Physical Rehabilitation Program Research Articles

Rehabilitation of cardiological patients with post-COVID syndrome: morphofunctional data report

INTRODUCTION. Post-COVID is a common complication of COVID-19, occurring in more than a third of patients, and condition will persist for more than 3 months after infection with the SARS-CoV-2. AIM. To evaluate impact and potential effectiveness of a comprehensive physical rehabilitation program on health of cardiac patients with complications of a previously suffered new coronavirus infection SARS-CoV-2 COVID-19. MATERIALS AND METHODS. The study involved 128 cardiology patients with post-COVID syndrome. The study participants comprised three groups depending on the 12-week physical rehabilitation program. The effectiveness of rehabilitation was assessed through parameters of cardiopulmonary testing, as well as the 6-minute walk exercise test and the degree of dyspnea according to modified mMRC dyspnea questionnaire. RESULTS. The mMCR index in CPR group was 1.0 [0.0–1.0] point, compared with 2.0 [1.0–2.0] in control and comparative groups (p 0.05); exercise tolerance VO2max increased by 8.3 ± 3.8 % (p 0.05); normalization of heart rate and blood pressure in response to physical activity after 12 weeks in intervention group was 5.0 ± 2.1 % compared to comparative and control groups; 6MWT test results 688 m, in the intervention group, versus 490 m, for participants in control group (p 0.05). DISCUSSION. A comparative analysis of previously conducted studies confirmed pattern between the inclusion of combined cardiorespiratory training in the protocol for 12-week rehabilitation of post-COVID complications among cardiac patients, and a decrease in the degree of shortness of breath, as well as an increase in exercise tolerance. CONCLUSIONS. Based on experimental data obtained, it is advisable to analyze the effects of Cardiopulmonary Physical Rehabilitation program in the framework of larger randomized clinical trials. This will allow a more detailed assessment of the clinical consequences, as well as the ability to adjust mode and dose of physical activity of proposed rehabilitation program.

#1036 Studying the quality of life in patients with CKD during the short physical rehabilitation program

Abstract Background and Aims The purpose of the study was to study the quality of life in patients with stages 2-3 CKD during a short physical rehabilitation program. Method The study included 130 patients with stage 2-3 CKD at the age of 45 - 65 years (average age - 58.7 ± 0.73 years). Patients included in the study were divided into 2 groups – main group and control group, depending on adherence to non-drug treatment: 1st - CG group (control) – patients receiving standard therapy (n = 30); 2nd - MG group (main) - patients who, in addition to medication treatment, received a course of physical training for 12 weeks 2-3 times a week (n = 100). Laboratory data were analyzed in patients urea, creatinine, electrolytes, albumin, total protein, blood hemoglobin. Results During the study of patients with CKD at pre-dialysis stages, patients in the main group rated their quality of life more positively. The total quality of life indicator in the main group during 12 weeks of regular physical training increased by 15.5% (p < 0.05). In the control group, after 12 weeks of physical training quality of life parameters remained at the same level, but there was a tendency to decrease. Patients in the study group reported significant improvements in physical quality of life measures compared with control group measures, including role limitations (physical) (mean change = −8.9 in the control group compared with mean change + 19.0 in study group P < 0.001), physical functioning (mean change = −0.7 in the control group compared with a mean change of +11.1 in the study group; P ˂ 0.005), Patients in the study group also reported a significant improvement in pain scores. Conclusion Thus, when studying the quality of life, a group of patients who received physical training with standard therapy noted an improvement in both physical and mental functioning.

Modular multimodal hospital-home chain physical activity rehabilitation programme (3M2H-PARP) in liver cancer: a protocol for a randomised controlled trial

IntroductionPatients with liver cancer are susceptible to experiencing a decline in muscle mass and function, which can lead to physical frailty and have a negative impact on prognosis. However, there...

Is Competency-Based Medical Education being implemented as intended? Early lessons learned from Physical Medicine and Rehabilitation

Background: As competency-based medical education (CBME) curricula are introduced in residency programs across Canada, systematic evaluation efforts are needed to ensure fidelity of implementation. This study evaluated early outcomes of CBME implementation in one Canadian Physical Medicine and Rehabilitation program that was an early adopter of CBME, with an aim to inform continuous quality improvement initiatives and CBME implementation nationwide. Methods: Using Rapid Evaluation methodology, informed by the CBME Core Components Framework, the intended outcomes of CBME were compared to actual outcomes. Results: Results suggested that a culture of feedback and coaching already existed in this program prior to CBME implementation, yet faculty felt that CBME added a framework to support feedback. The small program size was valuable in fostering strong relationships and individualized learning. However, participants expressed concerns about CBME fostering a reductionist approach to the development of competence. Challenges existed with direct observation, clear expectations for off-service training experiences, and tracking trainee progress. There was trepidation surrounding national curricular change, yet the institution-wide approach to CBME implementation created shared experiences and a community of practice. Conclusions: Program evaluation can help understand gaps between planned versus enacted implementation of CBME, and foster adaptations to improve the fidelity of implementation.

Balance confidence and associated factors among patients with knee osteoarthritis

IntroductionKnee osteoarthritis (KOA) is a progressive condition that results in decreased mobility, self-imposed restriction of activity, and impaired functions such as loss of self-efficacy, fear of falling, and balance impairments. This study assessed balance confidence and associated factors among patients with KOA. MethodsThis cross-sectional study involved 115 patients with KOA. The Western Ontario and McMaster University Osteoarthritis Index was used to evaluate pain, stiffness, and physical function while the Activity Specific Balance Confidence scale was used to assess the balance confidence. Pearson's chi-square test, Pearson's correlation and Spearman's rank correlation coefficient determined the association between variables. ResultsGreater number [67(58.3%)] of the participants had low levels of functioning in balance confidence. Significant associations were observed between balance confidence and pattern of KOA (X2 = 7.08, p = 0.029, φc = 0.248), fear of fall (X2 = 38.32, p = 0.001, φc = 0.577) and history of fall (X2 = 11.49, p = 0.003, φc = 0.316). Significant negative correlations were observed between balance confidence and pain (r = −0.498, p = 0.001), stiffness (r = −0.564, p = 0.01) and physical function (r = −0.676, p = 0.001). ConclusionThe low levels of balance confidence and related factors are a cause for concern and highlight the need to assess and monitor balance confidence in KOA rehabilitation using balance confidence ratings. This could prompt the integration of physical therapy rehabilitation programs that target balance confidence and related factors to improve mobility, quality of life and outcome of rehabilitation.

Arthroscopic Decompression of Calcific Tendinitis of the Shoulder and Repair of Residual Rotator Cuff Defect

Arthroscopic Decompression of Calcific Tendinitis of the Shoulder and Repair of Residual Rotator Cuff Defect

Problems of rehabilitation and recovery of military servicemen under special conditions

The problem of this study is the lack of a detailed study of physical rehabilitation (help) and recovery, which is necessary for all military personnel who took and participate in combat operations. The purpose of the study is to analyze and reveal the physical rehabilitation of servicemen in Ukraine during martial law. Research methods were used in the article such as: deduction method (from general to basic in the field of physical rehabilitation research in Ukraine), analysis method (to establish existing and effective physical rehabilitation for servicemen during martial law in Ukraine), generalization method (for writing conclusions and proposals), etc. The main results of the study: the types of physical rehabilitation that military personnel undergo to restore physical health are considered.(Physical rehabilitation for military personnel during martial law includes: therapeutic physical culture, natural physical factors, hardening, therapeutic massage, manual therapy, physical therapy, mechanotherapy, occupational therapy, kinesitherapy, occupational therapy, reflexology. Conducting rehabilitation activities for military personnel has its own characteristics due to participation in combat actions that were accompanied by excessive physical and psychological stress, generating powerful combat stress, demobilized fighters, returning home, note that their psyche is not adapted to peaceful civilian lifeThe scientific novelty of the research results is due to a detailed study of the problem of rehabilitation and recovery of servicemen during martial law in Ukraine. Conclusions and suggestions: the lack of rehabilitation doctors, the lack of clear packages of services for the rehabilitation and recovery of servicemen during martial law, the lack of quick communication between military units, medical institutions and the military medical commission regarding the rehabilitation and recovery of servicemen - these are all the gaps of today. To solve existing problems, it is necessary to: stimulate doctors to study in the field of rehabilitation; legislatively regulate the possibility of releasing disabled persons who have acquired a disability or those who were already disabled and went to the front as volunteers; to create a physical and psychological rehabilitation program for each serviceman who needs rehabilitation and recovery; creation of the concept of rehabilitation of soldiers released from captivity, etc.

FEATURES OF CHILDREN'S PHYSICAL THERAPY WITH LEGG-CALVE-PERTES DISEASE

Introduction. The article analyzes modern domestic and foreign publications related to the study of the effectiveness of physical therapy (PT) in Legg-Calve-Perthes disease (or juvenile osteochondrosis of the femoral head). Since today there is no certainty about the superiority of different FT agents in the treatment and rehabilitation of patients with Legg-Calve-Perthes disease of LKP), there is no unanimous opinion regarding the choice of the optimal time for the use of FT agents during the development of the disease, therefore, a review of rehabilitation programs with the features of the use of FT is relevant children with juvenile osteochondrosis of the femoral head.
 The aim of the study - study of physical therapy features in children with Legg-Calve-Perthes disease with analysis of existing physical rehabilitation programs.
 Conclusions. Legg-Calve-Perthes disease is characterized by unilateral or bilateral necrosis of the femoral head, which affects the range of motion of the hip. Despite the low incidence, LCP is a serious global health problem, as it affects a significant proportion of children under 15 years of age and is characterized by lameness, pain, and limitation of hip mobility.
 The causes of LKP disease are unknown. This disease is believed to be multifactorial, caused by a combination of environmental, metabolic, and genetic factors.
 The pathogenesis of LKP disease is complex, therefore, taking into account the multifactorial etiology, treatment and recovery, the prognosis of the disease is determined according to the characteristics of each patient, such as age, sex, type and size of the affected part of the femur.
 The analysis of the scientific and methodical literature indicated the need to observe the staged application of FT in the rehabilitation of this disease. The result of treatment and rehabilitation of patients with LKP depends to a large extent on the child's age, weight, gender, size of the femoral head necrososis, and the timeliness of medical and rehabilitation assistance. At the same time, the effectiveness and the choice of the optimal time for the use of FT agents in the course of the development of the disease of LCP have not been fully clarified.

Knowledge, attitudes, and perceptions of physical therapists towards conventional physical therapy-across-sectional study.

Conventional physical therapy (CPT) is widely used in clinical practice and known to contribute beneficially to patient's health conditions but remains loosely defined. Research has shown inconsistency in the definition and utilization of CPT among physical therapists in clinical and research settings, limiting its generalisability and reproducibility. Therefore, this study evaluates physical therapists' knowledge, attitudes, and perceptions toward CPT. A cross-sectional study using a self-administered questionnaire containing 36 questions was distributed among 238 licensed physical therapists. Descriptive and inferential statistics were used to measure the physical therapists' knowledge, attitudes, and perceptions towards CPT. Physical therapists showed limited knowledge of CPT in rehabilitation (4.09±1.698, 51%). However, the knowledge scores were significantly associated with age (P=0.002), educational levels (P=0.006), and years of work experience (P=0.001). Nevertheless, physical therapists showed an overall positive attitude towards CPT and perceived it as essential to rehabilitation. Most physical therapists have low knowledge about CPT but positive attitudes and perceptions. Therefore, customized medical education is necessary to incorporate CPT theories and applications into physical therapists' rehabilitation programs.

Preact to lower the risk of falling by customized rehabilitation across Europe: the feasibility study protocol of the PRECISE project in Italy.

Falls are a major worldwide health problem in older people. Several physical rehabilitation programs with home-based technologies, such as the online DigiRehab platform, have been successfully delivered. The PRECISE project combines personalized training delivered through the application with an artificial intelligence-based predictive model (AI-DSS platform) for fall risk assessment. This new system, called DigiRehab, will enable early identification of significant risk factors for falling and propose an individualized physical training plan to attend to these critical areas. The study will test the usability of the DigiRehab platform in generating personalized physical rehabilitation programs at home. Fifty older adults participants will be involved, 20 of them testing the beta version prototype, and 30 participants testing the updated version afterwards. The inclusion criteria will be age ≥65, independent ambulation, fall risk (Tinetti test), Mini Mental State Examination ≥24, home residents, familiarity with web applications, ability and willingness to sign informed consent. Exclusion criteria will be unstable clinical condition, severe visual and/or hearing impairment, severe impairment in Activities of Daily Living and absence of primary caregiver. The first part of the screening consists in a structured questionnaire of 10 questions regarding the user's limitations, including the risk of falling, while the second consists in 10 physical tests to assess the functional status. Based on the results, the program will help define the user's individual profile upon which the DSS platform will rate the risk of falling and design the personalized exercise program to be carried out at home. All measures from the initial screening will be repeated and the results will be used to optimize the predictive algorithms in order to prepare the tool in its final version. For the usability assessment, the System Usability Scale will be administered. The follow-up will take place after the 12-week intervention at home. A semi-structured satisfaction questionnaire will also be administered to verify whether the project will meet the needs of older adults and their family caregiver. We expect that personalized training prescribed by DigiRehab platform could help to reduce the need for care in older adults subjects and the care burden.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05846776].

Adolescents with hemophilic knee arthropathy can improve their gait characteristics, functional ability, and physical activity level through kinect-based virtual reality: A randomized clinical trial

BackgroundHemophilic arthropathy is caused by recurrent intra-articular bleeding, most commonly in the knee joints. In terms of physical impact, this arthropathy causes significant disability and hampers the physical activity and functionality of he affected individuals. ObjectiveThis study intended to examine the effect of a physical rehabilitation program incorporating Kinect-based virtual reality (KBVR) on gait characteristics, functional ability, and physical activity level in adolescents diagnosed with hemophilic knee arthropathy (HKA) Materials and methodsIn a randomized clinical trial, 56 boys, aged 10–14 years, with moderate HKA, were randomly allocated into two groups. The control group (n = 28) received conventional physical therapy (CPT), while the KBVR group (n = 52) received a 30-min KBVR exercise program in addition to the CPT. Training was conducted three times/week for 12 successive weeks. Gait characteristics (step length, cadence, velocity, peak knee extension moment during stance, and knee flexion amplitude during swing) were assessed using a gait analysis system, the functional ability was assessed through the 6-min walk test, and physical activity level assessed by the Adolescents' Physical Activity Questionnaire on the pre- and post-treatment occasions. ResultsThe KBVR group achieved more favorable changes in the gait characteristics [step length (P = 0.015), cadence (P = 0.004), velocity (P = 0.024), peak knee extension moment during stance (P = 0.018), and Knee flexion amplitude during swing (P = 0.032)], functional capacity (P = 0.002), and physical activity levels (P = 0.007) compared to the control group. ConclusionThe use of KBVR exercises within a rehabilitation program is a potentially effective therapeutic option for the total care of adolescents with HKA.

LYMPH DRAINAGE MASSAGE AS ONE OF THE MEASURES FOR CORRECTION OF LYMPH FLOW DISORDERS AFTER MASTECTOMY IN WOMEN WITH BREAST CANCER

Objective: Current physical rehabilitation programs for women after mastectomy related to breast cancer. Methods: theoretical analysis and generalization of scientific and methodical literature data on complications after mastectomy in the form of formation lymphedema and physical rehabilitation. Such means and procedures include self-massage, manual lymphatic drainage massage, physical therapy, compression bandaging, wearing elastic compression underwear, Kinesio Tex taping, pneumatic compression, ultrasound and electrostatic therapy, extracorporeal shock wave therapy and others. Results: existing physical rehabilitation programs include the use of therapeutic gymnastics, manual lymphatic drainage, physical therapy, and therapeutic massage aimed at preventing postoperative complications and countering pathological changes in the lymphatic system in the postoperative period. Conclusions: the analysis of scientific sources proved that after mastectomy, the main method of prevention and treatment of such a complication as lymphedema is the use of complex anti-congestion therapy based on manual lymphatic drainage, compression therapy, lymphatic drainage exercises and skin care.

Features of physical education and sports rehabilitation for combat veterans with traumatic brain injury

Traumatic brain injury (TBI) is a common consequence of combat actions, leading to significant disability of military personnel. The purpose of the article was to characterize the features of physical culture and sports rehabilitation of combatants with TBI. Scientific publications on medical and physical rehabilitation of individuals with traumatic brain injuries were analyzed. It was found that the integrated use of kinesitherapy, physical exercises, motor learning, sensory stimulation and cognitive training is effective. It is indicated that mine-explosive injury, which dominates among combat injuries, is often combined and accompanied by damage to several anatomical areas. It is the main cause of military casualties. Combat traumatic brain injuries cause severe and combined injuries, which causes high mortality and disability due to the development of a wide range of disorders. This significantly worsens the quality of life of victims. Emphasis is placed on the fact that the Ukrainian health care system will continuously face the consequences of war for the civilian population and military. Veterans will need not only timely and highly qualified medical care, but also long-term rehabilitation, which will contribute to their full reintegration into post-war society. The features of the development of long-term consequences of TBI in combat veterans have been insufficiently studied and need to be investigated to improve the rehabilitation and quality of life of victims, return them to labor and social activity. It is concluded that it is necessary to develop a special program of physical culture and sports rehabilitation for this category of combat veterans.

PATIENTS WITH HEMIPARESIS AND MYOFASCIAL PAIN SYNDROME DURING THE IMPLEMENTATION OF THE PHYSICAL REHABILITATION PROGRAM

Introduction. Hemorrhagic stroke causes significant deviations in the psycho-emotional, moral-volitional and social spheres. Kinesiotherapy is a new effective method used in rehabilitation and physical therapy programs for post-stroke patients with myofascial pain syndrome. This publication presents the results of the study of the quality of life of post-stroke patients before and at different times after complex kinesiotherapy, as well as the characteristics of the answers related to the quality of life after the program of combined rehabilitation and physical therapy are given.
 The aim of the study is to substantiate the inclusion of kinesiotherapy in the basic rehabilitation and physical therapy programs for post-stroke patients with myofascial pain syndrome.
 Materials and methods. The study included 105 patients aged 57 to 64 with a verified diagnosis of hemorrhagic stroke complicated by myofascial pain syndrome." The SF-36 general questionnaire was used to assess the quality of life.
 Results. It was established that indicators of the quality of life of post-stroke patients before implementation programs of rehabilitation and physical therapy are significantly reduced on most scales of physical, mental and social functioning; the quality of life profile of patients is characterized by compression and deformation. Conducting kinesiotherapy with acupuncture is accompanied by a marked improvement in quality of life indicators of post-stroke patients with myofascial pain syndrome. Responses related to the quality of life, in the form of improvement or stabilization, were registered in the majority of post-stroke patients with myofascial pain syndrome after complex kinesiotherapy – in 96% of patients after a combined program of rehabilitation and physical therapy and in 87% of patients after kinesiotherapy.
 Conclusions. The profile of the quality of life of patients with hemiparesis indicates its compression and deformation, which is caused by a significant decrease in indicators that characterize the physical, mental and social scales of functioning. Long-term monitoring of such patients after the implementation of the author's physical rehabilitation program indicates a stabilization of the quality of life, which is manifested by a pronounced improvement in the profile of 96% of post-stroke patients with myofascial pain syndrome after complex and in 87% of patients in combination with acupuncture.

A retrospective comparison of the biceps femoris long head muscle structure in athletes with and without hamstring strain injury history.

Hamstring strain injuries (HSI) and re-injuries are endemic in high-speed running sports. The biceps femoris long head (BFlh) is the most frequently injured muscle among the hamstrings. Structural parameters of the hamstring muscle are stated to be susceptible to strain injuries at this location. This retrospective study targeted comparing the BFlh's structural parameters between previously injured and uninjured athletes. Nineteen male athletes with previous BFlh strain injury history and nineteen athletes without former lower extremity injury history were included in this study. Fascicle length, mid-muscle belly and distal musculotendinous (MTJ) passive stiffnesses of the biceps femoris long head (BFlh) were examined via b-mode panoramic ultrasound scanning and ultrasound-based shear-wave elastography. Parameter comparisons of both legs within and between athletes with and without injury history were performed. Comparison of the BFlh fascicle length between the injured leg of the injured group and the legs of the controls revealed a trend to shorter fascicle lengths in the injured leg (p = 0.067, d = -0.62). However, the mid-muscle belly passive stiffness of the BFlh was significantly higher in the injured legs (p = 0.009, d = 0.7) compared with the controls. Additionally, the distal MTJ stiffness was much higher in the previously injured legs compared with controls (p < 0.001, d = 1.6). Outcomes support the importance of BFlh properties related to stiffness, and fascicle length for injury susceptibility in athletes. Future prospective studies should determine whether the higher stiffness in the injured athletes is a cause or consequence of the HSI. Physical therapy and rehabilitation programmes after HSI should focus on BFlh muscle properties i.e., elasticity and fascicle length for reducing re-injury and increasing sports performance.

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial

ObjectiveTo evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition...

Effect of Physical Exercises Rehabilitation Program on Knee Function for Patients with End-stage Knee Osteoarthritis Undergoing Arthroplasty.

Effect of Physical Exercises Rehabilitation Program on Knee Function for Patients with End-stage Knee Osteoarthritis Undergoing Arthroplasty.

Treatment of Equine Tarsus Long Medial Collateral Ligament Desmitis with Allogenic Synovial Membrane Mesenchymal Stem/Stromal Cells Enhanced by Umbilical Cord Mesenchymal Stem/Stromal Cell-Derived Conditioned Medium: Proof of Concept

Horses are high-performance athletes prone to sportive injuries such as tendonitis and desmitis. The formation of fibrous tissue in tendon repair remains a challenge to overcome. This impels regenerative medicine to develop innovative therapies that enhance regeneration, retrieving original tissue properties. Multipotent Mesenchymal Stem/Stromal Cells (MSCs) have been successfully used to develop therapeutic products, as they secrete a variety of bioactive molecules that play a pivotal role in tissue regeneration. These factors are released in culture media for producing a conditioned medium (CM). The aforementioned assumptions led to the formulation of equine synovial membrane MSCs (eSM-MSCs)—the cellular pool that naturally regenerates joint tissue—combined with a medium enriched in immunomodulatory factors (among other bioactive factors) produced by umbilical cord stroma-derived MSCs (eUC-MSCs) that naturally contribute to suppressing the immune rejection in the maternal–fetal barrier. A description of an equine sport horse diagnosed with acute tarsocrural desmitis and treated with this formulation is presented. Ultrasonographic ligament recovery occurred in a reduced time frame, reducing stoppage time and allowing for the horse’s return to unrestricted competition after the completion of a physical rehabilitation program. This study focused on the description of the therapeutic formulation and potential in an equine desmitis treatment using the cells themselves and their secretomes.

Sports Injury of Sanda Wushu Class of Students in Xi'an City

Background and Aim: Wushu is a traditional sport in China and is considered an ancient Chinese martial art. Wushu is a sport that is packaged as a teaching course about martial arts and dances and is also aimed at improving the health of people who train and learn at all ages. Therefore, in wushu martial arts when starting to practice or start playing Students or players must prepare their bodies to be able to fight, but if they learn by starting, injuries that may occur with training or playing this type of sport will always happen. Materials and Methods: Population and sample: The population used in this research were Sanda Wushu students’ a total number of 150 people. The research instrument was a questionnaire on Injury occurred during the Wushu course. created by the researcher with 3 parts, developed from a questionnaire on injuries of track and field athletes participating in the 39th National Games (Pengtee, 2011). The questionnaire has the following details: Part 1: Basic information of the buyer. Part 2: Sanda Wushu Injury Questionnaire Part 3: summarizes comments or suggestions regarding injury prevention. Result: From the survey of the causes of injuries, there were two causes: injuries that occurred from the outside environment from studying Sanda Wushu (66%) and injuries that occurred from the athletes themselves (34%) and of body positions that were injured in most athletes' competitions. It occurred in 38.7% of the body positions, 24% of the upper limbs, 20% of the lower limbs, and 17.3% of the head positions. Conclusion: From the summary of the above opinions, the injuries sustained in the class are injuries that are not serious and can be treated with basic first aid. Because studying at the school level is non-violent training, it is not surprising that it can be rehabilitated. In injury prevention, there were additional comments, namely the recommendation to increase protective equipment to be sufficient for the number of students and to improve the equipment appropriately. In addition, there is currently a training program for physical rehabilitation.

Implementation of physical rehabilitation programs for children with cancer across low- and middle-income countries: A need of the hour perspective.

Implementation of physical rehabilitation programs for children with cancer across low- and middle-income countries: A need of the hour perspective.