ASES (Accessory, Solution for Easier Support) Detachable Cap: Enhancing Medication Accessibility for Patients with Hand Muscle and Joint Weakness

The increasing prevalence of hand muscle and joint weakness, particularly among patients with conditions such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), posed significant challenges in medication management. This study aimed to address these challenges by developing and evaluating the ASES (Accessory, Solution for Easier Support) detachable cap, an ergonomic innovation designed to facilitate the opening and handling of medication bottles. The research employed a quasi-experimental post-test-only design, involving 20 participants aged 18 and above with hand muscle and joint weakness, residing in Koronadal City. The ASES detachable cap was assessed through torque and tear resistance tests to evaluate its physical properties, and a survey questionnaire measured patient satisfaction and convenience. Results indicated a significant reduction in the force required to open medication bottles, with mean torque values decreasing from 4.78 N-m to 1.71 N-m. The tear resistance test demonstrated high durability, with a mean tear strength of 20.49 N/mm². Participants reported high levels of satisfaction and convenience, with overall mean scores of 4.37 and 4.08, respectively. The study concluded that the ASES detachable cap effectively enhances medication accessibility and management for patients with hand muscle and joint weakness, improving their independence and quality of life.

ASES detachable cap, accessibility, assistive technology, ergonomic design, hand muscle and joint weakness, medication packaging

1. Adu, Y., Harder, J., Cox, C., Baum, G., Hernandez, E. J., & MacKay, B. J. (2024b). Evaluating the effect of VersaWrap tendon protector on functional outcomes in operative tendon repairs. Frontiers in Surgery, 11. https://doi.org/10.3389/fsurg.2024.1447515 [Google Scholar] [Crossref]

2. American Society for Testing and Materials. (2015). ASTM E2624-15: Standard Guide for Torque Calibration for Testing Screw Closure Systems. ASTM International. https://www.astm.org [Google Scholar] [Crossref]

3. American Society for Testing and Materials. (2020). ASTM D624-00(2020): Standard Test Method for Tear Strength of Conventional Vulcanized Rubber and Thermoplastic Elastomers. ASTM International. https://www.astm.org [Google Scholar] [Crossref]

4. American Society for Testing and Materials. (2022). ASTM D7860-14: Standard Test Method for Determining the Retention Characteristics of Torque Applied to Continuous Thread Closures. ASTM International. https://www.astm.org (https://www.astm.org/ [Google Scholar] [Crossref]

5. Ary, D., Jacobs, L. C., Irvine, C. K. S., & Walker, D. (2018). Introduction to Research in Education. Boston, MA Cengage Learning. - References - Scientific Research Publishing. https://www.scirp.org/reference/referencespapers?referenceid=2975029 [Google Scholar] [Crossref]

6. Austin, P. C., & Steyerberg, E. W. (2017). Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models. Statistical methods in medical research, 26(2), 796-808. https://doi.org/10.1177/0962280214558972)77/ [Google Scholar] [Crossref]

7. Barbosa, I. M., Alves, P. R., & Silveira, Z. C. (2021). Upper limbs’ assistive devices for stroke rehabilitation: a systematic review on design engineering solutions. Journal of the Brazilian Society of Mechanical Sciences and Engineering, 43(5). https://doi.org/10.1007/s40430-021-02919-4 [Google Scholar] [Crossref]

8. Beauchamp, T., & Childress, J. (2019). Principles of Biomedical Ethics: Marking its fortieth anniversary. The American Journal of Bioethics, 19(11), 9–12. https://doi.org/10.1080/15265161.2019.1665402 [Google Scholar] [Crossref]

9. Belal, A., Ragab, O., Shawky, E., Fadel, W., & Rafaat, H. (2020, January 21). Approach to Hand Weakness from Clinical, Neurophysiological, Neuroradiological and Laboratory Data. Iris Publishers. https://irispublishers.com/ann/fulltext/approach-to-hand-weakness-from-clinical-neurophysiological-neuroradiological.ID.000645.php [Google Scholar] [Crossref]

10. Braun‐Münker, M., Kahriman, B., & Ecker, F. (2019). The package barrier to user adherence: Comparative analysis of various types of opening instructions on the ease of opening comprising effectiveness, efficiency and user satisfaction. British Journal of Clinical Pharmacology, 86(10), 1982–1988. https://doi.org/10.1111/bcp.14060 [Google Scholar] [Crossref]

11. Braun-Münker, M., Kahriman, B., & Ecker, F. (2020). The package barrier to user adherence: Comparative analysis of various types of opening instructions on the ease of opening comprising effectiveness, efficiency and user satisfaction. https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14060 [Google Scholar] [Crossref]

12. Butler, C., Pimenta, R., Tommerdahl, J., Fuchs, C. T., & Caçola, P. (2019). Using a handwriting app leads to improvement in manual dexterity in kindergarten children. Research in Learning Technology. https://www.semanticscholar.org/paper/248c6e38a1c9743e60fc3c688ef2d310be312635 [Google Scholar] [Crossref]

13. CAHPS Patient Experience Surveys and guidance. (2024, May). Agency for Healthcare Research and Quality. https://www.ahrq.gov/cahps/surveys-guidance/index.html [Google Scholar] [Crossref]

14. Cai, Y., Han, Z., Cheng, H., Li, H., Wang, K., Chen, J., Liu, Z., Xie, Y., Lin, Y., Zhou, S., Wang, S., Zhou, X., & Jin, S. (2024). The impact of ageing mechanisms on musculoskeletal system diseases in the elderly. Frontiers in Immunology, 15. https://doi.org/10.3389/fimmu.2024.1405621 [Google Scholar] [Crossref]

15. Cano-García, L., Redondo-Rodríguez, R., Manrique-Arija, S., Domínguez-Quesada, C., Vacas, J. C., Armenteros-Ortiz, P., Ruiz-Vilchez, D., Martín-Martín, J. M., García-Studer, A., Ortiz-Márquez, F., Mena-Vázquez, N., & Fernández-Nebro, A. (2023). Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study. Nutrients, 15(16), 3500. https://doi.org/10.3390/nu15163500 [Google Scholar] [Crossref]

16. Castelli, G., Desai, K. M., & Cantone, R. E. (2020, December 15). Peripheral neuropathy: evaluation and differential diagnosis. AAFP. https://www.aafp.org/pubs/afp/issues/2020/1215/p732.html [Google Scholar] [Crossref]

17. CFR - Code of Federal Regulations Title 21. (2024, August 30). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr 77.2600&utm [Google Scholar] [Crossref]

18. Chen, A. (2025, February 25). Food Grade vs. Medical Grade Silicone: What’s the Difference. Hongju. https://hongjusilicone.com/food-grade-vs-medical-grade-silicone/ [Google Scholar] [Crossref]

19. Choueiry, G. (2020, October 14). One-Group Posttest Only Design: An Introduction. Quantifying Health. https://quantifyinghealth.com/one-group-posttest-only-design/ [Google Scholar] [Crossref]

20. Consumer Silicone Products. (2022, November 1). How to test food-grade silicone? - ZSR. ZSR. https://consumersiliconeproducts.com/blog/how-to-test-food-grade-silicon [Google Scholar] [Crossref]

21. Cooper, L., Fuzesi, P., Jacob, S. A., Kamalakannan, S., Lennon, M., Macaden, L., Smith, A., Welsh, T., Broadfoot, K., & Watson, M. C. (2023). Assistive technologies and strategies to support the medication management of individuals with hearing and/or visual impairment: A scoping review. Disability and Health Journal, 16(4), 101500. https://doi.org/10.1016/j.dhjo.2023.101500 [Google Scholar] [Crossref]

22. Cortez, K. J. C., Filarca, C. E., Osio-Salido, E., Penserga, G. G., & Reyes, B. H. M. (2022). Disease knowledge and functional disability of a cohort of rheumatoid arthritis in a tertiary government hospital in Manila, Philippines. Acta Medica Philippina, 56(2). https://doi.org/10.47895/amp.v56i2.3949 [Google Scholar] [Crossref]

23. DeCarlo, M. (2018). 12.2 pre-experimental and quasi-experimental design. Pressbooks. https://pressbooks.pub/scientificinquiryinsocialwork/chapter/12-2-pre-experimental-and-quasi-experimental-design/ [Google Scholar] [Crossref]

24. DeWolfe, A. (2021). How to perform a rubber & elastomer tear Strength Test – ASTM D624. ADMET. https://www.admet.com/blog/how-to-perform-a-rubber-elastomer-tear-strength-test-astm-d624/ [Google Scholar] [Crossref]

25. Donaldson, R., Swartz, J., Holtz, M., & Ostermayer, D. (2023, March 22). Hand and finger fractures. WikEM. https://wikem.org/wiki/Hand_and_finger_fractures [Google Scholar] [Crossref]

26. Dunn, L. B., Jeste, D. V., & Palmer, B. W. (2020). Incorporating the principles of informed consent in research with individuals who have cognitive or psychiatric impairments. Journal of the American Medical Association, 304(11), 1130–1131. https://doi.org/10.1001/jama.2010.1324 [Google Scholar] [Crossref]

27. Engel, R. J., & Schutt, R. K. (2022). Doctoral research methods in social work. Mavs Open Press. https://uta.pressbooks.pub/advancedresearchmethodsinsw/chapter/14-4/ [Google Scholar] [Crossref]

28. Fernández-Batanero, J. M., Montenegro-Rueda, M., Fernández-Cerero, J., & García-Martínez, I. (2022b). Assistive technology for the inclusion of students with disabilities: a systematic review. Educational Technology Research and Development, 70(5), 1911–1930. https://doi.org/10.1007/s11423-022-10127-7 [Google Scholar] [Crossref]

29. Forbrigger, S., DePaul, V. G., Davies, T. C., Morin, E., & Hashtrudi-Zaad, K. (2023). Home-based upper limb stroke rehabilitation mechatronics: challenges and opportunities. BioMedical Engineering OnLine, 22(1). https://doi.org/10.1186/s12938-023-01133-8 [Google Scholar] [Crossref]

30. Giana Carli Lorenzini, G.C., (2022). You need to be healthy to be sick: Exploring older people’s experiences with medication packaging at home. https://doi.org/10.1093/ageing/afac050 [Google Scholar] [Crossref]

31. Gilliam, E., Achenbach, P., Suemmermann, G. J., Wessely, M. N., Rossmanith, P., Dohrn, M. F., Schulz, J. B., Waschbisch, A., & Brunkhorst, R. (2024b). Assessing hand motor function in chronic immune-mediated neuropathies: a proof-of-concept study using a data glove. Journal of Neuro Engineering and Rehabilitation, 21(1). https://doi.org/10.1186/s12984-024-01518-3 [Google Scholar] [Crossref]

32. Haltaufderheide, J., Lucht, A., Strünck, C., & Vollmann, J. (2023). Socially Assistive Devices in Healthcare–a Systematic Review of Empirical Evidence from an Ethical Perspective. Science and Engineering Ethics, 29(1). https://doi.org/10.1007/s11948-022-00419-9 [Google Scholar] [Crossref]

33. Hayes, A. (2024, October 1). Descriptive statistics: Definition, overview, types, and examples. Investopedia.https://www.investopedia.com/terms/d/descriptive_statistics.asp [Google Scholar] [Crossref]

34. Hudson, R. (2023, September 11). Tendinopathy and tenosynovitis. https://patient.info/bones-joints-muscles/tendinopathy-and-tenosynovitis-tendinosis [Google Scholar] [Crossref]

35. Improving patient safety: reducing medication errors through use of acceptable, accessible medicines packaging - The Pharmaceutical Journal. (2021, March 17). The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/research/improving-patient-safety-reducing-medication-errors-through-use-of-acceptable-accessible-medi ines-packaging [Google Scholar] [Crossref]

36. Islam, S., MD. (2024). Empowering Individuals with Mobility Limitations through Advanced Home Automation Technologies. Doria. https://www.doria.fi/handle/10024/189912 [Google Scholar] [Crossref]

37. Jones, G., Trajanoska, K., Santanasto, A.J. (2021). Genome-wide meta-analysis of muscle weakness identifies 15 susceptibility loci in older men and women. Nat Commun 12, 654 (2021). https://doi.org/10.1038/s41467-021-20918-w [Google Scholar] [Crossref]

38. Karapinar‐Çarkit, F., Van Den Bemt, P. M., Sadik, M., Van Soest, B., Knol, W., Van Hunsel, F., & Van Riet‐Nales, D. A. (2020). Opportunities for changes in the drug product design to enhance medication safety in older people: Evaluation of a national public portal for medication incidents. British Journal of Clinical Pharmacology, 86(10), 1946–1957. https://doi.org/10.1111/bcp.14392 [Google Scholar] [Crossref]

39. Kınıklı, G. İ., Şahin, A., Güney, H., Yüksel, İ., & Kınıklı, G. (2016b, August 1). Investigation of grip strength and upper extremity functional disability in patients with rheumatoid arthritis. https://dergipark.org.tr/en/pub/jetr/issue/41758/503411 [Google Scholar] [Crossref]

40. Kuo, C., Yang, S., Shi, W., You, S., Qiu, S., Yang, B., Huang, S., & Farooqui, A. (2025). A high-efficiency technique for cutting silicone rubber molds using digital parting line data. The International Journal of Advanced Manufacturing Technology. https://doi.org/10.1007/s00170-025-15556-1 [Google Scholar] [Crossref]

41. Li, C., Zhu, S., Yang, C., Yang, M., Cheng, Y., Li, B., Liu, M., Ma, X., Zhang, Y., Cui, X., Zhang, W., & Li, C. (2025). Medical alloy materials in cutting and grinding: machinability performance assessment. The International Journal of Advanced Manufacturing Technology. https://doi.org/10.1007/s00170-025-15626-4 [Google Scholar] [Crossref]

42. Lorenzini, G., and Olsson, A. (2022). Exploring How and Why to Develop Patient-Centered Packaging: A Multiple-Case Study with Pharmaceutical Companies. https://doi.org/10.1007/s43441-021-00338-0 [Google Scholar] [Crossref]

43. Lorenzini, G.C., and Olsson, A. (2018). Towards patient-centered packaging design: An industry perspective on processes, functions, and constraints. https://doi.org/10.1002/pts.2419 (https://doi.org/ 10.1002/pts.2419). [Google Scholar] [Crossref]

44. Lorenzini, G.C., and Olsson, A. (2021). Exploring How and Why to Develop Patient-Centered Packaging: A Multiple-Case Study with Pharmaceutical Companies. https://link.springer.com/article/10.1007/s43441-021-00338-0 [Google Scholar] [Crossref]

45. Lorenzini, G.C. and Hellstrom, D. (2016). Medication Packaging and Older Patients: A Systematic Review. https://doi.org/10.1002/pts.2241. [Google Scholar] [Crossref]

46. Lorenzini G.C and Olsson A. (2021). Exploring the Combined Use of Solicited Diaries and Photography by Older Patients in Their Process of Self-Care with Medication Packaging. https://doi:10.1017/pds.2021.412. [Google Scholar] [Crossref]

47. Ma, J.-D., Chen, C.-T., Lin, J.-Z., Li, Q., Chen, L.-F., Xu, Y., Yang, Z.-H., Zheng, D., & Dai, L. (2021). Muscle wasting, a neglected complication associated with physical dysfunction in elderly patients with rheumatoid arthritis: a cross-sectional observational study. Scandinavian Journal of Rheumatology. https://www.semanticscholar.org/paper/a220c3173d61b2d8abc2d52a4d43e414576c83f2 [Google Scholar] [Crossref]

48. Mahran, S., Fathi, N., Seddek, M., & Goma, S. H. (2021). Physical ability and quality of life in rheumatoid arthritis and systemic lupus erythematosus: a brief comparison. Aktuelle Rheumatologie, 46(01), 88-96. https://doi.org/10.1177 (https://doi.org/10.1177/0962280214558972) [Google Scholar] [Crossref]

49. Manfuku, M., Inoue, J., Yamanaka, N., Kanamori, H., Sumiyoshi, K., & Osumi, M. (2024). Effects of taxane-induced peripheral neuropathy on hand dexterity impairment: evaluation of quantitative and subjective assessments. Supportive Care in Cancer, 32(5). https://doi.org/10.1007/s00520-024-08504-4 [Google Scholar] [Crossref]

50. Mathijssen, E. G., Vriezekolk, J. E., Eijsbouts, A. M., Van Den Hoogen, F. H., & Van Den Bemt, B. J. (2018). Support needs for medication use and the suitability of eHealth technologies to address these needs: a focus group study of older patients with rheumatoid arthritis. Patient Preference and Adherence, Volume 12, 349–358. https://doi.org/10.2147/ppa.s152759 [Google Scholar] [Crossref]

51. Matysiak, L., Kornmann, X., Saj, P., & Sekula, R. (2012). Analysis and optimization of the silicone molding process based on numerical simulations and experiments. Advances in Polymer Technology, 32(S1). https://doi.org/10.1002/adv.21272 [Google Scholar] [Crossref]

52. Meng, K., & Liu, F. (2022). Application of 3D digital image processing technology in modern packaging design. Advances in Multimedia, 2022, 1–12. https://doi.org/10.1155/2022/5239479 [Google Scholar] [Crossref]

53. Mesa Labs. (2024b). Cap Torque Testing: Standards and Regulations You Need to Know. Cap Torque Testing: Standards and Regulations You Need to Know. https://mesalabs.com/torque-news/cap-torque-testing-standards-and-regulations#:~:text=ASTM%20D7860%2D14(2022):,ease%20of%20opning%20for%20adults. [Google Scholar] [Crossref]

54. Momani, A. M. (2020). The unified theory of acceptance and use of technology. International Journal of Sociotechnology and Knowledge Development, 12(3), 79–98. https://doi.org/10.4018/ijskd.2020070105 [Google Scholar] [Crossref]

55. Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R. Z., Mohaini, M. A., Mutairi, A. A., Rabaan, A. A., Awad, M., & Al-Omari, A. (2021). The effective strategies to avoid medication errors and improving reporting systems. Medicines, 8(9), 46. https://doi.org/10.3390/medicines8090046 National Cancer Institute. (2024). Orthopedic surgeon. In Dictionary of cancer terms. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/orthope dic-surgeon# [Google Scholar] [Crossref]

56. Niu, Z., Huang, L., He, H., Mei, S., Li, L., & Griffiths, M. D. (2024). The revised patient satisfaction questionnaire (PSQ-R): validity, reliability, equivalence, and network analysis among hospitalized patients in the Chinese population. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11788-1 [Google Scholar] [Crossref]

57. Omar, A., Marwaha, K., & Bollu, P. C. (2023, May 1). Physiology, neuromuscular junction. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470413/ [Google Scholar] [Crossref]

58. Önder, M. E., Kılıçarslan, A., Keskin, E. D., & Bodur, H. (2022). Predictive factors for muscle weakness in Rheumatoid arthritis. https://acikerisim.aksaray.edu.tr/xmlui/handle/20.500.12451/9613 [Google Scholar] [Crossref]

59. Qian, N. H., & Jiang, N. B. (2023b). Silicone resin Applications for Heat-Resistant Coatings: A review. Polymer Science Series C, 65(2), 206–219. https://doi.org/10.1134/s1811238223700443 [Google Scholar] [Crossref]

60. Reshma. (2024, November 11). Why FDA Approved Silicone Rubber Is Essential For Gaskets & Seals In Food Processing. Elastostar Rubber Corporation. https://elastostar.com/why-is-fda-approved-silicone-rubber-chosen-for-gaskets-and-seals-in-the-food-processing-industry/ [Google Scholar] [Crossref]

61. Shetty, B., Naveen, G. J., & Rao, S. (2024). Silicone mold making: A versatile and cost-effective solution for diverse applications. AIP Conference Proceedings, 3231, 020006. https://doi.org/10.1063/5.0235868 [Google Scholar] [Crossref]

62. Soar, J., Yu, L., & Al-Hakim, L. (2020b). Older people’s needs and opportunities for assistive technologies. In Lecture notes in computer science (pp. 404–414). https://doi.org/10.1007/978-3-030-51517-1_37 [Google Scholar] [Crossref]

63. Solid And Liquid Silicone Rubber Material And Processing Guidelines: Vol. 10.23 (6709e Ed.). (2023). Wacker Chemie Ag. https://www.wacker.com/h/medias/6709-EN.pdf [Google Scholar] [Crossref]

64. SSP Manufacturing Inc. (2020, January 3.). Why is FDA-approved Silicone Rubber Chosen for Gaskets and Seals in the Food Processing Industry? - SSP Manufacturing, Inc. https://www.sspseals.com/blog/fda-approved-silicone-rubber-chosen-gaskets-seals-food-processing-industry [Google Scholar] [Crossref]

65. Standard Test Methods for Measurement of Torque Retention for Child Resistant and Non-Child Resistant Packages with Continuous Thread Closures Using Automated Torque Testing Equipment. (2022, October 12.). https://www.astm.org/d7860-14r22.html [Google Scholar] [Crossref]

66. Stavrou, A. (2023). Packaging design in today’s pharmaceutical industries. https://www.academia.edu/99004772/Packaging_design_in_today_s_pharmaceutical_industries [Google Scholar] [Crossref]

67. Sullivan, G. M., & Artino, A. R., Jr. (2016). Analyzing and interpreting data from Likert-type scales. Journal of Taluğ Demiriz, DY (2023). Interactive and sustainable approaches in packaging design as a communication tool. https://doi.org/10.29000/rumelide.1252840. [Google Scholar] [Crossref]

68. Test Method for Tear Strength of Conventional Vulcanized Rubber and Thermoplastic Elastomers. (2020). ASTM D624: Standard Test Method for Tear Strength of Conventional Vulcanized Rubber and Thermoplastic [Google Scholar] [Crossref]

69. Elastomers, 09.01(D11.10), 83.060. https://doi.org/10.1520/d0624-00r20 [Google Scholar] [Crossref]

70. Thackeray, K. (2023). The Definitive Guide to ASTM D624 Tear Strength Testing of rubber and elastomers. INSTRON. https://www.instron.com/en/testing-solutions/astm-standards/the-definitive-guide-to-astm-d624 [Google Scholar] [Crossref]

71. Thackeray, L. M. (2023). Tear Strength in Medical-Grade Silicone: Comparing ASTM and ISO Protocols for Consistency. Journal of Materials in Medicine, 12(2), 123–131. https://doi.org/10.1007/s10856-023-0754-y [Google Scholar] [Crossref]

72. Thilarajah, S., Newton, Courteney, et.al. (2022). The neglected barrier to medication use: a systematic review of difficulties associated with opening medication packaging. https://doi.org/10.1093/ageing/afac225 [Google Scholar] [Crossref]

73. Tomičević, L., Barešić, M., Mayer, M., & Anić, B. (2023). Musculoskeletal Manifestations of Systemic Lupus Erythematosus. Acta Clinica Croatica. https://doi.org/10.20471/acc.2023.62.04.18 [Google Scholar] [Crossref]

74. Varghese, R. J., Freer, D., Deligianni, F., Liu, J., & Yang, G. (2018). Wearable robotics for Upper-Limb rehabilitation and assistance. In Elsevier eBooks (pp. 23–69). https://doi.org/10.1016/b978-0-12-811810-8.00003-8 [Google Scholar] [Crossref]

75. Volpe, J.; Fischer, L.; Moffitt, A. Impact of aging on hand strength and function. J. Aging Health 2017, 29, 174-183. [Google Scholar] [Crossref]

76. Voshaar, M., Vriezekolk, J., Van Dulmen, S., Van Den Bemt, B., & Van De Laar, M. (2016). Barriers and facilitators to disease-modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskeletal Disorders, 17(1). https://doi.org/10.1186/s12891-016-1289-z [Google Scholar] [Crossref]

77. World Health Organization: WHO. (2022, July 14). Musculoskeletal health. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions [Google Scholar] [Crossref]

78. World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 [Google Scholar] [Crossref]

79. Xu, J., Zheng, M., Feng, Z., & Lin, Q. (2024b). CCL4L2 participates in tendinopathy progression by promoting macrophage inflammatory responses: a single-cell analysis. Journal of Orthopaedic Surgery and Research19(1). https://doi.org/10.1186/s13018-024-05268-9 [Google Scholar] [Crossref]

80. Yaseen, K. (2024, April 11). Osteoarthritis (OA). Merck Manual Professional Edition. https://www.merckmanuals.com/professional/musculoskeletal-and-connec https://www.merckmanuals.com/professional/musculoskeletal-and-connec)ive-tissue-disorders/joint-disorders/osteoarthritis-oa [Google Scholar] [Crossref]

81. Yaska, M., & Nuhu, B. M. (2024). Assessment of measures of central tendency and dispersion using Likert-type scale. African Journal of Advances in Science and Technology Research, 16(1), 33–45. https://doi.org/10.62154/ajastr.2024.016.010379 [Google Scholar] [Crossref]

82. Yong, J., MacDermid, J. C., & Packham, T. (2020). Defining dexterity—Untangling the discourse in clinical practice. Journal of Hand Therapy 33(4), 517–519. https://doi.org/10.1016/j.jht.2019.11.001 [Google Scholar] [Crossref]

83. Zamora-Abrahan, G. T., Salido, E. O., Lichauco, J. J. T., Gutierrez-Rubio, A. K. [Google Scholar] [Crossref]

84. M., Rivera-Go, I. C. T., Cortez, K. J. C., Suilan, K. E. A., Villo, J. G. B., & Del Rosario, A. G. (2023). Outcomes of Filipinos with inflammatory rheumatic diseases developing COVID-19 prior to vaccinations and new variants: a historical perspective. Clinical Rheumatology, 42(4), 1171–1175. https://doi.org/10.1007/s10067-023-06507-w [Google Scholar] [Crossref]

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