***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: This study examined the supplemental value of a cognitive coping skills training when added to an operant-behavioral treatment for chronic low-back pain patients . The complete treatment package ( OPCO ) was compared with an operant program + group discussion ( OPDI ) and a waiting-list control ( WLC ) . After the WL period , the WLC patients received a less protocol ized operant program usually provided in Dutch rehabilitation centers ( OPUS ) . Regression analyses showed that , compared with WLC , both OPCO and OPDI led to less negative affect , higher activity tolerance , less pain behavior , and higher pain coping and pain control . At posttreatment , OPCO led to better pain coping and pain control than OPDI . Calculation of improvement rates revealed that OPCO and OPDI had significantly more improved patients than OPUS on all the dependent variables . The discussion includes findings regarding treatment credibility , compliance , and contamination bias & NA ; The effects of outpatient group cognitive therapy , relaxation training , and cognitive therapy in combination with relaxation training on  chronic low back pain  and associated physical and psychosocial disability were evaluated and compared . One‐hundred and two mildly disabled chronic low back pain patients were assigned r and omly to a waiting‐list ( WL ) control condition and the 3 treatments .  Patient self‐report and observational measures were obtained pretreatment and post‐treatment for all conditions , and at 6‐ and 12‐month follow‐ups for the treatment conditions . Pain intensity decreased significantly pre‐ to post‐treatment for patients in all 3 treatment conditions , but not the WL condition . Depressive symptoms and disability improved significantly in all conditions ( including the waiting list ) from pretreatment to post‐treatment , with no statistically significant differences among treatments . At both follow‐ups , all 3 treatment groups remained significantly improved from pretreatment , with no statistically significant differences between treatments A prospect i ve r and omized study of 542 injured workers with continuing pain compared 271 workers who were treated at either one of two clinics that provided functional restoration with a control group of 271 subjects .  Chronic pain was caused by low back injury in 78 % of patients ; 79 % of those treated were at work 12 months after completion of treatment compared with 78 % of the control subjects . When the patients were divided into subsets , based on the accident date and followed monthly , the duration of absence from work , the compensation costs , the disability award costs , and the total costs were less for those treated than the control subjects , but these were not statistically significant . Using the difference in total costs as a measure of relative success , back injuries had better results than other injuries in this study 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 The aim of this cost-effectiveness study was to compare a combined operant programme plus cognitive/relaxation programme with an operant programme plus attention-control and to compare both programmes with a waiting-list control group and with operant rehabilitation provided , as usual , by the same rehabilitation centre . One hundred and forty eight patients with chronic low back pain were r and omly assigned to the different conditions . The economic endpoints were the costs of the programme and other health care utilisation , costs for the patient , and indirect costs associated with production losses due to low back pain . The effects were measured in terms of global assessment of change and utilities , using rating scale and st and ard gamble methods . The 3-year study determined that adding a cognitive component to an operant treatment did not lead to significant differences in costs and improvement in quality of life when compared with the operant treatment alone . Compared with the common individual rehabilitation therapy it can be concluded that the same effects can be reached at the same or lower costs with a shorter , more intense st and ardised group programme . The operant treatment alone is more effective than providing no treatment in the waiting-list control group The effects of outpatient group behavioral therapy including aerobic exercise ( BE ) , behavioral therapy only ( B ) , and aerobic exercise only ( E ) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients . Ninety-six Ss were r and omly assigned to the 3 treatments and a waiting-list control ( WL ) condition and assessed on a variety of patient self-report , spouse-rated , and direct observational measures at pretreatment , posttreatment , and 6- and 12-month follow-ups . Patients in the BE condition , but not the B or E conditions , improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures . At both follow-ups , all 3 treatment groups remained significantly improved from pretreatment , with no significant differences among treatments Fifty-eight out patients with chronic low back pain were r and omly allocated to one of six experimental conditions . Four conditions were design ated as treatment conditions and two as control conditions . The four treatment groups consisted of : cognitive treatment ( either with or without relaxation training ) and behavioural treatment ( either with or without relaxation training ) . The cognitive and behavioural groups also received physiotherapy . The two control conditions consisted of : attention ( physiotherapy plus discussion sessions ) and no-attention ( physiotherapy-only ) conditions . All conditions , including the two controls , received the same physiotherapy back-education and exercise program . For the sample as a whole , improvements were obtained on measures of affective distress , functional impairment , medication use , pain-related dysfunctional cognitions and use of active coping strategies . These improvements were generally maintained at 6- and 12-month follow-ups . The  combined psychological/physiotherapy treatment conditions improved significantly more than the physiotherapy-only conditions from pre to posttreatment on measures of pain intensity , self-rated functional impairment and pain-related dysfunctional cognitions . However , these differences were only weakly maintained at 6- and 12-month follow-ups . The behavioural conditions improved significantly more than the cognitive conditions from pre to posttreatment on the self-rated measure of functional impairment , but this difference was not maintained at 6- and 12-month follow-ups . Progressive relaxation training was found to make little contribution to either cognitive or behavioural treatments Forty-four chronic , but relatively well functioning , low back pain patients were assigned to either Cognitive Behaviour Therapy ( CBT ) . Electromyographic Biofeedback ( EMGBF ) or Wait List Control ( WLC ) . Both treatments were conducted over eight sessions in groups of four subjects . Results at post-treatment indicated significant improvements in functioning on measures of pain intensity , perceived level of disability , adaptive beliefs about pain and the level of depression in both the CBT and EMGBF conditions . These improvements were not evident for the WLC condition . At 6 months follow-up , treatment gains were maintained in the areas of pain intensity , pain beliefs , and depression , for both treatment groups , with further improvements occurring in anxiety and use of active coping skills . No significant differences were found between CBT and EMGBF on any of the outcome measures at either post-treatment or at 6 months follow-up . Further research is required to determine the degree to which these results reflect the mild level of psychological impairment and disability status of patients in the present study & 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 OBJECTIVES Because musculoskeletal pain is the second most frequent reason for seeking health care , the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis . STUDY DESIGN A prospect i ve study was conducted on consecutive patients with acute or subacute back pain , in which patients completed a screening question naire and were then followed up for 6 months to determine outcome . The primary outcome variable was accumulated sick leave . METHODS One hundred forty-two consecutive patients were asked to complete a question naire design ed for this study . This question naire contained 24 items concerning psychosocial aspects of the problem . Six months later , patients were contacted to complete outcome questions about accumulated sick leave .  RESULTS A total of 97 % of the patients completed both question naires . Although patients , on average , improved greatly , 18 % had 1 - 30 days and 20 % had fewer than 30 days of sick leave during the follow-up period . Five variables were found to be the strongest predictors of sick leave outcome ( fear-avoidance work beliefs , perceived improvement , problems with work function , stress , and previous sick leave ) , correctly classifying 73 % of the patients as opposed to a chance rate of 33 % . A total score was evaluated as a means of judging risk and found to be strongly related to outcome . CONCLUSION Potent psychosocial risk factors associated with future sick absenteeism were identified . Because the total score was related to outcome , the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations 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 Abstract Twenty chronic low back pain ( LBP ) patients with relatively high st and ing paraspinal EMG levels ( > 5 gmV ) were r and omly assigned to 2 groups . One group ( N = 10 ) received EMG biofeedback training to reduce st and ing paraspinal EMG levels , the other group ( N = 10 ) served as a waiting list control  group . Changes in perceived pain ( duration × intensity ) and paraspinal EMG in st and ing position were measured at a 3 week pretreatment baseline , during the 3 week treatment period , and at a 3 week post‐treatment baseline . Compared to patients in the waiting list control group , those who received EMG biofeedback showed a significant decrease in st and ing paraspinal EMG from pretreatment to post‐treatment baseline . However , no significant differences in reported pain were found during these periods . It is concluded that reduction of st and ing paraspinal EMG does not lead to reduction in pain THE R AND OMIZED controlled trial ( RCT ) , more than any other methodology , can have a powerful and immediate impact on patient care . Ideally , the report of such an evaluation needs to convey to the reader relevant information concerning the design , conduct , analysis , and generalizability of the trial . This information should provide the reader with the ability to make informed judgments regarding the internal and external validity of the trial . Accurate and complete reporting also benefits editors and review ers in their deliberations regarding su bmi tted manuscripts . For RCTs to ultimately benefit patients , the published report should be of the highest possible st and ard Cognitive behavioral 
    Output:
    
Behavioral treatment seems to be an effective treatment for patients with chronic low back pain , but it is still unknown what type of patients benefit most from what type of behavioral treatment