***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: The objective of the study was to establish the specific use of advice and exercise by physiotherapists , for the management of  chronic low back pain ( LBP ) . A question naire was mailed to a r and om sample of 600 members of the Irish Society of Chartered Physiotherapists . Open and closed questions were used to obtain information on treatments provided to chronic LBP patients . Respondents ' treatment goals were also investigated , along with the typical methods used to assess treatment outcome . Four hundred and nineteen of the sample returned the question naire ; 280/419 ( 67 % ) indicated that they currently treated LBP of which 76 % ( n=214 ) were senior grade therapists .  Advice and exercise  , respectively , were the treatments most frequently used for chronic LBP : advice was most commonly delivered as part of an exercise programme , with strengthening ( including core stability ) the most frequently used exercise type .  Supervision of exercise and follow-up advice  were underutilised with respect to the recommendations of relevant clinical guidelines . Pain relief was an important treatment goal . Emphasis on exercise programme  supervision , incorporating reassurance that its safe to stay active and ' hurt does not mean harm ' , must be more effectively disseminated and promoted in practice . The influence of follow-up advice on  exercise adherence warrants further investigation Background Traction is commonly used for the treatment of low back pain ( LBP ) , predominately with nerve root involvement ; however its benefits remain to be established . The aim of this study was to test the feasibility of a pragmatic r and omized controlled trial to compare the difference between two treatment protocol s ( manual therapy , exercise and advice , with or without traction ) in the management of acute/sub acute LBP with ' nerve root ' involvement . Methods 30 LBP patients with nerve root pain were recruited and r and omly assigned to one of two treatment groups . Primary outcome measures were the : McGill pain question naire , Rol and Morris disability question naire , and the SF36 Question naire ; recorded at baseline , discharge , 3 and 6 months post-discharge . Results 27 patients completed treatment with a loss of another four patients at follow up . Intention to treat analysis demonstrated an improvement in all outcomes at follow up points but there appeared to be little difference between the groups . Conclusion This study has shown that a trial recruiting patients with ' nerve root ' problems is feasible . Further research based upon a fully powered trial is required to ascertain if the addition of traction has any benefit in the management of these patients .Trial Registration Registration number : IS RCT BACKGROUND AND PURPOSE Since the release of acute low back pain management guidelines in 1994 , little was known about the effect of these guidelines on clinical practice . The purpose of this study was to examine physical therapists ' reported management of acute and subacute lumbar impairment . SUBJECTS One in 10 registered physical therapists who were r and omly selected from southern Ontario , Canada , ( n=454 ) and all registered physical therapists from northern Ontario ( n=331 ) were surveyed . METHODS In the question naire , case scenarios covered 3 areas related to the management of lumbar impairment : ( 1 ) physical examination , ( 2 ) treatment and recommendations , and ( 3 ) therapists ' beliefs regarding its management . RESULTS Five hundred sixty-nine question naires were returned ( response rate=72.5 % ) . Only data obtained for therapists ( n=274 ) whose weekly workload included more than 10 % of people with lumbar impairment were used in the analysis . Overall ,  patient education , exercise , and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment ( symptom onset of less than 5 weeks ) with or without sciatica , whereas exercise and work modification were preferred for subacute lumbar impairment ( symptom onset of 5 weeks or longer ) . There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness . Only 46.3 % of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment . DISCUSSION AND CONCLUSION Although the physical therapists surveyed , in general , followed the guidelines in managing acute lumbar impairment , they felt uncertain regarding the value of practice guidelines . Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines Background Patients with signs of nerve root irritation represent a sub-group of those with low back pain who are at increased risk of persistent symptoms and progression to costly and invasive management strategies including surgery . A period of non-surgical management is recommended for most patients , but there is little evidence to guide non-surgical decision-making . We conducted a preliminary study examining the effectiveness of a treatment protocol of mechanical traction with extension-oriented activities for patients with low back pain and signs of nerve root irritation . The results suggested this approach may be effective , particularly in a more specific sub-group of patients . The aim of this study will be to examine the effectiveness of treatment that includes traction for patients with low back pain and signs of nerve root irritation , and within the pre-defined sub-group . Methods / Design The study will recruit 120 patients with low back pain and signs of nerve root irritation . Patients will be r and omized to receive an extension-oriented treatment approach , with or without the addition of mechanical traction . R and omization will be stratified based on the presence of the pre-defined sub-grouping criteria . All patients will receive 12 physical therapy treatment sessions over 6 weeks . Follow-up assessment s will occur after 6 weeks , 6 months , and 1 year . The primary outcome will be disability measured with a modified Oswestry question naire . Secondary outcomes will include self-reports of low back and leg pain intensity , quality of life , global rating of improvement , additional healthcare utilization , and work absence . Statistical analysis will be based on intention to treat principles and will use linear mixed model analysis to compare treatment groups , and examine the interaction between treatment and sub-grouping status . Discussion This trial will provide a method ologically rigorous evaluation of the effectiveness of using traction for patients with low back pain and signs of nerve root irritation , and will examine the validity of a pre-defined sub-grouping hypothesis . The results will provide evidence to inform non-surgical decision-making for these patients .Trial Registration This trial has been registered with http:// Clinical Trials.gov : Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain PURPOSE S to compare the efficacy of mechanical lumbar traction with low ( 10 % of body weight ) and high traction force ( 50 % of body weight ) on the separation of the vertebrae in vivo using stature variations as criterion . Additionally , we aim ed to determine the time that the effects of traction last . MATERIAL AND METHODS Thirty apparently healthy subjects ( age : 20.9 ± 1.7 years old ) , 14 male and 16 female , were su bmi tted to two protocol s of 15 minutes of continuous traction ( with intensity of 10 % and 50 % of body weight ) , in two sessions one week apart . The protocol order was determined r and omly . Stature was assessed before and immediately after the traction and every five minutes for 30 minutes after traction ceased . RESULTS Immediately after the traction both protocol s induced a significant increase in stature , however the magnitude of the increase was significantly superior in the traction with 50 % of body weight ( 0.567 ± 0.049 vs. 0.298 ± 0.041 cm , p>0.001 ) . After the traction with 50 % of body weight the increase in the stature was maintained until ten minutes after the end of the traction , while after the traction with 10 % of body weight the effects on stature disappeared after five minutes . CONCLUSIONS The mechanical vertebral traction of the lumbar region performed continuously with 50 % of body weight during 15 minutes induced an increase in stature superior and longer in time than that observed with a traction force of 10 % of body weight STUDY DESIGN Single group test-retest repeated measures . OBJECTIVES To determine the effects of lumbar traction with 3 different amounts of force ( 10 % , 30 % and 60 % body weight ) on pain-free mobility of the lower extremity as measured by the straight leg raise ( SLR ) test . BACKGROUND There are several recommendations on how lumbar traction should be performed , but the duration , frequency , force , and type of technique to be applied differ among the sources . METHODS AND MEASURES Ten subjects with subjective complaints of low back pain or radicular symptoms with a positive unilateral SLR test below 45 degrees participated in this study . The pain-free mobility of the lower extremity in the SLR test position was measured prior to and immediately following 5 minutes of static traction in the supine position . R and om assignment in the order of the amount of applied traction was implemented . RESULTS The straight leg raise measurements were found to be significantly greater immediately following 30 % and 60 % of body weight traction as compared to pretraction and 10 % of body weight traction . The mean ( SD ) SLR measurements were pretraction ( 24.1 degrees + /- 13.0 ) , 10 % of body weight traction ( 27.4 degrees + /- 14.5 ) , 30 % of body weight traction ( 34.0 degrees + /- 14.3 ) , 60 % of body weight traction ( 36.5 degrees + /- 15.8 ) . CONCLUSIONS The results of this study indicate that traction in this group of patients improved the mobility of the lower extremity during the SLR test . Both 30 % and 60 % of body weight tractions were shown to be effective for increasing motion beyond pretraction levels Study Design . A prospect i ve , consecutive , cohort study of patients with acute low back pain classified into subgroups based on examination data and treated with a specific treatment approach . Objective . To calculate the interrater reliability of a classification system , and to compare initial patient characteristics and outcomes of physical therapy treatment when a classification approach is used . Summary of Background Data . Classification of patients with low back pain into homogeneous subgroups has been identified as a research priority . Identifying relevant subgroups of patients could improve clinical outcomes and research efficiency . Methods . Consecutive patients referred to physical therapy for treatment of acute low back pain were evaluated and classified into one of four subgroups ( immobilization , mobilization , specific exercise , or traction ) before treatment . Physical therapy treatment was based on the patient ’s classification . The classifications were compared for initial patient characteristics , frequency and duration of physical therapy , and improvement in Oswestry scores . Results . In this study , 120 patients were evaluated and classified . Analysis of interrater reliability showed a kappa value of 0.56 . Differences were found among the classifications for age , initial Oswestry score , history of low back pain , symptom distribution , and average change in Oswestry score with treatment . Conclusions . Reaching a consensus regarding relevant patient subgroups requires data on the reliability and validity of existing classification systems . Further work is required to vali date improvement in treatment outcomes using a classification approach Study Design . A r and omized clinical trial . Objectives . To assess the efficacy of motorized continuous traction for low back pain . Summary of Background Data . The available studies on the efficacy of lumbar traction do not allow clear conclusions because of severe method ologic flaws . The current trial aim ed to overcome these shortcomings . Methods . Patients with at least 6 weeks of nonspecific low back pain were selected .  High‐dose traction was compared with sham ( or low‐dose ) traction . Sham traction was given with a specially developed brace that becomes tighter in the back during traction . This was experienced as if real traction were exerted . The patients and the outcome assessor were unaware of treatment allocation . Outcome measures were : patient 's global perceived effect , severity of main complaints , functional status , pain , range of motion , work absence , and medical treatment . Results for the outcome measures at 12 weeks 
    Output:
    
Most of the orthopaedic physical therapists in the United States who responded to our survey reported that they used lumbar traction , though not necessarily consistent with proposed criteria that identify patients most likely to benefit from traction .
They used various traction delivery modes/parameters and used traction within comprehensive plans of care incorporating multiple interventions .
Professional characteristics ( education levels and clinical specialist credentialing ) were associated with traction usage