***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: Objectives Traditionally , orthopedic outpatient waiting lists are long , and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department . The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine . Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for out patients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain , physical function , and perceived recovery . Methods Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic r and omized controlled trial . The 2 interventions compared were naprapathic manual therapy ( index group ) and conventional orthopedic care ( control group ) .  Pain , physical function , and perceived recovery were measured by question naires at baseline and after 12 , 24 , and 52 weeks . The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated . Results After 52 weeks , statistically significant differences between the groups were found regarding impairment in pain , increased physical function , and regarding perceived recovery , favoring the index group . Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list . The level of agreement concerning the management decisions was 80 % . Discussion The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic out patients with disorders unlikely to benefit from surgery The purpose of this study was to investigate the comparative effectiveness of early use of thrust ( TM ) and non-thrust manipulation ( NTM ) in sample of patients with mechanical low back pain ( LBP ) . The r and omized controlled trial included patients with mechanically reproducible LBP , ≥ age 18-years who were r and omized into two treatment groups . The main outcome measures were the Oswestry Disability Index ( ODI ) and a Numeric Pain Rating Scale ( NPRS ) , with secondary measures of Rate of Recovery , total visits and days in care , and the work subscale of the Fears Avoidance Beliefs Question naire work subscale ( FABQ-w ) . A two-way mixed model MANCOVA was used to compare ODI and pain , at baseline , after visit 2 , and at discharge and total visits , days in care , and rate of recovery ( while controlling for patient expectations and clinical equipoise ) . A total of 149 subjects completed the trial and received care over an average of 35 days . There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories . Personal equipoise was significantly associated with ODI and pain . The findings suggest that there is no difference between early use of TM or NTM , and secondarily , that personal equipoise affects study outcome . Within-groups changes were significant for both groups Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed The aim of our study was to assess the effectiveness of thoracic manipulation ( TM ) on patients with chronic neck pain . 120 patients aged between 18 and 55 were r and omly allocated into two groups : an experimental group which received TM and a control group without the manipulative procedure . Both groups received infrared radiation therapy ( IRR ) and a st and ard set of educational material . TM and IRR were given twice weekly for 8 sessions . Outcome measures included craniovertebral angle ( CV angle ) , neck pain ( Numeric Pain Rating Scale ; NPRS ) , neck disability ( Northwick Park Neck Disability Question naire ; NPQ ) , health-related quality of life status ( SF36 Question naire ) and neck mobility . These outcome measures were assessed immediately after 8 sessions of treatment , 3-months and at a 6-month follow-up . Patients that received TM showed significantly greater improvement in pain intensity ( p = 0.043 ) , CV angle ( p = 0.049 ) , NPQ ( p = 0.018 ) , neck flexion ( p = 0.005 ) , and the Physical Component Score ( PCS ) of the SF36 Question naire ( p = 0.002 ) than the control group immediately post-intervention . All these improvements were maintained at the 6-month follow-ups . This study shows that TM was effective in reducing neck pain , improving dysfunction and neck posture and neck range of motion ( ROM ) for patients with chronic mechanical neck pain  up to a half-year post-treatment STUDY DESIGN R and omized controlled trial . OBJECTIVE To determine the validity of a previously suggested clinical prediction rule ( CPR ) for identifying patients most likely to experience short-term success following lumbar stabilization exercise ( LSE ) .  Background Although LSE is commonly used by physical therapists in the management of low back pain , it does not seem to be more effective than other interventions . A 4-item CPR for identifying patients most likely to benefit from LSE has been previously suggested but has yet to be vali date d. METHODS One hundred five patients with low back pain underwent a baseline examination to determine their status on the CPR ( positive or negative ) . Patients were stratified by CPR status and then r and omized to receive an LSE program or an intervention consisting of manual therapy ( MT ) and range-of-motion/flexibility exercises . Both interventions included 11 treatment sessions delivered over 8 weeks . Low back pain-related disability was measured by the modified version of the Oswestry Disability Index at baseline and upon completion of treatment . RESULTS The statistical significance for the 2-way interaction between treatment group and CPR status for the level of disability at the end of the intervention was P = .17 . However , among patients receiving LSE , those with a positive CPR status experienced less disability by the end of treatment compared with those with a negative CPR status ( P = .02 ) . Also , among patients with a positive CPR status , those receiving LSE experienced less disability by the end of treatment compared with those receiving MT ( P = .03 ) . In addition , there were main effects for treatment and CPR status . Patients receiving LSE experienced less disability by the end of treatment compared to patients receiving MT ( P = .05 ) , and patients with a positive CPR status experienced less disability by the end of treatment compared to patients with a negative CPR status , regardless of the treatment received ( P = .04 ) . When a modified version of the CPR ( mCPR ) containing only the presence of aberrant movement and a positive prone instability test was used , a significant interaction with treatment was found for final disability ( P = .02 ) . Of the patients who received LSE , those with a positive mCPR status experienced less disability by the end of treatment compared to those with a negative mCPR status ( P = .02 ) , and among patients with a positive mCPR status , those who received LSE experienced less disability by the end of treatment compared to those who received MT ( P = .005 ) . CONCLUSION The previously suggested CPR for identifying patients likely to benefit from LSE could not be vali date d in this study . However , due to its relatively low level of power , this study could not invali date the CPR , either . A modified version of the CPR that contains only 2 items may possess a better predictive validity to identify those most likely to succeed with an LSE program . Because this modified version was established through post hoc testing , an additional study is recommended to prospect ively test its predictive validity . LEVEL OF EVIDENCE Prognosis , level 1b- Objective The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporom and ibular disorder . Design Thirty-two women with a diagnosis of temporom and ibular disorder were r and omly allocated to an experimental group ( n = 16 ) , su bmi tted to upper thoracic manipulation , and a placebo group ( n = 16 ) , su bmi tted to a procedure in the thoracic region with no therapeutic effect . All volunteers underwent an evaluation of pain in the masticatory muscles and the temporom and ibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48–72 hrs . Two-way repeated- measures analysis of variance was used for the intragroup and intergroup analyses , with the level of significance set to 5 % ( P < 0.05 ) . Cohen d was calculated for the determination of the effect size . Results No significant group-by-time interaction was found ( P > 0.05 ) for algometry in any analysis , and Cohen d revealed no significant effect of the treatment . Moreover , no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale ( P > 0.05 ) , and Cohen d also revealed no significant effect of the treatment regarding this variable . Conclusions On the basis of the present findings , upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporom and ibular disorder Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease . Design R and omised , participant and single assessor blinded , placebo controlled trial . Setting Metropolitan region of Melbourne , Victoria , Australia . Participants 120 participants with chronic ( > 3 months ) rotator cuff disease recruited through medical practitioners and from the community . Interventions The active treatment comprised a manual therapy and home exercise programme ; the placebo treatment comprised inactive ultrasound therapy and application of an inert gel . Participants in both groups received 10 sessions of individual st and ardised treatment over 10 weeks . For the following 12 weeks , the active group continued the home exercise programme and the placebo group received no treatment . Main outcome measures The primary outcomes were pain and function measured by the shoulder pain and disability index , average pain on movement measured on an 11 point numerical rating scale , and participants ’ perceived global rating of overall change . Results 112 ( 93 % ) participants completed the 22 week trial . At 11 weeks no difference was found between groups for change in shoulder pain and disability index ( 3.6 , 95 % confidence interval −2.1 to 9.4 ) or change in pain ( 0.7 , −0.1 to 1.5 ) ; both groups showed significant improvements . More participants in the active group reported a successful outcome ( defined as “ much better ” ) , although the difference was not statistically significant : 42 % ( 24/57 ) of active participants and 30 % ( 18/61 ) of placebo participants ( relative risk 1.43 , 0.87 to 2.34 ) . The active group showed a significantly greater improvement in shoulder pain and disability index than did the placebo group at 22 weeks ( between group difference 7.1 , 0.3 to 13.9 ) , although no significant difference existed between groups for change in pain ( 0.9 , −0.03 to 1.7 ) or for the percentage of participants reporting a successful treatment outcome ( relative risk 1.39 , 0.94 to 2.03 ) . Several secondary outcomes favoured the active group , including shoulder pain and disability index function score , muscle strength , interference with activity , and quality of life . Conclusion A st and ardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists ’ contact in middle aged to older adults with chronic rotator cuff disease . However , greater improvements were apparent at follow-up , particularly in shoulder function and strength , suggesting that benefits with active treatment take longer to manifest . Trial registration Clinical trials NCT00415441 Background R and omised Controlled Trials ( RCTs ) are the preferred study design when comparing therapeutical interventions in medicine . To improve clarity , consistency and transparency of reporting RCTs , the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement was developed . Objectives ( 1 ) To assess the quality of reports and abstract s of RCTs in otorhinolaryngologic literature by using CONSORT checklists , ( 2 ) to compare the quality of reports and abstract s of otorhinolaryngologic RCTs between the top 5 general medical journals and top 5 otorhinolaryngologic journals , and ( 3 ) to formulate recommendations for authors and editors of otorhinolaryngologic ( ‘ ENT ’ ) journals 
    Output:
    
Conclusion : Our findings suggest that the CONSORT and RoB have a number of items that are unclear and unreliable , and that the quality of reporting in OMT trials has not improved in recent years .