***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: Objective : Regular multidisciplinary team meetings are the main way that teams operate , yet our earlier research found they can sometimes be suboptimal . We developed a model to structure multidisciplinary team meetings and assessed the feasibility , acceptability and impact of its implementation on meeting quality and patient outcomes . Design : Longitudinal cohort design with non-participant observation of multidisciplinary team meetings before and after implementation of the intervention . Setting : Inpatient stroke rehabilitation units . Subjects : Members of the multidisciplinary inpatient stroke rehabilitation teams . Intervention : A model to structure multidisciplinary team meetings . Main measures : Quality of multidisciplinary team meetings ( using a predefined checklist ) ; change in independence ( Barthel Index ) during admission ; length of stay ; meeting duration and the number of patients discussed . Results : At baseline , meeting quality was generally low . Following implementation , all aspects of meeting quality improved by 5%–58 % . This was achieved without loss of staff productivity or additional re sources : The mean number of patients treated during the observation periods was 36 ( SD 17.6 ) , which was unchanged after implementation . Nor were there any significant changes in the length of meetings ( mean = 76 minutes ) , time spent discussing each patient ( 5.4 vs. 7 minutes ) or length of stay ( 26.7 vs. 30.3 days ) , but there was a greater increase in Barthel Index score after implementation ( 3.8 vs. 4.7 ) indicating greater functional recovery . Conclusions : A feasible and acceptable model to structure multidisciplinary stroke team meetings has been developed and implemented . This increased meeting quality without increase in re sources and may increase patient recovery Background and Purpose — Treatments that improve function in late phase after stroke are urgently needed . We assessed whether multimodal interventions based on rhythm- and -music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke . Methods — Participants were assigned to rhythm- and -music therapy , horse-riding therapy , or control using concealed r and omization , stratified with respect to sex and stroke laterality . Therapy was given twice a week for 12 weeks . The primary outcome was change in participants ’ perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis . Secondary objective outcome measures were changes in balance , gait , grip strength , and cognition . Blinded assessment s were performed at baseline , postintervention , and at 3- and 6-month follow-up . Results — One hundred twenty-three participants were assigned to rhythm- and -music therapy ( n=41 ) , horse-riding therapy ( n=41 ) , or control ( n=41 ) . Post-intervention , the perception of stroke recovery ( mean change from baseline on a scale ranging from 1 to 100 ) was higher among rhythm- and -music therapy ( 5.2 [ 95 % confidence interval , 0.79–9.61 ] ) and horse-riding therapy participants ( 9.8 [ 95 % confidence interval , 6.00–13.66 ] ) , compared with controls ( −0.5 [ −3.20 to 2.28 ] ) ; P=0.001 ( 1-way ANOVA ) . The improvements were sustained in both intervention groups 6 months later , and corresponding gains were observed for the secondary outcomes . Conclusions — Multimodal interventions can improve long-term perception of recovery , as well as balance , gait , grip strength , and working memory in a mixed population of individuals in late phase after stroke . Clinical Trial Registration — URL : http//www . Clinical Trials.gov . Unique identifier : NCT01372059 Objective To evaluate the effects of the population -based , person-centred and integrated care service ‘ Embrace ’ at twelve months on three domains comprising health , wellbeing and self-management among community-living older people . Methods Embrace supports older adults to age in place . A multidisciplinary team provides care and support , with intensity depending on the older adults ’ risk profile . A r and omised controlled trial was conducted in fifteen general practice s in the Netherl and s. Older adults ( ≥75 years ) were included and stratified into three risk profiles : Robust , Frail and Complex care needs , and r and omised to Embrace or care as usual ( CAU ) . Outcomes were recorded in three domains . The EuroQol-5D-3L and visual analogue scale , INTERMED for the Elderly Self- Assessment , Groningen Frailty Indicator and Katz-15 were used for the domain ‘ Health . ’ The Groningen Well-being Indicator and two quality of life questions measured ‘ Wellbeing . ’ The Self-Management Ability Scale and Partners in Health scale for older adults ( PIH-OA ) were used for ‘ Self-management . ’ Primary and secondary outcome measurements differed per risk profile . Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses , for the whole sample and per risk profile . Results 1456 eligible older adults participated ( 49 % ) and were r and omized to Embrace ( n(T0 ) = 747 , n(T1 ) = 570 , mean age 80.6 years ( SD 4.5 ) , 54.2 % female ) and CAU ( n(T0 ) = 709 , n(T1 ) = 561 , mean age 80.8 years ( SD 4.7 ) , 55.6 % female ) . Embrace participants showed a greater – but clinical ly irrelevant – improvement in self-management ( PIH-OA Knowledge subscale effect size [ ES ] = 0.14 ) , and a greater – but clinical ly relevant – deterioration in health ( ADL ES = 0.10 ; physical ADL ES = 0.13 ) compared to CAU . No differences in change in wellbeing were observed . This picture was also found in the risk profiles . Complete case analyses showed comparable results . Conclusions This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health , wellbeing and self-management in community-living older adults Background Agitation is a common , challenging symptom affecting large numbers of people with dementia and impacting on quality of life ( QoL ) . There is an urgent need for evidence -based , cost-effective psychosocial interventions to improve these outcomes , particularly in the absence of safe , effective pharmacological therapies . This study aim ed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review , WHELD , on QoL , agitation , and antipsychotic use in people with dementia living in nursing homes , and to determine its cost . Methods and findings This was a r and omised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the  WHELD intervention with treatment as usual ( TAU ) in people with dementia living in 69 UK nursing homes , using an intention to treat analysis . All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications ( antipsychotic review ) , followed by ongoing delivery through a care staff champion model . The primary outcome measure was QoL ( DEMQOL-Proxy ) . Secondary outcomes were agitation ( Cohen-Mansfield Agitation Inventory [ CMAI ] ) , neuropsychiatric symptoms ( Neuropsychiatric Inventory – Nursing Home Version [ NPI-NH ] ) , antipsychotic use , global deterioration ( Clinical Dementia Rating ) , mood ( Cornell Scale for Depression in Dementia ) , unmet needs ( Camberwell Assessment of Need for the Elderly ) , mortality , quality of interactions ( Quality of Interactions Scale [ QUIS ] ) , pain ( Abbey Pain Scale ) , and cost . Costs were calculated using cost function figures compared with usual costs . In all , 847 people were r and omised to WHELD or TAU , of whom 553 completed the 9-month r and omised controlled trial . The intervention conferred a statistically significant improvement in QoL ( DEMQOL-Proxy Z score 2.82 , p = 0.0042 ; mean difference 2.54 , SEM 0.88 ; 95 % CI 0.81 , 4.28 ; Cohen ’s D effect size 0.24 ) . There were also statistically significant benefits in agitation ( CMAI Z score 2.68 , p = 0.0076 ; mean difference 4.27 , SEM 1.59 ; 95 % CI −7.39 , −1.15 ; Cohen ’s D 0.23 ) and overall neuropsychiatric symptoms ( NPI-NH Z score 3.52 , p < 0.001 ; mean difference 4.55 , SEM 1.28 ; 95 % CI −7.07,−2.02 ; Cohen ’s D 0.30 ) . Benefits were greatest in people with moderately severe dementia . There was a statistically significant benefit in positive care interactions as measured by QUIS ( 19.7 % increase , SEM 8.94 ; 95 % CI 2.12 , 37.16 , p = 0.03 ; Cohen ’s D 0.55 ) . There were no statistically significant differences between WHELD and TAU for the other outcomes . A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy , CMAI , and NPI-NH outcomes with the WHELD intervention . Antipsychotic drug use was at a low stable level in both treatment groups , and the intervention did not reduce use . The WHELD intervention  reduced cost compared to TAU , and the benefits achieved were therefore associated with a cost saving . The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education . An additional limitation was the inherent challenge of assessing QoL in this patient group . Conclusions These findings suggest that the WHELD intervention confers benefits in terms of QoL , agitation , and neuropsychiatric symptoms , albeit with relatively small effect sizes , as well as cost saving in a model that can readily be implemented in nursing homes . Future work should consider how to facilitate sustainability of the intervention in this setting . Trial registration IS RCT N Registry IS RCT Background : There is insufficient evidence to support the effectiveness of multidisciplinary rehabilitation on the health-related quality of life ( HRQoL ) of MS patients . Objectives : To evaluate the longer term effectiveness of inpatient multidisciplinary rehabilitation on the HRQoL  of MS patients . Methods : The study was a two-hospital , pragmatic , r and omized controlled trial with a 6-month follow-up . Patients aged 18–65 years with MS and Exp and ed Disability Status Scale scores ≤7.5 were r and omly assigned ( 1:1 ) to 4 weeks of inpatient multidisciplinary rehabilitation ( 20 days of scheduled rehabilitation ) or 6 months on a wait list . The outcome measures were Functional Assessment in Multiple Sclerosis ( FAMS ) , Multiple Sclerosis Impact Scale-29 ( MSIS-29 ) , EQ-5D-5L and 15D . Results : We r and omized 213 patients to the wait-list control group and 214 patients to the treatment group . Trends in favour of the treatment group were observed across all measures . However , the difference was significant in only two of the six measures . The treatment effect was −2.7 ( 95 % CI : −5.6 to ( −0.1 ) ) , p = 0.046 ) for the MSIS-29 Psychological and 0.017 ( 95 % CI : 0.005–0.030 , p = 0.008 ) for the 15D . FAMS , which we used to calculate the sample size , was not significant . Conclusion : The results indicated that inpatient multidisciplinary rehabilitation  is effective in improving the HRQoL of MS patients after 6 months OBJECTIVE To evaluate the relationship between rehabilitation team functioning and stroke patient outcomes .  DESIGN Prospect i ve observational study . SETTING Veterans Administration ( VA ) inpatient and subacute rehabilitation units . PARTICIPANTS Forty-six VA rehabilitation teams , including 530 rehabilitation team members from 6 disciplines ( medicine , nursing , social work , physical therapy , occupational therapy , speech language pathology ) and 1688 stroke patients treated by the teams . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Ten scales assessing team member perceptions of team functioning ( communication , perceived effectiveness , physician involvement , physician support , teamness , utility of quality information , innovation , interprofessional relationships , order and organization , task orientation ) and 3 primary patient outcome variables-functional improvement , discharge home , and length of rehabilitation stay ( LOS ) . RESULTS Three of the 10 measures of team functioning were significantly associated with patient functional improvement ( P < .05 ) : task orientation , order and organization , and utility of quality information . One measure of team functioning-effectiveness-was significantly associated with LOS ( P < .05 ) . None of the team variables predicted discharge destination . Aspects of team functioning that were important to outcomes differed depending on the outcome of interests . Efforts directed toward improving team activities and relationships , including collaborative planning and problem solving and the use of feedback information , may enhance rehabilitation treatment effectiveness . CONCLUSIONS Characteristics of team functioning predict selected rehabilitation outcomes The aim of the review was to assess the effect of patient education in ischaemic heart disease . Thirteen r and omised controlled trials of moderate to good quality including 68,556 patients were selected . The effect on mortality , cardiac morbidity , hospitalisation and health-related quality of life was 
    Output:
    
Findings : The evidence shows that rehabilitation may benefit any person with a long-lasting disability  , arising from any cause , may do so at any stage of the illness , at any age , and may be delivered in any setting .
The effective general interventions include  exercise , practice of tasks , education of and self-management by the patient , and psychosocial support .