***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: RésuméLe repos au lit est habituellement considéré comme un traitement efficace de la lombalgie aiguë . Cependant la durée optimale de cette mise au repos au lit est encore discutée , variant selon les écoles de 2 jours à 2 semaines . C'est un paramètre imporant à considérer , compte tenu des préjudices économiques et fonctionnels d'une inactivité prolongée . Le but de ce travail est de faire une évaluation objective de l'efficacité de deux durées de repos différentes , à l'aide d'une mesure dynamométrique de la fonction musculaire du tronc pratiquée à la suite d'une mise au repos plus ou moins longue . Cinquante et un patients , étudiants ou travaillant à leur propre compte , consultant pour des lombalgies aiguës , ont été r and omisés en deux groupes . Au groupe I a été prescrit un repos au lit de 3 jours et au groupe II un repos de 7 jours . Nous avons utilisé un appareil dynamométrique ( Isostation B200 , Isotechnologies , USA ) pour l'évaluation isoinertielle de la fonction musculaire du tronc dans les différents plans . Les patients ont été évalués au ler et au 5e jour dans le groupe I ; la seconde évaluation a été reportée au 9e jour dans le groupe II . Les variables mesurées dans le plan sagittal ont été les forces isometriques en flexion et extension , l'amplitude des mouvements sans résistance , la valeur moyenne des forces développées dans les mouvements de flexion et d'extension ainsi que les vitesses moyennes . On a également dem and é aux patients de situer sur une échelle graphique l'intensité de la douleur ressentie le jour de l'évaluation . L'amélioration de tous les paramètres mesurées a été importante et hautement significative ( P<0,001 ) dans les deux groupes . Les résultats du testing fonctionnel et de l'échelle des douleurs n'ont pas montré de différences significatives entre ces deux groupes . Chez ces patients relativement jeunes et motivés , un repos au lit de trois jours a abouti à la même amélioration de la fonction et de la douleur que le repos de sept jours . Compte tenu des résultats objectifs identiques et aussi des avantages physiologiques et économiques indiscutables , il est préférable de prescrire une mise au repos plus brève . Summary Bed rest is usually considered an efficient treatment for acute low back pain . However , the optimal duration of bed rest is still being discussed . The recommended periods vary from 2 days to 2 weeks . The duration of optimum length is an important topic given the economical and physiological drawbacks of prolonged inactivity . The purpose of this work is to measure objective ly the efficacy of two different duration s of bed rest through a dynamometric measure of trunk function . Some 51 male patients , students or self-employed , being treated for acute low back pain were r and omized into two groups . Group I was prescribed a bed rest period of 3 days and group II , a period of 7 days . We used a multiaxis isoinertial trunk testing dynamometric device ( Isostation B200 , Isotechnologies , USA ) . Patients were all assessed on day 1 and also on day 5 for group I or on day 9 for group II . The variables measured in the sagittal plane were isometric torques in flexion and extension , unresisted range of motion , average dynamic torques and average velocities . Patients were also asked to fill in a visual analogue pain scale on both assessment days . The improvement of all performance measures were important and highly significant ( P<0.001 ) in both groups . The results of the functional testing and the visual analogue pain scale showed no significant differences between the groups . In these relatively young and motivated patients , a duration of bed rest of 3 days result ed in the same objective functional improvement of trunk function and pain rating as a period of 7 days . This shorter duration should be considered as preferable , given the same objective results but important physiological and economical advantages The roles of bedrest , antiinflammatory medication , and analgesic medication in the treatment of acute back strain were objective ly analyzed to determine whether they have a measurable effect on the return of  patients  to full daily activities as well as on the relief of pain . Two hundred patients were studied prospect ively . Each patient had the diagnosis of acute back strain , which was defined as nonradiating low-back pain . The results of the patient 's neurologic examination , straight leg raising test , and lumbosacral spine roentgenograms had to be within normal limits for the patient to be included in the study . The results showed that bedrest , as compared with ambulation , will decrease the amount of time lost from work by 50 % . Bedrest will also decrease the amount of discomfort by 60 % . Analgesic medication , when combined with bedrest , will further decrease the amount of pain incurred , particularly when used in the first three days of the healing process . However , analgesic medication will not allow a more prompt return to work .  Antiinflammatory medication , when added to bedrest in the treatment of lumbago , does not provide an advantage over bedrest alone The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave A controlled trial of continuous lumbar traction in the treatment of  back pain and sciatica  showed similar improvements in both the treated group ( weighted traction ) and the control group ( simulated traction ) . The findings of this study question the justification of admitting patients with back pain into hospitals for purpose s of traction alone The results of a multicentered r and omised clinical trial are reported of bed rest and of a physiotherapy and education programme for patients who presented in family practice with an acute episode of low back pain . No beneficial effect of either treatment was observed on several clinical outcome measures , including straight leg raising , lumbar flexion , activities of daily living , and pain . In fact the results favoured early mobilisation over bed rest and suggested that the physiotherapy and education programme was doing more harm than good . Moreover , additional analyses , which focused on clinical ly interesting patient subgroups , discovered no subset of patients who benefited from either of the treatments under study . Having failed to identify any clinical ly important benefits , or other explanations for these negative results , we can only conclude that family doctors have little reason to prescribe either bed rest or isometric exercises to patients who suffer from low back pain Because back pain is a widespread and costly condition that tends to recur , treatment must focus on both the amelioration of acute symptoms and prevention over the long term . This paper reports a longitudinal evaluation of a program from a community hospital that emphasizes both these aspects . One hundred twenty patients routinely admitted to this program were r and omly assigned to treatment and control groups . These groups were assessed for differences in demonstrated physical strength , mobility , body mechanics , and self-care knowledge , and in levels of self-reported exercise , anxiety , and pain . There were significant immediate gains on physical measures of fitness and in observed body mechanics ; patients also reported significant gains in physical capabilities at home and in leisure activities . Self-care knowledge also improved . When assessed one year later , original gains in physical strength and mobility were being maintained , and self-reported physical capabilities also remained high . Although demonstrated knowledge of correct body mechanics declined over this period , it was still significantly greater than before the program . In light of these results , we believe that outpatient programs like the one reported here merit careful consideration in an era of concern about rising costs for primary health care & NA ; The current investigation studied the effectiveness of a secondary prevention program for nurses with back pain who were deemed at risk for developing a chronic problem . A 2 × 3 repeated measures design was employed with 2 groups and 3 assessment periods . The treatment group received an intervention design ed to reduce current problems , but above all to prevent reinjury and minor pains from becoming chronic medical problems , and it included a physical and behavioral therapy package . The control group was placed on a waiting‐list . Results indicated that the treatment group had significantly greater improvements than the control group for pain intensity , anxiety , sleep quality and fatigue ratings , observed pain behavior , activities , mood , and helplessness . These differences were generally maintained at the 6 month follow‐up . In addition , the treatment group broke a trend for increasing amounts of pain‐related absenteeism , while the control group did not . Taken as a whole , the results suggest that a secondary prevention program aim ed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems Patients with nonspecific mechanical low back pain ( n = 103 ) , examined by an orthopaedic surgeon and a social worker , were r and omized to an  activity group ( n = 51 ) and a control group ( n = 52 ) . Patients with defined orthopaedic , medical , or psychiatirc diagnoses were excluded before r and omization . No patients were excluded due to place of birth or difficulties in speaking or underst and ing the Swedish language . The purpose of the study was to compare mobility , strength and fitness after traditional care and after traditional care plus a grade d activity program with a behavioral therapy approach . A grade d activity program , with a behavioral therapy approach was given under the guidance of a physical therapist . The endpoint of the grade d activity program was return to work . This program significantly increased mobility , strength , and fitness more than could be explained by only a time recovery effect , especially in males . The patients in the activity group returned to work earlier than did the patients in the control group . Spinal rotation , abdominal muscle endurance time and lifting capacity were significantly correlated to rate of return to work .  Traditional care plus a grade d activity program were superior to only traditional care , evaluated in terms of mobility , strength and fitness . The grade d activity program proved to be a successful method of restoring occupational function and facilitating return to work in subacute low back pain patients . The patients in the grade d activity program learned that it is safe to move , while regaining function Objective . This r and omized clinical trial was design ed to determine the effect of treating low back pain as a benign , self limiting condition by light normal activity . Methods . Patients on sickness leave from work for more than 8 weeks were r and omized into two groups :  intervention ( n = 463 ) and  control ( n = 512 ) . Those in the intervention group were examined , provided information , and given instruction . Outcome was measured by return or failure to return to work ( still on sickness leave ) . Results . Survival analysis showed a highly significant ( P = 0.000 ) reduction in sickness leave in the intervention group as compared with the control group . At 200 days 60 % were still on sickness leave in the control group vs. 30 % in the intervention group . A multivariate analysis with age , sex , and treatment as cofactors showed that sex had no effect on length of sickness leave and that treatment retained its effect when adjusting for differences in age composition . Conclusion . This study indicates that low back pain treated as a benign , self limiting condition recommended to light mobilization gives superior results as compared to treatment within a conventional medical system & NA ; Current conceptions of chronic pain clearly suggest that proper care at the acute stage should prevent the development of chronic problems . Patients ( 198 ) seeking help for acute musculoskeletal pain ( MSP ) , e.g. , back and neck pain participated in two studies of the effects of an Early Active intervention which underscored ‘ well ’ behavior and function compared to a Treatment as Usual control group . The quantity of the Early Active treatment was a median of 1 doctor 's appointment and 3 meetings with a physical therapist .  Study I concerned patients with a prior history of sick‐listing for MSP , while study II involved patients with no prior history of MSP . Treatment satisfaction , pain experience , activities and sickness absenteeism were assessed before , after and at a 12‐month follow‐up . In study I ( patients with a history of MSP ) , the results showed significant improvements for both groups , but virtually no differences between the groups . Similarly , in study II ( no history of MSP ) both groups demonstrated significant improvements e.g. , for pain intensity and activity levels . However , the Early Active treatment result ed in significantly less sick‐listing relative to the control group . Moreover , the risk of developing chronic ( > 200 sick days ) pain was 8 times lower for the Early Activation group . This investigation shows that relatively simple changes in treatment result in reduced sickness absenteeism for ‘ first‐time ’ sufferers only . Consequently , the content and timing of treatment for pain appear to be crucial . Properly administered early intervention may therefore decrease sick leave and prevent chronic problems , thus saving considerable re sources BACKGROUND Bed rest and back-extension exercises are often prescribed for patients with acute low back pain , but the effectiveness of these two competing treatments remains controversial . METHODS We conducted a controlled trial among employees of 
    Output:
    
Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery .
Advice to stay active and to continue ordinary activities results in a faster return to work , less chronic disability , and fewer recurrent problems .
CONCLUSION A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain