017 revisions of the McDonald criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> were recruited from the MS unit at a large public hospital in southern Spain&#46; Participants between 18 and 65 years were included if they reported a moderate to high level of fatigue &#40;score &#8805; 4 in the Fatigue Severity Scale&#41; and were able to walk without aid for at least 100m &#40;score &#8804; 5&#46;5 in the Expanded Disability Status Scale&#44; EDSS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> The exclusion criteria were&#58; a severe neuropsychologist-confirmed cognitive and&#47;or psychiatric impairment&#59; a relapse episode in the previous month or during the study protocol&#59;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> a history of epilepsy or traumatic brain injury&#59; prior lower limb fracture or severe trauma&#59; changes in MS disease-modifying therapy within the previous month&#59;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> having internal metallic devices&#59;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and pregnancy or breastfeeding&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> Participants were asked not to engage in any new treatment for their MS during the study period but were allowed to continue with their regular medication intake&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Randomization and blinding</span><p id="para0014" class="elsevierStylePara elsevierViewall">A staff member performed randomization using a computer-generated random numbers sequence in permuted blocks&#44; considering a 1&#58;1 distribution ratio&#46; Allocation of the intervention was concealed with consecutively numbered sealed opaque envelopes&#46; Participants&#44; outcome assessors&#44; and the therapist in charge of the intervention&#44; remained blinded to treatment allocation&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Sample size</span><p id="para0015" class="elsevierStylePara elsevierViewall">Sample size was estimated using the G&#42;Power software&#44; version 3&#46;1&#46;9&#46;7 &#40;Heinrich-Heine University&#44; D&#252;sseldorf&#44; Germany&#41;&#46; For an alpha level of 0&#46;05 with 80&#37; power&#44; calculation was based on the observed effect of PEMF treatment&#44; compared to placebo&#44; on fatigue symptoms in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> We considered 2 groups&#44; 3 measurements and a mean between group difference after intervention of 8 points &#40;SD&#160;&#61;&#160;12&#41; on the Modified Fatigue Impact Scale&#46; This generated a sample of 44 patients &#40;including a 10&#37; dropout rate&#41; to complete the trial&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Interventions</span><p id="para0016" class="elsevierStylePara elsevierViewall">Interventions were performed at the hospital facilities by a physical therapist with over 10 years of neurorehabilitation experience&#46; All participants underwent a 4-week treatment protocol &#40;5 sessions per week&#41;&#46; Sessions were conducted during weekdays &#40;morning time&#41; and lasted 45 minutes&#46; Patients were instructed to remain in a comfortable supine position&#44; with knee extended&#44; over a whole-body mat system&#46; Two identical mats &#40;A and B&#41; were used &#40;Duo Forte Renaissance&#174;&#44; ZES Brno&#44; Brno&#44; Check Republic&#41;&#46; A mat green indicator lamp was lit during the entire session&#44; and participants were told that they would not feel any specific sensations&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> Only one of the devices &#40;mat B&#41; delivered pulsed electromagnetic fields&#46; Treatment started with an initial 15-Hz frequency that was automatically increased by 5-Hz every 10 min&#46; up to 30-Hz&#44; with a mean intensity between 25 to 35&#181;T&#46; The placebo group was exposed to a magnetically inactive field &#40;mat A&#41; for the same period and number of sessions&#46; Information about the placebo mat was safeguarded by staff external to the study and disclosed when data collection was completed&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Outcome measures</span><p id="para0017" class="elsevierStylePara elsevierViewall">The self-reported level of fatigue was the primary outcome&#46; Secondary outcomes included gait performance&#44; the burden of depressive symptoms&#44; and QOL&#46; One researcher collected the clinical and demographic data&#46; Two different assessors completed the evaluations at baseline &#40;before randomization&#41;&#44; immediately after the last treatment session&#44; and at 3 months after intervention &#40;follow-up&#41;&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">The primary outcomes were the Fatigue Severity Scale &#40;FSS&#41; and the Modified Fatigue Impact Scale &#40;MFIS&#41;&#46; The FSS is a 9-item questionnaire with a physical focus&#44; whereas the MFIS explores the effects of fatigue in the physical&#44; cognitive&#44; and psychosocial domains&#46; Higher scores represent a greater severity of fatigue&#46; The FSS and the MFIS are valid&#44; precise&#44; and show moderate to good reliability in people with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> Estimates of meaningful clinical changes range from 5&#46;6&#37; to 27&#37; for the FSS and from 4&#46;6&#37; to 24&#37; for the MFIS&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p><p id="para0019" class="elsevierStylePara elsevierViewall">We also made a number of secondary outcome measures&#46; Gait performance was assessed with the GAITRite&#174; system &#40;CIR Systems Inc&#46;&#44; Franklin&#44; NJ&#44; USA&#41;&#44; which is an 8-meter mat with motion sensors arranged in a grid-like pattern&#46; This system is valid and highly reliable to monitor spatiotemporal gait parameters&#44; e&#46;g&#46;&#44; speed&#44; cadence&#44; and functional ambulation performance&#44; in patients with MS&#59;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> and with the Timed 25-Foot Walk test &#40;T25FW&#41;&#46; A 20&#37; change in the T25FW is considered to be clinically relevant&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> The average score after two consecutive walks was used for analysis&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The Beck Depression Inventory II &#40;BDI-II&#41; consists of 21 items to grade and monitor psychic aspects of depression&#46; The BDI-II is a valid&#44; rapid&#44; and reliable tool&#44; with good internal consistency in people with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0021" class="elsevierStylePara elsevierViewall">Health-related QOL was self-reported with the Multiple Sclerosis International Quality of Life Questionnaire&#44; which covers nine dimensions&#58; daily life activities&#44; psychological well-being&#44; symptoms&#44; relationships with friends&#44; family and the healthcare system&#44; sentimental and sexual life&#44; coping&#44; and rejection&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Statistical analysis</span><p id="para0022" class="elsevierStylePara elsevierViewall">The statistical processing of data was conducted with the software IBM Statistics Package for Social Science&#174;&#44; v&#46;26 &#40;IBM Corp&#44; NY&#44; USA&#41;&#46; According to an intention-to-treat approach&#44; patients&#8217; data were analyzed in the group they were allocated&#46; All randomized participants were included in the analysis&#44; with the last observation carried forward method used to impute missing data&#46; The Shapiro-Wilk test was used to assess the normal distribution of the variables&#46; Data are reported as mean &#177; standard deviation&#44; mean difference &#40;MD&#41; with 95&#37; confidence interval &#40;CI&#41;&#44; or in absolute numbers &#40;percentages&#41;&#46; A linear mixed model for repeated measures was used to compare the changes in the outcome measures from baseline to end of intervention and at follow-up&#44; with group &#40;PEMF or placebo&#41; as the between-subjects factor&#44; and time &#40;pre&#44; end of intervention&#44; and follow-up&#41; as the within-subjects factor&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Results</span><p id="para0023" class="elsevierStylePara elsevierViewall">A total of 44 participants with RRMS &#40;84&#46;4&#37; females&#41;&#44; mean age of 41 &#177; 9&#46;9 years&#44; were recruited between May 2018 and September 2019&#46; Nine patients dropped out after the post-intervention assessment &#40;<a class="elsevierStyleCrossRef" href="#fig0001"><span class="elsevierStyleBold">Fig&#46; 1</span></a>&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0001"><span class="elsevierStyleBold">Table 1</span></a> lists the baseline demographic characteristics of the sample&#46; All participants had a minimal to significant disability and were able to walk without aid or rest for at least 300m &#40;EDSS score between 2 and 4&#46;5&#41;&#46; At baseline&#44; the PMFT and placebo groups showed similar values for all outcomes&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Primary outcome</span><p id="para0025" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0002"><span class="elsevierStyleBold">Table 2</span></a> summarizes the scores for self-reported level of fatigue in the study groups&#44; including the within- and between-group differences&#46; There were no differences in changes from baseline for both fatigue measures between the PEMF group and the placebo group at the end of treatment &#40;FSS&#44; MD&#61; -0&#46;6&#44; 95&#37;CI&#58; -1&#46;3&#44; 0&#46;1&#59; MFIS&#44; MD&#61; -5&#46;4&#44; 95&#37; CI&#58; -15&#46;1&#44; 4&#46;4&#41; or at 3 months post intervention &#40;FSS&#44; MD&#61; -0&#46;6&#44; 95&#37; CI&#58; -1&#46;4&#44; 0&#46;2&#59; MFIS&#44; MD&#61; -2&#46;1&#44; 95&#37; CI&#58; -10&#46;9&#44; 6&#46;8&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Secondary outcomes</span><p id="para0026" class="elsevierStylePara elsevierViewall">There were no differences between groups in score changes at post-intervention or at follow-up for any of the measures of gait performance&#44; severity of depression symptoms&#44; and QOL &#40;<a class="elsevierStyleCrossRef" href="#tbl0003"><span class="elsevierStyleBold">Table 3</span></a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Discussion</span><p id="para0027" class="elsevierStylePara elsevierViewall">The present findings demonstrated that the effect of PEMF therapy was not superior than placebo for the self-reported level of fatigue&#44; as measured with the FSS and the MFIS&#46; Further&#44; PEMF therapy was also not superior to evoke changes on gait performance&#44; depression&#44; and QOL compared with placebo&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Regarding MS-related fatigue&#44; between groups differences in changes did not surpass the minimum clinically important threshold &#40;more than 2 points for the FSS and around 16 to 20 points for the MFIS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> This is consistent with previous research on the topic&#46; Most current evidence indicates that PEMF&#44; either alone<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> or within a multimodal rehabilitation program&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> is no better than placebo to reduce the severity of fatigue symptoms in the short&#44;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0029"><span class="elsevierStyleSup">29&#8211;31</span></a> or medium term&#44;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> in people with MS&#46; In contrast&#44; two older studies from the same research group found a positive immediate effect&#44; although rather small&#44; after wearing a portable PEMF device for 4 to 8 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> Additionally&#44; a 3-month intervention low-frequency PEMF achieved a modest beneficial impact&#44; compared to placebo&#44; on the FSS and the MFIS after intervention<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> and at a 3-year follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> But&#44; the latter study had an open-label design and participants were not blinded to treatment allocation&#46; In clinical trials&#44; absent or questionable blinding may confound estimates of treatment efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> The magnitude of the risk of bias can depend on the intervention and the nature of the study measures&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> Placebo-controlled trials are especially important when the primary outcome is self-reported&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> and the intervention involves electrophysical modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> A placebo effect has been suggested as a reason for the lack of differences between active or sham PEMF therapy&#46; Simple rest for more than 15 minutes over a magnetically inactive PEMF mat can reduce the level of fatigue between 5&#37; to 14&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0029"><span class="elsevierStyleSup">29&#8211;31</span></a> which is similar to the 10&#37; to 12&#37; improvement observed in the MFIS in our placebo group&#46; Although we followed previous research to establish the treatment protocol&#44; it is questionable whether the role of placebo may be similar with shorter exposure times&#46; This needs to be further investigated&#46; In people with MS&#44; physiological mechanisms of electromagnetic fields include patterns of cortical activation and inhibition&#44;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> therapeutic effects on immune-relevant cells&#44; and a potential increase of blood oxygen and circulation&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> although these effects may depend on the current parameters &#40;wavelength and intensity&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> PEMF has also shown an antiinflammatory role in human and animal studies&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> However&#44; differences in medical and fatigue-related profiles among participants exposed to the intervention may also account for the inconsistency in the scientific literature&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">For the secondary outcomes&#44; this clinical trial is&#44; to our knowledge&#44; the first to investigate the efficacy of PEMF on spatiotemporal gait parameters other than speed&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Former studies have reported that a single session<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> or continuous exposure to PEMF<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> can increase walking speed and stride length&#44; compared to placebo or other approaches&#44; in individuals at risk of falling<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> or with knee osteoarthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> Similarly&#44; preliminary reports indicate that PEMF therapy reduces slowness of movement&#44; walking impairments&#44; and freezing of gait in adults with Parkinson&#39;s disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> In contrast&#44; and consistent with our results&#44; de Carvalho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> reported no differences on walking velocity&#44; measured with the Timed 10 meter walk test&#44; after an 8-week protocol &#40;3 times a week&#44; and 24 min per session&#41; using active or placebo low-frequency PEMF&#46; Based on the negative findings&#44; the fact that PEMF is a passive and costly approach&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> and the lack of standardized protocols in terms of current parameters and exposure time&#44;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> we cannot recommend this intervention to evoke changes in gait performance for people with RRMS&#46; New research may help to establish more definitive conclusions&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">There were no differences between groups for the BDI-II or the health-related QOL&#46; Magnetic field therapy&#44; delivered as repetitive transcranial magnetic stimulation&#44; has proven to modulate cortical excitability and depressant behaviors in animal models&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a> In addition&#44; evidence-based guidelines recommend this approach to manage the burden of depressive symptoms in people with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a> Yet&#44; results appear to differ when PEMF is applied peripherally at a body part or with whole-body mats&#46; Consistent with the current results&#44; a pilot trial demonstrated no positive impact of monopolar transmission of PEMF therapy on depression or QOL in patients with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> In contrast&#44; low-frequency PEMF was superior to placebo to evoke long-term positive changes on depression in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> In women with fibromyalgia&#44; this treatment has shown to improve health-related QOL&#44; with no beneficial effects for depression&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> This inconclusive evidence also applies to other musculoskeletal and neurological conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a></p><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Adverse effects</span><p id="para0031" class="elsevierStylePara elsevierViewall">PEMF therapy is a non-invasive and purportedly safe technique&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a> although little is known about the potential long-term hazards&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> As in previous research&#44;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> our participants did not report acute or minor adverse events&#46; Current recommendations suggest that magnetic field treatment should be used cautiously&#44; with supervision&#44; and only when recommended&#44; because some commercially-available products may not comply with safety guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0046"><span class="elsevierStyleSup">46</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Study limitations</span><p id="para0032" class="elsevierStylePara elsevierViewall">We did not include participants with severe disability or in need of a walking aid &#40;EDSS &#62; 4&#46;5&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Although this was intended to recruit an homogenous sample&#44; it may also limit the external validity of the findings&#46; Patients with MS show differences in inflammatory factors depending on disease activity and type&#44; thus the antiinflammatory effect of PEMF therapy may differ at different stages of the disease&#46; This needs to be investigated in further research that also includes a longer follow-up&#46; Finally&#44; the possible mediating effect of comorbidities was not investigated&#46;</p></span></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0024">Conclusion</span><p id="para0033" class="elsevierStylePara elsevierViewall">The study concluded that&#44; in adults with RRMS and with minimal to significant level of disability&#44; the use of low frequency PEMF therapy was not better than placebo to improve the level of fatigue&#44; walking performance&#44; severity of depression&#44; and QOL&#46;</p></span><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0025">Trial registered</span><p id="para0034" class="elsevierStylePara elsevierViewall">ACTRN12618000515291 &#40;<a href="https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373996&amp;isReview=true">https&#58;&#47;&#47;anzctr&#46;org&#46;au&#47;Trial&#47;Registration&#47;TrialReview&#46;aspx&#63;id&#61;373996&#38;isReview&#61;true</a>&#41;</p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => "Introduction"
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        4 => array:3 [
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          "titulo" => "Methods"
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            0 => array:2 [
              "identificador" => "sec0003"
              "titulo" => "Study design"
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              "titulo" => "Participants"
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              "titulo" => "Randomization and blinding"
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              "identificador" => "sec0006"
              "titulo" => "Sample size"
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              "identificador" => "sec0007"
              "titulo" => "Interventions"
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              "titulo" => "Outcome measures"
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          "titulo" => "Results"
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              "titulo" => "Primary outcome"
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              "titulo" => "Adverse effects"
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              "titulo" => "Study limitations"
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          "identificador" => "sec0016"
          "titulo" => "Conclusion"
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          "titulo" => "Trial registered"
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          "identificador" => "xack650310"
          "titulo" => "Acknowledgements"
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        10 => array:1 [
          "titulo" => "References"
        ]
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    "fechaRecibido" => "2021-09-09"
    "fechaAceptado" => "2022-10-03"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1604755"
          "palabras" => array:6 [
            0 => "Fatigue"
            1 => "Magnetic field therapy"
            2 => "Neurologic gait disorders"
            3 => "Placebo effect"
            4 => "Quality of life"
            5 => "Relapsing-remitting multiple sclerosis"
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    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara010" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">Electromagnetic field therapy did not have an impact on multiple sclerosis-related fatigue in adults with minimal to significant disability&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">The effect of electromagnetic fields was similar to placebo for measures of walking performance&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Magnetic field therapy did not evoke changes in depressive symptoms or quality of life&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Background</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Multiple sclerosis has a great disability burden&#46; Management of the disease is complex&#44; and patients often seek new conservative approaches&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Objective</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">To investigate the effect of low-frequency pulsed electromagnetic field &#40;PEMF&#41; therapy&#44; compared to placebo&#44; on the level of fatigue&#44; walking performance&#44; symptoms of depression&#44; and quality of life &#40;QOL&#41; in patients with relapsing-remitting multiple sclerosis &#40;RRMS&#41;&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Methods</span><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">Forty-four adults with RRMS and minimal to significant disability were randomly assigned to a 4-week protocol using a PEMF or a placebo whole-body mat&#46; The PEMF group were initially treated with 15Hz frequency&#44; gradually increased to 30Hz &#40;intensity between 25-35&#181;T&#41;&#46; The primary outcome was fatigue&#44; assessed with the Fatigue Severity Scale &#40;FSS&#41; and the Modified Fatigue Impact Scale &#40;MFIS&#41;&#46; Secondary measures included walking function &#40;GAITRite system and Timed 25-Foot Walk test&#41;&#44; the Beck Depression Inventory-II&#44; and the Multiple Sclerosis International Quality of Life Questionnaire&#46; Data were collected at baseline&#44; after intervention&#44; and at 3-months post-intervention &#40;follow-up&#41;&#46;</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Results</span><p id="spara014" class="elsevierStyleSimplePara elsevierViewall">There were no differences between groups for changes in fatigue symptoms from baseline to end of intervention &#40;mean and 95&#37; confidence interval FSS&#58; -0&#46;6&#44; 95&#37;CI&#58; -1&#46;3&#44; 0&#46;1&#59; MFIS&#58; -5&#46;4&#44; 95&#37; CI&#58; -15&#46;1&#44; 4&#46;4&#41; or at follow-up &#40;FSS&#58; -0&#46;6&#44; 95&#37; CI&#58; -1&#46;4&#44; 0&#46;2&#59; MFIS&#58; -2&#46;1&#44; 95&#37; CI&#58; -10&#46;9&#44; 6&#46;8&#41;&#46; Similarly&#44; both groups did not differ for any of the secondary outcomes at post-intervention or follow-up&#46;</p></span> <span id="abss0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Conclusions</span><p id="spara015" class="elsevierStyleSimplePara elsevierViewall">Low-frequency PEMF therapy is no more effective than placebo to produce changes in fatigue&#44; gait performance&#44; severity of depression&#44; and QOL in people with RRMS and minimal to significant disability&#46;</p></span>"
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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          "leyenda" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Data are mean &#177; standard deviation or frequency &#40;proportion&#41;&#46;</p><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; EDSS&#44; Expanded Disability Status Scale&#59; PEMF&#44; pulsed electromagnetic field&#46;</p>"
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age&#44; years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">40&#46;8 &#177; 9&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42&#46;2 &#177; 10&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Female&#59; no&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19 &#40;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19 &#40;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0010"></a><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">25&#46;2 &#177; 4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26&#46;2 &#177; 6&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Duration of disease&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;5 &#177; 6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&#46;2 &#177; 9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">EDSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;8 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;6 &#177; 1&#46;0&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Data are mean &#177; standard deviation or mean difference &#40;95&#37; confidence interval&#41;&#46; Bold data indicates when the 95&#37; CI does not cross zero&#46; PEMF&#44; pulsed electromagnetic field&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Between group differences</th></tr><tr title="table-row"><a name="en0022"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;7 &#177; 1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;8 &#177; 0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;8 &#177; 1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;5 &#177; 1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">-0&#46;9 &#40;-1&#46;4&#44; -0&#46;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;3 &#40;-0&#46;8&#44; 0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;6 &#40;-1&#46;3&#44; 0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;8 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;5 &#177; 1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">-0&#46;9 &#40;-1&#46;4&#44; -0&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;3 &#40;-0&#46;9&#44; 0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;6 &#40;-1&#46;4&#44; 0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">Modified Fatigue Impact Scale&#44; 0 to 84</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">51&#46;7 &#177; 15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&#46;6 &#177; 16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">39&#46;9 &#177; 19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">44&#46;3 &#177; 14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">-11&#46;7 &#40;-19&#46;1&#44;-4&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-6&#46;3 &#40;-13&#46;2&#44; 0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-5&#46;4 &#40;-15&#46;1&#44; 4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">44&#46;1 &#177; 19&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">45&#46;2 &#177; 15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">-7&#46;5 &#40;-14&#46;6&#44; -0&#46;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-5&#46;4 &#40;-11&#46;2&#44; 0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-2&#46;1 &#40;-10&#46;9&#44; 6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            "detalle" => "Table "
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          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Data are mean &#177; standard deviation or mean difference &#40;95&#37; confidence interval&#41;&#46; Bold data indicates when the 95&#37; CI does not cross zero&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">QoL&#44; Quality of life&#59; PEMF&#44; pulsed electromagnetic field&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0072"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">Outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0073"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Within group differences</th><a name="en0074"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0075"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0076"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PEMF group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0077"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Placebo group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en00074"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Between group differences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Walking velocity&#44; cm&#47;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">106&#46;1 &#177; 18&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&#46;1 &#177; 24&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;5 &#177; 21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">103&#46;8 &#177; 24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;4 &#40;-0&#46;1&#44; 8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;6 &#40;-1&#46;5&#44; 8&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8 &#40;-5&#46;9&#44; 7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">112&#46;1 &#177; 20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">103&#46;1 &#177; 23&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">6&#46;1 &#40;0&#46;7&#44; 11&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;0 &#40;-1&#46;9&#44; 7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1 &#40;-4&#46;1&#44; 10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Walking cadence&#44; steps&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;5 &#177; 7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">103&#46;7 &#177; 12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;9 &#177; 8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">106&#46;1 &#177; 14&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 &#40;-0&#46;1&#44; 5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;3 &#40;-0&#46;7&#44; 5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2 &#40;-3&#46;7&#44; 4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;4 &#177; 9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">106&#46;3 &#177; 12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;0 &#40;-0&#46;9&#44; 4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 &#40;-0&#46;9&#44; 5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;5 &#40;-4&#46;8&#44; 3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">Functional ambulation performace&#44; &#37;</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">95&#46;1 &#177; 4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">89&#46;9 &#177; 14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">94&#46;4 &#177; 5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">91&#46;9 &#177; 12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;7 &#40;-2&#46;3&#44; 0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;9 &#40;-3&#46;2&#44; 7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-2&#46;6 &#40;-7&#46;8&#44; 2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">95&#46;4 &#177; 5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">90&#46;8 &#177; 12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;3 &#40;-1&#46;7&#44; 2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9 &#40;-4&#46;3&#44; 6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;6 &#40;-6&#46;1&#44; 4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0150"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">Timed 25-Foot Walk test&#44; seconds</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;8 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;1 &#177; 5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;5 &#177; 1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;4 &#177; 3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;3 &#40;-0&#46;6&#44; 0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;6 &#40;-1&#46;7&#44; 0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3 &#40;-0&#46;7&#44; 1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;4 &#177; 1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;3 &#177; 2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;3 &#40;-0&#46;8&#44; 0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;7 &#40;-2&#46;1&#44; 0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;-1&#46;1&#44; 1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0173"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">Beck Depression Inventory-II&#44; 0 to 63</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Baseline &#40;T1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&#46;1 &#177; 11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;4 &#177; 8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-intervention &#40;T2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;6 &#177; 10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&#46;9 &#177; 9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-1&#46;5 &#40;-5&#46;9&#44; 3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;5 &#40;-2&#46;3&#44; 1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-1 &#40;-5&#46;7&#44; 3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3-months post-intervention &#40;T3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;4 &#177; 10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">17&#46;3 &#177; 9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Change T1 to T3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-1&#46;6 &#40;-5&#46;8&#44; 2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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