***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: Study Design . A question naire was mailed to 3000 r and omly selected 35‐45‐year‐old individuals in three communities in central Sweden . Objectives . To study the 1‐year prevalence of spinal pain and its ramifications in the form of pain , function , sick leave , and health care use . Summary of Background Data . Previous research ers have used a variety of definitions and population s , but primarily have investigated the occurrence of pain . Comprehensive data are needed concerning health care use , the degree of the pain problem , functional disturbances , and sick leave . Method . Participants in the study completed a question naire regarding spinal pain during the past year including the degree of their experienced pain , functional impairment , lost work days , and health care use . Results . A total of 2305 people ( 78.5 % ) responded to the question naire . Nonrespondents had similar characteristics but a slightly lower 1‐year prevalence rate than did respondents . For respondents , the prevalence of spinal pain during the past year was 66.3 % , with women having a slightly higher prevalence than men . Approximately 25 % of the respondents indicated that they had a substantial problem based on ratings of pain , functional impairment , and sick leave . Work absenteeism reported to the Public Social Insurance Office involved 19 % of those with pain , but an additional 15 % indicated unreported absenteeism . On average , those with pain visited health care providers three times during the past year , but a small number of those who experienced pain consumed large amounts of health care and illness benefits . An important gender difference was shown , such that when pain was at its worst , men took sick leave , whereas women sought health care . Conclusions . Taken together , these data indicate that spinal pain is common among 35‐45‐year‐old men and ‐ women , and that it is related to marked problems for approximately one fourth of those who experience pain . Gender differences exist in the pattern of sick leave and health care use , and a small proportion of those with pain consume very large amounts of the re sources . Consequently , there is a need for early , effective , preventive treatments Successful treatment of torticollis with electromyographic ( EMG ) biofeedback has been reported in a number of single case and single group studies . The present investigation represents the first controlled outcome study . Twelve torticollis patients were r and omly assigned to EMG biofeedback or relaxation training and grade d neck exercises ( RGP ) . The procedure involved three sessions of baseline assessment , 15 sessions of EMG BF or RGP , 6 sessions of EMG BF or RGP plus home-management , 6 sessions of home-management alone , and follow-up 3 months after the end of treatment . A variety of outcome measures were used including physiological ( EMG from the two sternocleidomastoid muscles , skin conductance level ) , behavioral ( angle of head deviation , range of movement of the head ) , and self-report ( depression , functional disability , body concept ) , therapist and “ significant other ” reports and independent observer assessment of videos . In both groups , neck muscle activity was reduced from pre- to posttreatment . This reduction was greater in the EMG biofeedback group . There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group . Therefore , the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects . Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of “ arousal . ” Significant improvements of extent of head deviation , and range of movement of the head , as well as reductions of depression were present , which were not different in the two groups . At the end of treatment , no patient was asymptomatic . Any therapeutic benefit was generally maintained at follow-up . The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one . Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger sample s are required Thirty patients with acute cervical pain were r and omized into 3 groups and treated with neck collar , transcutaneous nerve stimulation , or manual therapy . The improvement was rapid in all groups , but the restoration of the cervical mobility was significantly more rapid in the transcutaneous nerve stimulation group . Some of the patients with manual therapy treatment had remarkably quick symptom reduction , although this was not significantly better than the collar alone . It is concluded that transcutaneous nerve stimulation is a valuable pain reducer and gives a more rapid restoration of cervical mobility in acute cervical pain Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases with age . More women experience high‐disability neck pain than men . Wave analysis suggests that the point prevalence and 6‐month prevalence of high‐intensity and low‐disability neck pain are overestimated in this survey . Conclusion . This cross‐sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) of the adult population PURPOSE To describe and explore the relationships between pain , emotional state and coping strategies in patients with chronic radicular neck pain before and after surgery or conservative treatments . METHODS We r and omize 81 conseutive patients with cervical radicular pain and nerve root compression , verified by MRI , to either surgical decompression with fusion or physiotherapy or neck collar .  Emotional state was both measured with Mood Adjective Check List . Hospital Anxiety and Depression Scale and with a Coping Strategies Question naire . Pain was measured with VAS and function with Disability Index Rating . Measurements were made before treatment , and follow ups after 3 and 12 months post treatment . RESULTS We found generally a low emotional state with anxiety , depression and sleep-disturbances not only connected to pain . Pain improved faster in the surgery group but after one year no differences were seen . Surgery and physiotherapy improved function with heavy work compared to collar after 3 months . Many patients used active coping before treatment , but after treatment more passive coping strategies were found . CONCLUSION We recommend a multidisciplinary rehabilitation with cognitive behavioural therapy and psychological interventions OBJECTIVES This study compared the relative effectiveness of cervical spine manipulation and mobilization for neck pain . METHODS Neck-pain patients were r and omized to the following conditions : manipulation with or without heat , manipulation with or without electrical muscle stimulation , mobilization with or without heat , and mobilization with or without electrical muscle stimulation . RESULTS Of 960 eligible patients , 336 enrolled in the study .  Mean reductions in pain and disability were similar in the manipulation and mobilization groups through 6 months . CONCLUSIONS Cervical spine manipulation and mobilization yield comparable clinical outcomes This prospect i ve , r and omised study compares the efficacy of surgery , physiotherapy and cervical collar with respect to pain , motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment , with or without an additional bulging disk , as verified by MRI or CT-myelography .  Pain intensity was registered on a visual analogue scale ( VAS ) , muscle strength was measured by a h and -held dynamometer , Vigorometer and pinchometer .  Sensory loss and paraesthesia were recorded . The measurements were performed before treatment ( control 1 ) , 4 months after the start of treatment ( control 2 ) and after a further 12 months ( control 3 ) . A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements . The study found that before start of treatment the groups were uniform with respect to pain , motor weakness and sensory loss . At control 2 the surgery group reported less pain , less sensory loss and had better muscle strength , measured as the ratio of the affected side to the non-affected side , compared to the two conservative treatment groups . After a further year ( control 3 ) , there were no differences in pain intensity , sensory loss or paraesthesia between the groups . An improvement in muscle strengths , measured as the ratio of the affected to the non-affected side , was seen in the surgery group compared to the physiotherapy group in wrist extension , elbow extension , shoulder abduction and internal rotation , but there were no differences in the ratios between the collar group and the other treatment groups . With respect to absolute muscle strength of the affected sides , there were no differences at control 1 . At control 2 , the surgery group performed somewhat better than the two other groups but at control 3 there were no differences between the groups . We conclude that pain intensity , muscle weakness and sensory loss can be expected to improve within a few months after surgery , while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal OBJECTIVE To evaluate short- and medium-term effects of peripheral repetitive magnetic stimulation ( rMS ) on myofascial pain . METHODS Eighteen patients who presented with myofascial trigger points ( TPs ) at the level of the superior trapezius were separated into two groups according to a restricted r and omization scheme . Group 1 ( n=9 ) underwent treatment with rMS that consisted of a total of 10 sessions , each lasting 20min , in which 4000 magnetic stimuli were administered in 5s trains at 20Hz at the TP . Group 2 ( n=9 ) received a placebo treatment that consisted of the application of a non-functioning ultrasound therapy device to the TP . Patients were evaluated before treatment , at the end of treatment , and again 1 week and 1 month after the conclusion of the treatment . Clinical evaluation included parameters for measuring pain levels ( VAS , NPDVAS and algometry ) , the myofascial TP characteristics and the range of cervical movement ( ROM ) . RESULTS The rMS group showed a significant improvement in VAS , NPDVAS , algometry , as well as in the characteristics of the TP after conclusion of treatment . Improvements in the ROM were also present in rotation and controlateral bending . This improvement persisted after 1 month . On the other h and , the placebo group did not show any significant improvement in the tests considered . CONCLUSIONS The results of this study show that peripheral rMS may have positive short- and medium-term therapeutic effects on myofascial pain Study Design . A r and omized trial was conducted in which patients with back and neck pain , visiting a general practitioner , were allocated to chiropractic or physiotherapy . Objectives . To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain , with special reference to subgroups , recurrence rate , and additional health care use at follow‐up evaluation 12 months after treatment . Summary of Background Data . Earlier studies on the effect of spinal manipulation have shown inconsistent results . Mostly they include only short‐term follow‐up periods , and few cost‐effectiveness analyses have been made . Methods . A group of 323 patients aged 18‐60 years who had no contraindications to manipulation and who had not been treated within the previous month were included . Outcome measures were changes in Oswestry scores , pain intensity , and general health ; recurrence rate ; and direct and indirect costs . Results . No differences were detected in health improvement , costs , or recurrence rate between the two groups . According to Oswestry score , chiropractic was more favorable for patients with a current pain episode of less than 1 week ( 5 % ) and physiotherapy for patients with a current pain episode of greater than 1 month ( 6.8 % ) . Nearly 60 % of the patients reported two or more recurrences . More patients in the chiropractic group ( 59 % ) than in the physiotherapy group ( 41 % ) sought additional health care . Costs varied considerably among individuals and subgroups ; the direct costs were lower for physiotherapy in a few subgroups . Conclusions . Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population , but some differences were seen according to subgroups . Back problems often recurred , and additional health care was common . Implication s of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent . Models must be implemented and tested Study Design . This prospect i ve , r and omized study compares the efficacy of surgical and conservative treatments in patients with long-lasting cervical radicular pain . Objectives . To compare the effects of surgery , physiotherapy , and a cerv 
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The results for the electrotherapy subtypes are : Limited evidence of benefit : low or high frequency pulsed electromagnetic field ( PEMF ) compared to placebo , provides immediate post treatment pain relief only for chronic MND , acute whiplash ( WAD ) Unclear or conflicting evidence : direct and modulated Galvanic current compared to other treatments for pain in acute , subacute , chronic occipital headache iontophoresis compared to other treatments for pain , RTW , and self- assessment of overall outcome in acute , subacute WAD TENS compared to placebo for pain in acute WAD , chronic MND PEMF compared to placebo for medium or long term effect on pain , patient assessment of improvement , ADL in acute WAD , chronic MND Limited evidence of no benefit : diadynamic current compared to placebo for reduction of trigger point tenderness in chronic MND with radicular findings , cervicogenic headache permanent magnets compared to a placebo for pain in chronic MND electric muscle stimulation compared to a sham control for pain in chronic MND .