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Volume 1, Issue 2
Article Type: Research Article

What’s next? The views of older Australian physiotherapists around retirement age

Ann Binoj; Rose Boucaut*; Caroline Adams; Janette Young

Bachelor of Speech Pathology, University of South Australia, Adelaide SA, Australia

*Corresponding author:  Rose Boucaut
University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
Email ID: rose.boucaut@unisa.edu.au
Tel: +61-0403-990-355

Received: Oct 11, 2025
Accepted: Nov 03, 2025
Published Online: Nov 10, 2025
Journal: Annals of Gerontology and Geriatrics
Copyright: Boucaut R et al. © All rights are reserved

Citation: Binoj A, Boucaut R, Adams C, Young J. What’s next? The views of older Australian physiotherapists around retirement age. Ann Gerontol Geriatr Res. 2025; 1(2): 1026.

Abstract

Background: The physiotherapy profession has an ageing workforce as well as an increasing demand for clinical expertise. Exploring how older physiotherapists perceive retirement may contribute to understanding how their skills and expertise could be harnessed as part of managing impending physiotherapy workforce shortages in Australia; such information is currently sparse in the literature.

Method: This qualitative descriptive study design, explored the views of South Australian physiotherapists in regard to their impending retirement or their new lifestyle after retirement. Participants were engaged in semistructured interviews conducted, recorded and transcribed using Zoom and Otter. Recruitment was chiefly via snowball sampling. Participants were above 55 years of age, with internet access, and were registered and practising in Australia within the prior five years The interviews transcripts were thematically analysed.

Results: Nine physiotherapists participated in the study; eight women and one man. Four key themes were: identity, flexibility, staying relevant and giving back. Insights from this study suggest that maintaining relationships within their profession, staying engaged after retirement and transferring non-clinical skills to the community facilitated a successful transition to retirement.

Conclusions: Older physiotherapists are rich in knowledge and experience and are willing to pass their experience to the new generation of physiotherapists. The study uncovered ways in which the profession can enhance retention, minimise shortages and overall become future ready.

Keywords: Retirement; Physiotherapy; Health workforce.

Background

Internationally, an ageing population with reducing birthrate, has social and economic implications for the community and in particular for older workers and for the labor market [1]. In more than half the Organization for Economic Co-operation and Development (OECD) countries the future retirement age is increasing [2]. Due to the imminent exit of the Baby Boomer population from the workforce, it is predicted that employers will experience a considerable loss of knowledge and skills. The loss of skilled workers poses employers with a new challenge of how to retain this valuable knowledge and transfer it to the younger workforce [3] Where older staff remain in employment, workplaces also face the challenge of how best to manage these older workers [4]. Working beyond retirement age (65 years old) in Denmark was found to be facilitated by good pyscho-social work environment while high physical work demands was a barrier [5].

One sector that is set to see a significant staff shortage is healthcare, with the World Health Organisation (WHO) in their “Global strategy on human resources for health: Workforce 2030” predicting a shortage of 10 million healthcare workers by 2030 [6]. This gap is set to be exacerbated by the ageing population and increased burden of chronic disease in the community and the resulting demand for health services [7]. In the wider workforce, the number of older workers 55-64 years is increasing and set to equal 25% of the workforce globally by 2020 [8].

The healthcare workforce itself is ageing, giving rise to issues of staff retention, for example regarding the nursing workforce in Ireland, Ryan et al [9] reported the need for workforce planners and policy makers to focus on supporting older nurses to remain within the workforce.

In 2022, the health workforce in Australia represented 5% of the total employed workforce, with more than 688,000 healthcare professionals working in their registered professions. The health workforce was predominantly female (74% in 2022), with Nursing and Midwifery the largest professional group (372,800). There were 111,900 Medical practitioners and 180,900 Allied Health practitioners [10]. Physiotherapy is a large Allied Health workgroup in Australia. In 2023/4 there were 44, 895 physiotherapists in Australia [11]; 13.5% of physiotherapists were aged between 45-59 years old, and small proportion (4.9%) were in the 55-59 age bracket.

In the context of anticipated health workforce shortages, Bittman and colleagues [12] noted there is a need to focus on workers aged 45 years and beyond as one of the key responses by Australian government. There is a predicted increase in demand for physiotherapists with an expected 24.6% growth in available jobs by 2024 [13]. Hence there is a need to actively seek to retain experienced physiotherapists for their clinical skills and their capacity to mentor the next generation of graduates [13]. This study investigated older physiotherapists’ transition to retirement considerations.

The transition from work to retirement has been previously researched and three theoretical models have been identified to best describe patterns that individuals have in this transition. These theories are Atchley’s continuity theory of ageing, Merton’s role theory, and Elder’s life course perspective theory [14-16]. Continuity theory suggests that individuals can adapt successfully to their retirement if they develop relationships, a framework of thinking and adaptive skills during their professional career [17]. By using these attributes, they are able to maintain continuity and transition to retirement in a positive way. Role theory views a person’s career as their role, with the transition to retirement conceptualised as exiting from one role and moving to another [15]. This theory sees retirement as a loss of role identity, suggesting a linear relationship between how connected an individual is to their professional identity and difficulty transitioning to retirement [17]. From role theory [19] investigated how role identity, either work related or not work related, influences the transition to retirement. In contrast, the life course perspective theory considers the individual’s work, family, health and leisure as three interconnecting factors that contribute to the development of attributes that are key in facilitating a smooth transition to retirement [16]. It suggests that those who have addressed previous life transitions well, will have developed attributes for adaption, and in turn experience a smoother transition from work to retirement [17].

Transition to retirement also impacts an individual’s perceived identity. Retirement can be perceived by some individuals as a loss of meaningful work, social interaction and ultimately, their professional identity [18-20]. An American study found that older adults anticipated positive changes in their identities before retiring, however, after retirement these changes were less positive [21]. When employees are highly committed to their jobs, the loss of this aspect can cause a significant disruption to identity [21]. An Australian survey of musculoskeletal physiotherapy professionals in private practice found high levels of job satisfaction, with a mean score of 41.9 out of 50 [22]. High levels of job satisfaction may result in physiotherapy professionals having higher levels of organisational commitment and increase their chances of experiencing negative identity changes when considering retirement.

Whilst transition to retirement and retirement decisionmaking has been explored in other health professions, there is a gap in the research in terms of allied health. Opportunities for post-retirement contribution amongst nurses in the Northern Territory of Australia have been explored, introducing options aside from clinical work. The term ‘working retired’ was highlighted with an emphasis on employers sourcing significant ways in which the older nursing workforce could stay engaged and retain their skills through mentoring, assisting or management roles [23]. Retirement patterns of Australian doctors were investigated and showed retention rates among older doctors to be poor [24]. High workload and feeling unsupported pushed many senior doctors to retire, however, high job satisfaction was a major factor contributing to prolonged retention of the older workforce [24].

In their scoping review of retirement factors and strategies to prolong working, Wilson et al [25] called for further qualitative investigation for in-depth understandings of early retirement influences. The ageing physiotherapy workforce combined with the increasing demand and subsequent need for professionals warranted investigation into this population. The current study investigated the perceptions of older physiotherapists, requiring them to frame their perceptions on their transitions to retirement. Exploration of their decision-making could help identify trends in workplace practices and help to understand how older physiotherapists view their pathways to retirement. Knowing reasons for leaving the labour market (for example, push and pull factors), may assist in the prevention of early labour market detachment [26]. Further, the outcomes of the current study could be used to inform employers about how best to support older physiotherapists to possibly ease the increasingly higher demands in health care.

Methods

The research question posed in this study was: What are the perceptions of older Australian physiotherapists on their transition to retirement? Ethics approval for this study was obtained from the University of South Australia’s Human Research Ethics Committee (Project #205093) prior to commencement.

Research design

A qualitative descriptive design [25] was used to gather rich primary data, via interviews, from older physiotherapy professionals. Utilising a single case study design allowed for a naturalistic insight into the ways in which individuals perceived their retirement and gave each participant the opportunity to tell their story [27]. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Appendix) was used as a guide to aid in comprehensively conduct the study and report the results [28], adding to the rigour of the study.

Pilot interviews

The first author, a female speech pathology student in her fourth year of study, was given interview training from the three other members of the research team through mock interviews.

The pilot interviews enabled the first author to become familiar with the process and develop interviewing skills. Interview questions were also refined in this process and the order of questions was adjusted to improve the flow of questions and allow for a natural conversational style of interviews.

Recruitment

Initially, participants were purposefully recruited via the second author’s personal network and were physiotherapy professionals who were nearing retirement. Snowball sampling was then used to identify additional information-rich participants from other interviewees’ networks [29]. All participants resided in South Australia. Potential participants were sent an email from the second author on behalf of the first author inquiring about their willingness to participate. A total of thirteen physiotherapists agreed to be involved and were emailed by the first author with information about the project. Of the thirteen candidates, four did not meet the study inclusion criteria and were excluded from participation. Inclusion criteria included: above 55 years of age, cognitively able to participate, had internet access, registered and practised in Australia in the last 5 years, and located in Australia (Table 1). The four people excluded did not meet these criteria as they were not registered in Australia within the last 5 years. There was no relationship between the participants and the principal investigator prior to this research and the participants were aware of the occupation of the first author and the information on the participation sheet prior to the interviews.

Table 1: Inclusion and exclusion criteria.
Inclusion Exclusion
Over 55 years of age Under 55 years of age
Cognitively able to participate Health condition affecting participation
Has internet Access No internet access
Physiotherapists who were registered and practiced in Australia in last 5 years Not registered and practiced in Australia in last 5 years
Located in Australia Not located in Australia

Data collection

A semi-structured interview guide with seven guiding questions and several probing questions was developed in collaboration with the research team. Interviews were conducted via Zoom by the first author with only the first author present during this time.

Questions covered why participants chose a career in physiotherapy, thoughts on retirement, factors influencing their decision to retire, actions taken to retire and feelings around retirement. A semi-structured interview guide allowed the researcher to develop new questions in response to the participant’s answers. All participants provided informed consent prior to the interviews being conducted. Interviews were audiorecorded and transcribed using Zoom and Otter software and the transcriptions were cross-checked by the researcher with audio recordings. The interviews lasted between 15 to 45 minutes and each participant was interviewed once. No field notes were made during or after the interviews.

Data saturation was achieved by the eighth interview as additional data was not generating any new themes [30]. One more pre-scheduled interview was conducted, and it confirmed key ideas that emerged from prior interviews. Interview transcripts were reviewed individually by the first and second authors. These finalised transcriptions were then sent back to the participants for review, giving them the opportunity to confirm their responses. Five transcripts were returned to the author with minor changes and some information needed to be removed prior to analysis as requested by one of the participants.

Data analysis

Theming was completed with the whole research team to improve trustworthiness and maintain rigour. Inductive thematic analysis was conducted to find and cluster common ideas that were consistent across the data set [31]. Informed by Braun and Clarke [31] the six-phase approach to thematic analysis was undertaken over the course of multiple theming sessions with the whole team. These six phases are familiarisation with data, generating initial codes, searching for themes, reviewing potential themes, defining and naming themes and producing the report [31]. Themes were discussed, participants were given pseudonyms and visual representations were made to get a deeper understanding of the data set. A visual depiction of the themes, alongside a copy of the results and discussion were sent to all participants for review. Five participants wrote back, acknowledging the relevance of the themes, with one participant suggesting minor amendments that have been made.

Results

Nine participants, eight women and one man, at varying stages of their retirement were interviewed. Data was categorised into four themes: Identity, flexibility, staying relevant, and giving back and nine sub-themes

Table 2: Themes and subthemes.
Themes Sub-themes
Identity Structure in the day
Identified as a physiotherapist for their whole career
Grief and loss
Flexibility Organisation level
Increased work-life balance
Staying Relevant Staying connected
Preserving experience
Valuing older workers
Giving Back Mentoring and teaching younger physiotherapists
Volunteering

Theme: Identity

All participants acknowledged the effect that retirement had on their identity. Physiotherapy has shaped their lives since they began practising (up to 50 years ago) and with their transitions to retirement, they were all able to find ways to maintain characteristics of the profession whilst embracing new identities.

Structure in the day

Full-time work gave structure to the day and the professionals automatically know what is on their agenda for the day – commonly going to work for 8 hours and filling the surrounding time with housework or leisure activities. This becomes a pattern and is almost second nature after an extended amount of time. Retirement poses a challenge to individuals when it comes to day-to-day activities as it means that there is less structure in the day. Daniel, who had retired from clinical work, illustrated this, “I know when I stopped working at that practice, it took me a good two years to get out of the pattern of going to work.” This poses a question of what to do with the time that was previously spent working, as Daniel said, “What do I do today? I don’t know what to do”.

Physiotherapists who were still working validated this idea, expressing that going to work gave them structure in their day. Mary stated, “It [working] gives me structure in my life. I’ve got quite a well-planned week, and I think structure is important for people. I think people lose the plot when they haven’t got any structure.” Her response also emphasises the psychological element that comes with losing the particular schedule that was followed for many years. Jane supported this, saying “It’s work that fills the time and there is a real reason to keep working, to make yourself get out of bed in the morning. If you have no real compulsion to achieve anything in that particular day, it’s very easy to procrastinate and not to do it.” These responses highlight the role that structure has in an individual’s productivity and the real extent to which professionals rely on this structure to direct their days.

Identified as a physiotherapist their whole career

Working in the same profession for a whole lifetime shapes an individual’s identity, and over time professional and personal identity tend to meld into one. The participants all shared how working as a physiotherapist over a long period of time shaped their identity in some way. Jane stated, “That’s [being a physiotherapist] absolutely that’s your identity. That’s been my identity for probably 40-something years.” From the beginning of her career until now, her career has shaped the way she perceives herself and how she is perceived by others.

Practising for a long period of time means that characteristics of being a physiotherapist stuck with participants after they had retired, as Linda expressed, “I thought I’d really miss it, because I feel I feel I was partly defined by my work”. Debra, who had also retired from clinical work stated, “I still identify as a physio”, emphasising that even after retirement, this longrunning identity remains. Physiotherapists’ identities that they carried for decades are not something that they were quick to leave behind after retirement, as Linda summed up “I will never stop looking at people and their gait, and how they move and the asymmetries”.

Grief and loss

Loss of this identity as a physiotherapist came with significant grief for participants. Losing structure and character that had been a constant for many years posed significant challenges. Some participants whom had already retired, did not like using the word retired, as Daniel said, “I didn’t admit that I had retired.” The word ‘retired’ often comes with negative connotations and this negative self-perception may have led to a sense of loss and grief [32]. Daniel further emphasised this sense of loss, “…there was a feeling of emptiness.” Jane spoke about the mental toll that comes with this loss of identity “… [it is] psychologically jarring to go for decades and decades in a role that just one day stops.”

Theme: Flexibility

Participants emphasised the importance of flexibility when it came to the transition to retirement. Flexibility was identified to be a part of their working lives and their lives outside of work.

Organisational level

Flexibility within organisations was a crucial factor when it came to easing the transition to retirement. Many of the participants approached their journey to retirement by reducing their hours at work and dropping into part-time positions. Linda stated, “I’ve been extremely lucky to be able to slowly [retire]”. This slow transition was possible due to employers and organisations being flexible in offering capacity for older workers to gradually reduce their work hours. This flexibility is important in easing this transition as Linda expressed “…getting flexible hours is probably the most important thing for an older worker”.

When asked about how employers could best support this transition, participants highlighted the need for this flexibility. Jane spoke about the importance of organisations offering parttime options “Maintain a workforce so that they can actually still engage older workers on a different level on a part-time basis.” Jackie further supported this and said, “I think, allowing people to gradually reduce their hours [is] probably the best thing that people could be offered…” Betty stressed that this was the reason why she stayed practicing for a long time “… flexibility has been something that has been a wonderful part of keeping me in my career”.

Work-life balance

Part-time work also gave the physiotherapists an increased work-life balance. Continuing to work in a reduced capacity ensured that they were able to stay connected with the profession and maintain engagement whilst also having time to enjoy leisure activities. Jane expressed “I’ve got a really good combination of work and life”.

Theme: Staying relevant

Staying relevant was very important to the participants and they emphasised the significance of staying connected with their profession after retirement and were eager to preserve their skills and experience.

Staying connected

A sense of connectedness was important in maintaining relevance to the physiotherapy profession. Although some participants had already retired from clinical work, the need to stay engaged and connected was important to facilitate this transition. Jane stated, “There is a real need to have some form of engagement that makes you get out of bed.” Such engagement is necessary to enable older workers to maintain a sense of identity and give them motivation throughout this transition.

Additionally, this connectedness allows them to have meaningfulness as identified by Jane. She highlighted “There’s gotta be that vibrancy and…meaningfulness. You’ve got to stay relevant…people will treat you the way they perceive you.” Many of the participants maintained this ‘vibrancy’ by staying connected to physiotherapy. Betty summarised this sentiment saying “It [staying connected] certainly keeps me interested, keeps me learning. It keeps me feeling valued. It keeps me rewarded.”

Preserving experience

Another important aspect of staying relevant to the profession post-retirement is preserving and using all the experience that was gained while working. The participants were all practising as physiotherapists for decades and as such have an abundance of experience. As Lynn expressed “…to be honest, they can’t buy my experience. I probably have 20 more years’ experience than anyone else where I’m working.” Jane described the older, experienced physiotherapists retiring as “a huge waste of human resource[s].” All their life experiences contribute a large amount of knowledge and wisdom that can be used and shared and neglecting all the experience means that it all “just dies”.

This experience is highly valuable, and many participants wanted to preserve this experience and pass it on to the next generation. People often sought help from the experienced physiotherapists, as Jane said “People still want you. You know you’ve got that expertise in that experience that they can still use.” This applies to both clients and younger physiotherapists who can learn from the older workforce. Betty emphasised, “I’m working to pass on a legacy to the next generation so that they can… have some skills that I’ve gained”. Passing on their experience gives the professionals a way to maintain engagement with the profession.

Valuing older workers

Participants highlighted the importance of valuing older workers in the profession and how it helps them stay relevant. Linda stated, “I think older people should never be undervalued”. Workplaces tend to underestimate older workers, however, Linda expressed, “I think we’re more reliable, our work ethic is different.” Debra adds, “There’s a lot of talent that could be used…I think we should be a lot more seen in a society”, further emphasising that older workers have a lot of skills that should be valued and appreciated.

Theme: Giving back

Throughout the participants’ careers as physiotherapists, they were always giving back to society by helping their clients. As they began their transitions to retirement, they hoped to maintain this characteristic and give back to society in other ways.

Mentoring and teaching younger physiotherapists

Mentoring younger physiotherapists is a way that some participants identified as being able to give back to the profession. Daniel stated that after retirement, he was “like a mentor in that practice and a coach telling people how to do certain things… I had this enormous length of experience in…physiotherapy”. He is also an active member of the mentoring programmes offered by the Australian Physiotherapy Association. Debra further emphasised this as she said, “I think some people might even be prepared to work without getting paid, if they can get on a consultant role or like a mentor [role] …a lot of people seem really interested in giving back to the younger people.” Practises can utilise their older workers in mentoring roles, as Betty stated “supporting them [junior staff]…show[s] young ones that there is a pathway that can last quite a long time…” Daniel summarised the emotions helping others stirred up, “I do get a great deal of joy when someone asks me for help, and I can help them and they come back and thank me. My purpose in life is to gain joy and happiness from sharing my experiences in life.” Continuing to share his experiences through mentoring allows him to give back and be fulfilled after retirement from clinical work.

Teaching at university is another way in which older physiotherapists choose to give back professionally. Betty has maintained a long-term teaching role at a university in South Australia, alongside educating some physiotherapists who came from overseas and are seeking support with building their careers. The older workforce is actively looking for ways to give back to the younger generation, as Linda said, “I’m happy to share my knowledge…” Giving back and sharing skills benefits everyone, as Betty emphasised, “I’m trying to spread the ripple effect and give back”.

Volunteering

This characteristic of giving back to society extended after retirement, with some participants choosing to volunteer. Volunteering is a common path that older workers often take after retirement. Lynn expresses “I see volunteering as a huge advantage because I just think there’s so much need out there.” Although she is still working part-time, she engages in volunteer work with her church as a way to contribute outside the profession. Linda also belongs to a volunteer group of an aged care facility, preparing meals for residents. As physiotherapy professionals who have helped people for decades, they are able to help others in a different capacity.

Discussion

This study aimed to understand the perceptions of older physiotherapy professionals around their approach to retirement. Investigating their insights can assist in understanding how to aid in smoother transitions to retirement for physiotherapy professionals, along with presenting strategies to alleviate workforce shortages in Australia. Four main themes were uncovered from the data – identity, flexibility, staying relevant and giving back. These key themes were connected throughout their careers as physiotherapists and continued to tie into their retirement plans.

Although all theoretical models discussed previously were partially relevant, Atchley’s continuity theory is the theoretical model which best describes the data collected from this study [14]. According to continuity theory, the successful adaption to retirement seen amongst the participants of this study was due to the relationships they had built, their participation in activities, their framework of thinking and adaptive skills developed during their professional careers [14]. All nine of the participants had positive thoughts about their transition to retirement and those who were still working possessed an optimistic attitude when it came to their roles post-retirement. Physiotherapists possess certain attributes that make them successful in their practice. A 2021 study investigated the characteristics of a ‘good’ physiotherapist and found six overarching qualities. These qualities were being responsive, ethical, communicative, caring, competent and collaborative [33]. As a physiotherapist, the ability to nourish positive relationships with clients and colleagues is a key skill in successful practice. Building these relationships highlights the person-centred nature of this role and gives the clinician skills to make links not just in the workplace, but throughout their lives [34]. As such, these results indicate that a smooth transition to retirement among physiotherapists is dependent on skills developed during their careers, and the maintenance of these skills post-retirement.

Older physiotherapists in this study sought to still contribute to the workforce as they approached retirement and to maintain links to their professional identities. These links, whether they were mentoring, working part-time or volunteering kept these participants vibrant, valued and rewarded as they entered the next stage of life. This aligns with the concept of the ‘encore career’ for medical doctors described by Wijeratne and Earl. [20] and Voit and Carson’s [23] concept of ‘working retired’, a notion they identified from interviewing nurses in the Northern Territory (Australia) who sought work in non-clinical roles after retirement. Being a ‘working retired’ individual provides a smoother transition for older workers and can also provide a way to enhance healthcare delivery in Australia and retain a skilled workforce.

With many of the participants willing to maintain links with the profession, this raises the question of how the profession can best support them. According to The Organisation for Economic Co-operation and Development [35], the employment rate for older workers aged 55-64 years grew from 41.6% in 2000 to 62.1% in 2015. This statistic supports the data obtained from this study, as older physiotherapists chose to continue working beyond their traditional retirement age. Organisations need to recognise and value the skills and knowledge base that have been accumulated by practitioners over the years [36,37]. Offering flexible working arrangements and opportunities for mentoring roles can be a strategy to retain the older workforce and preserve knowledge. The ability to gradually reduce work hours and retain connection through part-time roles was identified by participants, as it eases the transition to retirement. Flexible arrangements, such as non-clinical mentoring roles for older workers are also beneficial for younger workers, as they can learn valuable skills from those with vast experience and knowledge. These strategies not only benefit the older workforce as they approach retirement, but they also address the healthcare workforce shortages in Australia.

The results of this study also provide a roadmap for older physiotherapy professionals who are beginning to plan their retirement. Collaboration and networking between older physiotherapists can allow them to identify their strengths and build connections with one another to find the best ways they can give back. Mutual support among older physiotherapists can also facilitate a more graceful transition, lightening the emotional load and feelings of grief and loss associated with retirement. This collaboration, networking and mutual support among physiotherapists allows them to apply their full potential and contribute to the enhancement of the healthcare system and to society as a whole.

Limitations

The small, purposefully chosen sample of this study was a strength, however, could also be seen as a limitation as results may not be transferrable across a larger cohort of older physiotherapists. There is scope for pursuing quantitative research based on these qualitative findings. Participants in this study were all from one state of Australia and hence future research could be expanded within and beyond Australia. The female, Anglo-Australian-dominated profile of physiotherapists was reflected in the profile of the participants, however, further studies could aim to recruit a more gender and ethnically diverse cohort [38].

Conclusion

This study shone a light on the considerations of older Australian physiotherapists as they navigated their transition to retirement. Key themes were found to profoundly impact their decisions as all participants strived to maintain links to the profession. The physiotherapy profession can harness the valuable skills of its older workforce to support newer practitioners through mentoring roles. The insights from this study offer valuable guidance for both professionals and the healthcare industry in navigating challenges and brings to light opportunities that retirement presents for older physiotherapists.

Declarations

Conflicts of interest and funding: None declared. No funding, from any source.

Previous presentation at a scientific meeting: This article has not been presented at any scientific meeting.

Acknowledgements: We thank Ms Linya Chi, Research Assistant, with final preparation of this manuscript for publication.

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