***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A range of health care practitioners use cranial techniques . Palpation of a cranial rhythmic impulse ( CRI ) is a fundamental clinical skill used in diagnosis and treatment with these techniques . There has been little research establishing the reliability of  CRI rate palpation . OBJECTIVE This study aim ed to establish the intraexaminer and interexaminer reliability of  CRI rate palpation  and to investigate the " core-link " hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum . DESIGN Within-subjects , repeated- measures design . SUBJECTS Two registered osteopaths , both with postgraduate training in diagnosis and treatment , using cranial techniques , palpated 11 normal healthy subjects . METHODS Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject . Examiners indicated the " full flexion " phase of the CRI by activating silent foot switches that were interfaced with a computer . Subject arousal was monitored using heart rate . Examiners were blind to each other 's results and could not communicate during data collection . RESULTS Reliability was estimated from calculation of intraclass correlation coefficients ( 2,1 ) . Intrarater reliability for examiners at either the head or the sacrum was fair to good , significant intraclass correlation coefficients ranging from + 0.52 to + 0.73 . Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent , ICCs ranging from -0.09 to + 0.31 . There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum . CONCLUSIONS The results fail to support the construct validity of the " core-link " hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field Objectives : With growing evidence for the effectiveness of craniosacral therapy ( CST ) for pain management , the efficacy of CST remains unclear . This study therefore aim ed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients . Material s and Methods : A total of 54 blinded patients were r and omized into either 8 weekly units of CST or light-touch sham treatment . Outcomes were assessed before and after treatment ( week 8) and again 3 months later ( week 20 ) . The primary outcome was the pain intensity on a visual analog scale at week 8 ; secondary outcomes included pain on movement , pressure pain sensitivity , functional disability , health-related quality of life , well-being , anxiety , depression , stress perception , pain acceptance , body awareness , patients ’ global impression of improvement , and safety . Results : In comparison with sham , CST patients reported significant and clinical ly relevant effects on pain intensity at week 8 ( −21 mm group difference ; 95 % confidence interval , −32.6 to −9.4 ; P=0.001 ; d=1.02 ) and at week 20 ( −16.8 mm group difference ; 95 % confidence interval , −27.5 to −6.1 ; P=0.003 ; d=0.88 ) . Minimal clinical ly important differences in pain intensity at week 20 were reported by 78 % within the CST group , whereas 48 % even had substantial clinical benefit . Significant between-group differences at week 20 were also found for pain on movement , functional disability , physical quality of life , anxiety and patients ’ global improvement . Pressure pain sensitivity and body awareness were significantly improved only at week 8 . No serious adverse events were reported . Discussion : CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention Background To determine whether the complementary approach of visceral manipulative osteopathic treatment accelerates complete meconium excretion and improves feeding tolerance in very low birth weight infants . Methods This study was a prospect i ve , r and omized , controlled trial in premature infants with a birth weight < 1500 g and a gestational age < 32 weeks who received a visceral osteopathic treatment 3 times during their first week of life or no treatment .  Results Passage of the last meconium occurred after a median of 7.5 days ( 95 % confidence interval : 6–9 days , n = 21 ) in the intervention group and after 6 days ( 95 % confidence interval : 5 - 9 days , n = 20 , ) in the control group ( p = 0.11 ) . However , osteopathic treatment was associated with a 8 day longer time to full enteral feedings ( p = 0.02 ) , and a 34 day longer hospital stay ( Median = 66 vs. 100 days i.e. ; p=0.14 ) . Osteopathic treatment was tolerated well and no adverse events were observed . Conclusions Visceral osteopathic treatment of the abdomen did not accelerate meconium excretion in VLBW ( very low birth weight)-infants . However infants in the osteopathic group had a longer time to full enteral feedings and a longer hospital stay , which could represent adverse effects . Based on our trial results , we can not recommend visceral osteopathic techniques in VLBW-infants . Trial registration Clinical trials.gov : Inevitable subjectivity makes interexaminer reliability of manual assessment procedures a special matter of concern . The cranial concept ( CC ) , one aspect of osteopathy , deals with very subtle changes that have to be palpated . One of the main principles of the CC is the primary respiratory mechanism ( PRM ) , which is hypothesized to be a palpable physiological phenomenon that occurs in rhythmic cycles , called flexion- and extension-phase , which are independent from cardiac and respiratory rates . Palpation of the PRM is one of the first steps in assessment within the CC . An inter- and intraexaminer reliability study design for repeated measures was used in this study . Forty nine healthy subjects were palpated simultaneously twice , once at the head and once at the pelvis .  PRM-frequency ( f ) , the mean duration of the flexion phase and the mean ratio of flexion- to extension-phase were used as the main outcome measures . Inter- and intraexaminer reliability and correlations to the respiratory rates were analysed for all three parameters . Inter- as well as intraexaminer agreement could not be described beyond chance agreement , as the range within the 95 % limits of agreement ( e.g. for f=6.6 cycles/90 s ) for all cases resembled the total range of values ( e.g. for f=7 cycles/90 s ) that were produced . A significant effect of the examiners ' respiration was found for both examiners at the pelvis ( P=0.004 for one examiner , P < 0.0001 for the other examiner ) , and for one examiner only at the head ( P=0.0017 ) . No correlation could be found for the subjects ' respiratory rates . In conclusion , PRM-rates could not be palpated reliably and under certain conditions were influenced by the examiners ' respiratory rates . These results do not support the hypotheses behind the PRM . The role of PRM palpation for clinical decision making and the models explaining the PRM should therefore be rethought BACKGROUND The efficacy of osteopathic manual therapy ( OMT ) applications on chronic nonspecific low back pain ( LBP ) has been demonstrated . However , visceral applications , which are an important part of OMT techniques , have not been included in those studies . OBJECTIVE The study 's objective was to determine the effect of OMT including visceral applications on the function and quality of life ( QoL ) in patients with chronic nonspecific LBP . DESIGN The study was design ed with a simple method of block r and omization . METHODS Thirty-nine patients with chronic nonspecific LBP were included in the study .  OMT group consisted of 19 patients to whom OMT and exercise methods were applied . The visceral osteopathic manual therapy ( vOMT ) group consisted of 20 patients to whom visceral applications were applied in addition to the applications carried out in the other group . Ten sessions were performed over a two-week period . Pain ( VAS ) , function ( Oswestry Index ) and QoL ( SF-36 ) assessment s were carried out before the treatment and on the sixth week of treatment . RESULTS Both of the treatments were found to be effective on pain and function , physical function , pain , general health , social function of the QoL sub-parameter . vOMT was effective on all sub-QoL parameters ( p<0.05 ) . Comparing the groups , it was determined that the energy and physical limitations of the QoL scores in vOMT were higher ( p < 0.05 ) . CONCLUSION Visceral applications on patients with non-specific LBP gave positive results together with OMT and exercise methods . We believe that visceral fascial limitations , which we think cause limitations and pain in the lumbar segment , should be taken into consideration BACKGROUND This study aim ed to investigate whether the addition of visceral manipulation , to a st and ard physiotherapy algorithm , improved outcomes in patients with low back pain . METHODS Sixty-four patients with low back pain who presented for treatment at a private physiotherapy clinic were r and omized to one of two groups : st and ard physiotherapy plus visceral manipulation ( n = 32 ) or st and ard physiotherapy plus placebo visceral manipulation ( n = 32 ) . The primary outcome was pain ( measured with the 0 - 10 Numerical Pain Rating Scale ) at 6 weeks . Secondary outcomes were pain at 2 and 52 weeks , disability ( measured with the Rol and -Morris Disability Question naire ) at 2 , 6 and 52 weeks and function ( measured with the Patient-Specific Functional Scale ) at 2 , 6 and 52 weeks . This trial was registered with the Australia and New Zeal and Clinical Trials Registry ( ACTRN12611000757910 ) . RESULTS The addition of visceral manipulation did not affect the primary outcome of pain at 6 weeks ( -0.12 , 95 % CI = -1.45 to 1.21 ) . There were no significant between-group differences for the secondary outcomes of pain at 2 weeks or disability and function at 2 , 6 or 52 weeks . The group receiving addition of visceral manipulation had less pain than the placebo group at 52 weeks ( mean 1.57 , 95 % CI = 0.32 to 2.82 ) . Participants were adequately blinded to group status and there were no adverse effects reported in either group . CONCLUSIONS Our study suggests that visceral manipulation in addition to st and ard care is not effective in changing short-term outcomes but may produce clinical ly worthwhile improvements in pain at 1 year STUDY OBJECTIVE To estimate the feasibility of preoperative ultrasound evaluation of the umbilical region in patients undergoing laparoscopy with a previous history of abdominal surgery . DESIGN Prospect i ve study ( Canadian Task Force Classification II-1 ) . SETTING Department of Obstetrics and Gynecology Fatebenefratelli Isola Tiberina Hospital . PATIENTS Twenty-five women with a previous history of open abdominal surgery ( group A ) and a group of 22 women with no previous history of surgery ( group B ) underwent dynamic ultrasound evaluation of the umbilical field . INTERVENTION Ultrasound Slide-By test . RESULTS Patients were asked to take a deep inspiratory breath , which accentuated respiratory excursion . The movement of the intraabdominal contents in a vertical fashion in relation to the abdominal wall , referred to as the " viscera slide , " between the bowel and peritoneum was evaluated . Abdominal wall tissue thickness , Uracus to peritoneum thickness ( UTP , mm ) were also evaluated . Non parametric Mann-Whitney testing was used . No major demographic differences between the 2 study groups was noted . The abdominal wall tissue thickness was not significantly different between the 2 groups . The UTP was shorter in A group than in B group ( 1.5 + /- 0.3 mm vs 3.5 + /- 0.9 mm , p = .002 ) . Absence of the " sliding viscera " sign was observed in 16 patients in group A and in 1 patient in group B. Patients with an absence of the sliding viscera sign were found to have subumbilical fibrous adhesions during laparoscopy . CONCLUSIONS Evaluation of trocar insertion sites may be difficult and remains a challenge for peritoneal endosurgical access . We have shown that absence of the " sliding viscera " sign is more likely to be linked to subumbilical adhesions and represents a quick method for preoperative assessment . The UTP may also be a useful measurement , which requires further validation 
    Output:
    
The analysis of reliability studies shows that the diagnostic techniques used in visceral osteopathy are unreliable .
Conclusions The results of the systematic review lead us to conclude that well-conducted and sound evidence on the reliability and the efficacy of techniques in visceral osteopathy is absent .