***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 The effectiveness of an exercise intervention for people in early and midstage Parkinson 's disease ( stages 2 and 3 of Hoehn and Yahr ) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described . DESIGN AND SETTING Fifty-one men and women , aged 55 - 84 years , identified through advertisement , local support groups , and local neurologists were enrolled into a r and omized , controlled trial . Subjects were assigned r and omly to an intervention or a usual care arm ( i.e. , no specific exercise ) . Of the original 51 participants , 46 completed the r and omized , controlled trial . Participants in the exercise arm ( n = 23 ) received individual instruction three times per week for 10 weeks . Participants in the usual care arm ( n = 23 ) were " wait listed " for intervention . MEASUREMENTS Changes over 10 weeks in spinal flexibility ( i.e. , functional axial rotation ) and physical performance ( i.e. , functional reach , timed supine to st and ) were the primary outcome measures . RESULTS MANOVA conducted for the three primary outcome variables demonstrated significant differences ( P < or = .05 ) between the two groups . Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group . There was no significant difference in supine to sit time . CONCLUSION Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD The purpose of this study was to determine if a balance and strength training program could improve equilibrium and strength in persons with stage I-III Parkinsonism . Subjects were pre-tested on strength and balance ( EquiTest ) and r and omized into either a treatment or a control group . The treatment subjects participated in 10 weeks of lower limb strength training and balance exercises design ed to challenge a stable posture and increase limits of stability . Both groups were then posttested on balance , knee flexion , knee extension , and ankle inversion strength . Subjects who received strength and balance training demonstrated significantly improved equilibrium and modest gains in knee flexion and extension strength , while the control group showed no improvement in conditions of destabilizing balance environments and significant declines in strength . Results indicate that 10 weeks of balance and strength training lead to improved equilibrium by producing positive changes in two different control mechanisms . One , training altered the ability to control the motor system when vestibular cues had to be the primary source of reliable feedback ; and two , training helped subjects to override faulty proprioceptive feedback and utilize reliable visual or vestibular cues OBJECTIVES To assess long term ( 24 months ) effects of the Lee Silverman voice treatment ( LSVT ® ) , a method design ed to improve vocal function in patients with Parkinson 's disease . METHODS Thirty three patients with idiopathic Parkinson 's disease were stratified and r and omly assigned to two treatment groups . One group received the LSVT ® , which emphasises high phonatory-respiratory effort . The other group received respiratory therapy ( RET ) , which emphasises high respiratory effort alone . Patients in both treatment groups sustained vowel phonation , read a passage , and produced a monologue under identical conditions before , immediately after , and 24 months after speech treatment . Change in vocal function was measured by means of acoustic analyses of voice loudness ( measured as sound pressure level , or SPL ) and inflection in voice fundamental frequency ( measured in terms of semitone st and ard deviation , or STSD ) . RESULTS The LSVT ® was significantly more effective than the RET in improving ( increasing ) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up . CONCLUSIONS The findings provide evidence for the efficacy of the LSVT ® as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson 's disease BACKGROUND Several previous studies have examined the health of carers , but they have usually focused on elderly subjects and have often not had representative control sample s. AIM To determine whether caring for a partner with Parkinson 's disease is associated with a worsening social , psychological and physical well-being than people with partners who do not suffer with Parkinson 's disease . METHOD One hundred and fifty-four carer spouses of subjects with Parkinson 's disease , and 124 non-carer spouses of r and omly selected population controls recruited from a national case-control study of early-onset Parkinson 's disease in the Republic of Irel and , between 1992 - 1994 , were studied . Outcome was measured along three dimensions : social functioning , assessed by the frequency of social contacts , outings and holidays ; psychological well-being , measured by the General Health Question naire ; and physical health , measured by the career 's use of medical services , medications and episodes of chronic illness . RESULTS Carer spouses were less likely to get out of the house once a week at least ( odds ratio 1.79 , 95 % confidence intervals 1.00 - 3.20 ) or to have had a holiday in the last year ( odds ratio 1.71 , 95 % confidence intervals 1.01 - 2.90 ) . Contact with friends and neighbours decreased with increasing care provision . For spouses providing a lot of care , there was an almost fivefold increase in psychiatric morbidity ( odds ratio 4.86 , 95 % confidence intervals 1.5 - 15.9 ) after adjusting for other variables . Most of the medical outcomes were less favourable among carers , but only the use of tranquilizers ( odds ratio 3.73 , 95 % confidence intervals 1.18 - 11.8 ) and episodes of chronic illness ( odds ratio 2.96 , 95 % confidence intervals 1.27 - 6.94 ) were significant . CONCLUSIONS Overall , career spouses have slightly worse social , psychological and physical profiles . For social outcomes , increasing care provision is associated with fewer contacts , outings and holidays . For psychological and physical measures , carers providing a lot of care experience worse health . These results have implication s for targeting appropriate interventions In this study , the extent to which bradykinesia in patients with idiopathic Parkinson 's disease can be influenced by practice and by specific training strategies was investigated . Fifteen patients with Parkinson 's disease tested after withdrawal of anti-Parkinson medication , and 15 matched control subjects , practised a ballistic aim ing task . Performance was tested before , during and after training and again 1 h later . The Parkinson 's disease patients and control subjects were r and omly assigned to one of two training schedules , practising with or without rhythmic auditory cues . At baseline , the Parkinson 's disease patients showed longer movement times , with a marked decrease in maximum acceleration and deceleration in the initial open-loop phase compared with those of the control subjects . With training , they were able to make significant improvement in the speed of aim ed movements , particularly in the early movement phase , without any deterioration in accuracy . These effects transferred to an untrained limb and were at least partially maintained after a 1-h delay . While patients remained impaired relative to control subjects at all phases of training and follow-up , the patients ' performance at the end of training did not differ significantly from the control subjects ' baseline function . Contrary to expectation , rhythmic auditory cues did not enhance improvement in the speed of aim ed movements in either patients or control subjects . If anything , less improvement was shown in the cued groups , although there were suggestions that the aim ing skill was retained better over the delay period . The results demonstrate preserved abilities to improve speed of single ballistic aim ing movements in Parkinson 's disease patients and the possibility of reducing bradykinesia by training Objective : To determine whether the Alex and er Technique , alongside normal treatment , is of benefit to people disabled by idiopathic Parkinson 's disease . Design : A r and omized controlled trial with three groups , one receiving lessons in the Alex and er Technique , another receiving massage and one with no additional intervention . Measures were taken pre and post-intervention , and at follow-up , six months later . Setting : The Polyclinic at the University of Westminster , Central London . Subjects : Ninety-three people with clinical ly confirmed idiopathic Parkinson 's disease . Interventions : The Alex and er Technique group received 24 lessons in the Alex and er Technique and the massage group received 24 sessions of massage . Main outcome measures : The main outcome measures were the Self- assessment Parkinson 's Disease Disability Scale ( SPDDS ) at best and at worst times of day . Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale . Results : The Alex and er Technique group improved compared with the no additional intervention group , pre-intervention to post-intervention , both on the SPDDS at best , p = 0.04 ( confidence interval ( CI ) –6.4 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.5 to –1.8 ) . The comparative improvement was maintained at six-month follow-up : on the SPDDS at best , p = 0.04 ( CI –7.7 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.8 to –0.9 ) . The Alex and er Technique group was comparatively less depressed post-intervention , p = 0.03 ( CI –3.8 to 0.0 ) on the Beck Depression Inventory , and at six-month follow-up had improved on the Attitudes to Self Scale , p = 0.04 ( CI –13.9 to 0.0 ) . Conclusions : There is evidence that lessons in the Alex and er Technique are likely to lead to sustained benefit for people with Parkinson 's disease The purpose of this study was to evaluate the effect of a home physiotherapy program for persons with Parkinson 's disease . Thirty-three patients took part in the study using a within-subject controlled design . Functional activities including walking and carrying out transfers were measured at home and in the hospital before and after a 6-week baseline period , after 6 weeks home physiotherapy and after 3 months follow-up . Spatiotemporal and plantar force variables of gait were determined with video and pododynography . Treatment provided by community physiotherapists consisted of teaching cueing and conscious movement control 3 times a week . The study revealed that patients had significantly higher scores on a functional activity scale after treatment in the home setting and to a lesser degree in hospital , a result , which was partly sustained at follow-up . However , duration of the transfer movements , spatiotemporal and plantar force variables were not significantly improved except for stride length . The results support application and development of the treatment concept and highlight that physiotherapy aim ed at improving function in Parkinson 's disease is best provided in the home situation Abstract Objective : To assess the relationship between severity and progression of illness in Parkinson ’s disease and the use of healthcare re sources . Design and setting : This was a prospect i ve cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients with Parkinson ’s disease treated in the hospital or community setting . Regression analyses were performed to construct the model that offered the best explanation for health expenditures using clinical and sociodemographic indicators . Patients and participants : All patients included in the study had well-defined idiopathic Parkinson ’s disease , were aged > 35 years , were receiving treatment with levodopa or other antiparkinsonian agents , and were capable of completing question naires , alone or with the help of a household member . The final study population consisted of 294 patients , of whom 54 were enrolled by general practitioners and 240 by neurologists . Interventions : Investigators completed a clinical question naire at the beginning and end of the 6-month observation period . Patients completed a question naire on their daily living conditions at the beginning and end of the study , and also completed monthly reports of healthcare use and loss of productivity .  Patients with motor fluctuations also filled in fluctuation diaries on 4 consecutive days at the beginning and end of the 6-month period . Re source data collected included hospital stays , ancillary care , drug therapy , medical visits and transportation . Social costs were evaluated in nonmonetary terms , with the exception of costs of adapting the home environment . Transfer payments were analysed using reports from patients . Main outcome measures and results : Hospital stays were the most expensive component of care ( 39 % of costs ) , followed by ancillary care ( 30 % ) and drug therapy ( 22 % ) . The mean medical cost was 308 euros ( EUR ) [ $ US357 ] for patients followed by a general practitioner and EUR2580 ( $ US2993 ) for patients followed by a neurologist . Costs also varied with age and motor fluctuations . Medical costs were strongly correlated with most clinical indicators and the cost generally progressed in line with the severity of the disease . The strongest correlation was between clinical indicators and ancillary care costs . Conclusions : These results confirm the importance of the social burden of Parkinson ’s disease . The regression results could be used to evaluate the benefit of novel treatments that reduce the intensity of motor fluctuations We performed a r and omized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson 's disease . The health promotion program ( PROPATH ) was design ed to improve health confidence , provide information and support , improve physical function through exercise , and work with the physician to optimize medical treatment and compliance . The intervention was delivered by mail , with disease assessment question naires completed by patient or caregiver at 0 , 2 , 4 , and 6 months , with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians . Two hundred ninety patients completed the 6-month trial , 140 patients in the intervention group and 150 in a control group of patients who received only question naires . The intervention group had significantly increased exercise , decreased " time off " and percentage of time off , reduced side effects , and decreased summary Parkinson 's scores by approximately 10 % ( P > 0.05 ) . Twelve of 13 variables showed differences favoring the intervention group . The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise 
    Output:
    
Conclusions : Findings may reflect publication bias , but suggest interventions can affect patients ' lives for the better in a variety of ways .
It is difficult to interpret the clinical importance of statistically significant improvements reported in most studies .