***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: Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Eighteen children with hemiplegia , mean age 8 years 5 months , underwent gait analysis and musculoskeletal modelling using specially design ed software . The maximum lengths of the hamstrings were determined for each child walking in and out of an ankle-foot orthosis ( AFO ) . The muscles were deemed to be short if shorter than the normal average -1SD . In bare feet 8 participants had short medial hamstrings with a higher proportion of these in the less involved individuals . All participants showed an increase in maximum hamstring length when wearing an AFO . In all but one child this was sufficient to restore hamstring length to within normal limits . These finding suggest that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology This study compared the functional efficacy of three commonly prescribed ankle-foot orthosis ( AFO ) configurations ( solid [ SAFO ] , hinged [ HAFO ] , and posterior leaf spring [ PLS ] ) . Sixteen independently ambulatory children ( 10 males , six females ; mean age 8 years 4 months , SD 2 years 4 months ; range 4 years 4 months to 11 years 6 months ) with spastic diplegia participated in this study . Four children were classified at level I of the Gross Motor Function Classification System ( GMFCS ; Palisano et al. 1997 ) ; the remaining 12 were at level II . Children were assessed  barefoot ( BF ) at baseline ( baseline assessment of energy consumption was performed with shoes on , no AFO ) and in each orthotic configuration after three months of use , using gait analysis , oxygen consumption , and functional outcome measures . AFO use did not markedly alter joint kinematics or kinetics at the pelvis , hip , or knee . All AFO configurations normalized ankle kinematics in stance , increased step/stride length , decreased cadence , and decreased energy cost of walking . Functionally , all AFO configurations improved the execution of walking/running/jumping skills , upper extremity coordination , and fine motor speed/dexterity . However , the quality of gross motor skill performance and independence in mobility were unchanged . These results suggest that most children with spastic diplegia benefit functionally from AFO use . However , some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use , shown by an increase in peak knee extensor moment in early stance , excessive ankle dorsiflexion , decreased walking velocity , and greater energy cost . Therefore , constraining ankle motion by using a PLS or SAFO should be considered for most , but not all , children with spastic diplegia Twenty-one subjects with spastic diplegic cerebral palsy were studied to quantify the effects of fixed and articulated ankle-foot orthoses ( AFOs ) on gait and delineate criteria for their use . Children underwent gait analysis under three conditions , fixed AFOs ( FAFOs ) , articulated AFOs ( AAFOs ) , and shoes alone . Greater dorsiflexion occurred at initial contact with both FAFOs and AAFOs than shoes alone . Dorsiflexion at terminal stance was greatest in AAFOs . Plantarflexor power generation at preswing was preserved in AAFOs . No differences were found in knee position during stance . Knee-extensor strength was positively related to knee extension during stance . No relationships were found between dorsiflexion range of motion , calf spasticity and strength , and peak dorsiflexion during stance .  AAFOs are appropriate for subjects with varying degrees of calf spasticity , as long as adequate passive range of motion is available . These findings can be applied primarily to children who do not have a preexisting tendency to crouch Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis ( HAFO ) , posterior leaf spring ( PLS ) , and solid ankle-foot orthosis ( SAFO ) , in preventing contracture , improving efficiency of gait , and enhancing performance of functional motor skills in 30 children ( 21 male , 9 female ; mean age 9 years 4 months ; age range 4 to 18 years , ) with spastic hemiplegia . Following a 3-month baseline period of no ankle-foot orthosis ( AFO ) use , each AFO was worn for 3 months after which ankle range of motion , gait analysis , energy consumption , and functional motor skills were assessed . The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait . Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration . The HAFO was the most effective in controlling knee hyperextension in stance , while PLS was the most effective in promoting knee extension in children with > 10 degree knee flexion in stance . Energy efficiency was improved in 21 of the children , with 13 of these children demonstrating the greatest improvement in HAFO and PLS . Improvements in functional mobility were greatest in the HAFO and PLS The effectiveness of ankle-foot orthoses ( AFOs ) on walking pattern was studied in 12 children with cerebral palsy between the ages of 3 and 7 years . Over a 2-year period two trials of fortnightly periods without AFOs were carried out . The range of ankle dorsiflexion , video analysis looking specifically at footfall , and rank scoring of the mediolateral shear force obtained using an oscilloscope printout from a Kistler force platform were compared with measurements obtained during periods when the child was wearing AFOs . The results using different outcomes were consistent , and indicated that the range of movement and gait deteriorated during the two trial periods during which the splints were not worn compared with periods during which the splints were worn . This finding needs to be confirmed in a large r and omised controlled trial BACKGROUND AND PURPOSE This study compared the effects of dynamic ankle-foot orthoses ( DAFOs ) with a plantar-flexion stop , polypropylene solid ankle-foot orthoses ( AFOs ) , and no AFOs on the gait of children with cerebral palsy ( CP ) . These orthoses were used to reduce the excessive ankle plantar flexion during the stance phase of gait . SUBJECTS AND METHODS Ten children with spastic CP ( 6 with diplegia and 4 with hemiplegia ) were tested after wearing no AFOs for an initial 2-week period , solid AFOs for 1 month , no AFOs for an additional 2 weeks , and DAFOs for 1 month . The effects of the two orthoses and no AFOs on lower-extremity muscle timing , joint motions , and temporal-distance characteristics were compared . RESULTS Both orthoses  increased stride length , decreased cadence , and reduced excessive ankle plantar flexion when compared with no orthoses . No differences were found for the gait variables when comparing the two orthoses . CONCLUSION AND DISCUSSION Based on the data , the authors believe that although both orthoses would be recommended for children with spastic CP and excessive ankle plantar flexion during stance , additional individual factors should be considered when selecting either orthosis OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To investigate the effectiveness of the hinged ankle-foot orthosis ( AFO ) on sit-to-st and ( STS ) transfers in children with spastic cerebral palsy . DESIGN Before-after trial . SETTING University-affiliated hospital . PARTICIPANTS Nineteen spastic diplegic children ( age range , 2 - 6 y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The transitional movement of STS was tested in r and om order with children while wearing the barefoot and hinged AFOs . The temporal , kinematic , and kinetic data during the task were collected by using a motion analyzer ( with 6 infrared cameras ) . Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test . RESULTS Total duration of STS transfer was significantly shortened with the hinged AFO ( P < .05 ) . The initial knee flexion , the initial angle , and the final angle of ankle dorsiflexion were increased with the AFO , compared with when barefoot ( P < .05 ) . However , the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO . The maximal moment and power of hip and knee joints were significantly increased with the AFO ( P < .05 ) , whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO . CONCLUSIONS Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO , some improvements of temporal , kinematic , and kinetic parameters were identified during the task . These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia Several studies indicated that walking with an ankle foot orthosis ( AFO ) impaired third rocker . The purpose of this study was to evaluate the effects of two types of orthoses , with similar goal setting s , on gait , in a homogeneous group of children , using both barefoot and shoe walking as control conditions . Fifteen children with hemiplegia , aged between 4 and 10 years , received two types of individually tuned AFOs : common posterior leaf-spring ( PLS ) and Dual Carbon Fiber Spring AFO ( CFO ) ( with carbon fibre at the dorsal part of the orthosis ) . Both orthoses were expected to prevent plantar flexion , thus improving first rocker , allowing dorsiflexion to improve second rocker , absorbing energy during second rocker , and returning it during the third rocker . The effect of the AFOs was studied using objective gait analysis , including 3D kinematics , and kinetics in four conditions : barefoot , shoes without AFO , and PLS and CFO combined with shoes . Several gait parameters significantly changed in shoe walking compared 
    Output:
    
The findings of this review have been used to generate guidelines for best practice of reporting for AFO intervention studies .