***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 
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    Input: STUDY DESIGN A prospect i ve unblinded r and omized clinical trial . OBJECTIVES To compare the effectiveness of 2 types of home program instruction , videotape versus personal instruction by a physical therapist , on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear . BACKGROUND Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs . Therefore , assessing the effectiveness of different methods of home program instruction is important . METHODS AND MEASURES Patients who consented to undergo surgical repair were r and omly assigned to either a videotape or personal instruction group . A self-reported compliance log categorized subjects as fully compliant , partially compliant , or noncompliant . The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12 , 24 , and 52 weeks postoperatively . The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time , were assessed by 2 separate 2x3x4 multiple analyses of variances ( MANOVAs ) , 1 for each outcome measure ( alpha = 0.025 ) . RESULTS Neither MANOVA was significant and the null hypotheses were not rejected . The main effect of time ( number of weeks postsurgery ) was significant across all time intervals for both outcome measures ( P < 0.0005 ) . CONCLUSIONS With a therapist available for questions , patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist . Self-reported compliance with the rehabilitation program had little effect on the outcomes Background Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations . Hypothesis Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment . Study Design Prospect i ve , r and omized clinical trial . Methods Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute , traumatic shoulder dislocations in young athletes . Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program . Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients . The average follow-up was 36 months . Results Three patients were lost to follow-up . Twelve nonoperatively treated patients remained for follow-up . Nine of these ( 75 % ) developed recurrent instability . Six of the nine have required subsequent open Bankart repair for recurrent instability . Of the nine operatively treated patients available for follow-up , only one ( 11.1 % ) developed recurrent instability . Conclusions Arthroscopic stabilization of traumatic , first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional , nonoperative treatment As a less invasive surgery of the shoulder , the mini-open repair was carried out from March 1997 through December 1998 in 22 patients ( mini-open repair group ) for all types of rotator cuff tears , except massive tears . A transacromial skin incision about 3 cm long was made . The anterior deltoid was split along its muscle fibers , and an anterior acromioplasty was accomplished by using a specially design ed bone rasp . The rotator cuff was repaired with use of the McLaughlin technique . The results were compared with those obtained in 36 patients subjected to conventional open surgery from April 1994 through February 1997 ( control group ) .  No significant difference was seen between the UCLA ( University of California , Los Angeles ) shoulder scores of the two groups 1 year after the repair . However , active forward flexion in the mini-open group was significantly greater than in the control group 3 and 6 months after surgery . With mini-open repair , patients seem to be able to return to sports or social activities earlier than with conventional open surgery BACKGROUND Acupuncture alleviates acute and chronic shoulder pain .  Yet it has not been determined whether acupuncture is useful following musculoskeletal surgery . HYPOTHESIS Compared to sham acupuncture , arthroscopic acromioplasty subjects who received real acupuncture would manifest significantly better recovery as demonstrated by : UCLA shoulder scale , improved range of motion , diminished pain , decreased need and duration of analgesic use , and enhanced patient satisfaction . METHODS Forty arthroscopic acromioplasty patients were r and omized to real or sham acupuncture .  UCLA shoulder scale scores , pain intensity , analgesic use , range of motion , and quality of life were monitored for four months . Data were analyzed with the general linear model ANOVA for repeated measures . RESULTS Thirty-five subjects completed the study .  Real acupuncture subjects scored significantly better on UCLA shoulder scale ( p<0.000 ) ; pain intensity ( p<0.022 ) ; self-reported analgesic use ( p<0.008 ) ; angles of abduction ( p<0.046 ) ; and in six of eight health status question naire components . CONCLUSIONS Following arthroscopic acromioplasty , real acupuncture compared to sham acupuncture offered significantly greater improvement via : ( 1 ) lower pain level , ( 2 ) less analgesic use , ( 3 ) range of motion , and ( 4 ) patient satisfaction Abstract Objective : To assess whether the clinical experience of undergraduate medical students relates to their performance in final  examinations  and whether learning styles relate either to final examination performance or to the extent of clinical experience . Design : Prospect i ve , longitudinal study of two cohorts of medical students assessed by question naire at time of application to medical school and by question naire and university examination at the end of their final clinical year . Subjects : Two cohorts of students who had applied to St Mary 's Hospital Medical School during 1980 ( n=1478 ) and 1985 ( n=2399 ) for admission in 1981 and 1986 respectively . Students in these cohorts who entered any medical school in the United Kingdom were followed up in their final clinical year in 1986–7 and 1991 - 2 . Main outcome measures : Students ' clinical experience of a range of acute medical conditions , surgical operations , and practical procedures as assessed by question naire  in the final year , and final examination results for the students taking their examinations at the University of London . Results : Success in the final examination was not related to a student 's clinical experiences . The amount of knowledge gained from clinical experience was , however , related to strategic and deep learning styles both in the final year and also at the time of application , five or six years earlier . Grade s in A level examinations did not relate either to study habits or to clinical experience . Success in the final examination was also related to a strategic or deep learning style in the final year ( although not at time of entry to medical school ) . Conclusions : The lack of correlation between examination performance and clinical experience calls into question the validity of final examinations . How much knowledge is gained from clinical experience as a student is able to be predicted from measures of study habits made at the time of application to medical school , some six years earlier , although not from results of A level examinations . Medical schools wishing to select students who will gain the most knowledge from clinical experience can not use the results of A level examinations alone but could assess a student 's learning style . Key messages Medical students with the most clinical experience do not perform best in final undergraduate examinations , throwing some doubt on the validity of the examinations The amount of knowledge a student gains from clinical experience correlates positively with deep and strategic learning styles as measured not only in the final year but also at the time of selection , five or six years earlier If it is important for students to obtain as much clinical experience as possible then final examinations require restructuring to assess and reward clinical experience , and selection should emphasise deep learning which can not be assessed from grade s at A level The use of deep and strategic learning styles in the final year of medical school predicts better performance in the final examination , but the same measures at the time of selection for admission to medical school do not predict examination OBJECTIVES To compare the effect of grade d physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement . METHODS R and omised controlled trial with 12 months ' follow up in a hospital setting . Ninety consecutive patients aged 18 to 55 years were enrolled . Symptom duration was between six months and three years . All fulfilled a set of diagnostic criteria for rotator cuff disease , including a positive impingement sign . Patients were r and omised either to arthroscopic subacromial decompression , or to physiotherapy with exercises aim ing at strengthening the stabilisers and decompressors of the shoulder . Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score . " Intention to treat " analysis was used , with comparison of means and control of confounding variables by general equation estimation analysis . RESULTS Of 90 patients enrolled , 84 completed follow up ( 41 in the surgery group , 43 in the training group ) . The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group . After 12 months the mean scores improved to 57.0 and 52.7 , respectively , the difference being non-significant . No group differences in mean pain and dysfunction score improvement were found . CONCLUSIONS Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training . Further studies are needed to qualify treatment choice decisions , and it is recommended that sample s are stratified according to disability level In a r and omized prospect i ve study , we selected 15 patients for arthroscopic subacromial decompression ( ASD ) and 19 patients for open subacromial decompression ( OSD ) . All had impingement syndrome ( Neer grade II ) , and had been unsuccessfully treated without surgery for more than 6 months . The UCLA Shoulder Rating Scale , Visual Analogue Scales for pain and satisfaction , isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 ( except isokinetic testing ) , 3 , 6 , and 12 months , and , finally , 8 years after surgery . We found essentially no differences in the clinical tests between the groups during this period . The use of ASD or OSD seems to be a matter of cosmesis and personal preference Current knowledge of the clinical course and efficacy of treatment for shoulder pain comes mainly from studies of hospital patients . However , only a few patients experiencing such pain require referral to a specialist . Although shoulder pain is common in the general population , the outcome of patients presenting in general practice is unknown.1 We conducted a prospect i ve cohort study to determine the outcome of shoulder pain in primary care . Twelve general practitioners recruited 166 patients who consulted with a new episode of shoulder pain during one year . They recorded demographic information , diagnosis , management , and an assessment of passive elevation of the shoulder ;  patients assessed the disability associated with their symptoms with a vali date d 22 item disability question naire.2 To assess outcome , identical disability question naires were sent to patients six and 18 months after consultation , together with a question measuring self assessed change in symptoms In a prospect i ve study , 87 consecutive patients with 88 chronic , full-thickness tears of the rotator cuff were r and omly assigned to either open surgical tendon repair and anterior acromioplasty ( 50 shoulders ) or arthroscopic debridement and subacromial decompression ( 38 shoulders ) . All patients were reexamined 2 to 5 years after the operation with the University of California at Los Angeles 35-Point Scale for Pain and Function of the Shoulder . The average ratings were 30.5 ( rotator cuff repair ) and 25.1 ( arthoscopic debridement/decompression ) for each group . The open surgical repair group faired significantly better than the arthroscopic debridement group ( p = .0028 ) . Thirteen required subsequent procedures , four with tendon repair and nine with decompression . Five in the decompression group experienced cuff tear arthropathy . Surgical repair of full-thickness rotator cuff tears provided results superior to those of arthroscopic debridement and subacromial decompression This prospect i ve study was design ed to measure the costs and benefits of using a laser rather than electrocautery for soft tissue resection during arthroscopic shoulder decompression . Forty-nine shoulders with refractory Neer stage II impingement ( persistent fibrosis and tendinitis ) were divided into 2 groups . The composition of the 2 groups was similar with regard to sex , worker 's compensation status , dominant arm involvement , duration of symptoms , and length of conservative treatment . In one group , electrocautery was used to ablate the bursa and periosteum , release the coracoacromial ligament , and maintain hemostasis . In the other group , a laser was used in place of electrocautery . Patients had been evaluated preoperatively with 2 functional scoring systems . The patients were reexamined at 1 week and at 1 , 2 , 3 , 6 , and 12 months after surgery . There were no differences between the groups with regard to functional outcome or satisfaction . There was also no difference in terms of estimated blood loss or operative time . However , there was a statistically significant difference in total hospital charges between groups , with the laser group having a 23 % higher hospital bill . On the basis of these results , it is concluded that there was no medical benefit to laser-assisted arthroscopic subacromial decompression but there was an increased monetary cost Objectives : To compare the prognosis of subacromial impingement ( SAI ) stage II treated conservatively or with subacromial decompression . Methods : A follow‐up study after 4–8 years in a r and omized controlled trial ( RCT ) with 90 adult cases with SA 
    Output:
    
Based upon our review of 14 trials examining heterogeneous interventions and all susceptible to bias , we can not draw firm conclusions about the effectiveness or safety of surgery for rotator cuff disease .