***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: One hundred and thirty-two patients discharged from a rheumatology unit were r and omly allocated to general practitioner care , attendance at hospital outpatient clinics , or follow-up by a senior occupational therapist attached to the hospital treatment team . At the end of 1 and 2 years a number of clinical and functional tests were applied , and information was gathered about the provision and use of aids and the provision of domestic support . In addition the st and ard of overall care was judged by an independent assessor . Although no significant intergroup differences in disease activity or function emerged , it is clear that patients prefer continuing contact with the hospital team , and this may lead to differences appearing in the future . The financial advantages of therapist follow-up are discussed A h and exerciser with an electronic counter and a visual display was used to measure compliance objective ly , to investigate the effects of visual feedback on compliance , and to assess the impact of exercise on seven mild and five moderate rheumatoid arthritis patients . A multiple time-series design varying the onset of the visual display was utilized . Compliance was assessed weekly over the 7 weeks of the study . Pretest and posttest measures of various indicators of h and functioning were taken by an occupational therapist . Visual display of the number of exercises completed decreased the number of noncompliant patients from six to two , with the maximum degree of noncompliance reduced from 44 to 5 % . Thus the use of visual display is effective in producing compliance to exercise regimens . In light of the small sample size , however , no definitive conclusions can be drawn regarding the effects of exercise on h and functioning OBJECTIVE To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function . METHODS Thirty-six patients with definite rheumatoid arthritis participated in the r and omized , controlled , cross-over design study of 3 commercial wrist extensor orthoses . Dominant-h and dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted . Functional impact was assessed using a written question naire . RESULTS All 3 commercial orthoses reduced grip strength when first donned . After a 1-week adjustment period , one orthosis , the Smith and Nephew Roylan D-Ring ( Roylan ) , afforded splinted grip strength equal to that of the nonsplinted grip strength . The other 2 orthoses continued to reduce grip strength , and afforded splinted grip strength significantly below that of the Roylan . The Roylan was deemed comfortable by more subjects than the other orthoses . CONCLUSIONS The belief that commercial orthotic use increases grip strength , either immediately or after 1 week , is not supported by this study 's data . Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength OBJECTIVES This study compared soft versus hard resting h and splints on pain and h and function in 39 persons with rheumatoid arthritis . Splint preference was also evaluated to determine its effects on splint wear compliance . METHOD A repeated measures research design was used to compare the two experimental conditions , wearing a soft splint versus a hard splint on the dominant h and for 28 days at night only , and an unsplinted control period of 28 days . RESULTS Arthritis pain was considerably less during both splinted periods when compared with the pretest . Subjects identified fewer joints as being painful during the soft splint condition than during the unsplinted condition . There were no significant differences among conditions on h and function measures . Splint preference was 57 % for the soft splint , 33 % for the hard splint , and 10 % for no splint . Splint wear compliance was significantly better with the soft splint ( 82 % ) than with the hard splint ( 67 % ) . CONCLUSION The findings indicate that resting h and splints are effective for pain relief and that persons with rheumatoid arthritis are more likely to prefer and comply with soft splint use for this purpose . Individualized splint prescription that focuses on client comfort and preference may enhance splint wear compliance Objective : To evaluate the long-term effects of joint protection on health status of people with early rheumatoid arthritis ( RA ) . Design : A four-year follow-up of a r and omized , controlled , assessor-blinded trial was conducted . Setting : Two rheumatology outpatient departments . Participants : People with rheumatoid arthritis less than five years since diagnosis . Interventions : Two 8-hour interventions were originally compared : a st and ard arthritis education programme , including 21/2 hours of joint protection based on typical UK occupational therapy practice ( plus 51/2 hours on RA , exercise , pain management , diet and foot care ) ; and a joint protection programme , using educational-behavioural training . Main measures : Adherence to joint protection , pain , h and pain on activity , Arthritis Impact Measurement Scales 2 and Arthritis Self-efficacy were recorded at 0 and 4 years . Results : Sixty-five people attended the joint protection and 62 the st and ard programmes . Groups at entry were similar in age ( 51 years ; 49 years ) , disease duration ( 21 months : 17.5 months ) and use of nonsteroidal anti-inflammatory and disease-modifying drugs . At four years , the joint protection group continued to have significantly better : joint protection adherence ( p=0.001 ) ; early morning stiffness ( p=0.01 ) ; AIMS 2 activities of daily living ( ADL ) scores ( p=0.04 ) compared with the st and ard group . The joint protection group also had significantly fewer h and deformities : metacarpophalangeal ( MCP ) ( p=0.02 ) and wrist joints ( p=0.04 ) . Conclusion : Attending an educational = behavioural joint protection programme significantly improves joint protection adherence and maintains functional ability long term . This approach is more effective than st and ard methods of training and should be more widely adopted OBJECTIVE Five styles of commercial static wrist extensor orthoses were compared to determine whether any style , or styles , afforded better power grip strength or finger dexterity . Because wrist extensor orthoses are intended for use during functional tasks , their influence on h and function is of great importance . METHOD Twenty-three right-h and -dominant women without upper extremity dysfunction participated in this crossover study . Dominant-h and finger dexterity and power grip strength were evaluated while wearing each of five commercial orthoses-Kendall-Futuro # 33 ( Futuro ) , AliMed Freedom Long ( AliMed Long ) , AliMed Freedom Short ( AliMed Short ) , Smith & Nephew Rolyan D-Ring ( Rolyan ) , and LMB Wrist Rest (LMB)-- and while using the dominant h and without an orthosis ( free h and ) . Finger dexterity was assessed with the unimanual subtest of the Purdue Pegboard . Grip strength was assessed with a Jamar hydraulic dynamometer . RESULTS Four of the study orthoses ( Futuro , AliMed Short , Rolyan , and LMB ) afforded finger dexterity that did not differ significantly from that of the free h and . The AliMed Long orthosis  slowed finger speed when compared with the speeds afforded by both the LMB orthosis and the free h and . The Rolyan orthosis permitted a power grip strength that was not significantly different from the free h and . The other four commercial orthoses reduced grip strength when compared with the strength observed when wearing a Rolyan orthosis and when gripping with a free h and . CONCLUSION The five styles of commercial orthoses affect power grip and finger dexterity differently . When power grip or finger dexterity are priorities , differences among the orthoses furnish grounds for initial suggestions , although medical needs and patient preference should be the overriding factors in the final selection of an orthosis Summary Seven patients with definite RA and bilateral ulnar deviation of Fearnley grade I were included in a study of the usefulness of noctural resting splints .  Each patient used the splint on average 17 months on one h and , r and omly chosen , with the free h and as control . Joint mobility , grip strength , pain and radiographic findings were recorded at start and finish of the study . Splint treatment influenced grip strength positively , and most patients stated pain relief during the night . However , all but one patient showed progression of ulnar deviation in both h and s , and there was no significant difference in progression between treated and nontreated h and s. This study thus supported the use of resting splints at night for pain relief but not for prevention of ulnar deviation Consecutive new attendees at a rheumatology clinic were r and omly allocated to one of three groups . All groups received routine care , but one received no other intervention , one an educational booklet on arthritis and one the booklet plus instruction from a health professional . Prior to intervention , all groups had similar knowledge . Nottingham Health Profile ( NHP ) and Health Assessment Question naire ( HAQ ) score . After 6 weeks , the knowledge score was significantly increased in both groups given the booklet , but not in the control group . The group instructed by a health professional showed no greater increase than the group given the booklet alone . Increased knowledge was not associated with improved clinical status and no group showed a significant change in NHP or HAQ scores . Nearly all patients said they found the booklet useful The effect of active h and exercise and warm wax treatment was evaluated in 52 rheumatoid arthritis patients r and omized into four groups : ( 1 ) both exercise and wax bath , ( 2 ) exercise only , ( 3 ) wax bath only , and ( 4 ) controls .  Treatment was given three times a week for 4 weeks . Deficits in flexion and extension in digits II-V bilaterally , grip function , grip strength , pain , and stiffness were measured before and after the treatment period . The control group was measured at corresponding times . Wax bath treatment followed by active h and exercise result ed in significant improvements of range of motion ( ROM ) and grip function . Active h and exercise alone reduced stiffness and pain with nonresisted motion and increased ROM .  Wax bath alone had no significant effect OBJECTIVE To study differing home h and exercise interventions to determine effects on grip strength , and secondarily any immediate or short term effects on range of motion , pain , deformities , h and disease activity , and dexterity . METHODS R and omized controlled trial of 12 weeks of home h and exercise  performed for 10 - 20 min twice daily . Study exercise interventions were range of motion exercises , balanced resistive exercises , and range of motion plus balanced resistive exercises . RESULTS Aside from transient , mild to moderate discomfort , exercises were well tolerated . Range of motion exercises were associated with improved right h and joint count . Range of motion plus balanced resistive exercises were associated with increased left h and dexterity .  Home h and exercise ( exercise groups combined ) significantly increased left grip strength . CONCLUSIONS Temporary use of home h and exercise has acceptable side effects and is an effective means of increasing grip strength Preliminary work regarding the development and pilot study of an individualized instructional program for rheumatoid arthritis clients is presented . The effect of the individualized instructional program was tested with 31 out patients . Using analysis of covariance , the experimental group subjects scored significantly higher on the knowledge post-test when compared to scores of control group subjects ( P = 0.0045 ) . Analysis of variance for repeated measures revealed no significant difference in performance of tasks for the control group and experimental group ( P = 0.08 ) . In a follow-up study , the effect of the self-instructional program ,  practice time , and contracting were explored for their effect on adherence to self-care activities . Experimental groups ( n = 42 ) scored significantly better than the control group ( n = 11 ) on the knowledge post-test ( P < 0.01 ) , performance of joint protection practice s ( P = 0.01 ) , range of motion exercises ( P = 0.01 ) , and adherence to joint protection practice s at home ( P < 0.01 ) . Groups did not differ on adherence to range of motion exercises at home ( P = 0.83 ) 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 In order to examine the effectiveness of  cognitive behavioral therapy for patients with rheumatoid arthritis ( RA ) three patients groups were studied : a  cognitive behavioral therapy group ( CBT ) , an occupational therapy group ( OT ) , and a waiting-list control group .  The CBT received a comprehensive , 10-session treatment package that taught progressive relaxation , rational thinking and the differential use of pain coping strategies . CBT result ed in minor changes in pain coping behavior at posttreatment , while CBT and OT showed an increase of knowledge of RA . No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up . Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study . It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied , as well as to the rather small changes in coping behavior We report a prospect i ve , r and omized pilot study 
    Output:
    
REVIEW ER 'S CONCLUSIONS There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis