***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 BACKGROUND Spinal pain is common and frequently disabling . Management guidelines have encouraged referral from primary care for spinal manipulation . However , the evidence base for these recommendations is weak . More pragmatic trials and economic evaluations have been recommended . OBJECTIVES Our aim was to assess the effectiveness and health care costs of a practice -based osteopathy clinic for subacute spinal pain . METHODS A pragmatic r and omized controlled trial was carried out in a primary care osteopathy clinic accepting referrals from 14 neighbouring practice s in North West Wales . A total of 201 patients with neck or back pain of 2 - 12 weeks duration were allocated at r and om between usual GP care and an additional three sessions of osteopathic spinal manipulation . The primary outcome measure was the Extended Aberdeen Spine Pain Scale ( EASPS ) . Secondary measures included SF-12 , EuroQol and Short-form McGill Pain Question naire . Health care costs were estimated from the records of referring GPs . RESULTS Outcomes improved more in the osteopathy group than the usual care group . At 2 months , this improvement was significantly greater in EASPS [ 95 % confidence interval ( CI ) 0.7 - 9.8 ] and SF-12 mental score ( 95 % CI 2.7 - 10.7 ) . At 6 months , this difference was no longer significant for EASPS ( 95 % CI -1.5 to 10.4 ) , but remained significant for SF-12 mental score ( 95 % CI 1.0 - 9.9 ) . Mean health care costs attributed to spinal pain were significantly greater by 65 UK pounds in the osteopathy group ( 95 % CI 32 - 155 UK pounds ) . Though osteopathy also cost 22 UK pounds more in mean total health care cost , this was not significant ( 95 % CI - 159 to 142 UK pounds ) . CONCLUSION A primary care osteopathy clinic improved short-term physical and longer term psychological outcomes , at little extra cost . Rigorous multicentre studies are now needed to assess the generalizability of this approach Summary A total of 101 out patients with acute or subacute low-back pain was r and omly allocated to one of two treatment groups . One group was given st and ardised conventional and optimised activating treatment by primary health care teams . The other group received , according to a pragmatic approach , another treatment programme including manipulation , specific mobilisation , muscle stretching , autotraction and cortisone injections . The treatment effect was evaluated by st and ardised telephone interviews 3 , 7 , 14 , 21 and 90 days after the start of treatment . The two groups were similar in most of the pretrial variables , including age , sex , occupation , education , previous low-back pain problems , previous treatment , sickleave , findings at the physical examination , quality -of-life score , presence of common symptoms , disability rating and pain score . In the early phase as well as at the 90 days ' follow-up , the group receiving manual therapy had significantly less pain , less disability , faster rate of recovery and lower drug consumption , indicating that this type of treatment is superior to conventional treatment BACKGROUND AND PURPOSE The prescriptive validity of a treatment-oriented extension-mobilization category for patients with low back syndrome ( LBS ) was examined . SUBJECTS Of a total of 39 patients with LBS referred for physical therapy , 24 patients ( 14 male , 10 female ) , aged 14 to 50 years ( means = 31.3 , SD = 11.6 ) , were classified as having signs and symptoms indicating treatment with an extension-mobilization approach .  The remaining subjects were dismissed from the study . Patients in the extension-mobilization category were r and omly assigned to either an experimental ( treatment ) group ( n = 14 ) or a comparison group ( n = 10 ) . METHODS The experimental and comparison group subjects were treated with either mobilization and extension ( a treatment matched to the category ) or a flexion exercise regimen ( an unmatched treatment ) . Outcome was assessed with a modified Oswestry Low Back Pain Question naire administered initially and at 3 and 5 days after initiation of treatment . Data were analyzed with a 2 x 3 ( treatment group x treatment period ) analysis of variance . RESULTS The subjects ' rate of improvement , as indicated by the Oswestry question naire scores , was dependent on the treatment group to which they were assigned . Subjects treated with extension and mobilization positively responded at a faster rate than did those treated with a flexion-oriented program . CONCLUSION AND DISCUSSION This study illustrates that a priori classification of selected patients with LBS into a treatment category of extension and mobilization and subsequently treating the patients accordingly with specified interventions can be an effective approach to conservative management of selected patients Abstract The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment . The aims of the study were to identify prognostic factors for disability at 1‐year follow‐up in patients with back pain visiting primary care , and to compare the effect of these in two treatment strategies – chiropractic and physiotherapy . Data were taken from a r and omised trial on patients with back/neck pain visiting the general practitioner , in which patients were allocated to chiropractic and physiotherapy as primary management .  Three hundred and twenty‐three patients , aged 18–60 years , who had no contraindications to manipulation and who had not been treated within the previous month were included in the study . Multiple regression analysis was used to identify prognostic factors . Dependent variables were mean Oswestry score and mean change in Oswestry score at 12‐month follow‐up . The multiple regression analysis revealed five significant ( P<0.001–0.01 ) prognostic factors ; duration of current episode , Oswestry score at entry , expectations of treatment , number of localisations , and well‐being . Besides , the regression coefficients for the significant factors were compared between the two treatment strategies . No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies . Twelve per cent of the patients had poor prognostic factors ( duration ≥1 month , more than one localisation , low expectations of treatment and low well‐being ) at entry . These patients had a mean Oswestry score above 20 % at 1‐year follow‐up . Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospect ively evaluated Abstract Recently a clinical prediction rule ( CPR ) for lumbar regional spinal thrust manipulation ( STM ) has shown predictive success in patients with back pain who met specific selection criteria . The purpose of this study was to compare the effectiveness of  STM  and mechanical diagnosis and therapy ( MDT ) in patients who are positive for the STM CPR . Following initial examination , 31 participants were r and omized to the STM group ( n = 16 ) and to the MDT group ( n = 15 ) . Two weeks following initial examination , four participants chose to cross over from the STM group to the MDT group . The Oswestry Disability Index ( ODI ) , Fear-Avoidance Beliefs Question naire work subscale ( FABQw ) , and the Numerical Pain Rating Scale ( NPRS ) were administered initially , and at 2-weeks and 4 week follow-up ( discharge ) . Data were analyzed to determine changes in ODI and NPRS scores from initial examination through one month . Of the 31 participants , one patient who met only three of five selection criteria and four others who chose to switch groups were removed from the analysis . Both groups exhibited statistically significant improvements in ODI and NPRS scores from baseline to final visit but there was no significant difference in scores between groups at 4 weeks . In this sample of patients , the selection criteria for this CPR were not exclusive for lumbopelvic STM . Mechanical diagnosis and therapy was an equally viable choice for these patients A clinical prediction rule to identify patients most likely to respond to spinal manipulation  has been published and widely cited but requires further testing for external validity . We performed a pre-planned secondary analysis of a r and omised controlled trial investigating the efficacy of spinal manipulative therapy in 239 patients presenting to general practice clinics for acute , non-specific , low back pain . Patients were r and omised to receive spinal manipulative therapy or placebo 2 to 3 times per week for up to 4 weeks . All patients received general practitioner care ( advice and paracetamol ) . Outcomes were pain and disability measured at 1 , 2 , 4 and 12 weeks . Status on the clinical prediction rule was measured at baseline . The clinical prediction rule performed no better than chance in identifying patients with acute , non-specific low back pain most likely to respond to spinal manipulative therapy  ( pain P = 0.805 , disability P = 0.600 ) . At 1-week follow-up , the mean difference in effect of spinal manipulative therapy  compared to placebo in patients who were rule positive rather than rule negative was 0.3 points less on a 10-point pain scale ( 95 % CI −0.8 to 1.4 ) . The clinical prediction rule proposed by Childs et al. did not generalise to patients presenting to primary care with acute low back pain who received a course of spinal manipulative therapy Objective : To evaluate if a comprehensive manual therapy programme reduces  sick leave due low back pain and facilitates return to work more than the conventional optimized activating care . Design : A r and omized controlled trial over a 10-week period with a two-year follow-up . Setting : Primary health care and Visby Hospital , Municipality of Gotl and , Sweden . Subjects : One hundred and sixty patients ( 70 women , 90 men , ages 20—55 years ) with acute or subacute low back pain with or without pain radiation into the legs . Interventions : St and ardized optimized activating care ( n = 71 ) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections ( n = 89 ) . Main measures : Sick leave measured as net sick leave volume , point prevalence and return to work . Results : After 10 weeks , significantly more manual therapy patients than reference patients had returned to work ( hazards ratio 1.62 , 95 % confidence interval ( CI ) 1.006—2.60 , P<0.05 ) , and among those on sick leave at baseline , significantly fewer were still on sick leave ( 8/58 versus 13/40 , ratio 0.35 , 95 % CI 0.13—0.97 , P<0.05 ) . For all other measures there were inconclusive differences in favour of the manual therapy group . No significant differences remained after two years . Conclusions : The manual therapy programme used in this study decreased sick leave and increased return to work more than the st and ardized optimized activating care only up to 10 weeks but not up to two years BACKGROUND CONTEXT Evidence -based clinical practice guidelines ( CPGs ) for the management of patients with acute mechanical low back pain ( AM-LBP ) have been defined on an international scale . Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments . To date , the value of implementing full and exclusively CPG-based treatment remains unclear . PURPOSE To determine if full CPGs-based study care ( SC ) results in greater improvement in functional outcomes than family physician-directed usual care ( UC ) in the treatment of AM-LBP . STUDY DESIGN / SETTING A two-arm , parallel design , prospect i ve , r and omized controlled clinical trial using blinded outcome assessment . Treatment was administered in a hospital-based spine program outpatient clinic . PATIENT SAMPLE Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks ' duration . Exclusion criteria included " red flag " conditions and comorbidities contraindicating chiropractic spinal manipulative therapy ( CSMT ) . OUTCOME MEASURES PRIMARY OUTCOME improvement from baseline in Rol and -Morris Disability Question naire ( RDQ ) scores at 16 weeks . SECONDARY OUTCOMES improvements in RDQ scores at 8 and 24 weeks ; and in Short Form-36 ( SF-36 ) bodily pain ( BP ) and physical functioning ( PF ) scale scores at 8 , 16 , and 24 weeks . METHODS Patients were assessed by a spine physician , then r and omized to SC ( reassurance and avoidance of passive treatments , acetaminophen , 4 weeks of lumbar CSMT , and return to work within 8 weeks ) , or family 
    Output:
    
In general , for the primary outcomes , there is low to very low quality evidence suggesting no difference in effect for SMT when compared to inert interventions , sham SMT , or when added to another intervention .
In general , side-lying and supine thrust SMT techniques demonstrate a short-term significant difference when compared to non-thrust SMT techniques for the outcomes of pain , functional status , and recovery .
AUTHORS ' CONCLUSIONS SMT is no more effective in participants with acute low-back pain than inert interventions , sham SMT , or when added to another intervention .
SMT also appears to be no better than other recommended therapies .