Background: Balance disorders are among the most frequent reasons for consultation and referral to specialist care. Osteopathic Manipulative Treatment (OMT) can influence the proprioceptive system by inducing alterations in the proprioceptive stimuli, hence affecting postural control. Objective: The present systematic review aimed to explore the effects of OMT in managing patients with vertigo and balance disorders. Methods: MEDLINE (PubMed), ScienceDirect, and Google Scholar were searched. Clinical trials and prospective observational studies were considered. Only studies that considered OMT as the main intervention, provided alone or combined with other interventions, were included. The methodological quality of the evidence was assessed with a modified version of the Newcastle-Ottawa Scale. Results: Five studies that enrolled a total of 114 subjects met our inclusion criteria. Overall, it has been observed that there is a positive effect on balance disorders through different outcomes in all of the included studies. Only two studies (9 subjects) mentioned low to moderate adverse events after OMT. Conclusions: OMT showed weak positive effects on balance function, encouraging the connection of conventional medicine and evidence-based complementary medicine for integrative clinical practice and interprofessional work. However, full-sized adequately powered randomized trials are required to determine the effectiveness of OMT for vertigo and balance disorders.

1.
Bruijn
SM
,
van Dieën
JH
.
Control of human gait stability through foot placement
.
J R Soc Interface
.
2018
Jun
;
15
(
143
):
15
.
[PubMed]
1742-5689
2.
Tramontano
M
,
Piermaria
J
,
Morone
G
,
Reali
A
,
Vergara
M
,
Tamburella
F
.
Postural Changes During Exteroceptive Thin Plantar Stimulation: The Effect of Prolonged Use and Different Plantar Localizations
.
Front Syst Neurosci
.
2019
Sep
;
13
:
49
.
[PubMed]
1662-5137
3.
Tramontano
M
,
Bonnì
S
,
Martino Cinnera
A
,
Marchetti
F
,
Caltagirone
C
,
Koch
G
, et al
.
Blindfolded Balance Training in Patients with Parkinson’s Disease: A Sensory-Motor Strategy to Improve the Gait
.
Parkinsons Dis
.
2016
;
2016
:
7536862
.
[PubMed]
2042-0080
4.
Bonnì
S
,
Ponzo
V
,
Tramontano
M
,
Martino Cinnera
A
,
Caltagirone
C
,
Koch
G
, et al
.
Neurophysiological and clinical effects of blindfolded balance training (BBT) in Parkinson’s disease patients: a preliminary study
.
Eur J Phys Rehabil Med
.
2019
Apr
;
55
(
2
):
176
82
.
[PubMed]
1973-9087
5.
Tramontano
M
,
Morone
G
,
Curcio
A
,
Temperoni
G
,
Medici
A
,
Morelli
D
, et al
.
Maintaining gait stability during dual walking task: effects of age and neurological disorders
.
Eur J Phys Rehabil Med
.
2017
Feb
;
53
(
1
):
7
13
.
[PubMed]
1973-9095
6.
Bent
LR
,
Inglis
JT
,
McFadyen
BJ
.
Vestibular contributions across the execution of a voluntary forward step
.
Exp Brain Res
.
2002
Mar
;
143
(
1
):
100
5
.
[PubMed]
0014-4819
7.
Bent
LR
,
McFadyen
BJ
,
Inglis
JT
.
Vestibular contributions during human locomotor tasks
.
Exerc Sport Sci Rev
.
2005
Jul
;
33
(
3
):
107
13
.
[PubMed]
0091-6331
8.
Bisdorff
A
,
Bosser
G
,
Gueguen
R
,
Perrin
P
.
The epidemiology of vertigo, dizziness, and unsteadiness and its links to co-morbidities
.
Front Neurol
.
2013
Mar
;
4
:
29
.
[PubMed]
1664-2295
9.
Rao
SS
.
Prevention of falls in older patients
.
Am Fam Physician
.
2005
Jul
;
72
(
1
):
81
8
.
[PubMed]
0002-838X
10.
Osoba
MY
,
Rao
AK
,
Agrawal
SK
,
Lalwani
AK
.
Balance and gait in the elderly: A contemporary review
.
Laryngoscope Investig Otolaryngol
.
2019
Feb
;
4
(
1
):
143
53
.
[PubMed]
2378-8038
11.
Nguyen
CT
,
Taw
MB
,
Wang
MB
.
Complementary and integrative treatments: balance disorders
.
Otolaryngol Clin North Am
.
2013
Jun
;
46
(
3
):
409
22
.
[PubMed]
0030-6665
12.
Cattaneo
D
,
Gervasoni
E
,
Pupillo
E
,
Bianchi
E
,
Aprile
I
,
Imbimbo
I
, et al;
NEUROFALL Group
.
Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial
.
Front Neurol
.
2019
Sep
;
10
:
865
.
[PubMed]
1664-2295
13.
McDonnell
MN
,
Hillier
SL
.
Vestibular rehabilitation for unilateral peripheral vestibular dysfunction
.
Cochrane Database Syst Rev
.
2015
Jan
;
1
:
CD005397
.
[PubMed]
1469-493X
14.
Stubbs
B
,
Schofield
P
,
Patchay
S
,
Leveille
S
.
Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults
.
Physiotherapy
.
2016
Jun
;
102
(
2
):
152
8
.
[PubMed]
0031-9406
15.
Obeso
JA
,
Rodríguez-Oroz
MC
,
Benitez-Temino
B
,
Blesa
FJ
,
Guridi
J
,
Marin
C
, et al
.
Functional organization of the basal ganglia: therapeutic implications for Parkinson’s disease
.
Mov Disord
.
2008
;
23
(
S3
Suppl 3
):
S548
59
.
[PubMed]
0885-3185
16.
Peppe
A
,
Paravati
S
,
Baldassarre
MG
,
Bakdounes
L
,
Spolaor
F
,
Guiotto
A
, et al
.
Proprioceptive Focal Stimulation (Equistasi®) May Improve the Quality of Gait in Middle-Moderate Parkinson’s Disease Patients. Double-Blind, Double-Dummy, Randomized, Crossover, Italian Multicentric Study
.
Front Neurol
.
2019
Sep
;
10
:
998
.
[PubMed]
1664-2295
17.
Tramontano
M
,
Bergamini
E
,
Iosa
M
,
Belluscio
V
,
Vannozzi
G
,
Morone
G
.
Vestibular rehabilitation training in patients with subacute stroke: A preliminary randomized controlled trial
.
NeuroRehabilitation
.
2018
;
43
(
2
):
247
54
.
[PubMed]
1053-8135
18.
Tramontano
M
,
Martino Cinnera
A
,
Manzari
L
,
Tozzi
FF
,
Caltagirone
C
,
Morone
G
, et al
.
Vestibular rehabilitation has positive effects on balance, fatigue and activities of daily living in highly disabled multiple sclerosis people: A preliminary randomized controlled trial
.
Restor Neurol Neurosci
.
2018
;
36
(
6
):
709
18
.
[PubMed]
0922-6028
19.
Tramontano
M
,
Medici
A
,
Iosa
M
,
Chiariotti
A
,
Fusillo
G
,
Manzari
L
, et al
.
The effect of vestibular stimulation on motor functions of children with cerebral palsy
.
Mot Contr
.
2017
Jul
;
21
(
3
):
299
311
.
[PubMed]
1087-1640
20.
Nam
SM
,
Kim
K
,
Lee
DY
.
Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability
.
J Phys Ther Sci
.
2018
Jan
;
30
(
1
):
113
5
.
[PubMed]
0915-5287
21.
Tramontano
M
,
Dell’Uomo
D
,
Cinnera
AM
,
Luciani
C
,
Di Lorenzo
C
,
Marcotulli
M
, et al
.
Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial
.
Funct Neurol
.
2019
Jan-Mar
;
34
(
1
):
7
13
.
[PubMed]
1971-3274
22.
Palmgren
PJ
, Sandstro ̈m PJ, Lundqvist FJ, Heikkila ̈ H. Improvement after chiropractic care in cervico-cephalic kinesthetic sensibility and subjective pain intensity in patients with non-traumatic chronic neck pain. J Manipulative Physiol Ther
2006
;29:100e6. Haavik-Taylor H, Bernadette M. Cervical spine manipulation alters sensory-motor integration: a somato-sensory evoked potential study. Clin Neurophysiol 2007;118:391e402.
23.
Haavik-Taylor H, Bernadette M. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol. 2007 Feb;118(2):391–402.
24.
Lunghi
C
,
Tozzi
P
,
Fusco
G
.
The biomechanical model in manual therapy: is there an ongoing crisis or just the need to revise the underlying concept and application
.
J Bodyw Mov Ther
.
2016
Oct
;
20
(
4
):
784
99
.
[PubMed]
1360-8592
25.
Hruby
RT
,
Lunghi
C
,
Fusco
G
.
The five osteopathic models: Rational, Application, Integration. From tradition to innovation for a centered person osteopathy
.
Pencaitland, UK
:
Handspring publishing
;
2017
.
26.
Tramontano
M
,
Pagnotta
S
,
Lunghi
C
,
Manzo
C
,
Manzo
F
,
Consolo
S
, et al
.
Assessment and Management of Somatic Dysfunctions in Patients With Patellofemoral Pain Syndrome
.
J Am Osteopath Assoc
.
2020
Mar
;
120
(
3
):
165
73
.
[PubMed]
0098-6151
27.
Tramontano
M
,
Martino Cinnera
A
,
Petracca
M
,
Gaeta
A
,
Tamburella
F
,
Audouard
M
, et al
.
Outpatient Satisfaction With Osteopathic Manipulative Treatment in a Hospital Center: A Survey
.
Altern Ther Health Med
.
2018
Sep
;
24
(
5
):
18
24
.
[PubMed]
1078-6791
28.
Franke
H
,
Franke
JD
,
Fryer
G
.
Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
.
BMC Musculoskelet Disord
.
2014
Aug
;
15
(
1
):
286
.
[PubMed]
1471-2474
29.
Cerritelli
F
,
Lacorte
E
,
Ruffini
N
,
Vanacore
N
.
Osteopathy for primary headache patients: a systematic review
.
J Pain Res
.
2017
Mar
;
10
:
601
11
.
[PubMed]
1178-7090
30.
Tassorelli
C
,
Tramontano
M
,
Berlangieri
M
,
Schweiger
V
,
D’Ippolito
M
,
Palmerini
V
, et al
.
Assessing and treating primary headaches and cranio-facial pain in patients undergoing rehabilitation for neurological diseases
.
J Headache Pain
.
2017
Sep
;
18
(
1
):
99
.
[PubMed]
1129-2369
31.
D’Ippolito
M
,
Tramontano
M
,
Buzzi
MG
.
Effects of Osteopathic Manipulative Therapy on Pain and Mood Disorders in Patients With High-Frequency Migraine
.
J Am Osteopath Assoc
.
2017
Jun
;
117
(
6
):
365
9
.
[PubMed]
0098-6151
32.
Ruffini
N
,
D’Alessandro
G
,
Cardinali
L
,
Frondaroli
F
,
Cerritelli
F
.
Osteopathic manipulative treatment in gynecology and obstetrics: A systematic review
.
Complement Ther Med
.
2016
Jun
;
26
:
72
8
.
[PubMed]
0965-2299
33.
Ponzo
V
,
Cinnera
AM
,
Mommo
F
,
Caltagirone
C
,
Koch
G
,
Tramontano
M
.
Osteopathic Manipulative Therapy Potentiates Motor Cortical Plasticity
.
J Am Osteopath Assoc
.
2018
Jun
;
118
(
6
):
396
402
.
[PubMed]
0098-6151
34.
Tamburella
F
,
Piras
F
,
Piras
F
,
Spanò
B
,
Tramontano
M
,
Gili
T
.
Cerebral Perfusion Changes After Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial
.
Front Physiol
.
2019
Apr
;
10
:
403
.
[PubMed]
1664-042X
35.
Johnson
SM
,
Kurtz
ME
.
Conditions and diagnoses for which osteopathic primary care physicians and specialists use osteopathic manipulative treatment
.
J Am Osteopath Assoc
.
2002
Oct
;
102
(
10
):
527
32
.
[PubMed]
0098-6151
36.
Morin
C
,
Aubin
A
.
Primary reasons for osteopathic consultation: a prospective survey in Quebec
.
PLoS One
.
2014
Sep
;
9
(
9
):
e106259
.
[PubMed]
1932-6203
37.
Moher
D
,
Liberati
A
,
Tetzlaff
J
,
Altman
DG
;
PRISMA Group
.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
.
PLoS Med
.
2009
Jul
;
6
(
7
):
e1000097
.
[PubMed]
1549-1277
38.
Giusti
R
.
Glossary of Osteopathic Terminology
.
American Association of Colleges of Osteopathic Medicine
;
2017
.[
https://www.aacom.org/docs/default-source/default-document-library/glossary2017.pdf?sfvrsn=a41c3b97_0 accessed 11/03/2020
].
39.
Wells
GA
,
Shea
B
,
O’Connell
D
.
Pet al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta- analyses
.
J Mark Manage
.
2011
;
27
:
808
33
. 0267-257X
40.
Russo
V
,
Ottaviani
C
,
Spitoni
GF
.
Affective touch: A meta-analysis on sex differences
.
Neurosci Biobehav Rev
.
2020
Jan
;
108
:
445
52
.
[PubMed]
0149-7634
41.
Papa
L
,
Amodio
A
,
Biffi
F
,
Mandara
A
.
Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness
.
J Bodyw Mov Ther
.
2017
Oct
;
21
(
4
):
866
72
.
[PubMed]
1360-8592
42.
Fraix
M
.
Osteopathic manipulative treatment and vertigo: a pilot study
.
PM R
.
2010
Jul
;
2
(
7
):
612
8
.
[PubMed]
1934-1482
43.
Rabin
E
,
Demin
A
,
Pirrotta
S
,
Chen
J
,
Patel
H
,
Bhambri
A
, et al
.
Parkinsonian gait ameliorated with a moving handrail, not with a banister
.
Arch Phys Med Rehabil
.
2015
Apr
;
96
(
4
):
735
41
.
[PubMed]
0003-9993
44.
Lopez
D
,
King
HH
,
Knebl
JA
,
Kosmopoulos
V
,
Collins
D
,
Patterson
RM
.
Effects of comprehensive osteopathic manipulative treatment on balance in elderly patients: a pilot study
.
J Am Osteopath Assoc
.
2011
Jun
;
111
(
6
):
382
8
.
[PubMed]
0098-6151
45.
Fraix
M
,
Gordon
A
,
Graham
V
,
Hurwitz
E
,
Seffinger
MA
.
Use of the SMART Balance Master to quantify the effects of osteopathic manipulative treatment in patients with dizziness
.
J Am Osteopath Assoc
.
2013
May
;
113
(
5
):
394
403
.
[PubMed]
1945-1997
46.
Sloane
PD
.
Dizziness in primary care. Results from the National Ambulatory Medical Care Survey
.
J Fam Pract
.
1989
Jul
;
29
(
1
):
33
8
.
[PubMed]
0094-3509
47.
Yardley
L
,
Owen
N
,
Nazareth
I
,
Luxon
L
.
Prevalence and presentation of dizziness in a general practice community sample of working age people
.
Br J Gen Pract
.
1998
Apr
;
48
(
429
):
1131
5
.
[PubMed]
0960-1643
48.
Johansson
M
,
Andersson
G
.
Prevalence of dizziness in relation to psychological factors and general health in older adults
.
Audiol Med
.
2006
;
4
(
3
):
144
50
. 1651-386X
49.
Lystad
RP
,
Bell
G
,
Bonnevie-Svendsen
M
,
Carter
CV
.
Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review
.
Chiropr Man Therap
.
2011
Sep
;
19
(
1
):
21
.
[PubMed]
2045-709X
50.
Nardone
A
,
Schieppati
M
.
The role of instrumental assessment of balance in clinical decision making
.
Eur J Phys Rehabil Med
.
2010
Jun
;
46
(
2
):
221
37
.
[PubMed]
1973-9095
51.
Bergamini
E
,
Iosa
M
,
Belluscio
V
,
Morone
G
,
Tramontano
M
,
Vannozzi
G
.
Multi-sensor assessment of dynamic balance during gait in patients with subacute stroke
.
J Biomech
.
2017
Aug
;
61
:
208
15
.
[PubMed]
0021-9290
52.
Belluscio
V
,
Bergamini
E
,
Tramontano
M
,
Orejel Bustos
A
,
Allevi
G
,
Formisano
R
, et al
.
Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors
.
Sensors (Basel)
.
2019
Dec
;
19
(
23
):
E5315
.
[PubMed]
1424-8220
53.
Belluscio
V
,
Bergamini
E
,
Iosa
M
,
Tramontano
M
,
Morone
G
,
Vannozzi
G
.
The iFST: an instrumented version of the Fukuda Stepping Test for balance assessment
.
Gait Posture
.
2018
Feb
;
60
:
203
8
.
[PubMed]
0966-6362
54.
Ruffini
N
,
D’Alessandro
G
,
Mariani
N
,
Pollastrelli
A
,
Cardinali
L
,
Cerritelli
F
.
Variations of high frequency parameter of heart rate variability following osteopathic manipulative treatment in healthy subjects compared to control group and sham therapy: randomized controlled trial
.
Front Neurosci
.
2015
Aug
;
9
:
272
.
[PubMed]
1662-4548
55.
Nelson
KE
,
Sergueef
N
,
Glonek
T
.
The effect of an alternative medical procedure upon low-frequency oscillations in cutaneous blood flow velocity
.
J Manipulative Physiol Ther
.
2006
Oct
;
29
(
8
):
626
36
.
[PubMed]
0161-4754
56.
Barnes
PL
,
Laboy
F
3rd
,
Noto-Bell
L
,
Ferencz
V
,
Nelson
J
,
Kuchera
ML
.
A comparative study of cervical hysteresis characteristics after various osteopathic manipulative treatment (OMT) modalities
.
J Bodyw Mov Ther
.
2013
Jan
;
17
(
1
):
89
94
.
[PubMed]
1360-8592
57.
Polidori
G
,
Kinne
M
,
Mereu
T
,
Beaumont
F
,
Kinne
M
.
Medical Infrared Thermography in back pain osteopathic management
.
Complement Ther Med
.
2018
Aug
;
39
:
19
23
.
[PubMed]
0965-2299
58.
Dørflinger
LH
,
Knudsen
JL
.
[An introduction to patient reported outcome measures in quality assessment]
.
Ugeskr Laeger
.
2015
May
;
177
(
19
):
V07140381
.
[PubMed]
1603-6824
59.
Lavallee
DC
,
Chenok
KE
,
Love
RM
,
Petersen
C
,
Holve
E
,
Segal
CD
, et al
.
Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care
.
Health Aff (Millwood)
.
2016
Apr
;
35
(
4
):
575
82
.
[PubMed]
0278-2715
60.
Fleischmann
M
,
Vaughan
B
.
The challenges and opportunities of using patient reported outcome measures (PROMs) in clinical practice
.
Int J Osteopath Med
.
2018
;
28
:
56
61
. 1746-0689
61.
Crump
RT
,
Liu
G
,
Chase
M
,
Sutherland
JM
.
Patient-reported outcomes and surgical triage: A gap in patient-centered care
.
Qual Life Res
.
2016
Nov
;
25
(
11
):
2845
51
.
[PubMed]
0962-9343
62.
Jenkinson
C
,
Morley
D
.
Patient reported outcomes
.
Eur J Cardiovasc Nurs
.
2016
Apr
;
15
(
2
):
112
3
.
[PubMed]
1474-5151
63.
Licciardone
JC
,
Brimhall
AK
,
King
LN
.Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials.BMC Musculoskelet Disord.
2005
; 4;6:43.
64.
Kim
JS
,
Zee
DS
.
Clinical practice. Benign paroxysmal positional vertigo
.
N Engl J Med
.
2014
Mar
;
370
(
12
):
1138
47
.
[PubMed]
0028-4793
65.
Fife
TD
,
Iverson
DJ
,
Lempert
T
,
Furman
JM
,
Baloh
RW
,
Tusa
RJ
, et al;
Quality Standards Subcommittee, American Academy of Neurology
.
Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology
.
Neurology
.
2008
May
;
70
(
22
):
2067
74
.
[PubMed]
0028-3878
66.
Cerritelli
F
,
Chiacchiaretta
P
,
Gambi
F
,
Perrucci
MG
,
Barassi
G
,
Visciano
C
, et al
.
Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study
.
Sci Rep
.
2020
Feb
;
10
(
1
):
3214
.
[PubMed]
2045-2322
67.
Wells
MR
,
Giantinoto
S
,
D’Agate
D
,
Areman
RD
,
Fazzini
EA
,
Dowling
D
, et al
.
Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson’s disease
.
J Am Osteopath Assoc
.
1999
Feb
;
99
(
2
):
92
8
.
[PubMed]
0098-6151
68.
Stanton
TR
,
Leake
HB
,
Chalmers
KJ
,
Moseley
GL
.
Evidence of Impaired Proprioception in Chronic, Idiopathic Neck Pain: Systematic Review and Meta-Analysis
.
Phys Ther
.
2016
Jun
;
96
(
6
):
876
87
.
[PubMed]
0031-9023
69.
Patel
KV
,
Phelan
EA
,
Leveille
SG
,
Lamb
SE
,
Missikpode
C
,
Wallace
RB
, et al
.
High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study
.
J Am Geriatr Soc
.
2014
Oct
;
62
(
10
):
1844
52
.
[PubMed]
0002-8614
70.
Hart
LG
,
Deyo
RA
,
Cherkin
DC
.
Physician office visits for low back pain.
Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976).
1995
1;20(1):11-9.
71.
Carnes
D
,
Mars
T
,
Plunkett
A
, et al
A mixed methods evaluation of a third wave cognitive behavioural therapy and osteopathic treatment programme for chronic pain in primary care (OsteoMAP). Int J Osteopath Med
2017
; 24:12e7.
72.
Nanke
L
,
Abbey
H
.
Developing a new approach to persistent pain management in osteopathic practice. Stage 1: A feasibility study for a group course
.
Int J Osteopath Med
.
2017
;
26
:
10
7
. 1746-0689
73.
Lederman
E
.
A process approach in osteopathy: beyond the structural model
.
Int J Osteopath Med
.
2017
;
23
:
22
35
. 1746-0689
74.
Higgins
JP
,
Altman
DG
,
Gøtzsche
PC
,
Jüni
P
,
Moher
D
,
Oxman
AD
, et al;
Cochrane Bias Methods Group
;
Cochrane Statistical Methods Group
.
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
.
BMJ
.
2011
Oct
;
343
oct18 2
:
d5928
.
[PubMed]
0959-8138
75.
Jadad
AR
,
Moore
RA
,
Carroll
D
,
Jenkinson
C
,
Reynolds
DJ
,
Gavaghan
DJ
, et al
.
Assessing the quality of reports of randomized clinical trials: is blinding necessary
.
Control Clin Trials
.
1996
Feb
;
17
(
1
):
1
12
.
[PubMed]
0197-2456
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