***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 Adolescent idiopathic scoliosis ( AIS ) remains the most common deforming orthopedic condition in children . Increasingly , both adults and children are seeking complementary and alternative therapy , including chiropractic treatment , for a wide variety of health concerns . The scientific evidence supporting the use chiropractic intervention is inadequate . The purpose of this study was to conduct a pilot study and explore issues of safety , patient recruitment and compliance , treatment st and ardization , sham treatment refinement , inter-professional cooperation , quality assurance , and outcome measure selection . Methods Six patients participated in this 6-month study , 5 of whom were female . One female was braced . The mean age of these patients was 14 years , and the mean Cobb angle was 22.2 degrees . The study design was a r and omized controlled clinical trial with two independent and blinded observers . Three patients were treated by st and ard medical care ( observation or brace treatment ) , two were treated with st and ard medical care plus chiropractic manipulation , and one was treated with st and ard medical care plus sham manipulation . The primary outcome measure was Cobb , and the psychosocial measure was Scoliosis Quality of Life Index . Results Orthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial . Patient recruitment and compliance was good . Chiropractic treatments were safely employed , and research protocol s were successful . Conclusion Overall , our pilot study showed the viability for a larger r and omized trial . This pilot confirms the strength of existing protocol s with amendments for use in a full r and omized controlled trial . Trial registration This trial has been assigned an international st and ard r and omized controlled trial number by Current Controlled Trials , Ltd. http://www.controlled-trials.com/is rct n/. The number is IS RCT N41221647 OBJECTIVE To evaluate chiropractic management of primary nocturnal enuresis in children . DESIGN A controlled clinical trial for 10 wk preceded by and followed by a 2-wk nontreatment period . SETTING Chiropractic clinic of the Palmer Institute of Graduate Studies and Research . PARTICIPANTS Forty-six nocturnal enuretic children ( 31 treatment and 15 control group ) , from a group of 57 children initially included in the study , participated in the trial . INTERVENTION High velocity , short lever adjustments of the spine consistent with the Palmer Package Techniques ; or a sham adjustment using an Activator at a nontension setting administered to the examiner 's underlying contact point . Two 5th-year chiropractic students under the supervision of two clinic faculty performed the adjustments . MAIN OUTCOME MEASURES Frequency of wet nights . RESULTS The post-treatment mean wet night frequency of 7.6 nights/2 wk for the treatment group was significantly less than its baseline mean wet night frequency of 9.1 nights/2 wk ( p = 0.05 ) . For the control group , there was practically no change ( 12.1 to 12.2 nights/2 wk ) in the mean wet night frequency from the baseline to the post-treatment . The mean pre- to post-treatment change in the wet night frequency for the treatment group compared with the control group did not reach statistical significance ( p = 0.067 ) . Twenty-five percent of the treatment-group children had 50 % or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction . CONCLUSIONS Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis . A larger study of longer duration with a 6-month follow-up is therefore warranted OBJECTIVE The purpose of this study was to describe Danish chiropractic patients younger than 18 years . METHODS Question naires were mailed to all chiropractic clinics in Denmark during a r and omly assigned month between September 2007 and September 2008 . All patients younger than 18 years or their parents were asked to complete a question naire collecting information on age , presenting complaint , duration and consequences of this complaint , referral mode , and use of pain medication . RESULTS Babies were the most common pediatric patients with about one third being between 0 and 4 months of age . Infantile colic was the most common presenting complaint in this age group . For the older children , musculoskeletal problems were the most dominant complaint , ranging from 33 % among the preschool children to 75 % among the teenagers . These complaints were often chronic and about a third of the children older than 2 years had experienced symptoms for more than 1 year before seeing the chiropractor . These health complaints were reported to restrict activity as well as alter mood , and 39 % of the 2- to 17-year olds used analgesics . There was limited referral of patients from other health care professionals . CONCLUSIONS Babies made up most of the Danish chiropractic patients younger than 18 years . Among the older children and the adolescents , musculoskeletal complaints were most common and mostly of a chronic nature . The large number of pediatric patients in chiropractic practice s and the paucity of evidence of treatment effectiveness indicate the need for further research in these age groups Objective . To compare supination at the wrist followed by flexion at the elbow ( the traditional reduction technique ) to hyperpronation at the wrist in the reduction of radial head subluxations ( nursemaid 's elbow ) . Material s and Methods . This prospect i ve , r and omized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation . Patients were r and omized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function . The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt . Failure of that technique 30 minutes after the initial reduction attempt result ed in a cross-over to the alternate method of reduction . The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted . If the patient failed both techniques , radio-graphy of the elbow was performed . Results . A total of 90 patients were enrolled in the study . Five patients were removed from further analysis secondary to a final diagnosis of fracture , 84 were reduced successfully , and 1 failed both techniques . Demographic characteristics of each group were similar . Thirty-nine of 41 patients ( 95 % ) r and omized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients ( 77 % ) r and omized to supination . Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group . Hyperpronation was more successful ; 40 of 41 patients ( 97.5 % ) in the hyperpronation group were reduced successfully versus 38 of 44 patients ( 86 % ) in the supination group . Of the 6 patients who crossed over from supination to hyperpronation , 5 were reduced on the first attempt and 1 was reduced on the second attempt . Conclusions . In the reduction of radial head subluxations , the hyperpronation technique required fewer attempts at reduction compared with supination , was successful more often than supination , and was often successful when supination failed OBJECTIVE To provide a review of the literature and rate the quality of published studies regarding chiropractic care , including spinal manipulation , for asthmatic patients . METHODS A multimodal search strategy was conducted , including multiple data base search es , along with reference and journal h and - search ing . Studies were limited to those published in English and in peer- review ed journals or conference proceedings between January 1980 and March 2009 . All study design s were considered except personal narratives or review s. Retrieved articles that met the inclusion criteria were rated for quality by using the Downs and Black checklist . A brief summary was also written for each retrieved study . RESULTS Eight articles met the inclusion criteria of this review in the form of one case series , one case study , one survey , two r and omized controlled trials ( RCTs ) , one r and omized patient and observer blinded cross-over trial , one single blind cross study design , and one self-reported impairment question naire . Their quality scores ranged from 5 to 22 out of 27 . CONCLUSION Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and , to a lesser degree objective measures , none of which were statistically significant . It is evident that some asthmatic patients may benefit from this treatment approach ; however , at this time , the evidence suggests chiropractic care should be used as an adjunct , not a replacement , to traditional medical therapy OBJECTIVE This study investigates the effect of chiropractic treatment on  hip joint extension ability  and running velocity . METHODS This was a prospect i ve , r and omized , controlled experimental pilot study . Seventeen healthy male junior athletes ( age , 17 - 20 years ) training in middle distance running were recruited from local Swedish athletic associations .  Hip extension ability and running velocity were measured before and after the study period . Chiropractic investigations comprised motion palpation of the sacroiliac and hip joints and modified Thomas test of the ability to extend the leg . In the treatment group , findings of restrictive joint dysfunctions formed the basis for the choice of chiropractic treatment . The interventions were based on a pragmatic approach consisting of high-velocity , low-amplitude manipulations targeted toward , but not exclusively to , the sacroiliac joints . RESULTS The treatment group showed significantly greater hip extension ability after chiropractic treatment than did controls ( P < .05 ) . Participants in the treatment group did not show a significant decrease in time for running 30 m after treatment ( average , -0.065 seconds ; P = .0572 ) , whereas the difference was even smaller for the control subjects ( average , -0.003 ; P = .7344 ) . CONCLUSIONS The results imply that chiropractic treatment can improve hip extensibility in subjects with restriction as measured by the modified Thomas test . It could be speculated that the running step was amplified by increasing the angle of step through facilitated hip joint extension ability . The possible effect of chiropractic treatment to enhance the running velocity , by increasing the hip joint extension ability and thereby increasing the running step , remains unproven A prospect i ve , uncontrolled study of 316 infants suffering from infantile colic and selected according to well-defined criteria shows a satisfactory result of  spinal manipulative therapy  in 94 % of the cases . The median age of the infants was 5.7 wk at the beginning of the treatment . The results were evaluated by analysis of a diary continuously kept by the mother and an assessment file comprised by interview . The study was carried out as a multicenter study lasting 3 months and involving 73 chiropractors in 50 clinics . The results occurred within 2 wk and after an average of three treatments OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies Background The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions . Methods The conclusions are based on the results of systematic review s of r and omized clinical trials ( RCTs ) , widely accepted and primarily UK and United States evidence -based clinical guidelines , plus the results of all RCTs not yet included in the first three categories . The strength/ quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs . Results By September 2009 , 26 categories of conditions were located containing RCT evidence for the use of manual therapy :  13 musculoskeletal conditions , four types of chronic headache and nine non-musculoskeletal conditions . We identified 49 recent relevant systematic review s and 16 evidence -based clinical guidelines plus an additional 46 RCTs not yet included in systematic review s and guidelines .Additionally , brief references are made to other effective non-pharmacological , non-invasive physical treatments . Conclusions Spinal manipulation/mobilization is effective in adults for : acute 
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CONCLUSION Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT , especially among children with asthma .