***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 compare short-term and long-term effectiveness of the Arthritis Self-Help Course ( ASHC ) and the Chronic Disease Self-Management Program ( CDSMP ) for persons with arthritis concerning health care use , health-related quality of life , health behaviors , and arthritis self-efficacy . METHODS Forty-eight workshops were r and omized to the  ASHC ( n = 26 ) or CDSMP ( n = 22 ) . A total of 416 individuals , including 365 African Americans , participated . The mean age for each group was 64 years , mean years of education was 11.7 , mean number of chronic conditions was 4 , and 75 - 80 % of participants in each group were female . Multivariate statistical tests were used to assess effectiveness within and between programs for all workshop participants and African Americans . RESULTS At 4 months all ASHC participants including African Americans , had significant improvements ( P < or= 0.05 ) in self-efficacy , stretching and strengthening exercises , aerobic exercises , and general health . All CDSMP participants had statistically significant improvements in self-efficacy , disability , pain , and general health . African American CDSMP participants showed statistically significant improvements in general health . Trends toward improvement ( P = 0.051 - 0.100 ) were shown in 5 variables among African American CDSMP participants and in 4 variables among all CDSMP participants . Statistically significant differences between the 2 programs at 4 months were seen in pain and disability in both groups . The CDSMP produced stronger results . Significant results at 1 year within and between programs were minimal for both groups . CONCLUSION When population s with arthritis and multiple comorbid conditions are targeted , the CDSMP may be most cost effective Summary Cognitive behavioral therapy was compared with pain education within an underserved , low‐socioeconomic status , rural chronic pain population . Both interventions were found to be viable treatment options . ABSTRACT Chronic pain is a common and costly experience . Cognitive behavioral therapies ( CBT ) are efficacious for an array of chronic pain conditions . However , the literature is based primarily on urban ( white ) sample s. It is unknown whether CBT works in low‐socioeconomic status ( SES ) minority and nonminority groups . To address this question , we conducted a r and omized controlled trial within a low‐SES , rural chronic pain population . Specifically , we examined the feasibility , tolerability , acceptability , and efficacy of group CBT compared with a group education intervention ( EDU ) . We hypothesized that although both interventions would elicit short‐ and long‐term improvement across pain‐related outcomes , the cognitively‐focused CBT protocol would uniquely influence pain catastrophizing . Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment ( N = 26 ) , the intention‐to‐treat sample ( ITT ; N = 83 ) , and the completer sample ( N = 61 ) . Factors associated with treatment completion were examined . Results indicated significantly more drop‐outs occurred in CBT . ITT analyses showed that participants in both conditions reported significant improvement across pain‐related outcomes , and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU . Results of the completer analyses produced a similar pattern of findings ; however , CBT produced greater gains on cognitive and affect variables  than EDU . Treatment gains were maintained at 6‐month follow‐up ( N = 54 ) . Clinical significance of the findings and the number of treatment responders is reported . Overall , these findings indicate that CBT and EDU are viable treatment options in low‐SES minority and nonminority groups . Further research should target disseminating and sustaining psychosocial treatment options within underserved population This study examines the impact of health education on prevalence of and expenditure on treatment of self-reported  arthritis-related illness among elderly persons in rural Bangladesh . An intervention study was conducted , including 1135 elderly persons ( > or=60 years ) from eight r and omly selected villages , four each of an intervention and a control area . The analyses include 839 elderly persons who participated in both pre- and post-intervention surveys ( intervention area : n = 425 , control area : n = 414 ) . Participants of the intervention area were further categorized as compliant ( n = 315 ) and non-compliant ( n = 110 ) based on adherence to the intervention instructions . The intervention that lasted for 15 months comprised home-based physical exercise , dietary instructions and other aspects of management . Results show that although there was no significant difference in self-reported arthritis-related illness between the compliant and non-compliant groups at baseline , it was significantly lower in the compliant group ( 71 % ) at post-intervention compared with the non-compliant ( 81 % ) . Related monthly expenditure on treatment was significantly reduced in the compliant group ( from Taka 104 to Taka 52 ) but not in the other two groups . Logistic regressions further showed that the control group had a higher probability of increased treatment-related expenditure compared with the compliant group ( OR 2.0 , 95 % CI 1.4 - 2.8 ) OBJECTIVE R and omized controlled trials in patient education often have difficulty enrolling vulnerable population s-specifically , older , poorer , and less educated individuals . We undertook a r and omized controlled trial ( RCT ) of an educational intervention for arthritis management , which included strategies to remove literacy-related barriers to participation . This paper reports on the multi-stage recruitment process and assesses whether refusal to participate was related to education , age , gender , working status , or insurance status . METHODS The recruitment protocol was design ed to eliminate literacy-related barriers to participation . Patients were never asked to read or fill out forms . Interactions were oral , using everyday terms and short , clear sentences . Patients who declined during a screening call were considered Stage 1 Refusers . Patients who initially expressed interest but neither completed a baseline question naire nor provided consent were considered Stage 2 Refusers . Patients who consented were considered Enrollees . Age , gender , and insurance status were compared between Stage 1 Refusers and Enrollees . A second analysis compared these variables , plus educational attainment and working status , between Stage 2 Refusers , and Enrollees . RESULTS Of 408 eligible patients , there were 193 ( 47.3 % ) Stage 1 Refusers , 81 ( 19.9 % ) Stage 2 Refusers and 134 ( 32.8 % ) Enrollees . A higher proportion of Stage 1 Refusers than Enrollees were > or = 65 years old ( 58 % vs. 37 % , p = .0003 ) . Multivariate analysis , adjusting for gender and insurance status , confirmed the effect of older age on refusal ( OR = 2.3 ( 1.4 , 3.6 ) ) . There were no significant differences between Stage 2 Refusers and Enrollees . CONCLUSION We found no evidence of refusal to participate due to educational attainment , working status , insurance status , or gender .  Older patients were more likely to refuse participation at the first stage of recruitment . PRACTICE IMPLICATION S Research ers should continue efforts to increase participation among older patients , particularly when studies are design ed to be generalized to an elderly population as is the case with arthritis research . Strategies used in this recruitment protocol design ed to remove literacy-related barriers to recruitment may be responsible for the observation that subjects with lower education did not have a higher rate of refusal . Such strategies deserve further study OBJECTIVE To determine the effectiveness of a pictorial ' mind map ' together with the Arthritis Research Campaign ( ARC ) booklet for imparting knowledge to participants with rheumatoid arthritis ( RA ) . Also , we wished to relate this to their reading ability . METHODS We studied 363 participants with RA . Reading ability was assessed using the REALM , and knowledge was assessed using the Knowledge Scale Question naire ( KSQ ) . Information on educational attainment , disease state and levels of anxiety and depression was also collected . Participants were r and omly assigned to receive either the ARC booklet alone or the booklet and the mind map together . RESULTS A significant minority ( 15 % ) of participants were functionally illiterate .  There was a statistically significant increase in knowledge across both groups from baseline to re assessment after they were given the literature , but there was no difference in attainment between the groups . The more literate participants gained more knowledge regardless of the information they were given . They were also significantly less anxious and less depressed . CONCLUSIONS The ARC booklet with or without the mind map was associated with a significant increase in knowledge .  Poor readers had poor educational attainment and poor knowledge acquisition . The information on the mind map was not more accessible to them . Different educational strategies will be necessary to educate these patients Summary As part of the WHO/International League Against Rheumatism ( ILAR ) sponsored community organized programme for the control of rheumatic disease ( COPCORD ) , an arthritis community education programme ( ACE ) was undertaken utilizing the traditional form of entertainment in a rural area in Central Java-the wayang . The point prevalence rate of musculoskeletal complaints was estimated in 4683 men & women aged 15 years and over by house-to-house interviews . From 1105 respondents recording recent musculoskeletal pain , 844 were r and omly selected and half the latter attended a puppet shadow play ( wayang ) incorporating the ACE . The other half , matched for age , sex and educational level who did not see the play , served as controls . A question naire containing biphasic choices of correct or incorrect ways of performing activities of daily living ( ADL ) to minimize musculoskeletal problems was administered to the whole group before , 1 month and 6 months after the wayang . Increased knowledge of correct ways of performing ADL ( correct ADL ) in the intervention group compared with the control group at 1 and 6 months after wayang was significant ( P<0.05 ) . Comprehension of correct ADL following the wayang could be demonstrated even in subjects who were illiterate and those who had attended primary school only . Retention of knowledge at the 6 month assessment declined more markedly in the illiterate group . ACE by wayang was shown to be feasible and effective in transferring knowledge on ADL to people with musculoskeletal problems in the sample population in Java . This effect could be shown even in the poorly educated section of the community . In the absence of adequate numbers of skilled primary health care professionals , public education programmes utilizing traditional forms of entertainment should be considered , especially in rural communities in developing countries OBJECTIVES To develop and assess the effectiveness of a drug information leaflet ( DIL ) for D-penicillamine ( DPA ) and determine whether additional verbal information provides enhanced benefit . METHODS Three preliminary studies were undertaken : a reading age study ; the development of a DIL for DPA ; and a DPA knowledge question naire . The primary study assessed the effect of the DIL on the knowledge of 30 patients at weeks 0 and 24 after commencing DPA . A follow-up study of 100 patients r and omly assigned to receive the DIL alone ( control group ) or with additional verbal backup ( experimental group ) determined the effects of additional verbal information by comparison of DPA knowledge question naire scores at weeks 0 and 24 . RESULTS The reading study showed that 12 % of the sample had difficulty reading and so the DPA DIL was design ed to be easy to read using the Flesch Reading Index . An assessment of knowledge of DPA prior to reading the DIL result ed in scores ranging from 0 to 13 with a median of 2 ( maximum possible 14 ) . By week 24 the median score was 10 ( range 6 - 14 ) , which was significant at P < 0.0001 . The assessment of additional verbal backup showed that both the control group and the experimental group knew little about DPA on study entry , with a median score 2 in each group . On study exit , both groups knew significantly more ( P < 0.001 ) about the drug ; the control group scored 9 and the experimental group 11 ( not significantly different ; P=0.109 ) . CONCLUSIONS A large minority of patients have poor reading skills , but when a DIL is design ed to be easy to read patients gain significant amounts of knowledge from it . Providing additional verbal explanations did bring about increases in knowledge but these were not significant Objective . To evaluate the influence of a 6-week Arthritis Self-Management Program ( ASMP ) on health-related quality of life ( HRQOL ) and self-management skills in clinical setting s. Methods . Individuals with hip or knee osteoarthritis referred to orthopedic surgeons or rheumatologists at 6 hospitals in Victoria , Australia , were recruited . In a r and omized controlled trial , participants received the Stanford ASMP and self-help book ( intervention ) or book only ( control ) . Assessment s included the Assessment of Quality of Life instrument ( AQoL ; range −0.04 to 1.00 ) and Health Education Impact Question naire ( heiQ ; range 1–6 ) at baseline and up to 12 months . The primary outcome was HRQOL at 12 months ( assessed using the AQoL ) . Results . Recruitment was concluded early due to persistent challenges including infrequent referrals and patient inability or disinterest in participating . Of 1125 individuals screened , only 120 were r and omized ( control , n = 62 ; intervention , n = 58 ) . Seven ASMP were conducted while 18 scheduled ASMP were cancelled . Forty-four of 58 intervention group participants received the intervention as allocated ( 76 % ) ; all control group participants were sent the book ( 100 % ) . Ninety-four participants ( 78 % ) completed 12-month assessment s ( control , 90 % ; intervention , 66 % 
    Output:
    
High quality evidence is lacking on the effectiveness of musculoskeletal education interventions for people with lower literacy levels .