***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 : How a scar is managed postoperatively influences its cosmetic outcome . After suture removal , scars are susceptible to skin tension , which may be the trigger for hypertrophic scarring . Paper tape to support the scar may reduce multidirectional forces and prevent hypertrophic scarring . Methods : Seventy patients who had undergone cesarean section at the Royal Brisbane and Women 's Hospital were r and omized to treatment and control groups . Patients in the control group received no postoperative intervention . Patients in the treatment group applied paper tape to their scars for 12 weeks . Scars were assessed at 6 weeks , 12 weeks , and 6 months after surgery using ultrasound to measure intradermal scar volume . Scars were also assessed using the International Clinical Recommendations . Results : Paper tape significantly decreased scar volume by a mean of 0.16 cm3 , ( 95 percent confidence interval , 0.00 to 0.29 cm3 ) . At 12 weeks after surgery , 41 percent of the control group developed hypertrophic scars compared with none in the treatment group ( exact test , p = 0.003 ) . In the treatment group , one patient developed a hypertrophic scar and four developed stretched scars only after the tape was removed . The odds of developing a hypertrophic scar were 13.6 times greater in the control than in the treatment group ( 95 percent confidence interval , 3.6 to 66.9 ) . Of the 70 patients r and omized , 39 completed the study . Four patients in the treatment group developed a localized red rash beneath the tape . These reactions were minor and transient and resolved without medical intervention . Conclusions : The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring . Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension Hypertrophic scars ( HTS ) , the excessive deposition of scar tissue by fibroblasts , is one of the most common skin disorders . Fibroblasts derived from surgical scar tissue produce high levels of α-smooth muscle actin ( α-SMA ) and transforming growth factor-β1 ( TGF-β1 ) . However , the molecular mechanisms for this phenomenon is poorly understood . Thus , the purpose of this study was to evaluate the molecular mechanisms of HTS and their potential therapeutic implication s. Fibroblasts derived from skin HTS were cultured and characterized in vitro . The fibroblasts were synchronized and r and omly assigned to two groups : cyclic stretch and cyclic stretch pre-treated with SB203580 ( a p38MAPK inhibitor ) . Cyclic stretch at 10 % strain was applied at a loading frequency of 10 cycles per minute ( i.e. 5 seconds of tension and 5 seconds of relaxation ) for 0 h , 6 h and 12 h. Cyclic stretch on HTS fibroblasts led to an increase in the expression of α-SMA and TGF-β1 mRNA and protein and the phosphorylation of p38MAPK . SB203580 reversed these effects and caused a decrease in matrix contraction . Furthermore , HTS fibroblast growth was partially blocked by p38MAPK inhibition . Therefore , the mechanism of cyclic stretch involves p38 MAPK , and its inhibition is suggested as a novel therapeutic strategy for HTS PURPOSE Hypertrophic scarring and depression are the principal problems of burn rehabilitation . This study was done to verify the effects of skin rehabilitation massage therapy ( SRMT ) on pruritus , skin status , and depression for Korean burn survivors . METHODS A pretest-posttest design using a nonequivalent control group was applied to examine the effects of SRMT for 3 months in a group of 18 burn survivors . The major dependent variables-including pruritus , objective and subjective scar status , and depression-were measured at the beginning and at the end of the therapy to examine the effects of SRMT . RESULTS Burn survivors receiving SRMT showed reduced pruritus , improved skin status , and depression . The remaining scar also showed improvement in skin pigmentation , pliability , vascularity , and height ( compared to the surrounding skin ) as measured on the Vancouver Scar Scale ( VSS ) . CONCLUSIONS The findings demonstrate that SRMT for burn survivors may improve their scars both objective ly and subjectively , and also reduce pruritus and depression Transforming growth factor beta 1 ( TGF-beta1 ) plays a key role in connective tissue remodeling , scarring , and fibrosis . The effects of mechanical forces on TGF-beta1 and collagen deposition are not well understood . We tested the hypothesis that brief ( 10 min ) static tissue stretch attenuates TGF-beta1-mediated new collagen deposition in response to injury . We used two different models : ( 1 ) an ex vivo model in which excised mouse subcutaneous tissue ( N = 44 animals ) was kept in organ culture for 4 days and either stretched ( 20 % strain for 10 min 1 day after excision ) or not stretched ; culture media was assayed by ELISA for TGF-beta1 ; ( 2 ) an in vivo model in which mice ( N = 22 animals ) underwent unilateral subcutaneous microsurgical injury on the back , then were  r and omized to stretch ( 20 - 30 % strain for 10 min twice a day for 7 days ) or no stretch ; subcutaneous tissues of the back were immunohistochemically stained for Type-1 procollagen . In the ex vivo model , TGF-beta1 protein was lower in stretched versus non-stretched tissue ( repeated measures ANOVA , P < 0.01 ) . In the in vivo model , microinjury result ed in a significant increase in Type-1 procollagen in the absence of stretch ( P < 0.001 ) , but not in the presence of stretch ( P = 0.21 ) . Thus , brief tissue stretch attenuated the increase in both soluble TGF-beta1 ( ex vivo ) and Type-1 procollagen ( in vivo ) following tissue injury . These results have potential relevance to the mechanisms of treatments applying brief mechanical stretch to tissues ( e.g. , physical therapy , respiratory therapy , mechanical ventilation , massage , yoga , acupuncture ) INTRODUCTION Exercises are commonly prescribed to improve shoulder range following axillary burns , but the effect of additional splinting is unclear . AIM To compare splinting and exercise to exercise alone in adults with axillary burns . METHOD Prospect i ve r and omised study allocating participants to a splinting ( n=27 ) or no splinting group ( n=25 ) . Outcomes measured at six and twelve weeks were shoulder abduction and flexion range , quality of life using the Burn Specific Health Scale-Brief ( BSHS-B ) question naire and upper limb function using the Upper Extremity Functional Index ( UEFI ) and the Grocery Shelving Task ( GST ) . RESULTS At week twelve , there was no difference between groups for shoulder abduction ( mean difference 0 ° , 95 % CI -22 to 22 ° ) , flexion ( mean difference 2 ° , 95 % CI -18 to 23 ° ) , BSHS-B ( mean difference -2 points , 95 % CI -23 to 18 points ) , UEFI ( mean difference -3 points , 95 % CI -19 to 14 points ) and GST ( mean difference -9s , 95 % CI -20 to 3s ) . Adherence to splinting decreased from 77 % of participants at week one to 16 % at week twelve . CONCLUSION Shoulder splints did not improve clinical outcomes in this study population and low adherence rates suggest splinting may be unacceptable to patients and makes drawing firm conclusions difficult OBJECTIVE To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn . METHOD One hundred and forty-six burn patients with hypertrophic scar(s ) were r and omly divided into an experimental group and a control group . All patients received st and ard rehabilitation therapy for hypertrophic scars and 76 patients ( massage group ) additionally received burn scar rehabilitation massage therapy .  Both before and after the treatment , we determined the scores of visual analog scale ( VAS ) and itching scale and assessed the scar characteristics of thickness , melanin , erythema , transepidermal water loss ( TEWL ) , sebum , and elasticity by using ultrasonography , Mexameter ( ® ) , Tewameter ( ® ) , Sebumeter ( ® ) , and Cutometer ( ® ) , respectively . RESULTS The scores of both VAS and itching scale decreased significantly in both groups , indicating a significant intragroup difference . With regard to the scar characteristics , the massage group showed a significant decrease after treatment in scar thickness , melanin , erythema , TEWL and a significant intergroup difference . In terms of scar elasticity , a significant intergroup difference was noted in immediate distension and gross skin elasticity , while the massage group significant improvement in skin distensibility , immediate distension , immediate retraction , and delayed distension . CONCLUSION Our results suggest that burn rehabilitation massage therapy is effective in improving pain , pruritus , and scar characteristics in hypertrophic scars after burn BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . & NA ; The objective of this study was to identify the effects of a skin rehabilitation nursing program ( SRNP ) on skin status , depression , and burn‐specific health in Korean burn survivors . A pretest‐posttest design with a nonequivalent control group was used to examine the effects of SRNP for 3 months in a group of 26 burn survivors . The SRNP group of 13 burn survivors received massage therapy 30 minutes three times a week for 3 months compared to a control group of 13 burn survivors  receiving typical care . The SRNP group showed no significant changes in the burn scar , subjective skin status , depression , or burn‐specific health .  Burn survivors  receiving SRNP had reduced burn scar depth after the intervention compared to the control group . The findings of this study demonstrate that SRNP for burn survivors may improve burn scars , and findings suggest that future studies with a larger sample should be conducted using SRNP as an intervention for burn survivors INTRODUCTION Injury from burns is very common and must be treated with considerable care by the rehabilitation team to prevent contractures that may occur . Physiotherapy is vital in rehabilitation of burn-injured patients . PURPOSE The aim of this study is to compare a burn rehabilitation treatment ( BRT ) protocol with a routine burn rehabilitation treatment to find out rehabilitation related problems . METHODS For all burn-injured patients admitted to a general hospital in Tehran on 2005 , a group match clinical trial was done and then r and omly divided into two groups . For the first group , ordinary physiotherapy was done according to the routine prescription and the BRT protocol has been carried out for the second group . At the time of patient registration , a question naire was completed which consisted of gender , age , TBS , depth and cause of injury . On the other h and , post burn contractures , thrombosis and duration of staying in hospital was measured at discharge . RESULTS There was not any significant difference ( p>0.05 ) in gender , age , TBS , cause and depth of injury between two groups . In addition , there was not any significant difference ( p>0.05 ) between thrombosis and duration of staying patients in hospital . However , these results show significant difference ( p<0.01 ) in burn contractures between two groups . In the BRT group , 6 % had burn contractures , with 73 % routine rehabilitation treatment . CONCLUSION The result of this study indicates that intensive rehabilitation decreased burn complications . Burn rehabilitation teams could consider the BRT protocol Various attempts have been made to intervene with the formation of hypertrophic scarring ( HTS ) or to ameliorate it once it has developed , but none have yet proved effective . Massage therapy is routinely used by therapists for the treatment of various conditions , and there have been reports of increased scar pliability and decreased scar b and ing 
    Output:
    
Conclusion From extensive literature search , there was no strong evidence indicating the positive effect of mechanical stretch using stretching exercise , massage , or splinting on hypertrophic scars .
A firm conclusion can not be drawn for the discrepancy of outcome measures and varied effectiveness .