https://aging.jmir.org/issue/feedJMIR Aging2023-01-04T09:45:03-05:00JMIR Publicationseditor@jmir.orgOpen Journal Systems This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org/, as well as this copyright and license information must be included. Using technological innovations and data science to inform and improve health care services and health outcomes for older adults. https://aging.jmir.org/2024/1/e53240/ Identifying Predictive Risk Factors for Future Cognitive Impairment Among Chinese Older Adults: Longitudinal Prediction Study2024-03-22T15:00:20-04:00Collin SakalTingyou LiJuan LiXinyue LiBackground: The societal burden of cognitive impairments in China has prompted researchers to develop clinical prediction models aimed at making risk assessments that enable preventative interventions. However, it is unclear what types of risk factors best predict future cognitive impairment, if known risk factors make equally accurate predictions across different socioeconomic groups, and if existing prediction models are equally accurate across different subpopulations. Objective: This paper aimed to identify which domain of health information best predicts future cognitive impairment among elderly Chinese and to examine if discrepancies exist in predictive ability across different population subsets. Methods: Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we quantified the ability of demographics, instrumental activities of daily living, activities of daily living, cognitive tests, social factors, psychological factors, diet, exercise and sleep, chronic diseases, and three recently published logistic regression-based prediction models to predict 3-year risk of cognitive impairment in the general Chinese population and among male, female, rural, urban, educated, and uneducated elderly. Predictive ability was quantified using the Area Under the Curve (AUC) and sensitivity-specificity curves through twenty repeats of ten-fold cross-validation. Results: A total of 4047 participants were included in the study, of which 337 developed cognitive impairments 3-years after the baseline data collection. The risk factor groups with the most predictive ability in the general population were demographics (AUC: 0.78, 95% CI: 0.77-0.78), cognitive tests (AUC: 0.72, 95% CI: 0.72-0.73), and instrumental activities of daily living (AUC: 0.71, 95% CI: 0.70-0.71). Demographics, cognitive tests, instrumental activities of daily living, and all three re-created prediction models had significantly higher AUCs when making predictions among women compared to men and among the uneducated compared to the educated. Conclusions: This study suggests that demographics, cognitive tests, and instrumental activities of daily living are the most useful risk factors for predicting future cognitive impairment among elderly Chinese. However, the most predictive risk factors and existing models have lower predictive power among male, urban, and educated elderly. More efforts are needed to ensure that equally accurate risk assessments can be conducted across different socioeconomic groups in China. 2024-03-22T15:00:20-04:00 https://aging.jmir.org/2024/1/e53564/ Strategies to Mitigate Age-Related Bias in Machine Learning: Scoping Review2024-03-22T10:00:04-04:00Charlene ChuSimon Donato-WoodgerShehroz S KhanTianyu ShiKathleen LeslieSamira Abbasgholizadeh-RahimiRune NyrupAmanda Grenier<strong>Background:</strong> Research suggests that digital ageism, that is, age-related bias, is present in the development and deployment of machine learning (ML) models. Despite the recognition of the importance of this problem, there is a lack of research that specifically examines the strategies used to mitigate age-related bias in ML models and the effectiveness of these strategies. <strong>Objective:</strong> To address this gap, we conducted a scoping review of mitigation strategies to reduce age-related bias in ML. <strong>Methods:</strong> We followed a scoping review methodology framework developed by Arksey and O’Malley. The search was developed in conjunction with an information specialist and conducted in 6 electronic databases (IEEE Xplore, Scopus, Web of Science, CINAHL, EMBASE, and the ACM digital library), as well as 2 additional gray literature databases (OpenGrey and Grey Literature Report). <strong>Results:</strong> We identified 8 publications that attempted to mitigate age-related bias in ML approaches. Age-related bias was introduced primarily due to a lack of representation of older adults in the data. Efforts to mitigate bias were categorized into one of three approaches: (1) creating a more balanced data set, (2) augmenting and supplementing their data, and (3) modifying the algorithm directly to achieve a more balanced result. <strong>Conclusions:</strong> Identifying and mitigating related biases in ML models is critical to fostering fairness, equity, inclusion, and social benefits. Our analysis underscores the ongoing need for rigorous research and the development of effective mitigation approaches to address digital ageism, ensuring that ML systems are used in a way that upholds the interests of all individuals. <strong>Trial Registration:</strong> Open Science Framework AMG5P; https://osf.io/amg5p 2024-03-22T10:00:04-04:00 https://aging.jmir.org/2024/1/e50880/ Assessing the Impact of Internet Skills on Depressive Symptoms Among Chinese Middle-Aged and Older Adults: Cross-Sectional Instrumental Variables Analysis2024-03-21T16:00:18-04:00Aruhan MuZhiyong LiuBackground: The potential benefits of information technology for the well-being of older adults have been widely anticipated. However, findings regarding the impact of Internet use on depressive symptoms are inconsistent. As a result of IT’s exponential growth, Internet skills have supplanted Internet access as the source of the digital divide. Objective: This study evaluates the effect of Internet skills on depressive symptoms through the instrumental variables approach. Methods: Data from the China Health and Retirement Longitudinal Study’s wave 4 (2018) was used. This included 16,949 community residents aged 45 years and above. To overcome the endogeneity issue, we use an instrumental variables approach. Results: The results reveal the emergence of a second-level digital divide, the disparity in Internet skills, among Chinese middle-aged and older adults. Liner regression suggests that a 1% increase in Internet skills is associated with 0.037% decrease in depressive symptoms (β = -0.037, SE = 0.009), which underestimates the causal effect. As expected, Internet skills are an endogenous variable (F test p-value < 0.001). IV regressions indicate that a 1% increase in Internet skills reduces 1.135% (SE = 0.471) to 1.741% (SE = 0.297) depressive symptoms. Two instrumental variables are neither weak (F value 16.7 and 28.5 > 10) nor endogenous (Wu-Hausman test p-value 0.095 > 0.05 or 0.01). Conclusions: Better mental health is predicted through improved and higher Internet skills. Consequently, residents and policymakers in China should focus on bridging the digital divide in Internet skills amongst middle-aged and older adults. Clinical Trial: Not applicable. 2024-03-21T16:00:18-04:00 https://aging.jmir.org/2024/1/e48265/ Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study2024-03-21T09:15:04-04:00Christian MychajliwHeiko HolzNathalie MinuthKristina DawidowskyGerhard Wilhelm EschweilerFlorian Gerhard MetzgerFranz Wortha<strong>Background:</strong> Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). <strong>Objective:</strong> This study aims to develop and empirically test a digital tablet–based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. <strong>Methods:</strong> A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI—diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. <strong>Results:</strong> Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=−3.64, SE 0.86; <i>z</i>=−4.25; <i>P</i><.001); higher reaction times (<i>F</i><sub>1,41</sub>=22.32; <i>P</i><.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=−0.34; SE 0.12; <i>t</i>=−2.81; <i>P</i>=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%). <strong>Conclusions:</strong> Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice. <strong>Trial Registration:</strong> 2024-03-21T09:15:04-04:00 https://aging.jmir.org/2024/1/e53975/ Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis2024-03-05T15:00:16-05:00Danielle A SternerJeffrey R StoutKworweinski LafontantJoon-Hyuk ParkDavid H FukudaLadda ThiamwongBackground: Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave a way for interventions that may mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, can be assessed quickly via bioelectrical impedance analysis (BIA), and may be indicative of physical function. Objective: This study aimed to characterize the relationships between hand grip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (Short FES-I), and IR among community-dwelling older adult women classified as having low or high PhA. Methods: A cross-sectional analysis was conducted in 85 older women with a mean age of 75.0 (SD 7.2) years, weight of 71.0 (SD 15.0) kg, and height of 162.6 (SD 6.1) cm. To examine the influence of PhA on performance measures, participants were divided into two PhA groups, high (>4.1°; n=56) and low (≤4.1°; n=29). Data were non-normative, so Mann-Whitney U test was used to evaluate between-group differences and Kendall’s tau coefficients were utilized to determine the partial correlations. Results: The low PhA group had significantly higher IR (mean 0.85, SD 0.03; P<.001, rrb=0.92) compared to the high PhA group (mean 0.81, SD 0.03). The high PhA group had superior HGS (mean 21.4kg, SD 6.2kg; P=.007, rrb=0.36), BTrackS balance scores (mean 26.6cm, SD 9.5cm; P =.03, rrb=0.30), and STS scores (mean 16.0, SD 5.5; P<.001, rrb=0.49) compared to the low PhA group (HGS mean 17.6kg, SD 4.7kg; BTrackS mean 37.1cm, SD 21.1cm; STS mean 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS, BTrackS balance scores, STS, and Short FES-I (P<.05). However, when adjusted for age among the whole sample, only PhA was strongly correlated with HGS (τb=0.75, P=.003) and STS scores (τb=0.76, P=.002). Short FES-I scores were moderately correlated with IR (τb=0.46, P=.07) after controlling for age. No significant between group differences were observed for height, weight, or body mass index. Conclusions: PhA and IR are associated with physical function and the fear of falling in older women. However, PhA and not IR, was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA ≤4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at risk of functional decline and heightened fear of falling. Clinical Trial: ClinicalTrials.gov (NCT06063187) 2024-03-05T15:00:16-05:00 https://aging.jmir.org/2024/1/e48292/ Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review2024-03-04T09:45:03-05:00Pippa KirbyHelen LaiSophie HorrocksMatthew HarrisonDanielle WilsonSarah DanielsRafael A CalvoDavid J SharpCaroline M Alexander<strong>Background:</strong> Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care–related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. <strong>Objective:</strong> This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. <strong>Methods:</strong> A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. <strong>Results:</strong> The search yielded 1694 papers, with 31 (1.83%) being analyzed after screening. Most (21/31, 68%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13%) papers used formal methods for evaluating impact. <strong>Conclusions:</strong> Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved—researchers, patients, and other stakeholders—can learn how we can best conduct research together. 2024-03-04T09:45:03-05:00 https://aging.jmir.org/2024/1/e46522/ Barriers to and Facilitators of Older People’s Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years2024-02-28T09:15:04-05:00Annemarie MoneyAlex HallDanielle HarrisCharlotte Eost-TellingJane McDermottChris Todd<strong>Background:</strong> The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. <strong>Objective:</strong> This study aims to explore the views of adults aged >75 years on accessing public services digitally. <strong>Methods:</strong> We conducted semistructured qualitative interviews with a variety of adults aged ≥75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. <strong>Results:</strong> Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58% female; 23/24, 96% White British; and 18/24, 75% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) “initial motivation to participate digitally”—for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) “narrow use and restricted activity on the web”—undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) “impact of digital participation on well-being”—choosing to go to the shops or general practitioner’s surgery to get out of the house and get some exercise; (4) “the last generation?”—respondents feeling that there were generational barriers to adapting to new technology and change; and (5) “making digital accessible”—understanding the support needed to keep those engaged on the web. <strong>Conclusions:</strong> As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need. 2024-02-28T09:15:04-05:00 https://aging.jmir.org/2024/1/e43999/ Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives2024-02-26T09:30:04-05:00Johanna FritzPetra von Heideken WågertAnnelie K GusdalRose-Marie Johansson-PajalaCaroline Eklund<strong>Background:</strong> Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. <strong>Objective:</strong> This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. <strong>Methods:</strong> This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. <strong>Results:</strong> The results included 7 categories of determinants for implementing the ICT tool. <i>Being able to introduce the ICT tool in an appropriate manner</i> concerns the personnel’s options for introducing and supporting the ICT tool, including their competencies in using digital equipment<i>. Organizational structure</i> concerns a structure for communication within the organization. <i>Leadership</i> concerns engagement and enthusiasm as driving forces for implementation. <i>The digital maturity of the social services personnel</i> concerns the personnel’s skills and attitudes toward using digital equipment. <i>Resources</i> concern time and money. <i>IT support</i> concerns accessibility, and <i>legal liability</i> concerns possibilities to fulfill legal responsibilities<i>.</i> <strong>Conclusions:</strong> The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results. 2024-02-26T09:30:04-05:00 https://aging.jmir.org/2024/1/e53025/ The #SeePainMoreClearly Phase II Pain in Dementia Social Media Campaign: Implementation and Evaluation Study2024-02-08T09:45:22-05:00Louise I R CastilloVivian TranMary BrachaniecChristine T ChambersKelly ChessieAlec CourosAndre LeRuyetCharmayne LeRuyetLilian ThorpeJaime WilliamsSara WheelwrightThomas Hadjistavropoulos<strong>Background:</strong> Social media platforms have been effective in raising awareness of the underassessment and undertreatment of pain in dementia. <strong>Objective:</strong> After a successful pilot campaign, we aimed to scale our pain-in-dementia knowledge mobilization pilot initiative (ie, #SeePainMoreClearly) to several social media platforms with the aid of a digital media partner. The goal of the initiative was to increase awareness of the challenges in the assessment and management of pain among people with dementia. A variety of metrics were implemented to evaluate the effort. Through this work, we endeavored to highlight key differences between our pilot initiative (which was a grassroots initiative), focusing largely on Twitter and YouTube, and the current science-media partnership. We also aimed to generate recommendations suitable for other social media campaigns related to health or aging. <strong>Methods:</strong> Evidence-based information about pain in dementia was summarized into engaging content (eg, videos) tailored to the needs of various knowledge users (eg, health professionals, families, and policy makers). We disseminated information using Facebook (Meta Platforms), Twitter (X Corp), YouTube (Alphabet Inc), Instagram (Meta Platforms), and LinkedIn (LinkedIn Corp) and measured the success of the initiative over a 12-month period (2020 to 2021). The evaluation methods focused on web analytics and questionnaires related to social media content. Knowledge users’ web responses about the initiative and semistructured interviews were analyzed using thematic analysis. <strong>Results:</strong> During the course of the campaign, >700 posts were shared across all platforms. Web analytics showed that we drew >60,000 users from 82 countries to our resource website. Of the social media platforms used, Facebook was the most effective in reaching knowledge users (ie, over 1,300,000 users). Questionnaire responses from users were favorable; interview responses indicated that the information shared throughout the initiative increased awareness of the problem of pain in dementia and influenced respondent behavior. <strong>Conclusions:</strong> In this investigation, we demonstrated success in directing knowledge users to a resource website with practical information that health professionals could use in patient care along with pain assessment and management information for caregivers and people living with dementia. The evaluation metrics suggested no considerable differences between our pilot campaign and broader initiative when accounting for the length of time of each initiative. The limitations of large-scale health campaigns were noted, and recommendations were outlined for other researchers aiming to leverage social media as a knowledge mobilization tool. <strong>Trial Registration:</strong> 2024-02-08T09:45:22-05:00 https://aging.jmir.org/2024/1/e53010/ Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions2024-02-07T09:45:23-05:00Rik DawsonHeidi GilchristMarina PinheiroKarn NelsonNina BowesCathie SherringtonAbby Haynes<strong>Background:</strong> Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. <strong>Objective:</strong> This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. <strong>Methods:</strong> A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders’ experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. <strong>Results:</strong> All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult–friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom’s convenience, use of tailored web-based exercise resources, and companionable local support. <strong>Conclusions:</strong> This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult–friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. <strong>Trial Registration:</strong> Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 2024-02-07T09:45:23-05:00