***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: There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions , but this usefulness has not been studied in multiple system atrophy ( MSA ) to date . The aim of this small pilot study was to identify the feasibility of a larger r and omized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability , mood , and health-related quality of life in patients with MSA . Patient groups were comparable for age , gender distribution , type of MSA , and severity . The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson 's Disease Rating Scale ( total score and Activities of Daily Living [ ADL ] section ) , and PDQ-39 scores ( total scores and ADL subsection ) . An occupational therapy program may improve functional abilities in patients with mild to moderate MSA . A larger multicenter study is needed 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 The medical treatment of idiopathic Parkinson 's disease has improved the quality of life and increased survival of patients with Parkinson 's disease . However , as the illness progresses , impairments in daily living activities occur . A clinical trial for a group rehabilitation program was initiated to maintain the functional status of these patients . The research protocol consisted of a pretreatment evaluation , r and om assignment to experimental or control groups , and posttreatment evaluations after therapy , at 6 months and at 1 year . The results showed that the subjects of the treated experimental group maintained their functional status after 1 year , demonstrated a significant decrease of bradykinesia , and perceived a significant improvement in their psychological well-being . This study confirms the value of an occupational therapy group approach and its benefits to the functional independence , to the improvement of physical and motor symptoms , and to the quality of life of persons with Parkinson 's disease The development and validation of a short and simple measure of perceived health problems is described . Extensive testing with selected groups , including the elderly , the chronically ill , pregnant women , fracture victims , and a r and om sample of the community has established the face , content and criterion validity , and the reliability of the instrument . The Nottingham  Health Profile  is intended as a st and ardized tool for the survey of health problems in a population , but is equally valid and useful as a means of evaluating the outcome of medical and /or social interventions and as an adjunct to the clinical interview In a controlled clinical study , we investigated the effects of behavioral treatment on postural and gait initiation problems idiopathic Parkinson 's disease ( PD ) . Comparable groups of patients received therapy ( experimental group , n = 15 ) and nonspecific psychological treatment ( control group , n = 14 ) for 10 weeks . We monitored various variables reflecting properties of posture and gait initiation by using an optoelectronic motion analyzer ( electronic movement analysis system , ELITE ) . A clinician blind to group membership of the patients assessed PD severity with the United Parkinson 's Disease Rating Scale ( UPDRS ) before and after the treatment period . ELITE measures of postural stability and movement initiation revealed treatment-specific effects . In addition , UPDRS motor scores showed significant improvement only after behavioral treatment . We conclude that behavioral treatment in Parkinson 's disease may improve motor disabilities in moderately advanced PD patients Objective : To perform a pilot trial of occupational therapy ( OT ) to optimise functional independence in Parkinson disease ( PD ) to assess accrual/withdrawal rates , acceptability , outcome measures , and inform sample -size calculation . Method : Non-demented patients with idiopathic PD and difficulties with activities of daily living ( ADL ) were recruited provided they had not received OT in the last 2 years and /or physiotherapy in the last year . Patients were r and omised to immediate OT or OT after completion of the trial . Patients r and omised to OT were assessed at home by an experienced therapist and then received six home treatment sessions over 2 months . Interventions were targeted at functional independence and mobility goals . Outcome measures were : Nottingham Extended Activity of Daily Living Scale , Rivermead Mobility Index , Unified Parkinson ’s Disease Rating Scale ADL scale , Parkinson ’s Disease Question naire 39 , EuroQol-EQ-5D , Hospital Anxiety and Depression Scale , and health economics analysis . Results : 39 patients ( 25 male ; mean age 73 years ) were recruited from four centres over 16 months . The mean difference in NEADL at 8 months was 3.5 ( 95 % CI −3.2 to 10.2 ) . The mean difference in PDQ-39 Summary Score was 3.8 ( 95 % CI −4.94 to 12.6 ) . There were strong correlations between the PDQ-39 and other outcomes . The intervention was acceptable to patients , with a low withdrawal rate and good question naire completion . Conclusion : R and omisation to a trial of OT in PD is feasible . NEADL and PDQ-39 are relevant outcomes and provided data to inform sample size for an adequately powered r and omised trial for which there is pressing need Objective : To evaluate the effects of weights on postural h and tremor related to self-feeding in subjects with Parkinson 's disease ( PD ) . Design : In a repeated- measures design , postural h and tremor was recorded three times in each of three weight conditions in a single session for each subject . The order of all recording conditions was r and omized . Setting : Intervention was applied and measurement was conducted in a university-based motor performance laboratory . Subjects : Fourteen men and two women diagnosed with PD and having h and tremor participated ( mean age 67.1 years , mean duration of PD 4.6 years ) . All were community-dwelling . Intervention : The control condition consisted of holding a built-up spoon ( 108 g ) . There were two experimental conditions : holding a weighted spoon ( 248 g ) ; and holding the built-up spoon while wearing a weighted wrist cuff ( 470 g ) . Main outcome measures : Three measures of tremor amplitude and two measures of tremor frequency were calculated from recordings of displacement of the spoon obtained from laser displacement sensors . Results : Repeated- measures analyses of variance revealed no signi”cant differences across conditions in any measure of tremor amplitude or in either measure of tremor frequency . Correlational and Mann – Whitney U-test analyses revealed that none of age , disease duration or medication intake had any signi”cant relationship with tremor amplitude in the control condition or with whether amplitude was altered by weights . Conclusions : The ” ndings suggest that there is no support for the clinical recommendation of using weighted utensils or weighted wrist cuffs to alleviate postural h and tremor in PD In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed Gibberd and others ( 11 April , p 1196 ) and sympathise over the problems they encountered . In a similar controlled trial ' we had difficulty in making due allowance for spontaneous fluctuations in motor performance and concentration which characterise this illness and particularly in assessing the influence of depression and motivation . We had to ab and on attempts to measure the latter factors with appropriate question naires because we often found that the patients fell asleep during assessment . Transport difficulties can prove a major obstacle and tend to influence selection of patients . Exhausting journeys to hospital made some patients underst and ably reluctant to attend twice weekly for outpatient physiotherapy and some became so rigid in anticipation of belated transport that they were unable to leave their home . In addition to organisational difficulties , there seems to be little agreement concerning the principles and methods of physiotherapy appropriate for Parkinsonian disabilities . Nevertheless , we found modest but unequivocal improvement in 10 of 21 patients , and in seven benefit was sustained for at least five weeks after the cessation of treatment . We could not determine whether improvement was physical , psychological , or both . Now that the limitations as well as the potential of antiParkinsonian medication has been determined , clinicians will want to know how best to use diminishing physiotherapy re sources . Clearly there is a need for further trials to clarify these common practical problems of management Ottenbacher KJ , Hinderer SR : Evidence -based practice : methods to evaluate individual patient  improvement . Am J Phys Med Rehabil 2001;80:786–796.The expectations and dem and s associated with evidence -based practice in medical rehabilitation require the use of research procedures that are practice based and practitioner oriented . Traditional research methods , including r and omized clinical trials , are powerful techniques for determining the efficacy of rehabilitation interventions ; however , r and omized clinical trials have some practical and ethical limitations when applied to many research questions important to the field of medical rehabilitation , and alternative methods are needed to fully examine the effectiveness of treatment techniques for individual patients and to document clinical accountability . This paper examines the use of single-system design s and N of 1 research strategies . The advantages and limitations of single-system methods are described , and examples relevant to the documentation of clinical outcomes in medical rehabilitation are presented 
    Output:
    
Although both trials reported a positive effect from occupational therapy , all of the improvements were small .
Considering the significant method ological flaws in the studies , the small number of patients examined , and the possibility of publication bias , there is insufficient evidence to support or refute the efficacy of occupational therapy in Parkinson 's disease .