***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 AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Study design Method ological study nested within a multicentre r and omised controlled trial ( RCT ) of yoga plus usual general practitioner ( GP ) care vs usual GP care for chronic low back pain . Objective To explore the treatment effects of non-compliance using three approaches in an RCT evaluating yoga for low back pain . Summary of background data A large multicentre RCT using intention-to-treat ( ITT ) analysis found that participants with chronic low back pain who were offered a 12-week progressive programme of yoga plus usual GP care had better back function than those offered usual GP care alone . However , ITT analysis can underestimate the effect of treatment in those who comply with treatment . As such , the data were analysed using other approaches to assess the problem of non-compliance . The main outcome measure was the self-reported Rol and Morris Disability Question naire ( RMDQ ) . Methods Complier average causal effect ( CACE ) analysis , per- protocol analysis and on-treatment analysis were conducted on the data of participants who were fully compliant , predefined as attendance of at least three of the first six sessions and at least three other sessions . The analysis was repeated for participants who had attended at least one yoga  session ( i.e. any compliance ) , which included participants who were fully compliant . Each approach was described , including strengths and weaknesses , and the results of the different approaches were compared with those of the ITT analysis . Results For the participants who were fully compliant ( n = 93 , 60 % ) , a larger beneficial treatment effect was seen using CACE analysis compared with per- protocol , on-treatment and ITT analyses at 3 and 12 months . The difference in mean change in RMDQ score between r and omised groups was −3.30 [ 95 % confidence interval ( CI ) −4.90 to −1.70 , P < 0.001 ] at 3 months and −2.23 ( 95 % CI −3.93 to −0.53 , P = 0.010 ) at 12 months for CACE analysis , −3.12 ( 95 % CI −4.26 to −1.98 , P < 0.001 ) at 3 months and −2.11 ( 95 % CI −3.33 to −0.89 , P = 0.001 ) at 12 months for per- protocol analysis , and −2.91 ( 95 % CI −4.06 to −1.76 , P < 0.001 ) at 3 months and −2.10 ( 95 % CI −3.31 to −0.89 , P = 0.001 ) at 12 months for on-treatment analysis . For the participants who demonstrated any compliance ( n = 133 , 85 % ) , the results were generally consistent with the fully compliant group at 3 months , but the treatment effect was smaller . The difference in mean change in RMDQ score between r and omised groups was −2.45 ( 95 % CI −3.67 to −1.24 ) for CACE analysis , −2.30 ( 95 % CI −3.43 to 1.17 ) for per- protocol analysis and −2.15 ( 95 % CI −3.25 to −1.06 ) for on-treatment analysis , which was slightly less than that for ITT analysis . In contrast , at 12 months , per- protocol and on-treatment analyses showed a larger treatment effect compared with CACE and ITT analyses : per protocol analysis −1.86 ( 95 % CI −3.02 to −0.71 ) , on-treatment analysis −1.99 ( 95 % CI −3.13 to −0.86 ) and CACE analysis −1.67 ( 95 % CI −2.95 to −0.40 ) . Conclusion ITT analysis estimated a slightly smaller treatment effect in participants who complied with treatment . When examining compliance , CACE analysis is more rigorous than per- protocol and on-treatment analyses . Using CACE analysis , the treatment effect was larger in participants who complied with treatment compared with participants who were allocated to treatment , and the difference between ITT and CACE analyses for the fully compliant group at 3 months was small but clinical ly important . Per- protocol and on-treatment analyses may produce unreliable estimates when the effect of treatment is small . International St and ard R and omised Trial Number Register IS RCT N 81079604 A systematic review revealed three small r and omised controlled trials of  yoga  for  low back pain  , all of which showed effects on back pain that favoured the yoga group . To build on these studies a larger trial , with longer term follow-up , and a number of different yoga teachers delivering the intervention is required . This study protocol describes the details of a r and omised controlled trial ( RCT ) to determine the effectiveness and cost-effectiveness of Yoga for chronic Low Back Pain , which is funded by Arthritis Research Campaign ( arc ) and is being conducted by the University of York . 262 patients will be recruited from GP practice s in 5 centres in Engl and . Patients will be r and omised to receive usual care or 12 weekly classes of yoga .  A yoga programme will be devised that can be delivered by yoga teachers of the two main national yoga organisations in the UK ( British Wheel of Yoga and Iyengar Yoga Association ( UK ) ) . Trial registration : Current controlled trials registry IS RCT N81079604 ( date registered 30/03/2007 ) INTRODUCTION Previously , outpatient Yoga programs for patients with chronic low back pain ( CLBP ) lasting several months have been found to reduce pain , analgesic requirement and disability , and improve spinal mobility . This study evaluated changes in pain , anxiety , depression and spinal mobility for CLBP patients on short-term , residential Yoga and physical exercise programs , including comprehensive yoga lifestyle modifications . METHODS A seven day r and omized control single blind active study in an residential Holistic Health Centre in Bangalore , India , assigned 80 patients ( 37 female , 43 male ) with CLBP to yoga and physical exercise groups . The Yoga program consisted of specific asanas and pranayamas for back pain , meditation , yogic counselling , and lectures on yoga philosophy . The control group program included physical therapy exercises for back pain , and matching counselling and education sessions . RESULTS Group × time interactions ( p<0.05 ) and between group differences ( p<0.05 ) were significant in all variables . Both groups ' scores on the numerical rating scale for pain reduced significantly , 49 % in Yoga ( p<0.001 , ES=1.62 ) , 17.5 % in controls ( p=0.005 , ES=0.67 ) . State anxiety ( STAI ) reduced 20.4 % ( p<0.001 , ES=0.72 ) and trait anxiety 16 % ( p<0.001 , ES=1.09 ) in the yoga group . Depression ( BDI ) decreased in both groups , 47 % in yoga ( p<0.001 , ES=0.96 , ) and 19.9 % in controls ( p<0.001 , ES=0.59 ) . Spinal mobility ( ' Sit and Reach ' instrument ) improved in both groups , 50 % , in yoga ( p<0.001 , ES=2.99 ) and 34.6 % in controls ( p<0.001 , ES=0.81 ) . CONCLUSION Seven days intensive residential Yoga program reduces pain , anxiety , and depression , and improves spinal mobility in patients with CLBP more effectively than physiotherapy exercises The present study has been conducted to evaluate selected yogic procedures on individuals with low back pain .  The underst and ing of back pain as one of the commonest clinical presentations during clinical practice made the path to the present study . It has also been calculated that more than three-quarters of the world 's population experience back pain at some time in their lives . Twelve patients were selected and r and omly divided into two groups , viz . , group A yogic group and group B control group . Advice for life style and diet was given for all the patients . The effect of the therapy was assessed subjectively and objective ly . Particular scores drawn for yogic group and control group were individually analyzed before and after treatment and the values were compared using st and ard statistical protocol s. Yogic intervention revealed 79 % relief in both subjective and objective parameters ( i.e. , 7 out of 14 parameters showed statistically highly significant P < 0.01 results , while 4 showed significant results P < 0.05 ) . Comparative effect of yogic group and control group showed 79 % relief in both subjective and objective parameters . ( i.e. , total 6 out of 14 parameters showed statistically highly significant ( P < 0.01 ) results , while 5 showed significant results ( P < 0.05 ) OBJECTIVE To conduct a pilot trial of yoga for the treatment of chronic low back pain ( LBP ) to inform the feasibility and practicality of conducting a full-scale trial in the UK ; and to assess the efficacy of yoga for the treatment of chronic low back pain . DESIGN A pragmatic r and omised controlled trial was undertaken comparing yoga to usual care . PARTICIPANTS Twenty participants who had presented to their GP with chronic low back pain in the previous 18 months were recruited via GP records from one practice in York , UK . INTERVENTIONS Twenty patients were r and omised to either 12 weekly 75-min sessions of specialised yoga plus written advice , or usual care plus written advice . Allocation was 50/50 . MAIN OUTCOME MEASURES Recruitment rate , levels of intervention attendance , and loss to follow-up were the main non- clinical outcomes . Change as measured by the Rol and and Morris disability question naire was the primary clinical outcome . Changes in the Aberdeen back pain scale , SF-12 , EQ-5D , and pain self-efficacy were secondary clinical outcomes . Data were collected via postal question naire at baseline , 4 weeks , and 12 weeks follow-up . RESULTS Of the 286 patients identified from the GP data base , 52 ( 18 % ) consented and returned the eligibility question naire , out of these 20 ( 6.9 % ) were eligible and r and omised . The total percentage of patients r and omised from the GP practice population was 0.28 % . Ten patients were r and omised to yoga , receiving an average of 1.7 sessions ( range 0 - 5 ) , and 10 were r and omised to usual care . At 12 weeks follow-up data was received from 60 % of patients in the yoga group and 90 % of patients in the usual care group ( 75 % overall ) . No significant differences were seen between groups in clinical outcomes apart from on the Aberdeen back pain scale at four weeks follow-up where the yoga group reported significantly less pain . CONCLUSION This pilot study provided useful data and information to inform the design and development of a full-scale trial of yoga for CLBP in the UK . A key finding is the calculation of GP practice total list size required for patient recruitment in a full-scale trial , and the need to implement methods to increase class attendance Background . Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain ( cLBP ) in white adults with high socioeconomic status . The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income population s are unknown . Methods . We conducted a 12-week r and omized , parallel-group , dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly ( n = 49 ) versus twice-weekly ( n = 46 ) st and ardized yoga classes supplemented by home practice . Primary outcomes were change from baseline to 12 weeks in pain ( 11-point scale ) and back-related function ( 23-point modified Rol and -Morris Disability Question naire ) . Results . 82 % of participants were nonwhite ; 77 % had annual household incomes < $ 40,000 . The sample 's baseline mean pain intensity [ 6.9 ( SD 1.6 ) ] and function [ 13.7 ( SD 5.0 ) ] reflected moderate to severe back pain and impairment . Pain and back-related function improved within both groups ( P < 0.001 ) . However , there were no differences between once-weekly and twice-weekly groups for pain reduction [ −2.1 ( 95 % CI −2.9 , −1.3 ) versus 
    Output:
    
Studies provided limited evidence on risk of clinical improvement , measures of quality of life , and depression .
There was no evidence on work-related disability .
AUTHORS ' CONCLUSIONS There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months .
It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain , or whether yoga added to exercise is more effective than exercise alone .
Yoga is associated with more adverse events than non-exercise controls , but may have the same risk of adverse events as other back-focused exercise .
Yoga is not associated with serious adverse events .