***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: Abstract Whiplash‐associated disorders are common and incur considerable expense in social and economic terms . There are no known effective treatments for those people whose pain and disability persist beyond 3 months . We conducted a r and omized , assessor‐blinded , controlled trial at two centres in Australia . All participants received 3 advice sessions . In addition the experimental group participated in 12 exercise sessions over 6 weeks . Primary outcomes were pain intensity , pain bothersomeness and function measured at 6 weeks and 12 months . Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months . The effect of exercise on the 0–10 pain intensity scale was −1.1 ( 95%CI −1.8 to −0.3 , p = 0.005 ) at 6 weeks and −0.2 ( 0.6 to −1.0 , p = 0.59 ) at 12 months ; on the bothersomeness scale the effect was −1.0 ( −1.9 to −0.2 , p = 0.003 ) at 6 weeks and 0.3 ( −0.6 to 1.3 , p = 0.48 ) at 12 months . The effect on function was 0.9 ( 0.3 to 1.6 , p = 0.006 ) at 6 weeks and 0.6 ( −0.1 to 1.4 , p = 0.10 ) at 12 months . High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months . In the short‐term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash . Exercise is more effective for subjects with higher baseline pain and disability OBJECTIVE To compare the effects of manual therapy and stretching exercise on neck pain and disability . DESIGN An examiner-blinded r and omized cross-over trial . PATIENTS A total of 125 women with non-specific neck pain . METHODS PATIENTS were r and omized into 2 groups . Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week . After 4 weeks the treatments were changed . The follow-up times were after 4 and 12 weeks . Neck pain ( visual analogue scale ) and disability indices were measured . RESULTS Mean value ( st and ard deviation ) for neck pain was 50 mm ( 22 ) and 49 mm ( 19 ) at baseline in Group 1 and Group 2 , respectively , and decreased during the first 4 weeks by 26 mm ( 95 % Confidence Interval 20 - 33 ) and 19 mm ( 12 - 27 ) , respectively . There was no significant difference between groups . Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy ( p=0.01 ) as well as neck stiffness ( p=0.01 ) . CONCLUSION Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain . The difference in effectiveness between the 2 treatments was minor . Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain , at least in the short-term OBJECTIVE --To assess the long term effect of early mobilisation exercises in patients with acute sprains of the neck after road accidents . DESIGN --Single blind r and omised prospect i ve study of patients receiving physiotherapy , advice on mobilisation , or on an initial period of rest followed up after two years by postal question naire . SETTING --Accident and emergency department in urban hospital . PATIENTS --247 Consecutive patients ( mean age at injury 30.6 years ) presenting within 48 hours after injury with no pre-existing disease of the neck or serious skeletal injury . Of these , 167 patients responded to the question naire ; 77 who responded but had not completed their treatment or review course were included in the analysis as a fourth group ( non-attenders ) . MAIN OUTCOME MEASURE -- Presence of symptoms after two years . RESULTS --Of the 167 patients ( 68 % ) responding , the percentage of patients still with symptoms was not significantly different in those receiving rest or physiotherapy ( 46 % , 12/26 v 44 % , 24/54 ) , but that in those receiving advice on early mobilisation was significantly lower ( 23 % , 11/48 , p = 0.02 ) . Of the 104 patients without symptoms , 94 ( 90 % ) recovered within six months and 62 ( 60 % ) within three months . Patients without symptoms who received advice or physiotherapy wore a collar  for a significantly shorter time than those with persistent symptoms ( mean duration 1.4 ( SD 0.7 ) months v 2.8 ( 1.6 ) months , p = 0.005 and 1.6 ( 1.1 ) months v 1.8 ( 1.3 ) months , p = 0.006 respectively ) . CONCLUSIONS --Advice to mobilise in the early phase after neck injury reduces the number of patients with symptoms at two years and is superior to manipulative physiotherapy . Prolonged wearing of a collar is associated with persistence of symptoms Abstract Objectives Firstly , to compare the effectiveness of a brief physiotherapy intervention with “ usual ” physiotherapy for patients with neck pain . Secondly , to evaluate the effect of patients ' preferences on outcome . Design Non-inferiority r and omised controlled trial eliciting preferences independently of r and omisation . Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire . Participants 268 patients ( mean age 48 years ) with subacute and chronic neck pain , who were referred by their general practitioner and r and omly assigned to a brief physiotherapy intervention ( one to three sessions ) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy , at the discretion of the physiotherapist concerned . Main outcome measures The Northwick Park neck pain question naire ( NPQ ) , a specific measure of functional disability result ing from neck pain . Also , the short form 36 ( SF-36 ) question naire , a generic , health related , quality of life measure ; and the Tampa scale for kinesophobia , a measure of fear and avoidance of movement . Results At 12 months , patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group ( mean difference 1.99 , 95 % confidence interval 0.45 to 3.52 ; P = 0.01 ) . Although the result shows a significant inferiority of the intervention , the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention ( below 1.2 points of NPQ score ) . Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy . Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain . Patients with a preference for the brief intervention may do at least as well with this approach . Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further Study Design . A question naire was mailed to 3000 r and omly selected 35‐45‐year‐old individuals in three communities in central Sweden . Objectives . To study the 1‐year prevalence of spinal pain and its ramifications in the form of pain , function , sick leave , and health care use . Summary of Background Data . Previous research ers have used a variety of definitions and population s , but primarily have investigated the occurrence of pain . Comprehensive data are needed concerning health care use , the degree of the pain problem , functional disturbances , and sick leave . Method . Participants in the study completed a question naire regarding spinal pain during the past year including the degree of their experienced pain , functional impairment , lost work days , and health care use . Results . A total of 2305 people ( 78.5 % ) responded to the question naire . Nonrespondents had similar characteristics but a slightly lower 1‐year prevalence rate than did respondents . For respondents , the prevalence of spinal pain during the past year was 66.3 % , with women having a slightly higher prevalence than men . Approximately 25 % of the respondents indicated that they had a substantial problem based on ratings of pain , functional impairment , and sick leave . Work absenteeism reported to the Public Social Insurance Office involved 19 % of those with pain , but an additional 15 % indicated unreported absenteeism . On average , those with pain visited health care providers three times during the past year , but a small number of those who experienced pain consumed large amounts of health care and illness benefits . An important gender difference was shown , such that when pain was at its worst , men took sick leave , whereas women sought health care . Conclusions . Taken together , these data indicate that spinal pain is common among 35‐45‐year‐old men and ‐ women , and that it is related to marked problems for approximately one fourth of those who experience pain . Gender differences exist in the pattern of sick leave and health care use , and a small proportion of those with pain consume very large amounts of the re sources . Consequently , there is a need for early , effective , preventive treatments Study Design . A single‐blinded , r and omized treatment study with a follow‐up period of 6 months . Objective . To study the long‐term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident . Patients in the first group were encouraged to act as usual , i.e. , continue to engage in their normal , pre‐injury activities ; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar . The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident . Summary of Background Data . Few r and omized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain . Method . Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim , Norway . The study group included 201 patients ( 47 % of the study group ) with neck sprain that result ed from a car accident .  Neck and shoulder movements and subjective symptoms , which were assessed using several different measurements , were assessed during the follow‐up period . Results . There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups . There was a significantly better outcome for the act‐as‐usual group in terms of subjective symptoms , including pain localization , pain during daily activities , neck stiffness , memory , and concentration , and in terms of visual analog scale measurements of neck pain and headache . Conclusions . The outcome was better for patients who were encouraged to continue engaging in their normal , pre‐injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury Objective : To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders . Design : A r and omized controlled trial with follow-up at three and nine months after r and omization . Setting : An interdisciplinary rehabilitation centre . Subjects : Forty-seven patients with subacute disorders following a whiplash trauma . Interventions : Patients were r and omized to a supervised training group or a self-administered home training group . Main measures : Primary outcome measures were the Self-Efficacy Scale , the Tampa Scale for Kinesiophobia and the Pain Disability Index . Secondary outcome measures were neck pain intensity , sensory and affective dimensions of pain , pain location and duration , muscle tenderness , grip strength , cervical mobility , sick leave and analgesic consumption . Results : Forty patients ( 85 % ) completed the intervention period , and the drop-outs were followed up by intention-to-treat . The results showed that supervised training was significantly more favourable than home training , with a more rapid improvement in self-efficacy ( P=0.03 ) , fear of movement/(re)injury ( P=0.03 ) and pain disability ( P=0.03 ) at three months . Further , supervised training significantly reduced the frequency of analgesic consumption ( P=0.03 ) . The improvements were partly maintained at nine months , even though there was no amelioration in pain and physical disorders . Despite the favourable outcome , supervised intervention did not reduce sick leave . Conclusions : The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term , but additional research is needed to extend these findings and eluci date treatment strategies that also are cost effective Study Design . R and omized clinical trial . Objective . To compare the effectiveness of education and advice given by general practitioners ( GPs ) with education , advice , and active exercise therapy given by physiotherapists ( PTs ) for patients with whiplash-associated disorders . Summary of Background Data . Available evidence from systematic review s has indicated beneficial effects for active interventions in patients with whiplash-associated disorders . However , it remained unclear which kind of active treatment was most effective . Methods . Whiplash patients with symptoms or disabilities at 2 weeks after accident were recruited in primary care . Eligible patients still having symptoms or disabilities at 4 weeks were r and omly allocated to GP care or physiotherapy . GPs and PTs treated patients according to a dynamic multimodal treatment protocol primarily aim ed to increase activities and influence unfavorable psychosocial factors for recovery . We trained all health care providers about the characteristics of the whiplash problem , available evidence regarding prognosis and treatment , and protocol of the interventions . The content of the information provided to patients during treatment depended on the treatment goals set by the GPs or PTs . Also , the type of exercises chosen by the PTs depended on the treatment goals , and it was not explicitly necessary that exercise therapy was provided in all patients . Primary outcome measures included neck pain intensity , headache intensity , and work activities . Furthermore , an independent blind 
    Output:
    
This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods , including advice to activate , advice on stress coping skills , and ' neck school ' .