***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 Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain . This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain ( CMNP ) . Methods Forty-eight patients with CMNP were r and omly allocated to single-level thoracic manipulation ( STM ) at T6–T7 or multiple-level thoracic manipulation ( MTM ) , or to a control group ( prone lying ) .  Cervical range of motion ( CROM ) , visual analog scale ( VAS ) , and the Thai version of the Neck Disability Index ( NDI-TH ) scores were measured at baseline , and at 24-hour and at 1-week follow-up . Results At 24-hour and 1-week follow-up , neck disability and pain levels were significantly ( P<0.05 ) improved in the STM and MTM groups compared with the control group . CROM in flexion and left lateral flexion were increased significantly ( P<0.05 ) in the STM group when compared with the control group at 1-week follow-up . The CROM in right rotation was increased significantly after MTM compared to the control group ( P<0.05 ) at 24-hour follow-up . There were no statistically significant differences in neck disability , pain level at rest , and CROM between the STM and MTM groups . Conclusion These results suggest that both single-level and multiple-level thoracic manipulation  improve neck disability , pain levels , and CROM at 24-hour and 1-week follow-up in patients with CMNP Background This pilot r and omized controlled trial evaluated the feasibility of conducting a full scale study and compared the efficacy of exercise , spinal manipulation , and a mind-body therapy called Neuro Emotional Technique for the treatment of pregnancy-related low back pain , a common morbidity of pregnancy . Methods Healthy pregnant women with low back pain of insidious onset were eligible to enroll in the study at any point in their pregnancy . Once enrolled , they remained in the study until they had their babies . Women were r and omly allocated into one of three treatment groups using opaque envelopes . The treatment schedule paralleled the prenatal care schedule and women received individualized intervention . Our null hypothesis was that spinal manipulation and Neuro Emotional Technique would perform no better than exercise in enhancing function and decreasing pain . Our primary outcome measure was the Rol and Morris Disability Question naire and our secondary outcome measure was the Numeric Pain Rating Scale . Intention to treat analysis was conducted . For the primary analysis , regression was conducted to compare groups on the outcome measure scores . In a secondary responder analysis , difference in proportions of participants in attaining 30 % and 50 % improvement were calculated . Feasibility factors for conducting a future larger trial were also evaluated such as recruitment , compliance to study protocol s , cost , and adverse events . Results Fifty-seven participants were r and omized into the exercise ( n = 22 ) , spinal manipulation ( n = 15 ) , and Neuro Emotional Technique ( n = 20 ) treatment arms . At least 50 % of participants in each treatment group experienced clinical ly meaningful improvement in symptoms for the Rol and Morris Disability Question naire . At least 50 % of the exercise and spinal manipulation participants also experienced clinical ly meaningful improvement for the Numeric Pain Rating Scale . There were no clinical ly meaningful or statistically significant differences between groups in any analysis . Conclusions This pilot study demonstrated feasibility for recruitment , compliance , safety , and affordability for conducting a larger study in the future . Spinal manipulation and exercise generally performed slightly better than did Neuro Emotional Technique for improving function and decreasing pain , but the study was not powered to detect the between-group differences as statistically significant . Trial registration Clinical Trials.gov ( Identifier : NCT00937365 ) Abstract This single-blind r and omised clinical trial compared osteopathic manipulative treatment with chemonucleolysis ( used as a control of known efficacy ) for symptomatic lumbar disc herniation . Forty patients with sciatica due to this diagnosis ( confirmed by imaging ) were treated either by chemonucleolysis or manipulation . Outcomes ( leg pain , back pain and self-reported disability ) were measured at 2 weeks , 6 weeks and 12 months . The mean values for all outcomes improved in both groups . By 12 months , there was no statistically significant difference in outcome between the treatments , but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks . A similar number from both groups required additional orthopaedic intervention ; there were no serious complications . Crude cost analysis suggested an overall financial advantage from manipulation . Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis , it can be considered as an option for the treatment of  symptomatic lumbar disc herniation  , at least in the absence of clear indications for surgery . Further study into the value of manipulation at a more acute stage is warranted Objectives Traditionally , orthopedic outpatient waiting lists are long , and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department . The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine . Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for out patients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain , physical function , and perceived recovery . Methods Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic r and omized controlled trial . The 2 interventions compared were naprapathic manual therapy ( index group ) and conventional orthopedic care ( control group ) .  Pain , physical function , and perceived recovery were measured by question naires at baseline and after 12 , 24 , and 52 weeks . The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated . Results After 52 weeks , statistically significant differences between the groups were found regarding impairment in pain , increased physical function , and regarding perceived recovery , favoring the index group . Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list . The level of agreement concerning the management decisions was 80 % . Discussion The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic out patients with disorders unlikely to benefit from surgery OBJECTIVE The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance , chronic pain , and associated dizziness in a sample of older adults with impaired balance . METHODS The authors conducted a r and omized pilot study targeting a sample size of 30 , comparing 2 schedules of chiropractic care to a no-treatment group . Group 1 ( limited schedule ) was treated for 8 weeks , group 2 ( extended schedule ) was treated for 8 weeks and then once per month for 10 months , and group 3 received no treatment . Assessment s were made at baseline and 1 , 2 , 6 , and 12 months later . The primary outcome was changed in the Berg Balance Scale ( BBS ) from baseline to 1 year . Changes in the Pain Disability Index and Dizziness H and icap Index were also measured . RESULTS Thirty-four patients were enrolled , 13 in group 1 , 15 in group 2 , and 6 in group 3 . Only 5 had baseline BBS scores less than 45 , indicating increased risk for falls . There were no treatment-related adverse events . Nine patients dropped out by 1 year . No significant differences within or between groups in median BBS from baseline to 12 months were observed . Median Pain Disability Index scores improved more from baseline to 1 year in group 2 compared with groups 1 and 3 ( P = .06 , Kruskal-Wallis test ) . For the 9 patients with dizziness , a clinical ly significant improvement in Dizziness H and icap Index scores of groups 1 and 2 was observed at 1 month and remained lower than baseline thereafter ; this was not true of group 3 . CONCLUSION Further investigation of the possible benefit of chiropractic maintenance care ( extended schedule ) for balance and pain-related disability is feasible and warranted , as well as both limited and extended schedules for patients with idiopathic dizziness The purpose of this study was to investigate the comparative effectiveness of early use of thrust ( TM ) and non-thrust manipulation ( NTM ) in sample of patients with mechanical low back pain ( LBP ) . The r and omized controlled trial included patients with mechanically reproducible LBP , ≥ age 18-years who were r and omized into two treatment groups . The main outcome measures were the Oswestry Disability Index ( ODI ) and a Numeric Pain Rating Scale ( NPRS ) , with secondary measures of Rate of Recovery , total visits and days in care , and the work subscale of the Fears Avoidance Beliefs Question naire work subscale ( FABQ-w ) . A two-way mixed model MANCOVA was used to compare ODI and pain , at baseline , after visit 2 , and at discharge and total visits , days in care , and rate of recovery ( while controlling for patient expectations and clinical equipoise ) . A total of 149 subjects completed the trial and received care over an average of 35 days . There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories . Personal equipoise was significantly associated with ODI and pain . The findings suggest that there is no difference between early use of TM or NTM , and secondarily , that personal equipoise affects study outcome . Within-groups changes were significant for both groups The aim of our study was to assess the effectiveness of thoracic manipulation ( TM ) on patients with chronic neck pain . 120 patients aged between 18 and 55 were r and omly allocated into two groups : an experimental group which received TM and a control group without the manipulative procedure . Both groups received infrared radiation therapy ( IRR ) and a st and ard set of educational material . TM and IRR were given twice weekly for 8 sessions . Outcome measures included craniovertebral angle ( CV angle ) , neck pain ( Numeric Pain Rating Scale ; NPRS ) , neck disability ( Northwick Park Neck Disability Question naire ; NPQ ) , health-related quality of life status ( SF36 Question naire ) and neck mobility . These outcome measures were assessed immediately after 8 sessions of treatment , 3-months and at a 6-month follow-up . Patients that received TM showed significantly greater improvement in pain intensity ( p = 0.043 ) , CV angle ( p = 0.049 ) , NPQ ( p = 0.018 ) , neck flexion ( p = 0.005 ) , and the Physical Component Score ( PCS ) of the SF36 Question naire ( p = 0.002 ) than the control group immediately post-intervention . All these improvements were maintained at the 6-month follow-ups . This study shows that TM was effective in reducing neck pain , improving dysfunction and neck posture and neck range of motion ( ROM ) for patients with chronic mechanical neck pain  up to a half-year post-treatment STUDY DESIGN R and omized controlled trial . OBJECTIVE To determine the validity of a previously suggested clinical prediction rule ( CPR ) for identifying patients most likely to experience short-term success following lumbar stabilization exercise ( LSE ) .  Background Although LSE is commonly used by physical therapists in the management of low back pain , it does not seem to be more effective than other interventions . A 4-item CPR for identifying patients most likely to benefit from LSE has been previously suggested but has yet to be vali date d. METHODS One hundred five patients with low back pain underwent a baseline examination to determine their status on the CPR ( positive or negative ) . Patients were stratified by CPR status and then r and omized to receive an LSE program or an intervention consisting of manual therapy ( MT ) and range-of-motion/flexibility exercises . Both interventions included 11 treatment sessions delivered over 8 weeks . Low back pain-related disability was measured by the modified version of the Oswestry Disability Index at baseline and upon completion of treatment . RESULTS The statistical significance for the 2-way interaction between treatment group and CPR status for the level of disability at the end of the intervention was P = .17 . However , among patients receiving LSE , those with a positive CPR status experienced less disability by the end of treatment compared with those with a negative CPR status ( P = .02 ) . Also , among patients with a positive CPR status , those receiving LSE experienced less disability by the end of treatment compared with those receiving MT ( P = .03 ) . In addition , there were main effects for treatment and CPR status . Patients receiving LSE experienced less disability by the end of treatment compared to patients receiving MT ( P = .05 ) , and patients with a positive CPR status experienced less disability by the end of treatment compared to patients with a negative CPR status , regardless of the treatment received ( P = .04 ) . When a modified version of the CPR ( mCPR ) containing only the presence of aberrant movement and a positive prone instability test was used , a significant interaction with treatment was found for final disability ( P = .02 ) . Of the patients who received LSE , those with a positive mCPR status experienced less disability by the end of treatment compared to those with a negative mCPR status ( P = .02 ) , and among patients with a positive mCPR status , those who received LSE experienced less disability by the end of treatment compared to those who received MT ( P = .005 ) . CONCLUSION The previously suggested CPR for identifying patients likely to benefit from LSE could not be vali date d in this study . However , due to its relatively low level of power , this study could not invali date the CPR , either . A modified version of the CPR that contains only 2 items may possess a better predictive validity to identify those most likely to succeed with an LSE program . Because this modified version was established through post hoc testing , an additional study is recommended to prospect ively test its predictive valid 
    Output:
    
The region treated was not a significant predictor for reporting on adverse events .
Predictors for reporting on adverse events included larger sample size , publication after the 2010 CONSORT statement , low risk of bias and trials involving multiple intervention sessions .