***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials People with heart failure ( HF ) are living longer but with disabling dyspnea that erodes quality of life ( QOL ) . Decreased strength of inspiratory muscles ( IMs ) may contribute to dyspnea in HF , and inspiratory muscle training ( IMT ) has been shown to improve the strength of IMs . The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program . B and ura 's Self-Efficacy Theory directed nursing interventions . This r and omized controlled trial employed an experimental group ( IMT ) and a control group ( education ) . Data were collected during six home visits . Outcome measures included maximal inspiratory pressure , perceived dyspnea , self-efficacy , and health-related QOL . Significant differences in PI(max ) , dyspnea , and respiratory rate were found . Implication s for further research and practice are discussed Background : It has been previously shown that the inspiratory muscles of patients with congestive heart failure ( CHF ) are weaker than those of normal persons . This weakness may contribute to the dyspnea and limit exercise capacity in these patients . The respiratory muscles can be trained for both strength and endurance A continuous method for recording changes in breathlessness ( dyspnea ) during exercise is introduced and compared with the traditional discrete method . In study 1 , a category-rating scale was presented on a computer screen , and 14 healthy , young female subjects exercised on a cycle ergometer until exhaustion . Two approaches were used to obtain ratings of breathlessness : a discrete method , in which subjects gave single judgments every minute , and a continuous method , in which subjects throughout exercise moved the mouse so that a bar on the screen extended to the desired location along the scale . Psychophysical results relating measures of breathlessness and the variables of work , oxygen consumption , and minute ventilation were statistically indistinguishable with the two methods , and both methods were highly reliable across test sessions . In study 2 , both measurement methods were employed , and the subjects were 14 healthy , young males . In each of two sessions ( discrete or continuous method ) , subjects first rated their breathlessness during an incremental test in which the workload was increased over time and levels of work , and minute ventilation were recorded . Subjects then exercised for 10 min at 60 % of the maximal oxygen consumption achieved during the incremental test . At two points during steady-state exercise , a respiratory load was introduced that lasted for 1 min . It was possible to determine the responsiveness of subjects to onset and offset of the respiratory load for the continuous method but not for the discrete method . In study 3 , patients with chronic obstructive pulmonary disease employed both methods , and it was found that the continuous method was better at determining whether subjects showed a significant positive slope of the regression line between breathlessness ratings and physiological variables AIMS To assess whether a domiciliary programme of specific inspiratory muscle training in stable chronic heart failure results in improvements in exercise tolerance or quality of life . METHODS AND RESULTS We conducted a r and omized controlled trial of 8 weeks of inspiratory muscle training in 18 patients with stable chronic heart failure , using the Threshold trainer . Patients were r and omized either to a training group inspiring for 30 min daily at 30 % of maximum inspiratory mouth pressure , or to a control group of ' sham ' training at 15 % of maximum inspiratory mouth pressure .  Sixteen of the 18 patients completed the study .  Maximum inspiratory mouth pressure improved significantly in the training group compared with controls , by a mean ( SD ) of 25.4 ( 11.2 ) cmH2O ( P=0.04 ) . There were , however , no significant improvements in treadmill exercise time , corridor walk test time or quality of life scores in the trained group compared with controls . CONCLUSION Despite achieving a significant increase in inspiratory muscle strength , this trial of simple domiciliary inspiratory muscle training using threshold loading at 30 % of maximum inspiratory mouth pressure did not result in significant improvements in exercise tolerance or quality of life in patients with chronic heart failure Purpose : The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training ( IMT ) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures . Methods : Articles were found by search ing CINAHL , PubMed , Medline via First Search , and ProQuest data bases . Articles used in the review were r and omized trials of IMT vs. sham IMT or no intervention  , published in English in a peer‐ review ed journal , included patients with chronic obstructive pulmonary disease ( COPD ) , and specified the intensity of training . The quality of the studies was evaluated by 2 independent review ers using the method ological rigor scale described by Medlicott and Harris as well as Sackett 's levels of evidence . Fifteen articles met the inclusion criteria and were used in this review . Results : Consistent improvements in maximal inspiratory pressures ( ranging from ‐11 to ‐30 cm H2O ) and inspiratory muscle endurance were found . Improvements in dyspnea and health‐related quality of life were also observed . Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests . High‐intensity IMT result ed in improved training efficiency with respect to inspiratory muscle strength , but evidence of the effect of high‐intensity IMT on other clinical outcomes is lacking . Conclusion : Despite research spanning decades , there are numerous limitations in the literature regarding IMT . IMT appears to improve dyspnea , waking test distance , and health‐related quality of life in individuals with COPD , but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance . This review discussed several considerations critical to the design of future trials AIM To investigate the effects of inspiratory muscle training ( IMT ) on functional capacity and balance , respiratory and peripheral muscle strength , pulmonary function , dyspnea , fatigue , depression , and quality of life in heart failure patients . METHODS A prospect i ve , r and omized controlled , double-blinded study . Thirty patients with heart failure ( NYHA II-III , LVEF<40 % ) were included . Sixteen patients received IMT at 40 % of maximal inspiratory pressure ( MIP ) , and 14 patients received sham therapy ( 15 % of MIP ) for 6 weeks . Functional capacity and balance , respiratory muscle strength , quadriceps femoris muscle strength , pulmonary function , dyspnea , fatigue , quality of life , and depression were evaluated . RESULTS Functional capacity and balance , respiratory and peripheral muscle strength , dyspnea , depression were significantly improved in the treatment group compared with controls ; quality of life and fatigue were similarly improved within groups ( p < 0.05 ) . Functional capacity ( 418.59 ± 123.32 to 478.56 ± 131.58 m , p < 0.001 ) , respiratory ( MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH(2)O , p < 0.001 ) and quadriceps femoris muscle strength ( 240.91 ± 106.08 to 301.82 ± 111.86 N , p < 0.001 ) , FEV(1)% , FVC% and PEF% , functional balance ( 52.73 ± 3.15 to 54.25 ± 2.34 , p < 0.001 ) , functional dyspnea ( 2.27 ± 0.88 to 1.07 ± 0.79 , p < 0.001 ) , depression ( 11.47 ± 7.50 to 3.20 ± 4.09 , p < 0.001 ) , quality of life , fatigue ( 42.73 ± 11.75 to 29.07 ± 13.96 , p < 0.001 ) were significantly improved in the treatment group . Respiratory muscle strength ( MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH(2)O , p = 0.001 ) , FVC% , depression ( 14.36 ± 9.04 to 9.50 ± 10.42 , p = 0.011 ) , quality of life and fatigue ( 42.86 ± 12.67 to 32.93 ± 15.87 , p = 0.008 ) were significantly improved in the control group . CONCLUSION The IMT improves functional capacity and balance , respiratory and peripheral muscle strength ; decreases depression and dyspnea perception in patients with heart failure .  IMT should be included effectively in pulmonary rehabilitation programs BACKGROUND AND PURPOSE Persons with chronic heart failure ( HF ) have poor ventilatory muscle strength , and this weakness is associated with dyspnea . The purpose of this study was to examine the effects of inspiratory muscle training ( IMT ) on ventilatory muscle strength and dyspnea in patients with chronic HF . SUBJECTS Fourteen patients ( mean age [ + /-SD ] = 52 + /- 8.5 years ) with end-stage cardiomyopathy and chronic HF ( mean left ventricular ejection fraction = 23 % + /- 13 % and New York Heart Association class = 3.6 + /- 0.6 ) participated in the study . METHODS Inspiratory muscle training was performed at 20 % of maximal inspiratory pressure ( MIP ) for 5 to 15 minutes , three times a day , for 8 weeks . Dyspnea was evaluated at rest and during exercise . RESULTS Both MIP and maximal expiratory pressure ( MEP ) were greater after 2 weeks of IMT ( 51 + /- 21 to 63 + /- 23 cm H2O and 85 + /- 22 to 96 + /- 19 cm H2O , representing 24 % and 13 % improvement ) . Dyspnea scores at rest and during exercise decreased after 2 weeks ( 2.0 + /- 0.7 to 1.3 + /- 0.5 and 3.6 + /- 0.5 to 2.6 + /- 0.6 , representing 29 % and 28 % improvement ) and plateaued throughout the remainder of IMT . Baseline MEP was related to the percentage of change in MEP after IMT ( r = -.72 ) , and several measures of pulmonary function were related to the degree of improvement in dyspnea after IMT ( r = -.57 to -.82 ) and in MIP after IMT ( r = .71 ) . CONCLUSION AND DISCUSSION Improvements in MIP , MEP , and dyspnea were found after 2 weeks of IMT . Greater pulmonary function was associated with greater improvement in dyspnea and ventilatory muscle strength after IMT . These improvements may decrease the dependency and impairment associated with chronic HF OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It 
    Output:
    
Effects on quality of life scores were inconsistent .
Inspiratory muscle training is beneficial for improving respiratory muscle strength , functional capacity , and dyspnea in patients with stable heart failure and respiratory muscle weakness