Technological Resources for Physical Rehabilitation in Cancer Patients Undergoing Chemotherapy: A Scoping Review.

1. Introduction

Cancer continues to be a leading public health challenge worldwide, with an estimated 20 million new cases and 10 million deaths reported in 2022 alone, according to GLOBOCAN [ 1 , 2 , 3 ]. By 2040, global cancer incidence is expected to rise to 29.9 million cases annually, with over 70 million people living after cancer, which will place an increasing burden on healthcare systems and affect the long-term well-being of survivors [ 3 , 4 , 5 ]. As the number of cancer survivors grows, the long-term effects of both the disease and its treatments become more critical to address.

Chemotherapy, despite advances in cancer treatment, remains a common therapeutic approach, either used alone or in combination with targeted and immunotherapeutic agents [ 6 , 7 ]. Unfortunately, chemotherapy exposes patients to a range of adverse effects, increasing morbidity and treatment costs while negatively impacting health-related quality of life (HR-QOL), and may limit the administration of future treatments, potentially affecting long-term outcomes [ 6 , 7 , 8 ].

Comprehensive care is critical for cancer patients during treatment, as prolonged periods of inactivity and the disease itself can result in fatigue, peripheral neuropathy, nausea, cardiotoxicity, cognitive impairments, and overall functional decline [ 7 , 9 ]. These effects often persist long after treatment, causing long-term functional challenges in returning to normal life, work, or independent living [ 10 ]. Although supportive care interventions address some of these effects, many remain difficult to manage, emphasizing the need for continuous improvements in mitigating chemotherapy-related side effects [ 7 , 8 ].

In these context, physical rehabilitation plays a crucial role in helping patients maintain or regain functionality during cancer treatment [ 10 , 11 ]. Exercise has shown substantial benefits, including improved mental health, reduced fatigue, and enhanced well-being, with guidelines recommending at least 150 min of aerobic activity and 2–3 resistance sessions per week during and after treatment [ 12 ].

Despite these benefits, several factors have been identified as barriers to exercise, including cancer therapy-related side effects, kinesiophobia, lack of access to tailored facilities, and individual health beliefs and preferences [ 13 ]. In recent years, digital technological advancements have introduced new possibilities for health [ 14 , 15 , 16 ]. As digital technologies advance, becoming smarter and interconnected through wireless communication, unimaginable possibilities open for the advancement of science, health, and rehabilitation [ 15 ].

In this setting, technologies such as mobile health applications, wearable devices, telerehabilitation platforms, and virtual reality systems are designed to remotely monitor, guide, and support physical activity and symptom management [ 17 , 18 , 19 ]. These tools enable patients and healthcare providers to engage in rehabilitation programs more efficiently, offering personalized feedback, progress tracking, and symptom management, often in real time [ 15 , 16 ]. However, despite the growing interest in digital health interventions within oncology, the scope of available technological resources for physical rehabilitation in cancer patients undergoing chemotherapy remains unexplored [ 18 , 20 ].

While existing studies suggest that mobile health applications and tele-rehabilitation tools can enhance self-management and symptom control in cancer patients, a comprehensive map of these technologies is necessary to identify trends and gaps in the literature [ 18 , 21 ]. This scoping review aims to map the available technological resources for physical rehabilitation in cancer patients undergoing chemotherapy, highlighting areas where further research is needed to optimize the use of technology in cancer care.

2. Materials and Methods

A scoping review was carried out to explore the current body of scientific literature, following the guidelines established by the Joanna Briggs Institute (JBI) [ 22 , 23 ]. The PRISMA-ScR framework (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) was utilized to ensure systematic organization and transparency throughout the research process, as outlined in the PRISMA-ScR guidelines [ 22 , 24 , 25 ]. The review protocol was also registered on the Open Science Framework ® platform, with the following https://doi.org/10.17605/OSF.IO/RV795 .

2.1. Research Method

The research question was developed using the Population, Concept, and Context (PCC) framework, as outlined by the Joanna Briggs Institute [ 23 , 25 ]. The study focused on adults over the age of 18 who were cancer patients undergoing chemotherapy (Population), participating in physical rehabilitation programs (Context), and using technological resources (Concept). These criteria guided the selection of studies for the bibliographic sample, with search terms derived from this framework. To ensure broad coverage, the search included both free terms and database-specific descriptors. The search strategy was tailored for each database using English-language descriptors and syntax customized to the following platforms: MEDLINE ® , CINAHL ® , Scopus, SPORTDiscuss, and COCHRANE. A combination of medical subject headings (MeSHs), subject headings, and free-text terms was employed, enhancing the search’s comprehensiveness ( Appendix A Table A1 ). Additional articles were manually added by examining the reference lists of all publications included in the review, a method referred to as “backward citation searching”. The literature search was carried out to include studies published up to 31 March 2024, with no time restrictions.

2.2. Eligibility Criteria

The inclusion and exclusion criteria were established based on the PCC framework, focusing on the guiding question: What technological resources are available for physical rehabilitation in cancer patients undergoing chemotherapy? Sub-questions were posed to refine the focus, exploring which types of technologies are used, what functionalities they provide, and their feasibility or acceptability.

Studies were excluded if they focused on: individuals under the age of 18; patients receiving treatments other than chemotherapy; or programs focused solely on well-being, psychological support, behavior change, or symptom management instead of physical rehabilitation. Additionally, studies focused on the prehabilitation phase or cancer survivors post-treatment were excluded, as well as non-primary research (editorials, letters, reviews, gray literature, dissertations, and book chapters). Only primary research published in English, French, Spanish, or Portuguese was considered. Qualitative, quantitative, and mixed-methods studies were included.

2.3. Data Extraction

The search results from each database were imported into Rayyan ® software ( https://www.rayyan.ai , accessed on 14 August 2024), a web-based tool designed to assist in the systematic review process, to streamline the review process [ 26 ]. After removing duplicate references, two researchers (A.A. and C.S.F.) independently carried out the initial screening of titles and abstracts, applying the previously established inclusion and exclusion criteria. The full texts of the selected references were then obtained to finalize decisions on their inclusion [ 27 ]. Any disagreements regarding inclusion or exclusion were resolved by consulting a third researcher (B.A.) to reach a consensus.

Each selected article was assigned an identifier (S) based on the order of review. The PRISMA 2020 framework was used to organize the data and to ensure transparency and consistency throughout the screening and selection process [ 28 ].

2.4. Data Analysis

Data were collected using a customized extraction form, capturing the following details for each study: author, year of publication, and country; study design; study objective; participant characteristics; type of technology used; purpose; type of intervention; main instruments; and outcomes ( Table 1 ). Data extraction and synthesis were performed independently by two researchers (A.A. and C.S.F.), with a third researcher (B.A.) available to resolve any disagreements.

To provide a structured categorization of technological resources in healthcare, data were analyzed based on the “Classification of Digital Health Interventions v1.0” from the World Health Organization [ 29 ]. This framework provides a structured approach for describing digital technologies in healthcare, categorizing them into four key target groups: clients, healthcare providers, health system managers, and data services. For this analysis, we extracted information regarding the target group and type of technological resource used in each study, aligning it with the WHO classification.

A multi-input table was created to present the relationships between the types of technologies and their targets, functionalities, and primary objectives. Table 2 offers a comprehensive overview of technological interventions.

3. Results

A total of 624 articles were retrieved from the initial search across various databases. After removing duplicates, 572 articles remained for the initial screening based on title and abstract. Forty-five articles were selected for full-text review, including those identified through backward citation searching. Ultimately, 32 studies met the inclusion criteria for analysis ( Figure 1 ) [ 28 ].

A detailed summary of the included studies, including information on the authors, year and country of publication, study design, objective, population characteristics, technology type, objectives, interventions, measurement tools, and outcomes, is presented in Table 1 .

3.1. Characteristics of the Included Studies

Although there was no time limit set, the included studies span from 2013 to 2024 [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], with the majority published between 2018 and 2024 (S01, S03, S04, S05, S08, S09, S10, S11, S12, S13, S14, S16, S21, S22, S23, S26, S27, S29, and S31). The studies were conducted in various countries, highlighting the global interest in technological interventions for cancer rehabilitation. The most represented countries are the USA (S01, S09, S12, S13, S15, S19, and S29), Canada (S08, S10, S11, S24, and S27), and Germany (S04, S07, S12, and S17), with additional studies from every part of the globe (Brazil, Republic of Korea, China, Australia, Japan, France, Denmark, Sweden, Norway, and Turkey).

The study designs varied, with randomized controlled trials (RCTs) being the most common, used in nine studies (S04, S06, S09, S18, S19, S20, S22, S27, S31). This was followed by single-arm interventional studies, featured in eight studies (S01, S03, S09, S10, S12, S23, S29, S32). Pilot studies were conducted in five studies (S05, S08, S09, S10, S17), while feasibility studies appeared in four studies (S08, S11, S21, S32). Additionally, non-randomized controlled trials were used in two studies (S23, S30), and qualitative studies were included in two studies (S13, S14). The review also included one case report (S07) and two longitudinal observational studies (S15, S24).

The studies included in this review encompassed a diverse range of cancer patients, with populations varying in size, cancer type, and treatment phase. Most studies focused on patients undergoing chemotherapy at various stages of their treatment. A significant number of studies specifically targeted patients actively undergoing chemotherapy, including S01, S02, S04, S06, S08, S10, S11, S13, S15, S17, S18, and S19. Other studies included patients receiving multiple treatments, such as chemotherapy combined with other modalities (S03, S05, S07, S09, S12, S16, S20, S21, S23, and S32). A few studies focused on other treatment phases, such as cancer survivorship (S14, S24, S25). Sample sizes varied across the studies. The smallest study involved a single patient (S07), while the largest primary study included 112 participants (S25). Common cancer types were well-represented, including breast cancer (S01, S04, S05, S06, S12, S15, S18, S19, S21, S23, S27), colorectal cancer (S02, S09, S14, S23), lung cancer (S03, S08, S10, S13, S16, S22), multiple myeloma (S11, S13), and hematologic malignancies (S20, S32).

3.2. Characteristics of Technological Resources

Each technology in the reviewed studies was carefully implemented to address specific rehabilitation goals, including the promotion of physical activity, improvement of mental health, reduction in fatigue, and enhancement of quality of life for cancer patients during and after chemotherapy. The wide array of technological resources used in these interventions, such as wearable devices, mHealth applications, telerehabilitation platforms, VR, and AVGs, reflects the diverse approaches to supporting cancer rehabilitation. These resources can be systematically classified using the WHO Digital Health Intervention (DHI) v1.0 framework [ 29 ], which organizes interventions based on the target group—clients (e.g., self-monitoring and coaching), healthcare providers, or health systems. The majority of the interventions targeted clients, focusing on promoting physical activity, monitoring health parameters, and managing symptoms (DHI 1.1–1.4), as outlined in Table 1 [ 29 ].

Wearable devices emerged as one of the most widely used tools, particularly for monitoring physical activity, vital signs, and sleep patterns. According to the WHO DHI classification, these devices fall under DHI 1.2: Client-targeted monitoring interventions (S02, S07, S09, S15, S17-S24, S26-S29) [ 26 ]. For example, wearables like Fitbit (S09, S15) were commonly used to track steps and physical activity, while accelerometers such as the SenseWear (S22, S26) and ActiGraph (S29) provided continuous monitoring of physical activity and physiological metrics like heart rate and step count. Additionally, sports watches like the Polar V800 (S07) played a role in tracking exercise intensity during high-intensity training programs.

In conjunction with wearables, mHealth applications (apps) were frequently deployed to offer additional functionalities such as feedback, progress monitoring, and tailored rehabilitation programs. In studies like S02, S03, S04, S12, S13, and S16, these applications facilitated physical activity tracking and often included components such as dietary guidance, symptom management, and mental health support. These mHealth apps are categorized under DHI 1.1: Client-targeted digital interventions [ 29 ]. Notable examples include the PINK! app (S04, S12), which supported physical activity and provided nutritional and mental health guidance. Similarly, apps like GO-EXCAP (S13) and other smartphone-based applications (S16) facilitated exercise capacity tracking while offering psychological support to patients.

In addition to wearables and mobile apps, digital platforms (S01, S06, S08, S10, S11, S14, S25) enabled patients to participate in home-based rehabilitation programs, with real-time supervision and monitoring of physical exercises. These platforms, classified under DHI 1.4: Client-targeted support for rehabilitation and management, allowed healthcare providers to engage with patients remotely, offering interactive components that enhanced patient engagement and adherence to their rehabilitation programs [ 29 ].

Technologies also extended beyond monitoring and feedback into immersive environments such as VR-based interventions (S03, S32), which fall under DHI 1.4 [ 29 ]. These VR-based tools combined physical therapy with psychological support to improve both physical and mental well-being during cancer treatment.

AVGs were another innovative approach used in studies such as S05, S30, S31 and S32. Through exergames like Xbox Kinect and Nintendo Wii, patients engaged in gamified exercise programs aimed at improving endurance, strength, and functionality. These interventions are categorized under DHI 1.3: Client-targeted digital health education and training [ 29 ].

Furthermore, web-based platforms like the e-CuidateChemo platform (S08) and the Exercise Planning and Tracking (EPT) tool (S01) provided structured exercise programs for patients at home, mitigating physical decline associated with chemotherapy. These systems are classified as DHI 1.1: Client-targeted digital interventions for self-management [ 29 ], emphasizing their role in empowering patients to take control of their rehabilitation.

In summary, most of the studies ( n = 13) focused on client-targeted interventions (DHI 1.0), with the primary goal of promoting physical activity, monitoring symptoms, and managing rehabilitation remotely [ 29 ]. Table 2 provides a comprehensive overview of the technological resources used in these studies, their WHO DHI classifications, functionalities, and key findings.

3.3. Technological Functionalities

The technological resources employed across the studies served a wide range of functionalities, categorized according to the WHO’s DHI v1.0 classification [ 29 ]. A graphical representation of the technological resources and their functionalities is provided in Figure 2 , illustrating the distribution of technologies across different categories, including physical activity tracking, exercise programs, symptom management, and mental health support.

A primary functionality observed was “client-targeted tools for self-monitoring” of physical activity (DHI 1.2), predominantly using wearables. These devices, including Fitbits, accelerometers, and pedometers, were widely used to monitor exercise intensity, track steps, and assess physical activity levels across studies like S02, S03, S09, S11, S13, S16, S22, S23, S25, and S29. Increased adherence to physical activity guidelines was commonly reported with these tools. For instance, the use of Fitbits in S09 was associated with improved step counts and walking distance. Similarly, pedometers and activity trackers in S21, S23, and S25 were linked to enhanced physical activity levels and reductions in sedentary behavior.

Beyond monitoring, several technologies also supported structured exercise programs, classified under “client-targeted therapy” (DHI 1.1). Mobile Health applications (e.g., S02, S05) and telerehabilitation platforms (e.g., S08, S10, S13) allowed patients to engage in structured exercise regimens incorporating both strength and aerobic training. Notably, studies like S01, S06, S12, S18, S20, S30, and S31 demonstrated how web-based or interactive rehabilitation tools contributed to improvements in physical function, endurance, and muscle strength. Furthermore, exergaming technologies in studies such as S20, S30, and S31 provided engaging, interactive exercises, enhancing upper extremity functionality and shoulder mobility.

In addition to physical rehabilitation, several technological resources extended their functionalities to include symptom management and mental health support. For example, wearables in studies like S03 and S13 helped monitor symptoms such as fatigue and psychological distress, enabling patients to manage both the physical and emotional impacts of their treatment. Similarly, VR-based interventions (e.g., S03, S30) contributed not only to physical rehabilitation but also to the improvement of mental health outcomes, reducing anxiety and depression. The PINK! app (e.g., S04, S12) effectively supported mental well-being by reducing psychological distress and fatigue in breast cancer patients.

4. Discussion

This scoping review highlights the potential of technological tools to enhance physical rehabilitation in cancer patients undergoing chemotherapy. The 32 studies analyzed employed a variety of technologies, including wearable devices, mHealth apps, digital platforms (web-based apps and telerehabilitation), VR, and exergaming systems, with a predominant focus on client-targeted functionalities. These tools were found to address critical rehabilitation needs, such as improving adherence to physical activity protocols, enhancing functional capacity, and managing chemotherapy-related side effects.

Wearable devices, such as Fitbits and accelerometers (such as SenseWear, ActiGraph and sports watches), emerged as the most frequently used technology [ 31 , 38 , 44 , 45 ]. Primarily serving as self-monitoring tools (DHI 1.2), wearables tracked metrics like steps, heart rate, and sleep patterns. Real-time feedback provided by these devices was shown to improve adherence to physical activity guidelines. For instance, a study in 2022 [ 38 ] demonstrated that using Fitbit increased step count and walking distance in colorectal cancer patients during chemotherapy. Similarly, research conducted in 2019 [ 45 ] showed the effectiveness of SenseWear in tracking physical performance among advanced lung cancer patients. The feasibility and usability of wearables were consistently high across studies, with patients successfully integrating these tools into their daily lives. A 2017 study [ 44 ] found that the Fitbit Zip effectively supported real-time feedback on physical activity, helping patients meet recommended activity levels during breast cancer treatment. Patients showed strong adherence to wearable devices, finding them easy to use even during demanding chemotherapy cycles, as demonstrated in studies [ 31 , 44 ]. These wearables, particularly Fitbit and accelerometers, proved effective in promoting adherence to physical activity, which is essential for maintaining functionality during chemotherapy.

Similarly, mHealth applications and telerehabilitation platforms also demonstrated high usability. Platforms such as eChez-Soi and GO-EXCAP provided real-time feedback and personalized interventions, which patients found intuitive and motivating [ 37 , 42 ]. These tools helped sustain engagement and adherence, particularly when real-time feedback was incorporated into their functionality. However, advanced technologies like VR presented challenges, as access to devices and technological literacy posed barriers for some patients, as noted in studies [ 32 , 61 ].

The technologies evaluated in this review were largely suitable for cancer rehabilitation. Wearable devices were particularly effective in tracking physical activity, a critical component of rehabilitation during chemotherapy [ 31 , 44 ]. Telerehabilitation platforms provided a valuable solution for patients with limited mobility or those living far from treatment centers, as highlighted in studies [ 37 , 39 ]. These platforms enabled remote supervision and interaction with healthcare providers, allowing patients to participate in structured exercise programs from home. However, more complex technologies, such as VR and exergaming, proved more beneficial for younger or tech-savvy patients who were more familiar with gaming systems, as seen in studies [ 46 , 60 ].

Mobile health applications were widely used across studies to support structured exercise programs and symptom management. For instance, the PINK! app was particularly effective in reducing psychological distress and fatigue among breast cancer patients, while GO-EXCAP provided tailored, home-based exercise programs that promoted patient autonomy [ 41 , 42 ]. These applications, categorized as client-targeted interventions for self-management (DHI 1.1), addressed areas such as physical activity, nutrition, and mental health coaching, with high feasibility and engagement, even when patients experienced treatment-related fatigue [ 42 ].

Telerehabilitation platforms and web-based applications, as demonstrated in studies such as [ 36 , 37 ], enabled patients to receive remote supervision for their rehabilitation exercises. These platforms, classified under remote care interventions (DHI 1.1), allowed for real-time monitoring and provided feedback, which improved functional capacity and endurance. For example, the eChez-Soi platform [ 37 ] achieved high patient satisfaction and notable functional improvements, particularly among lung cancer patients who found it difficult to attend in-person rehabilitation sessions [ 39 ].

Virtual reality and exergaming systems were explored in four studies [ 32 , 46 ], offering a more interactive and engaging approach to rehabilitation. Virtual reality was shown to improve body composition and reduce fatigue, as demonstrated in one study [ 32 ], while exergaming systems (e.g., Xbox Kinect) used in [ 46 ] engaged patients in gamified exercises to enhance muscle function and increase physical activity levels. Although these technologies provided high levels of engagement, their adoption was limited by patient access and familiarity with the devices.

Across the studies, the feasibility of these technologies was consistently rated as high. Wearables like Fitbits and accelerometers demonstrated strong usability and adherence, while telerehabilitation platforms provided an accessible and flexible alternative to in-person rehabilitation. However, advanced technologies like VR faced challenges related to technological literacy and access, limiting their widespread adoption.

The findings of this scoping review align with previous studies that underscore the increasing role of digital health interventions in cancer rehabilitation. Wearable devices and mHealth applications, such as those used to monitor physical activity and manage symptoms, have demonstrated significant potential in improving patient adherence to rehabilitation protocols [ 17 , 18 ]. These technologies not only offer real-time feedback but also facilitate self-management, resulting in improved patient outcomes and satisfaction. However, the integration of more advanced technologies like VR poses challenges, including technological literacy and access [ 19 ]. Despite these barriers, VR has been effective in reducing symptoms such as anxiety, pain, and fatigue, emphasizing its potential in cancer rehabilitation. Furthermore, a study [ 62 ] has highlighted the importance of balancing the benefits of exercise programs with the potential risks, especially for patients undergoing systemic treatments. Addressing barriers and facilitators, as identified in another study [ 63 ], is crucial for ensuring broader adoption and success of digital health tools in oncology care.

Challenges and Limitations

This scoping review identified several challenges when analyzing technological resources for physical rehabilitation in cancer patients undergoing chemotherapy. A significant challenge was the diversity of technologies across the 32 included studies. Interventions ranged from simple wearables like pedometers and accelerometers [ 31 , 44 , 47 ] to advanced systems like VR and exergaming [ 32 , 59 ], as well as telerehabilitation platforms [ 37 , 39 ]. This diversity made it challenging to categorize and analyze the technologies due to differences in technological complexity and functionality. The technologies were classified using the WHO DHI framework to streamline the analysis.

Another challenge was the inconsistency in study designs, outcomes, and reporting. Some studies were large-scale trials [ 39 , 42 ], while others were smaller pilot studies or case reports [ 36 , 38 ], making direct comparisons difficult. Moreover, few studies provided detailed long-term adherence data, limiting insights into the sustainability of interventions. Although some studies [ 31 , 44 ] reported high adherence to wearables and mHealth apps, the lack of longitudinal data restricted a comprehensive understanding of their long-term impact.

Access to technology and digital literacy were also significant barriers. Advanced interventions, such as VR and telerehabilitation [ 32 , 46 ], posed challenges for older patients or those with limited technological experience. Additionally, telerehabilitation platforms [ 37 ] required reliable internet access, which was not always available for patients in rural or low-resource settings, further contributing to disparities in access.

Moreover, there was a lack of personalized interventions. Most technologies followed a standardized approach, which may not have addressed the individual needs of cancer patients. Only a few studies [ 38 ] offered tailored interventions based on patient preferences or abilities, and this lack of customization may have impacted patient engagement and outcomes.

Finally, limited evidence exists on the cost-effectiveness of these technological interventions. While the studies demonstrated the feasibility and usability of wearables and mHealth apps [ 33 , 41 ], none provided a comprehensive cost analysis. This absence of cost-effectiveness data raises concerns about the scalability and equitable application of these interventions in broader clinical practice.

5. Conclusions

This scoping review mapped various technological resources used for physical rehabilitation in cancer patients undergoing chemotherapy, including wearables, mobile-based applications, telerehabilitation, web-based platforms, virtual reality, and exergames. These technologies may have the potential to improve physical function, manage symptoms, and enhance quality of life. However, despite the positive outcomes in the short term, their long-term effectiveness remains uncertain and requires further validation through clinical trials. The diversity of tools such as mHealth apps (e.g., the PINK! app) and wearables like Fitbit illustrates the broad range of options available for cancer rehabilitation, though personalization and sustained engagement are areas that need enhancement. A key challenge identified was patient adherence, particularly due to factors such as fatigue and low motivation, which are common in patients undergoing chemotherapy. However, technologies that provided real-time feedback, such as wearables and specific mHealth apps, showed promise in improving engagement with rehabilitation programs. Future research should prioritize the development of more personalized interventions tailored to patients’ individual needs and preferences, which can improve adherence and optimize rehabilitation outcomes.

Additionally, evaluating the cost-effectiveness and accessibility of these technologies is crucial, especially for underserved and low-resource populations. Overcoming barriers to access, including digital exclusion, is essential to ensure that these technological resources are equitably available to all cancer patients, thus maximizing their rehabilitation potential.

Appendix A

Author Contributions

Conceptualization, A.A. and C.S.F.; methodology, A.A. and C.S.F.; software, A.A. and C.S.F.; validation, M.M., B.A., and M.C.F.; formal analysis, A.A. and C.S.F.; data curation, A.A. and C.S.F.; writing—original draft preparation, A.A.; writing—review and editing, C.S.F. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors are solely responsible for the content and writing of the paper. The authors report no conflicts of interest.

Funding Statement

This research received no external funding.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

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