***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 H and exercises are recommended for patients with h and osteoarthritis ( HOA ) , though evidence for their effect is conflicting . Objective To evaluate , in a r and omised controlled trial , the effect of HOA information plus home-based h and exercises ( exercise group ) compared with information only ( control group ) in women with HOA . Methods Interventions were delivered by two occupational therapists . Exercise group participants received eight follow-up calls over the 3-month study and recorded adherence , pain after exercises and adverse events in a diary . Primary outcome was activity performance measured after 3 months by the Patient-Specific Functional Scale ( PSFS ) , with a range of 0–10 . Secondary outcomes were measurements of h and function , disease activity , symptoms and number of responders to treatment according to the OMERACT-OARSI criteria . Results Of 80 women r and omised ( 40 : 40 ) ( mean age ( SD ) 60.8 years ( 7.0 ) ) , follow-up was 89 % ( n=71 ) . An intention-to-treat analysis was performed . The adjusted mean difference for the exercise versus control group was 1.4 points ( 95 % CI 0.6 to 2.2 , effect size 1.0 ) for the PSFS score .  Thirteen patients in the  exercise  group versus three participants in the control group reached a positive minimal clinical important difference of 2.2 points in the PSFS total score , while none versus two , respectively , had a negative change ( p=0.007 ) . For secondary outcomes , significant mean differences were found in grip strength and thumb web space , in fatigue , joint pain and the Functional Index for HOA activity performance scores . Sixteen exercise-group participants fulfilled the OMERACT-OARSI response criteria versus two control-group participants ( p<0.001 ) . Conclusions H and exercises were well tolerated and significantly improved activity performance , grip strength , pain and fatigue in women with HOA . Trial registration number : ISRTCN79019063 Background Osteoarthritis is the leading cause of disability in older adults . Evidence of effectiveness for self-management of h and osteoarthritis is lacking . Methods In this r and omised , factorial trial , we evaluated the effectiveness of joint protection versus no joint protection , and h and exercise versus no h and exercise in adults , 50 years of age or older , with h and osteoarthritis . Following a population survey ( n=12 297 ) , eligible individuals were r and omly assigned ( 1:1:1:1 ) to : leaflet and advice ; joint protection ; h and exercise ; joint protection plus h and exercise . Joint protection and h and exercises were delivered by nine occupational therapists , over four group sessions . The primary outcome was the OARSI/OMERACT responder criteria at 6 months . Outcomes were collected blind to allocation ( 3 , 6 , 12 m ) . Analysis was by intention to treat . Results Of 257 participants r and omised ( 65:62:65:65 ) ( mean age ( SD ) 66 years ( 9.1 ) ; female 66 % ) follow-up was 85 % at 6 m ( n=212 ) . Baseline characteristics and loss to follow-up were similar between groups . There were no reported treatment side effects . At 6 m 33 % assigned joint protection were responders compared with 21 % with no joint protection ( p=0.03 ) . Of those assigned h and exercises , 28 % were responders compared with 25 % with no exercises ( n.s . ) . Differences in secondary outcomes were not statistically significant , except for improvement in pain self-efficacy with joint protection ( 3 m p=0.002 ; 6 m p=0.001 ; 12 m p=0.03 ) . Conclusions These findings show that occupational therapists can support self-management in older adults with h and osteoarthritis , and that joint protection provides an effective intervention for medium term outcome . ( Funded by the Arthritis Research UK IS RCT N 33870549 ) OBJECTIVE To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis ( OA ) of the hip . METHODS A single-blind , r and omized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital . The manual therapy program focused on specific manipulations and mobilization of the hip joint . The exercise therapy program focused on active exercises to improve muscle function and joint motion . The treatment period was 5 weeks ( 9 sessions ) . The primary outcome was general perceived improvement after treatment . Secondary outcomes included pain , hip function , walking speed , range of motion , and quality of life . RESULTS Of 109 patients included in the study , 56 were allocated to manual therapy and 53 to exercise therapy . No major differences were found on baseline characteristics between groups . Success rates ( primary outcome ) after 5 weeks were 81 % in the manual therapy group and 50 % in the exercise group ( odds ratio 1.92 , 95 % confidence interval 1.30 , 2.60 ) . Furthermore , patients in the manual therapy group had significantly better outcomes on pain , stiffness , hip function , and range of motion . Effects of manual therapy on the improvement of pain , hip function , and range of motion endured after 29 weeks . CONCLUSION The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip Purpose The objective of this study was to evaluate whether women with knee osteoarthritis performing a rehabilitation programme consisting of low-load exercises combined with PVO exhibited the same results in changes in quadriceps strength , pain relief , and functional improvement when compared to women receiving a programme consisting of high-load exercises without PVO . Methods Thirty-four women ( mean age , 61 years ) with a diagnosis of knee osteoarthritis were r and omly assigned to a conventional or occlusion group . The women in the conventional group ( n = 17 ) performed a 6-week quadriceps strengthening and stretching programme using a load around 70 % of the 1-repetition maximum ( RM ) . The women in the occlusion group ( n = 17 ) performed the same programme , however , only using a load around 30 % of the 1-RM , while PVO was induced . The PVO was achieved using a pressure cuff applied to the upper third of the thigh and inflated to 200 mmHg during the quadriceps exercise . An 11-point Numerical Pain Rating Scale ( NPRS ) , the Lequesne question naire , the Timed-Up and Go ( TUG ) test , and muscle strength measurement using a h and -held dynamometer were used as outcome measures at baseline ( pretreatment ) and at the end of the 6-week of treatment . Pain , using the NPRS , was also assessed when performing the quadriceps exercises during the exercise sessions . Results At baseline , demographic , strength , pain , and functional assessment data were similar between groups . Patients from both the conventional and occlusion groups had a higher level of function ( Lequesne and TUG test ) , less pain ( NPRS ) , and higher quadriceps strength at the 6-week evaluation when compared to baseline ( all P < 0.05 ) . However , the between-group analysis showed no differences for all outcomes variables at posttreatment ( n.s . ) . Patients in the occlusion group experienced less anterior knee discomfort during the treatment sessions than those in the high-load exercise group ( P < 0.05 ) . Conclusion A rehabilitation programme that combined PVO to low-load exercise result ed in similar benefits in pain , function , and quadriceps strength than a programme using high-load conventional exercise in patients with knee osteoarthritis . However , the use of PVO combined with low-load exercise result ed in less anterior knee pain during the training sessions . Level of evidence Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies OBJECTIVE To determine the clinical effectiveness of an exercise programme on self-reported h and activity performance in people with h and osteoarthritis ( OA ) . DESIGN In this r and omized , controlled trial , participants with physician-confirmed h and OA were r and omly allocated to a 12-week exercise intervention ( group- and home-based ) or usual care . The primary outcome was self-reported h and activity performance at 3 months measured by the Functional Index for H and Osteoarthritis ( FIHOA ) and a patient-generated measure of disability , the Patient-Specific Functional Scale ( PSFS ) . RESULTS Of 130 r and omized participants ( mean age 66 ( st and ard deviation ( SD ) 9 ) ; female 90 % ) , 120 ( 92 % ) and 119 ( 92 % ) completed the 3- and 6-month follow-ups . The adjusted mean difference for the exercise vs control group was -0.5 points ( 95 % confidence interval ( CI ) -1.6 , 0.6 ) for the FIHOA score ( 0 - 30 scale , 0 = best ) and 0.9 points ( 95 % CI 0.1 , 1.7 ) for the PSFS score ( 0 - 10 scale , 10 = best ) . Small significant mean differences in favour of the intervention group were found for h and pain , h and stiffness and disease activity , whereas no mean differences were observed in h and dexterity or maximal grip strength . A significantly larger proportion in the intervention ( 46 % ) vs control group ( 16 % ) fulfilled the Outcome Measures in Rheumatological Clinical Trials-Osteoarthritis Research Society International ( OMERACT-OARSI ) responder criteria at 3 months ( OR = 4.4 , 95 % CI 1.9 , 10.2 ) . At the 6-month follow-up , there were no significant group differences in any outcome . CONCLUSIONS The exercise programme was well tolerated among people with h and OA , but result ed only in small , beneficial short-term improvements on self-reported measures and not on most performance-based tests . Future studies should address optimal grip strength exercises and dosage . TRIAL REGISTRATION Clinical Trials.gov registration number : NCT01245842 STUDY DESIGN R and omized Clinical Trial . INTRODUCTION H and exercises have been recommended as treatment for h and osteoarthritis ( OA ) but research evidence is sparse . PURPOSE OF THE STUDY To investigate effects of daily 16-week home-based h and exercise among persons with h and OA . METHODS Forty-six older adults completed a crossover trial  with washout between exercise and sham treatments . The AUSCAN physical function sub-scale served as the primary outcome measure . Other outcomes included pain and stiffness sub-scales , dexterity , and grip & pinch strengths . RESULTS Changes in AUSCAN sub-scales did not differ between exercise and sham treatments . No changes in dexterity were seen . Grip and pinch measures modestly improved after exercise but not sham . CONCLUSIONS It is possible that our exercise protocol may have been too ambitious for this age group . Future research will further the underst and ing of the role of h and exercise in h and OA symptomatology . LEVEL OF EVIDENCE 2b Abstract Background : Exercising is recommended for people with h and osteoarthritis ( HOA ) , but there is no consensus regarding the design of exercise programmes . Objective : To describe the development and content of an evidence -based exercise programme for people with HOA . Methods : The development was based on research evidence , professional expertise , and client evidence and adhered to the new Medical Research Council framework for design and evaluation of complex interventions . The process included literature search and appraisal , discussion s with clinicians and 
    Output:
    
Conclusion There is no evidence that resistance training has a significant effect on grip strength or h and function in people with h and osteoarthritis .
Low- quality evidence suggests it has a small , clinical ly unimportant pain-relieving effect .