***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 
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    Input: One hundred sixteen consecutive patients entered a functional restoration treatment program for chronic low back pain and were compared with 72 patients not treated . A two-year follow-up survey reached more than 85 % of both groups ; its findings were compared with earlier results of a five-month and one-year follow-up . Analysis demonstrated that 87 % of the treatment group was actively working after two years , as compared with only 41 % of the nontreatment comparison group . Moreover , about twice as many of the comparison group patients had additional spine surgery relative to the treatment group . The comparison group continued with an approximately five times higher rate of patient visits to health professionals in the second year as the treatment group . Also , treatment group reinjury rates were no higher than those expected in the general population , while nontreatment subjects had a higher incidence of reinjury . Finally , a small treatment " dropout " group did poorest of all , with results in almost all areas even worse than those of the comparison group patients A prospect i ve r and omized study of 542 injured workers with continuing pain compared 271 workers who were treated at either one of two clinics that provided functional restoration with a control group of 271 subjects .  Chronic pain was caused by low back injury in 78 % of patients ; 79 % of those treated were at work 12 months after completion of treatment compared with 78 % of the control subjects . When the patients were divided into subsets , based on the accident date and followed monthly , the duration of absence from work , the compensation costs , the disability award costs , and the total costs were less for those treated than the control subjects , but these were not statistically significant . Using the difference in total costs as a measure of relative success , back injuries had better results than other injuries in this study The results of a r and omized clinical trial can be reported using relative and /or absolute estimators of treatment effect . These various measures convey different information , and the choice can influence the physician 's appreciation of the size of treatment effect and , subsequently , treatment decisions . We compare the estimators with respect to the clinical ly relevant information conveyed to physicians , and identify which clinical questions can and can not be answered directly by each . We also identify opportunities for misinterpretation when one estimator is substituted for another , or when an estimator is mislabeled . Clinical ly important questions are addressed most directly by reporting both relative and absolute effects using relative risk and its complement , relative risk reduction , and risk difference and its reciprocal , number needed to treat . This is true of estimates of treatment effect derived from a single trial and also from meta- analysis of a group of trials . Because the control group 's risk affects the numerical value of the odds ratio , the odds ratio can not substitute for the risk ratio in conveying clinical ly important information to physicians . This is especially important when large treatment effects are shown in trials carried out in population s at high baseline risk Study Design The authors conducted a controlled clinical trial with 1-year follow-up to define the effectiveness of an intensive physical and psychosocial training program on patients with low back pain . Summary of Background Data The intervention group included 152 patients ( mean age 40.5 yr , Million index 45.1/100 ) , and the reference group included 141 patients ( mean age 40.4 yr , Million index 44.5/100 ) . Methods The progressive intervention program consisted of intensive physical training and psychosocial activation . The outcomes were physical and psychosocial measures , the pain and disability index ( Million ) , sick leaves , and occupational h and icap . Results The intervention was more efficient with respect to physical measures and pain and disability index . There were only mild or no differences in changes between the study groups in psychology variables , sick leaves , or retirement . Conclusions The intervention program could improve physical disability , but to improve occupational h and icap , activities of the whole society ( social legislation , labor market policy ) are needed Worker 's Compensation Board ( WCB ) cl aim ants suffering from soft tissue injuries were treated in a limited functional restoration program ( FRP ) and compared to a r and omized group of cl aim ants referred back to their family doctors for “ usual care . ” The FRP consisted of exercise , work conditioning , group education and behavioral counseling design ed to maximize function , improve pain coping strategies , and ultimately return cl aim ants to work . Results showed that treated cl aim ants were significantly more likely to be back at work or “ work ready ” ( in a job search , in retraining or school ) 18 months posttreatment than cl aim ants left to the “ usual care ” of their attending physicians . They also reported lower pain levels and improved sleep on follow-up . Cl aim ants with low back pain were more successful in returning to work than those with nonback pain or multiple complaints . Results are discussed in terms of the need for better coordination of care to ensure positive outcomes , ideal features of a successful FRP and the need to better underst and who will benefit from this intervention Inpatient and outpatient treatments were compared with a control intervention in 288 men and 168 women , aged 35 - 54 , who were at work , but suffered from chronic or recurrent low back pain .  Physical measurements and back pain assessment s  were carried out before the intervention and at a 3-month follow-up . Physical fitness improved most in the in patients , but the out patients did not differ from the controls . Correlations between back pain and physical measurements indicated that increase of lumbar and hip mobility was more important than increase of trunk strength for subjective progress in these patients . Increased trunk extension strength correlated significantly with subjective progress in women , who also had higher correlations between improved physical fitness and progress than men The long-term outcome results of  inpatient and outpatient treatment  of low back pain ( LBP ) were studied in 476 subjects ( aged 35 - 54 , 63 % men ) r and omly assigned to three study groups : in patients ( n = 157 ) , out patients ( n = 159 ) , and controls ( n = 160 ) . The study included changes in the severity of low back pain , grade and disability , compliance with self-care , data on disability pensions , and days of sickness allowance  during a 2.5-year follow-up period . These variables were used as outcome criteria . Pain and disability had decreased significantly in the two treated groups up to the 3-month follow-up . LBP was still a little slighter in the in patients at the 1.5-year and 22-month follow-ups , but there were no significant differences between the groups in disability caused by LBP . The refresher programme carried out 1.5 years after the first one did not bring about as clear short-term improvement in pain and disability as the first treatment . During the whole 2.5-year follow-up compliance with self-care was better in the two treated groups , especially in the in patients . Days of sickness allowance had increased somewhat more in the controls than in the in patients during the follow-up . No differences between the groups were found in the number of disability pensions granted In a r and omized , blinded study , we compared the outcome from a full-time functional restoration program with the outcome from shorter active rehabilitation programs for patients with chronic , disabling low back pain . The study initially included 132 patients , r and omized into one of three treatment programs : ( 1 ) an intensive 3-week multidisciplinary program ; ( 2 ) active physical training and back school ; or ( 3 ) psychological pain management and active physical training .  Nine of the r and omized patients never started in any program , so the studied population consisted of 123 patients . Of these , 14 patients ( 11 % ) dropped out . The results presented here are at 1 year following treatment , where we achieved a 92 % response rate , including the drop-outs . The functional restoration program was superior to the shorter programs as to work-ready rate , health care contacts , back pain level , disability level , staying physically active , and reduction in analgesics . There was no significant difference between Programs 2 and 3 in most of these parameters . As for sick leave and leg pain , there was no significant difference between Programs 1 and 2 , although a difference was observed when comparing Program 3 with each of the other two . Conclusively , it seems that there is human , as well as economical , benefit from a functional restoration program compared to less intensive programs for these patients Fifty-eight out patients with chronic low back pain were r and omly allocated to one of six experimental conditions . Four conditions were design ated as treatment conditions and two as control conditions . The four treatment groups consisted of : cognitive treatment ( either with or without relaxation training ) and behavioural treatment ( either with or without relaxation training ) . The cognitive and behavioural groups also received physiotherapy . The two control conditions consisted of : attention ( physiotherapy plus discussion sessions ) and no-attention ( physiotherapy-only ) conditions . All conditions , including the two controls , received the same physiotherapy back-education and exercise program . For the sample as a whole , improvements were obtained on measures of affective distress , functional impairment , medication use , pain-related dysfunctional cognitions and use of active coping strategies . These improvements were generally maintained at 6- and 12-month follow-ups . The  combined psychological/physiotherapy treatment conditions improved significantly more than the physiotherapy-only conditions from pre to posttreatment on measures of pain intensity , self-rated functional impairment and pain-related dysfunctional cognitions . However , these differences were only weakly maintained at 6- and 12-month follow-ups . The behavioural conditions improved significantly more than the cognitive conditions from pre to posttreatment on the self-rated measure of functional impairment , but this difference was not maintained at 6- and 12-month follow-ups . Progressive relaxation training was found to make little contribution to either cognitive or behavioural treatments OBJECTIVE Musculoskeletal disorders ( MSD ) are a leading cause of morbidity in the population , yet their prominence seems to be insufficiently appreciated . We describe the ranking compared with other major body systems of the prevalence of MSD , including arthritis and rheumatism , and back/neck disorders , as a cause of chronic health problems , longterm disability , restricted activity days , consultation with health professionals , and use of both prescription and nonprescription drugs . METHODS We analyzed data from the 1990 Ontario Health Survey , a stratified r and om sample of the household dwelling population in Ontario , based on 45,650 individuals aged 16 years and over . RESULTS MSD ranked first in prevalence as the cause of chronic health problems , longterm disabilities , and consultations with a health professional and ranked 2nd for restricted activity days and use of both prescription and nonprescription drugs . No other body systems ranked invariably within the top 2 ranks for the morbidity indices examined . Even when compared to other major disease groups , arthritis and rheumatism ranked consistently in the top 3 and back/neck disorders also ranked high . MSD were mentioned as a reason for 40 % of all chronic conditions , 54 % of all longterm disability , 24 % of restricted activity days and almost 20 % of health care utilization . The impact of MSD was even greater in the 65 and over age group . CONCLUSIONS MSD have a major role in the health profile of the population . This high burden of illness should be considered in planning health care services and setting research priorities Abstract A functional restoration ( FR ) program , dealing with a combination of intensive physical and ergonomic training , psychological pain management , and patient education , was tested in two r and omized , parallel group studies . In one of these patients following the FR program were compared with a non-treated control group ( project A ) , and in the other with patients on two less intensive treatment programs ( project B ) . A total of 238 chronic low back pain patients participated in the two studies , 106 entering project A and 132 project B. Patients from the two projects were comparable except that the patients in project A were recruited from all over the country , whereas patients in project B all were living in and around Copenhagen . Thirteen patients never started any treatment , and 20 patients ( 9 % ) dropped out during the treatment period . Of the 207 who completed treatment , 89 % returned a mailed question naire 5 years later . This was the case for 55 % of the drop-outs . The questions referred to work situation , pain level , activities of daily living , days of sick leave , contact with health care professionals , physical activity , use of medication , and a subjective overall assessment . The results show that in project A the treated group reported significantly fewer contacts with the health care system and significantly fewer days of sick leave over the 5-year follow-up period compared to the control group . In all other parameters , including work ability , there was no statistically significant difference between the two groups . In project B , patients treated in the FR program did significantly better in most measured parameters , except in leg pain , use of pain medication and sport activity , where no significant differences were found between groups . The overall result shows a positive long-term effect of the FR program , but it also shows the necessity of testing a given treatment in different projects and design s , among other things due to statistical variations Outcome of inpatient and outpatient treatment of  low back pain  was studied in 459 patients ( aged 35 - 54 years , 63 % men ) ; 156 in patients , 150 out patients and 153 controls .  Changes in low back pain and in disability caused by it , and adherence and accomplishment of back exercises were used as short-term outcome criteria . The overall results showed a significant decrease in pain and disability and better compliance in the two treated groups when compared to the controls . There was also a significant difference in treatment gains between the in patients and out patients ; i.e. the decrease in pain was greater and the frequency of back exercises higher in the in patients . The in patients also estimated their treatment benefits more positively than the out patients Chronic low-back pain is a frequent symptom causing considerable socioeconomic costs in many countries . Outpatient treatment of low-back pain often remains unsatisfactory . In our prospect i ve study , one hundred patients on the five months waiting list were allocated r and omly to attending the hospital  either four months or six months later , the latter serving as a control group for those undergoing treatment . Health status was assessed using a multidimensional question naire , which had proven a reliable , valid and sensitive instrument in former studies . After four to six weeks of multidisciplinary inpatient treatment , a significant decrease in pain , anxiety and depression was found , whereas no improvement was observed 
    Output:
    
There was strong evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration improves function when compared with inpatient or outpatient non-multidisciplinary treatments .
There was moderate evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain when compared with outpatient non-multidisciplinary rehabilitation or usual care .
There was contradictory evidence regarding vocational outcomes of intensive multidisciplinary biopsychosocial intervention .
Some trials reported improvements in work readiness , but others showed no significant reduction in sickness leaves .
Less intensive outpatient psychophysical treatments did not improve pain , function , or vocational outcomes when compared with non-multidisciplinary outpatient therapy or usual care .
Few trials reported effects on quality of life or global assessment s. CONCLUSIONS The review ed trials provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain .
Less intensive interventions did not show improvements in clinical ly relevant outcomes