***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: Study Design . Single blind r and omized study . Objectives . To compare the effectiveness of  lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration . Summary of Background Data . To the authors ’ best knowledge , only one r and omized study has evaluated the effectiveness of lumbar fusion . The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician . Patients and Methods . Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and /or L5–S1 at radiographic examination were r and omized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy , or cognitive intervention and exercises . The cognitive intervention consisted of a lecture to give the patient an underst and ing that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it . This was reinforced by three daily physical exercise sessions for 3 weeks . The main outcome measure was the Oswestry Disability Index . Results . At the 1-year follow-up visit , 97 % of the patients , including 6 patients who had either not attended treatment or changed groups , were examined . The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery , compared with 42 to 30 after cognitive intervention and exercises . The mean difference between groups was 2.3 ( −6.7 to 11.4 ) ( P = 0.33 ) . Improvements inback pain , use of analgesics , emotional distress , life satisfaction , and return to work were not different . Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment , and lower limb pain was reduced more after surgery . The success rateaccording to an independent observer was 70 % after surgery and 76 % after cognitive intervention and exercises .  The early complication rate in the surgical group was 18 % . Conclusion . The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration r and omized to cognitive intervention and exercises , or lumbar fusion Study Design . A prospect i ve r and omized controlled trial . Objectives . To examine the effectiveness of combined manipulative treatment , stabilizing exercises , and physician consultation compared with physician consultation alone for chronic low back pain . Summary of Background Data . Strong evidence exists that manual therapy provides more effective short-term pain relief than does placebo treatment in the management of chronic low back pain . The evidence for long-term effect is lacking . Methods . Two hundred four chronic low back pain patients , whose Oswestry disability index was at least 16 % , were r and omly assigned to either a manipulative-treatment group or a consultation group . All were clinical ly examined , informed about their back pain , provided with an educational booklet , and were given specific instructions based on the clinical evaluation . The treatment included four sessions of manipulation and stabilizing exercises aim ing to correct the lumbopelvic rhythm . Question naires inquired about pain intensity , self-rated disability , mental depression , health-related quality of life , health care costs , and production costs . Results . At the baseline , the groups were comparable , except for the percentage of employees ( P = 0.01 ) . At the 5- and 12-month follow-ups , the manipulative-treatment group showed more significant reductions in pain intensity ( P < 0.001 ) and in self-rated disability ( P = 0.002 ) than the consultation group . However , we detected no significant difference between the groups in health-related quality of life or in costs . Conclusions . The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone . The present study showed that short , specific treatment programs with proper patient information may alter the course of chronic low back pain AIM The aim of the study was to evaluate the outcome of  outpatient rehabilitation in patients with low back pain and lumbar disk disease with a  specific stabilizing exercise of the M. multifidus and M. transversus abdominis . METHOD 99 out patients admitted to a rehabilitation unit were included in a prospect i ve r and omized controlled interventional trial . The interventional group consisted of 50 patients ( 34 male , 16 female ; mean age 41.1 + /- 9.1 , range ; 21 - 54 years ) , 49 patients ( 31 male , 18 female ; mean age 37.9 + /- 9.5 , range ; 19 - 55 years ) were in the control group . Outcomes were assessed at the beginning and the end of the treatment and at a three month follow-up with the Oswestry Low Back Pain Disability Question naire , the Hannover Functional Ability Question naire FFbH-R , the pain scale SES and a numeric rating scale . RESULTS In both groups there was a significant functional improvement as measured with the Oswestry Score and the FFbH-R. The interventional group showed better values at the end of the treatment . Pain as well could be reduced significantly by the treatment , but no differences were noted between the two groups . CONCLUSION Outpatient rehabilitation improved functional capacity and pain in both groups . Advantages could be seen in the interventional group concerning functional status . The specific stabilizing exercise approach appears to be effective in conservative treatment programs of low back pain and lumbar disk disease Study Design . A multicenter , r and omized controlled trial with unblinded treatment and blinded outcome assessment was conducted . The treatment period was 6 weeks with follow-up assessment after treatment , then at 3 , 6 , and 12 months . Objectives . To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination , as compared with a control group . Summary of Background Data . Headaches arising from cervical musculoskeletal disorders are common . Conservative therapies are recommended as the first treatment of choice . Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term . There is no evidence for exercise , and no study has investigated the effect of combined therapies for cervicogenic headache . Methods . In this study , 200 participants who met the diagnostic criteria for cervicogenic headache were r and omized into four groups : manipulative therapy group , exercise therapy group , combined therapy group , and a control group . The primary outcome was a change in headache frequency . Other outcomes included changes in headache intensity and duration , the Northwick Park Neck Pain Index , medication intake , and patient satisfaction . Physical outcomes included pain on neck movement , upper cervical joint tenderness , a craniocervical flexion muscle test , and a photographic measure of posture . Results . There were no differences in headache-related and demographic characteristics between the groups at baseline . The loss to follow-up evaluation was 3.5 % . At the 12-month follow-up assessment , both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity , and the neck pain and effects were maintained ( P < 0.05 for all ) . The combined therapies was not significantly superior to either therapy alone , but 10 % more patients gained relief with the combination . Effect sizes were at least moderate and clinical ly relevant . Conclusion . Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache , and the effects are maintained Study Design . A r and omized clinical trial . Objectives . To examine the effects of a treatment program focusing on specific stabilizing exercises after a 2-year follow-up period . Summary of Background Data . An individualized treatment approach with specific stabilizing exercises is shown to be effective for women with pelvic girdle pain 1 year after delivery . No previous study has examined the long-term effects of treatment for women with postpartum pelvic girdle pain . Methods . Eighty-one women with pelvic girdle pain postpartum were assigned r and omly to 2 treatment groups for 20 weeks . Patient self-reported question naires measuring pain , disability , and health-related quality of life were collected after 20 weeks of treatment and 1 and 2 years postpartum . Results . All 81 women returned the question naires for the 2-year follow-up . Sixteen were excluded from the analysis , mainly due to new pregnancies . The significant differences between the groups in functional status , pain , and physical health ( SF-36 ) were maintained 2 years after delivery . Minimal disability was found in 85 % of the specific stabilizing exercise group as compared to 47 % in the control group . The control group showed significant improvement in functional status with median change score of 6.0 ( Q1–Q3 of −12–0 ) . Minimal evening pain was reported by 68 % in the specific stabilizing exercise group versus 23 % in the control group . However , the group differences disappeared for all measures when controlling for score level 1 year after delivery by regression analysis . Conclusion . The significant differences between the groups persisted with continued low levels of pain and disability in the specific stabilizing exercise group 2 years after delivery . Significant reduction in disability was found within the control group . Those with the highest level of disability and greatest potential for improvements recovered most , regardless of intervention group OBJECTIVE To compare trunk muscle coordination in people with and without low back pain with varying speeds of limb movement . STUDY DESIGN Abdominal and back extensor muscle activity in association with upper limb movement was compared among three speeds of movement and between people with and without low back pain . PARTICIPANTS Fourteen subjects with a history of recurrent low back pain and a group of age- and sex-matched control subjects . MEASURES The onsets of electromyographic activity of the trunk and limb muscles , frequency of trunk muscle responses , and angular velocity of arm movements . RESULTS Early activation of transversus abdominis ( TrA ) and obliquus internus abdominis ( OI ) occurred in the majority of trials , with movement at both the fast and intermediate speeds for the control group . In contrast , subjects with low back pain failed to recruit TrA or OI in advance of limb movement with fast movement , and no activity of the abdominal muscles was recorded in the majority of intermediate speed trials . There was no difference between groups for slow movement . CONCLUSION The results indicate that the mechanism of preparatory spinal control is altered in people with lower back pain for movement at a variety of speeds Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Study Design . A r and omized , controlled trial , test‐retest design , with a 3‐ , 6‐ , and 30‐month postal question naire follow‐up . Objective . To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis . Summary of Background Data . A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine ( deep abdominal muscles and lumbar multifidus ) , considered to provide dynamic stability and fine control to the lumbar spine . In no study have research ers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised . Methods . Forty‐four patients with this condition were assigned r and omly to two treatment groups . The first group underwent a 10‐week specific exercise treatment program involving the specific training of the deep abdominal muscles , with co‐activation of the lumbar multifidus proximal to the pars defects . The activation of these muscles was incorporated into previously aggravating static postures and functional tasks . The control group underwent treatment as directed by their treating practitioner . Results . After intervention , the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels , which was maintained at a 30‐month follow‐up . The control group showed no significant change in these parameters after intervention or at follow‐up . Summary . A " specific exercise " treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis Study Design This prospect i ve study consisted of the evaluation of a double sacroiliac block in patients with low back pain . Objectives To determine the prevalence of sacroiliac pain in a selected population of patients suffering from low back pain , and to assess certain pain provocation tests . Summary of Background Data Previous studies have implicated the sacroiliac joint as a potential etiology of back and leg pain , but none has tested double anesthetic blocks in a prospect i ve fashion . Methods Fifty‐four patients with unilateral low back pain , pain mapping compatible with a sacroiliac origin , tenderness over the sacroiliac joint , and no obvious source of pain in the lumbar spine were selected for a double anesthetic block . The procedure consisted of a thorough clinical examination with a visual analog scale , testing of sacroiliac pain provocation tests followed by a first screening block with a short‐acting anesthetic . A second examination consisting of the same tests assessed the efficacy of the first block . If results were positive , a confirmatory block was performed . All blocks were performed under fluoroscopic guidance . Results Nineteen patients had a  positive response to the first block . Among them , 10 ( 18.5 % ) were temporarily relieved by the confirmatory block . No pain provocation 
    Output:
    
The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain .
Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain , pelvic pain , and in reducing recurrence after acute low back pain