***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 To examine the effects of 2 manual therapy methods compared with one counselling session with a physiotherapist with " advice-only to stay active " for treating low back pain/leg pain and disability . DESIGN A r and omized , controlled trial with a 1-year follow-up . SUBJECTS A total of 134 subjects with low back disorders . METHODS Participants with acute to chronic first or recurrent low back pain , excluding those with " red flag " criteria , were assigned r and omly to one of the 3 intervention groups : an orthopaedic manual therapy group ( n=45 ) , a McKenzie method group ( n=52 ) , and an " advice only to be active " group ( advice-only ) ( n=37 ) . Data on leg and low back pain intensity and disability ( Rol and -Morris Disability question naire ) were collected at baseline , and at 3- , 6- , and 12-month follow-up points . RESULTS At the 3-month follow-up point , significant improvements had occurred in all groups in leg and low back pain and in the disability index , but with no significant differences between the groups . At the 6-month follow-up , leg pain ( -15 mm ; 95 % confidence interval ( CI ) -30 to -1 ) , back pain ( effect : -15 mm ; -27 to -4 ) , and disability index ( -4 points ; -7 to -1 ) improved ( p < 0.05 ) more in the McKenzie method group than in the advice-only group . At the 1-year follow-up , the McKenzie method group had ( p=0.028 ) a better disability index ( -3 points ; -6 to 0 ) than did the advice-only group . In the orthopaedic manual therapy group at the 6-month and 1-year follow-up visits , improvements in the pain and disability index were somewhat better than in the advice-only group ( p=0.067 and 0.068 , respectively ) . No differences emerged between the orthopaedic manual therapy and McKenzie method groups in pain- and disability-score changes at any follow-up . CONCLUSION The orthopaedic manual therapy and McKenzie methods seemed to be only marginally more effective than was one session of assessment and advice-only 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 OBJECT The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica . Their hypothesis was that bed rest , physiotherapy , and continuation of activities of daily living ( ADLs ) ( control treatment ) are each of equivalent efficacy . METHODS This r and omized controlled trial was design ed for comparison of bed rest , physiotherapy , and continuation of ADLs . The setting was an outpatient clinic . General practitioners were asked to refer patients for treatment as soon as possible . The authors enrolled 250 patients ( < 60 years of age ) with sciatica of less than 1-month 's duration and who had not yet been treated with bed rest or physiotherapy .  Primary outcome measures were radicular pain ( based on a visual analog pain scale [ VAPS ] ) and hampered ADLs ( Quebec Disability Scale [ QDS ] ) . Secondary outcome measures were the rates of treatment-related failure and surgical treatment . Measures were assessed at baseline and during follow up at 1 , 2 , and 6 months . Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 ( 95 % confidence interval [ CI ] -6.4 to 11.4 ) and -4.8 ( 95 % CI -10.6 to 0.9 ) at 1 month and 0.9 ( 95 % CI -8.7 to 10.4 ) and -2.7 ( 95 % CI -9.9 to 4.4 ) at 2 months , respectively . The respective differences between physiotherapy and control treatment were 0.8 ( 95 % CI -8.2 to 9.8 ) and -0.5 ( 95 % CI -6.3 to 5.3 ) at 1 month and -0.3 ( 95 % CI -9.4 to 10 ) and 0.0 ( 95 % CI -7.2 to 7.3 ) at 2 months . The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 ( 95 % CI 0.8 - 3.5 ) and 1.5 ( 95 % CI 0.7 - 3.6 ) at 6 months . When physiotherapy was compared with control treatment , these ratios were 1.5 ( 95 % CI 0.7 - 3.2 ) and 1.2 ( 95 % CI 0.5 - 2.9 ) at 6 months , respectively . CONCLUSIONS Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs 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 Background . The management of common low back pain has two principal objectives : to relieve acute pain and to attempt prevention of transition to chronicity . Several studies have shown the ineffectiveness of prolonged periods of bed rest . Objective . To compare 4 days of bed rest with continued normal daily activity in acute low back pain , taking into account the type of work ( physical or sedentary labor ) . Methods . This open , comparative multicenter study enrolled 281 ambulatory patients , ages 18 to 65 years , with low back pain ( onset < 72 hours ) . The subjects did not have pain radiating below the buttocks and did not have work-related injuries . They were r and omized into two treatment groups : one instructed to continue normal activity ( insofar as the pain allowed ) , and the other prescribed 4 days of bed rest . After inclusion , patients were seen at three visits : on day 6 or 7 , after 1 month , and after 3 months . Results . On day 6 or 7 , pain intensity was similar for both groups , as was the overall judgment of the treatment by patients and physicians . At 1 and 3 months , the groups again had equivalent intensity of back pain , functional disability , and vertebral stiffness . A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave ( 86%vs 52%;P < 0.0001 ) . This difference was greater for the patients whose work was sedentary . Conclusions . For patients with acute low back pain , normal activity is at least equivalent to bed rest . The findings of this study indicate that prescriptions for bed rest , and thus for sick leaves , should be limited when the physical dem and s of the job are similar to those for daily life activities Bed rest is usually recommended for  acute low back pain .  Although the optimal duration of bed rest is uncertain , a given prescription may directly affect the number of days lost from work or other activities . In a r and omized trial , we compared the consequences of recommending two days of bed rest ( Group I ) with those of recommending seven days ( Group II ) . The subjects were 203 walk-in patients with mechanical low back pain ; 78 percent had acute pain ( less than or equal to 30 days ) , and none had marked neurologic deficits . Follow-up data were obtained at three weeks ( 93 percent ) and three months ( 88 percent ) . Although compliance with the recommendation of bed rest was variable , patients r and omly assigned to Group I missed 45 percent fewer days of work than those assigned to Group II ( 3.1 vs. 5.6 days , P = 0.01 ) , and no differences were observed in other functional , physiologic , or perceived outcomes . For many patients without neuromotor deficits , clinicians may be able to recommend two days of bed rest rather than longer periods , without any perceptible difference in clinical outcome . If widely applied , this policy might substantially reduce absenteeism from work and the result ing indirect costs of low back pain for both patients and employers BACKGROUND AND METHODS Bed rest is widely advocated for sciatica , but its effectiveness has not been established . To study the effectiveness of bed rest in patients with a lumbosacral radicular syndrome of sufficient severity to justify treatment with bed rest for two weeks , we r and omly assigned 183 subjects 
    Output:
    
Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed ; patients with sciatica experience little or no difference between the two approaches .
Low quality evidence suggests little or no difference between those who received advice to stay active , exercises or physiotherapy .