***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: Background The evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled . Objective The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain . Design This was a r and omized , placebo-controlled trial . Setting The study was conducted in an outpatient physical therapy department in Australia . Patients The participants were 154 patients with chronic low back pain of more than 12 weeks ’ duration . Intervention Twelve sessions of motor control exercise ( ie , exercises design ed to improve function of specific muscles of the low back region and the control of posture and movement ) or placebo ( ie , detuned ultrasound therapy and detuned short-wave therapy ) were conducted over 8 weeks . Measurements Primary outcomes were pain intensity , activity ( measured by the Patient-Specific Functional Scale ) , and patient 's global impression of recovery measured at 2 months . Secondary outcomes were pain ; activity ( measured by the Patient-Specific Functional Scale ) ; patient 's global impression of recovery measured at 6 and 12 months ; activity limitation ( measured by the Rol and -Morris Disability Question naire ) at 2 , 6 , and 12 months ; and risk of persistent or recurrent pain at 12 months . Results The exercise intervention  improved activity and patient 's global impression of recovery but did not clearly reduce pain at 2 months . The mean effect of exercise on activity ( measured by the Patient-Specific Functional Scale ) was 1.1 points ( 95 % confidence interval [CI]=0.3 to 1.8 ) , the mean effect on global impression of recovery was 1.5 points ( 95 % CI=0.4 to 2.5 ) , and the mean effect on pain was 0.9 points ( 95 % CI=−0.01 to 1.8 ) , all measured on 11-point scales . Secondary outcomes also favored motor control exercise . Limitation Clinicians could not be blinded to the intervention they provided . Conclusions Motor control exercise produced short-term improvements in global impression of recovery and activity , but not pain , for people with chronic low back pain . Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups Background Non-specific low back pain ( NSLBP ) in subacute and chronic stages can be treated effectively with exercise therapy . Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP . A subgroup of patients with movement control impairment ( MCI ) improved significantly on patient specific function and disability in a previous case series after movement control exercises . Methods / Design In a r and omised controlled trial ( RCT ) we will compare the effectiveness of movement control and general exercise in patients with MCI . 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practice s. Patients r and omly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI . The general exercise group will follow an exercise protocol aim ed at improving endurance and flexibility . Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home . The primary outcome is the level of disability assessed using the patient specific functional scale ( PSFS ) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up . Secondary outcomes concern low back pain related disability ( Rol and Morris question naire , RMQ ) , grade d chronic pain scale ( GCPS ) , range of motion and tactile acuity . Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI . Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our underst and ing of the mechanisms behind MCI and its relation to NSLBP.Trial registration Current Controlled Trials IS RCT & NA ; Dysfunction in the motor system is a feature of persistent whiplash associated disorders . Little is known about motor dysfunction in the early stages following injury and of its progress in those persons who recover and those who develop persistent symptoms . This study measured prospect ively , motor system function ( cervical range of movement ( ROM ) , joint position error ( JPE ) and activity of the superficial neck flexors ( EMG )  during a test of cranio‐cervical flexion ) as well as a measure of fear of re‐injury ( TAMPA ) in 66 whiplash subjects within 1 month of injury and then 2 and 3 months post injury . Subjects were classified at 3 months post injury using scores on the neck disability index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . Motor system function was also measured in 20 control subjects . All whiplash groups demonstrated decreased ROM and increased EMG ( compared to controls ) at 1 month post injury . This deficit persisted in the group with moderate/severe symptoms but returned to within normal limits in those who had recovered or reported persistent mild pain at 3 months . Increased EMG persisted for 3 months in all whiplash groups . Only the moderate/severe group showed greater JPE , within 1 month of injury , which remained unchanged at 3 months . TAMPA scores of the moderate/severe group were higher than those of the other two groups . The differences in TAMPA did not impact on ROM , EMG or JPE . This study identifies , for the first time , deficits in the motor system , as early as 1 month post whiplash injury , that persisted not only in those reporting moderate/severe symptoms at 3 months but also in subjects who recovered and those with persistent mild symptoms Design . R and omized prospect i ve study of the effects of three types of active therapy on back muscle function in chronic low back pain patients . Objectives . To quantify the effects of 3 months active therapy on strength , endurance , activation , and fatigability of the back entensor muscles . Summary of Background Data . Many studies have documented an association between chronic low back pain and diminished muscular performance capacity . Few studies have quantified the changes in these measures following interventions using objective measurement techniques or related them to changes in clinical outcome . Methods . A total of 148 individuals ( 57 % women ) with chronic low back pain ( age , 45.0 ± 10.0 years ; duration of low back pain , 10.9 ± 9.5 years ) were r and omized to a treatment that they attended for 3 months : active physiotherapy , muscle reconditioning on devices , or low-impact aerobics . Before and after therapy , assessment s were made of the following : trunk muscle strength ( in flexion , extension , lateral bending , and axial rotation ) , erector spinae activation ( maximal , and during forward bending movements ) , back extensor endurance ( Biering-S/orensen test ) , and erector spinae fatigability ( determined from changes in the median frequency of the surface electromyographic signal ) during isometric and dynamic tests . Results . A total of 132 of 148 patients ( 89 % ) completed the therapy . Isometric strength in each movement direction increased in all groups post-therapy ( P < 0.0008 ) , most notably in the devices group . Activation of the erector spinae during the extension tests also increased significantly in all groups and showed a weak , but significant , relationship with increased maximal strength ( P = 0.01 ) . Pretherapy 55 % of the subjects showed no relaxation of the back muscles at L5 when in the fully flexed position ; no changes were observed in any group post-therapy . Endurance time during the Biering-S/orensen test increased significantly post-therapy in all groups ( P = 0.0001 ) , but there were no significant changes in EMG-determined fatigability . Fatigability of the lumbar muscles at L5 ( EMG median frequency changes ) during the dynamic test increased post-therapy ( P = 0.0001 ) without group differences . Conclusion . Significant changes in muscle performance were observed in all three active therapy groups post-therapy , which appeared to be mainly due to changes in neural activation of the lumbar muscles and psychological changes concerning , for example , motivation or pain tolerance Study Design . A r and omized controlled study with 12 months intervention . Objective . To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone ( NZ ) and behavior modeling as secondary prevention of  low back pain ( LBP ) and disability .  Summary of Background Data . Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability . In addition , cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability . Methods . Middle-aged working men with recent LBP but without severe disability were r and omly allocated to either a training ( TG , n = 52 ) or control group ( CG , n = 54 ) . The aim was to exercise twice a week for 12 months , once guided and once independently . The outcome measures were the changes in intensity of LBP , disability , self-evaluated future work ability , and neuromuscular fitness . Results . The intensity of LBP decreased significantly more ( 39 % ) in the TG than in CG at 12 months . The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months ; however , the proportion was significantly bigger in TG compared with CG ( P = 0.028 ) . There effects on disability indexes and fitness were not statistically significant . Conclusions . Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men STUDY DESIGN R and omized clinical trial . OBJECTIVES To determine the efficacy of trunk balance exercises for individuals with chronic low back pain . BACKGROUND The majority of exercises focusing on restoring lumbopelvic stability propose targeting the feedforward control of the lumbopelvic region . Less attention has been paid to feedback control during balance adjustments . METHODS Seventy-nine patients were r and omly allocated to 2 different groups . The experimental group performed trunk balance exercises in addition to st and ard trunk flexibility exercises . The control group performed strengthening exercises in addition to the same st and ard trunk flexibility exercises . The primary outcome measures were pain intensity ( visual analogue scale ) , disability ( Rol and -Morris Question naire ) , and quality of life ( 12-Item Short-Form Health Survey ) . Secondary outcomes were painful positions , use of analgesic drugs , and referred pain . Analysis of variance and relative risk were used to analyze the data for the primary and secondary outcome measures , respectively . The number of participants reaching the minimal clinical ly important difference in the 2 groups for each outcome measure was compared using relative risk . RESULTS A significant difference in scores on the Rol and -Morris Question naire ( P = .011 ) and the physical component of the 12-Item Short-Form Health Survey ( P = .048 ) , and in the number of participants reaching the minimal clinical ly important difference for the Rol and -Morris Question naire ( relative risk , 1.79 ; 95 % confidence interval [ CI ] : 1.05 , 3.04 ) and the secondary outcome of painful positions ( relative risk , 1.37 ; 95 % CI : 1.03 , 1.83 ) were found in favor of the experimental treatment . CONCLUSIONS Trunk balance exercises combined with flexibility exercises were found to be more effective than a combination of strength and flexibility exercises in reducing disability and improving the physical component of quality of life in patients with chronic low back pain Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more [ Purpose ] This study aim ed to examine the effects of sensorimotor training on the anticipatory postural adjustment ( APA ) of chronic low back pain ( CLBP ) patients . [ Subjects and Methods ] Fourteen CLBP patients were r and omly assigned to Group II ( ordinary physical therapy , n=7 ) and Group III ( sensorimotor training , n=7 ) . In addition , a normal group ( Group I ) consisting of seven subjects was chosen as the control group . The two CLBP groups received their own treatment five times per week , for four weeks , for 40 minutes each time . Changes in pain and functional performance evaluation were examined by the visual analogue scale ( VAS ) and the Oswestry Disability Index ( ODI ) . In order to look at the change in APA , muscle onset time was examined using electromyography ( EMG ) . [ Results ] Group III showed significant changes in both VAS and ODI . According to comparison of the results for muscle onset time , there were significant decreases in Group III 's transversus abdominis muscle ( TrA ) and external oblique muscle ( EO ) in the st and ing and sitting positions . There were significant differences between Group II and III in terms of the TrA in the sitting position . [ Conclusion ] Sensorimotor training makes patients capable of learning how to adjust muscles , thereby alleviating pain and improving muscle performance Background In the treatment of  chronic back pain  , cognitive methods are attracting increased attention due to evidence of effectiveness similar to that of traditional therapies . The purpose of this study was to compare the effectiveness of performing a cognitive intervention based on a non-injury model with that of a symptom-based physical training method on the outcomes of  low back pain ( LBP ) , activity limitation , LBP attitudes ( fear-avoidance beliefs and back beliefs ) , physical activity levels , sick leave , and quality of life , in chronic LBP patients . Methods The study was a pragmatic , single-blind , r and omised , parallel-group trial . Patients with chronic/recurrent LBP were r and omised to one of the following treatments : 1 . Educational programme : the emphasis was on creating confidence that the back is strong , that loads normally do not cause any damage despite occasional temporary pain , that 
    Output:
    
Low quality evidence suggests PrT may be more effective than not intervening at all .
Low quality evidence suggests that PrT is no more effective than conventional physiotherapy .
Low quality evidence suggests PrT is inferior to educational and behavioural approaches .
A descriptive summary of the evidence suggests that there is no consistent benefit in adding PrT to neck- and low back pain rehabilitation and functional restoration