4006-776-356 出国就医服务电话

免费获得国外相关药品，最快 1 个工作日回馈药物信息

出境医 / 临床实验 / Therapy Exercises and Physiotherapy Delivered Operant Conditioning in the Treatment Chronic Low Back Pain

Therapy Exercises and Physiotherapy Delivered Operant Conditioning in the Treatment Chronic Low Back Pain

Study Description
Brief Summary:
This research investigates the effect of two physiotherapy models in the treatment of chronic nonspecific low back pain. Participants will be divided into three groups, two experimental and one control. In both experimental groups, the participants will be included in the intensive program of therapeutic exercises, under the supervision and guidance of the physiotherapist, and the group will differ in that a group of cognitive-behavioral therapies will be implemented by a physiotherapist, operative conditioning. In the control group, subjects will recive the usual treatment. The Back school will be applied in all groups.

Condition or disease Intervention/treatment Phase
Low Back Pain Behavioral: Operant conditioning Behavioral: Therapy Exercises in Group Behavioral: Back School Not Applicable

Detailed Description:

Low back pain is a global public health problem, one of the main causes of disability of the population, as well as enormous economic costs in the health system. This claim specifically relates to chronic low back pain. The clinical picture of chronic low back pain in addition to pain, muscle spasm and functional disability dominate psychological problems, which significantly affects the outcome of treatment. The multidisciplinary approach to treatment of chronic low back pain has proven to be the most effective, bad economically unacceptable and unavailable in many countries. Therefore, it is necessary to find the most effective and economically most acceptable approach to treatment of chronic low back pain. Physiotherapy is an unavoidable method of treating this painful condition, and changes in treatment approach are most evident in this medical profession. Recently, physiotherapy includes two models in the treatment chronic low back pain. Biomedical model consisting of well-known physiotherapy methods and a Biopsychosocial model that, in addition to known physiotherapy methods, includes a part of cognitive-behavioral therapy associated with motion and behavior, operative conditioning. Therapeutic exercise as a effective method indispensable part in both models of physiotherapy.

The reason of changes in physiotherapy is a varied clinical picture of chronic low back pain. The proven effect of therapeutic exercises has been determined to reduce the body's symptoms, pain and functional disabilities. The effect of reducing psychological symptoms has been poorly investigated. Also, the use of therapeutic exercises in the practice creates a number of concerns related to the intensity of exercise, mode and time-frame of their application, and the type or method of exercise.

Because it's already a known effect operant conditioning through a multidisciplinary approach to reducing the psychological symptoms of chronic low back pain, it is suggested that this part of cognitive behavioral therapy be implemented in physiotherapy, namely therapeutic exercise. Research to determine the effect of biopsychosocial physiotherapy models is scarce and insufficiently clear.

The aims of this research are:

  1. Determine the efficacy of a biomedical model of physiotherapy in the treatment of chronic nonspecific low back pain,
  2. Determine the effectiveness of the biopsychosocial model of physiotherapy in the treatment of chronic nonspecific low back pain, and
  3. Compare the effectiveness of these interventions.
Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: By randomization, the subjects will be divided into three groups, two trial groups and a control group. In the first experimental group, the investigated interventions will consist of therapeutic exercises and back school. In the second experimental group, in addition to the therapeutic exercises and the back school, operative conditioning will be performed by the magister physiotherapy. The subjects in the control group will be exposed to the usual treatment.
Masking: Single (Outcomes Assessor)
Masking Description: Due to the nature of interventions that will be applied in this study, blinding of therapists who will carry out the intervention regarding therapeutic exercises will not be possible to implement, but physiotherapists (apart creators of research) will not know the research hypothesis. Fully blinding of the examinees is also impossible to implement, but partially blinding will occur, as the patients in the biopsychosocial group will not explain the applied behavioral therapy. Blinding will be applied to researchers who will collect data (measure outcomes) and statisticians.
Primary Purpose: Treatment
Official Title: Controlled, Randomized, Blind Trial Therapy Exercises and Operant Conditioning for Chronic Nonspecific Low Back Pain
Actual Study Start Date : May 1, 2019
Actual Primary Completion Date : November 30, 2019
Actual Study Completion Date : December 30, 2019
Arms and Interventions
Arm Intervention/treatment
Experimental: Biomedical group
Therapy Exercises and Back School by month, 2 times a week for 60 minutes.
 Behavioral: Therapy Exercises in Group
Aerobic exercises, Stretching exercises and flexibility, Range of motion, Balance and coordination, Breathing exercises Stabilization exercises Muscle strength training exercises
Other Name: Exercises Therapy, Kinesitherapy

Behavioral: Back School
Basic information on low back pain - anatomy, physiology, causes, treatment. Correct postures - standing, sitting, driving, sleeping, Correct body movements - lifting, pushing, walking.
Experimental: Biopsychosocial group
Operant Conditioning implement in physiotherapy, Therapy Exercises and Back School by month, 2 times a week for 60 minutes.
 Behavioral: Operant conditioning
Active participation of respondents, Overcoming and eliminating negative behaviors, Encouraging positive behavior in pain, Overcoming the fear of the movement, Motivation to implementation pre-set specific goals.

Behavioral: Therapy Exercises in Group
Aerobic exercises, Stretching exercises and flexibility, Range of motion, Balance and coordination, Breathing exercises Stabilization exercises Muscle strength training exercises
Other Name: Exercises Therapy, Kinesitherapy

Behavioral: Back School
Basic information on low back pain - anatomy, physiology, causes, treatment. Correct postures - standing, sitting, driving, sleeping, Correct body movements - lifting, pushing, walking.
No Intervention: Usual care
Usual care and written instructions on Therapeutic Exercises and Back School for home work.
Outcome Measures
Primary Outcome Measures :
  1. VAS - Visual Analog Scale [ Time Frame: < 1 minutes ]
    Self-reported pain intensity, before randomization, after completion of the intervention, 3 and 6 months after randomization. Each item scored 0-100 mm (0=No pain; 100=Pain as bad as can be).


Secondary Outcome Measures :
  1. Roland Morris Disability Questionnaire [ Time Frame: <5 minutes ]
    Self-reported assessment of functional disability in low back pain. It consists of 24 questions that question how crossbreeding affects daily activities, and is calculated by a sum of total answers of 0 to 24. A larger sum indicates greater disability; before and after the intervention, 3. i 6. month after randomization.

  2. Goniometry of spine [ Time Frame: 5 minutes ]
    Functional assessment of range of motion in lumbal spine with goniometer - flexion, extension and lateroflexion right and left;before and after the intervention, 3. i 6. month after randomization.

  3. Finger to Floor Test -FTF; Thomayerov test [ Time Frame: 1 minutes ]
    Functional assessment flexion lumbal spine, using a centimeter band, measure the distance of finger-floor, before and after the intervention, 3. i 6. month after randomization.

  4. Prone double straight leg raise test [ Time Frame: 5 minutes ]
    Assessment of muscle strength back extensors, measured in seconds, before and after the intervention, 3. i 6. month after randomization.

  5. Hospital Anxiety and Depression Scale- HAD [ Time Frame: 5 minutes ]
    Self-reported intensity depression and anxiety, before and after the intervention, 3. i 6. month after randomization. It consists of 14 questions, 7 questions for assessing depression, 7 for assessing anxiety, and the time period related to questions and answers last week. Responses are scored at four levels from 0 to 3 (0 = not at all, 3 = all the time) so the results may vary from 0 to 21 for depression or anxiety. Respondents with score 0-7 are not depressed / anxious, 8-10 indicates a marginal state, and 11-21 represent depression / anxiety.

  6. Fear-Avoidance Beliefs Questionnaire-FABQ [ Time Frame: 5 minutes ]

    Assessment to avoid movement due to fear of pain, before and after the intervention, 3. i 6. after randomization.

    It consists of 16 particles and each question is evaluated from 0 to 6. A higher score indicates a greater presence of fear / avoidance. FABQ is divided into two parts (work and physical activity), one measures the correlation of work with the current feeling of pain in low back pain, and the second connection of physical activity on the current sense of pain in low back pain.


  7. Short form health survey 12-SF-12 [ Time Frame: 5 minutes ]

    Assessment quality of life, before and after the intervention, 3. i 6. month after randomization.

    The instrument by which the subjective sense of individual health is measured through 12 questions examines the physical, psychological and social consequences caused by impaired health. With this questionnaire it is possible to quantitatively compare each dimension of health, because the score for each question are transformed into standard values and placed on the scale from 0 to 100 (the higher the score the better health) and thus get two major dimensions of health, physical and mental health, Physical Common Score-PCS and Mental Common Score-MCS.


  8. Questionnaire assessment of satisfaction with treatment [ Time Frame: 2 minutes ]
    Self-structured self-rating questionnaire for assessing the satisfaction of respondents with their treatments and their financial viability, at the end of the research.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • People with a diagnosis of nonspecific pain in the spinal area with symptoms of pain 3 and > months, confirmed by a doctor specialist family medicine,
  • Age from 18 to 75 years of life,
  • Both sexes.

Exclusion Criteria:

  • Acute and Subacute low back pain,
  • Specific Low Back Pain,
  • Operative interventions on the spine,
  • Other health problems of the patient: pregnancy or gynecological diseases, blood vessels, elevated blood pressure, malignant and benign tumors in the spine, spinal abnormalities, spinal traumas, urological disorders and psychological disorders,
  • Mental health problems that prevent the verbal expression and understanding of the questionnaire, and
  • People who have been included in the therapeutic exercise program for the past 6 months.
Contacts and Locations

Locations
Layout table for location information
Bosnia and Herzegovina
Dom zdravlja Mostar
Mostar, Bosnia and Herzegovina, 88000
Rehabilitacijski centar "Život"
Mostar, Bosnia and Herzegovina, 88000
Sponsors and Collaborators
Antonija Hrkać
Investigators
Layout table for investigator information
Principal Investigator: Antonija Hrkać Faculty of Health Science
Tracking Information
First Submitted Date  ICMJE July 14, 2019
First Posted Date  ICMJE July 17, 2019
Last Update Posted Date January 10, 2020
Actual Study Start Date  ICMJE May 1, 2019
Actual Primary Completion Date November 30, 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 16, 2019) 		VAS - Visual Analog Scale [ Time Frame: < 1 minutes ]
Self-reported pain intensity, before randomization, after completion of the intervention, 3 and 6 months after randomization. Each item scored 0-100 mm (0=No pain; 100=Pain as bad as can be).
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: July 16, 2019)
  • Roland Morris Disability Questionnaire [ Time Frame: <5 minutes ]
    Self-reported assessment of functional disability in low back pain. It consists of 24 questions that question how crossbreeding affects daily activities, and is calculated by a sum of total answers of 0 to 24. A larger sum indicates greater disability; before and after the intervention, 3. i 6. month after randomization.
  • Goniometry of spine [ Time Frame: 5 minutes ]
    Functional assessment of range of motion in lumbal spine with goniometer - flexion, extension and lateroflexion right and left;before and after the intervention, 3. i 6. month after randomization.
  • Finger to Floor Test -FTF; Thomayerov test [ Time Frame: 1 minutes ]
    Functional assessment flexion lumbal spine, using a centimeter band, measure the distance of finger-floor, before and after the intervention, 3. i 6. month after randomization.
  • Prone double straight leg raise test [ Time Frame: 5 minutes ]
    Assessment of muscle strength back extensors, measured in seconds, before and after the intervention, 3. i 6. month after randomization.
  • Hospital Anxiety and Depression Scale- HAD [ Time Frame: 5 minutes ]
    Self-reported intensity depression and anxiety, before and after the intervention, 3. i 6. month after randomization. It consists of 14 questions, 7 questions for assessing depression, 7 for assessing anxiety, and the time period related to questions and answers last week. Responses are scored at four levels from 0 to 3 (0 = not at all, 3 = all the time) so the results may vary from 0 to 21 for depression or anxiety. Respondents with score 0-7 are not depressed / anxious, 8-10 indicates a marginal state, and 11-21 represent depression / anxiety.
  • Fear-Avoidance Beliefs Questionnaire-FABQ [ Time Frame: 5 minutes ]
    Assessment to avoid movement due to fear of pain, before and after the intervention, 3. i 6. after randomization. It consists of 16 particles and each question is evaluated from 0 to 6. A higher score indicates a greater presence of fear / avoidance. FABQ is divided into two parts (work and physical activity), one measures the correlation of work with the current feeling of pain in low back pain, and the second connection of physical activity on the current sense of pain in low back pain.
  • Short form health survey 12-SF-12 [ Time Frame: 5 minutes ]
    Assessment quality of life, before and after the intervention, 3. i 6. month after randomization. The instrument by which the subjective sense of individual health is measured through 12 questions examines the physical, psychological and social consequences caused by impaired health. With this questionnaire it is possible to quantitatively compare each dimension of health, because the score for each question are transformed into standard values and placed on the scale from 0 to 100 (the higher the score the better health) and thus get two major dimensions of health, physical and mental health, Physical Common Score-PCS and Mental Common Score-MCS.
  • Questionnaire assessment of satisfaction with treatment [ Time Frame: 2 minutes ]
    Self-structured self-rating questionnaire for assessing the satisfaction of respondents with their treatments and their financial viability, at the end of the research.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Therapy Exercises and Physiotherapy Delivered Operant Conditioning in the Treatment Chronic Low Back Pain
Official Title  ICMJE Controlled, Randomized, Blind Trial Therapy Exercises and Operant Conditioning for Chronic Nonspecific Low Back Pain
Brief Summary This research investigates the effect of two physiotherapy models in the treatment of chronic nonspecific low back pain. Participants will be divided into three groups, two experimental and one control. In both experimental groups, the participants will be included in the intensive program of therapeutic exercises, under the supervision and guidance of the physiotherapist, and the group will differ in that a group of cognitive-behavioral therapies will be implemented by a physiotherapist, operative conditioning. In the control group, subjects will recive the usual treatment. The Back school will be applied in all groups.
Detailed Description

Low back pain is a global public health problem, one of the main causes of disability of the population, as well as enormous economic costs in the health system. This claim specifically relates to chronic low back pain. The clinical picture of chronic low back pain in addition to pain, muscle spasm and functional disability dominate psychological problems, which significantly affects the outcome of treatment. The multidisciplinary approach to treatment of chronic low back pain has proven to be the most effective, bad economically unacceptable and unavailable in many countries. Therefore, it is necessary to find the most effective and economically most acceptable approach to treatment of chronic low back pain. Physiotherapy is an unavoidable method of treating this painful condition, and changes in treatment approach are most evident in this medical profession. Recently, physiotherapy includes two models in the treatment chronic low back pain. Biomedical model consisting of well-known physiotherapy methods and a Biopsychosocial model that, in addition to known physiotherapy methods, includes a part of cognitive-behavioral therapy associated with motion and behavior, operative conditioning. Therapeutic exercise as a effective method indispensable part in both models of physiotherapy.

The reason of changes in physiotherapy is a varied clinical picture of chronic low back pain. The proven effect of therapeutic exercises has been determined to reduce the body's symptoms, pain and functional disabilities. The effect of reducing psychological symptoms has been poorly investigated. Also, the use of therapeutic exercises in the practice creates a number of concerns related to the intensity of exercise, mode and time-frame of their application, and the type or method of exercise.

Because it's already a known effect operant conditioning through a multidisciplinary approach to reducing the psychological symptoms of chronic low back pain, it is suggested that this part of cognitive behavioral therapy be implemented in physiotherapy, namely therapeutic exercise. Research to determine the effect of biopsychosocial physiotherapy models is scarce and insufficiently clear.

The aims of this research are:

  1. Determine the efficacy of a biomedical model of physiotherapy in the treatment of chronic nonspecific low back pain,
  2. Determine the effectiveness of the biopsychosocial model of physiotherapy in the treatment of chronic nonspecific low back pain, and
  3. Compare the effectiveness of these interventions.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
By randomization, the subjects will be divided into three groups, two trial groups and a control group. In the first experimental group, the investigated interventions will consist of therapeutic exercises and back school. In the second experimental group, in addition to the therapeutic exercises and the back school, operative conditioning will be performed by the magister physiotherapy. The subjects in the control group will be exposed to the usual treatment.
Masking: Single (Outcomes Assessor)
Masking Description:
Due to the nature of interventions that will be applied in this study, blinding of therapists who will carry out the intervention regarding therapeutic exercises will not be possible to implement, but physiotherapists (apart creators of research) will not know the research hypothesis. Fully blinding of the examinees is also impossible to implement, but partially blinding will occur, as the patients in the biopsychosocial group will not explain the applied behavioral therapy. Blinding will be applied to researchers who will collect data (measure outcomes) and statisticians.
Primary Purpose: Treatment
Condition  ICMJE Low Back Pain
Intervention  ICMJE
  • Behavioral: Operant conditioning
    Active participation of respondents, Overcoming and eliminating negative behaviors, Encouraging positive behavior in pain, Overcoming the fear of the movement, Motivation to implementation pre-set specific goals.
  • Behavioral: Therapy Exercises in Group
    Aerobic exercises, Stretching exercises and flexibility, Range of motion, Balance and coordination, Breathing exercises Stabilization exercises Muscle strength training exercises
    Other Name: Exercises Therapy, Kinesitherapy
  • Behavioral: Back School
    Basic information on low back pain - anatomy, physiology, causes, treatment. Correct postures - standing, sitting, driving, sleeping, Correct body movements - lifting, pushing, walking.
Study Arms  ICMJE
  • Experimental: Biomedical group
    Therapy Exercises and Back School by month, 2 times a week for 60 minutes.
    Interventions:
    • Behavioral: Therapy Exercises in Group
    • Behavioral: Back School
  • Experimental: Biopsychosocial group
    Operant Conditioning implement in physiotherapy, Therapy Exercises and Back School by month, 2 times a week for 60 minutes.
    Interventions:
    • Behavioral: Operant conditioning
    • Behavioral: Therapy Exercises in Group
    • Behavioral: Back School
  • No Intervention: Usual care
    Usual care and written instructions on Therapeutic Exercises and Back School for home work.
Publications *
  • Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014 May;95(5):986-995.e1. doi: 10.1016/j.apmr.2013.10.032. Epub 2014 Jan 21. Review.
  • Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, Goldgrub R, Nordin M, Gross DP, Shearer HM, Carroll LJ, Stern PJ, Ameis A, Southerst D, Mior S, Stupar M, Varatharajan T, Taylor-Vaisey A. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6.
  • Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD002014. doi: 10.1002/14651858.CD002014.pub3. Review.
  • Hall A, Richmond H, Copsey B, Hansen Z, Williamson E, Jones G, Fordham B, Cooper Z, Lamb S. Physiotherapist-delivered cognitive-behavioural interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review. Disabil Rehabil. 2018 Jan;40(1):1-9. doi: 10.1080/09638288.2016.1236155. Epub 2016 Nov 21. Review.
  • Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR; Back Skills Training Trial investigators. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet. 2010 Mar 13;375(9718):916-23. doi: 10.1016/S0140-6736(09)62164-4. Epub 2010 Feb 25.
  • Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016 Apr 25;4(2). pii: E22. doi: 10.3390/healthcare4020022. Review.
  • National Collaborating Centre for Primary Care (UK). Low Back Pain: Early Management of Persistent Non-specific Low Back Pain [Internet]. London: Royal College of General Practitioners (UK); 2009 May. Available from http://www.ncbi.nlm.nih.gov/books/NBK11702/
  • Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015 Dec;29(12):1155-67. doi: 10.1177/0269215515570379. Epub 2015 Feb 13. Review.
  • Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7. Epub 2011 Oct 6. Review.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: July 16, 2019) 		180
Original Estimated Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE December 30, 2019
Actual Primary Completion Date November 30, 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • People with a diagnosis of nonspecific pain in the spinal area with symptoms of pain 3 and > months, confirmed by a doctor specialist family medicine,
  • Age from 18 to 75 years of life,
  • Both sexes.

Exclusion Criteria:

  • Acute and Subacute low back pain,
  • Specific Low Back Pain,
  • Operative interventions on the spine,
  • Other health problems of the patient: pregnancy or gynecological diseases, blood vessels, elevated blood pressure, malignant and benign tumors in the spine, spinal abnormalities, spinal traumas, urological disorders and psychological disorders,
  • Mental health problems that prevent the verbal expression and understanding of the questionnaire, and
  • People who have been included in the therapeutic exercise program for the past 6 months.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 75 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Bosnia and Herzegovina
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04023162
Other Study ID Numbers  ICMJE Studija I
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: Yes
Plan Description: All of individual participant data collected during the trial, after deidentification.
Supporting Materials: Study Protocol
Supporting Materials: Statistical Analysis Plan (SAP)
Supporting Materials: Informed Consent Form (ICF)
Supporting Materials: Clinical Study Report (CSR)
Supporting Materials: Analytic Code
Time Frame: Beginning 3 months and ending 5 years following article publication.
Access Criteria: Anyone who wishes to access the data.
Responsible Party Antonija Hrkać, University of Mostar
Study Sponsor  ICMJE Antonija Hrkać
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Antonija Hrkać Faculty of Health Science
PRS Account University of Mostar
Verification Date July 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

治疗医院

新药特效药

前沿医讯