***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: Objectives —To compare the therapeutic effect of two different exercise protocol s in athletes with jumper 's knee . Methods —R and omised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises . Measurement was performed at baseline and after six and 12 weeks . Primary outcome measures were pain ( visual analogue scale 1–10 ) and return to sport . Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30 ° /second . Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 ( group ) × 3 ( time ) analysis of variance . Two by two contingency tables were used to test differences in rates of return to sport . Analysis of variance ( 2 ( injured versus non-injured leg ) × 2 ( group ) × 3 ( time ) ) was also used to determine differences for secondary outcome measures . Results —Over the 12 week intervention , pain diminished by 2.3 points ( 36 % ) in the leg extension/curl group and 3.2 points ( 57 % ) in the squat group . There was a significant main effect of both exercise protocol s on pain ( p<0.01 ) with no interaction effect . Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks , but five of those subjects still had low level pain . Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain . There was no significant difference between groups in numbers returning to sporting activity . There were no differences in the change in quadriceps or hamstring muscle moment of force between groups . Conclusions —Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper 's knee in a 12 week period and permit a high proportion of patients to return to sport . Not all patients , however , return to sport by that time Background : Conservative treatment of patellar tendinopathy has been minimally investigated . Effective vali date d treatment protocol s are required . Objectives : To investigate the immediate ( 12 weeks ) and long term ( 12 months ) efficacy of two eccentric exercise programmes for the treatment of patellar tendinopathy . Methods : This was a prospect i ve r and omised controlled trial of 17 elite volleyball players with clinical ly diagnosed and imaging confirmed patellar tendinopathy . Participants were r and omly assigned to one of two treatment groups : a decline group and a step group . The decline group were required to perform single leg squats on a 25 ° decline board , exercising into tendon pain and progressing their exercises with load . The step group performed single leg squats on a 10 cm step , exercising without tendon pain and progressing their exercises with speed then load . All participants completed a 12 week intervention programme during their preseason . Outcome measures used were the Victorian Institute of Sport Assessment ( VISA ) score for knee function and 100 mm visual analogue scale ( VAS ) for tendon pain with activity . Measures were taken throughout the intervention period and at 12 months . Results : Both groups had improved significantly from baseline at 12 weeks and 12 months . Analysis of the likelihood of a 20 point improvement in VISA score at 12 months revealed a greater likelihood of clinical improvements in the decline group than the step group . VAS scores at 12 months did not differ between the groups . Conclusions : Both exercise protocol s improved pain and sporting function in volleyball players over 12 months . This study indicates that the decline squat protocol offers greater clinical gains during a rehabilitation programme for patellar tendinopathy in athletes who continue to train and play with pain Background —There is no disease specific , reliable , and valid clinical measure of Achilles tendinopathy . Objective —To develop and test a question naire based instrument that would serve as an index of severity of Achilles tendinopathy . Methods —Item generation , item reduction , item scaling , and pretesting were used to develop a question naire to assess the severity of Achilles tendinopathy . The final version consisted of eight questions that measured the domains of pain , function in daily living , and sporting activity . Results range from 0 to 100 , where 100 represents the perfect score . Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy ( n = 45 ) , presurgical patients with Achilles tendinopathy ( n = 14 ) , and two normal control population s ( total n = 87 ) . Results —The VISA-A question naire had good test-retest ( r = 0.93 ) , intrarater ( three tests , r = 0.90 ) , and interrater ( r = 0.90 ) reliability as well as good stability when compared one week apart ( r = 0.81 ) . The mean ( 95 % confidence interval ) VISA-A score in the non-surgical patients was 64 ( 59–69 ) , in presurgical patients 44 ( 28–60 ) , and in control subjects it exceeded 96 ( 94–99 ) . Thus the VISA-A score was higher in non-surgical than presurgical patients ( p = 0.02 ) and higher in control subjects than in both patient population s ( p<0.001 ) . Conclusions —The VISA-A question naire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects . The continuous numerical result of the VISA-A question naire has the potential to provide utility in both the clinical setting and research . The test is not design ed to be diagnostic . Further studies are needed to determine whether the VISA-A score predicts prognosis To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results AIM Prognosis and treatment of Achilles tendon pain ( achillodynia ) has been insufficiently studied . The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia . METHODS Patients with achillodynia for at least 3 months were r and omly allocated to one of two exercise regimens  . Exercise was performed daily for a 3-month period . Symptom severity was evaluated by tendon tenderness , ultrasonography , a question naire on pain and other symptoms , and a global assessment of improvement . Follow-up was performed at time points 3 , 6 , 9 , 12 weeks and 1 year . RESULTS Of 53 patients with achillodynia 45 patients were r and omized to either eccentric exercises or stretching exercises . Symptoms gradually improved during the 1-year follow-up period and were significantly better assessed by pain and symptoms after 3 weeks and all later visits . However , no significant differences could be observed between the two groups . Women and patients with symptoms from the distal part of the tendon had significantly less improvement . CONCLUSIONS Marked improvement in symptoms and findings could be gradually observed in both groups during the 1-year follow-up period . To that extent this is due to effect of both regimens or the spontaneous improvement is unsettled BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Achilles tendinopathy is common and treatment with eccentric exercises seems promising . We design ed a prospect i ve r and omized clinical trial to test the hypothesis that eccentric calf muscle exercises reduce pain and improve function in patients with Achilles tendinopathy . Forty-four patients were recruited from primary care ( mean age : 45 years ; 23 women ; 65 % active in sports ) and r and omized to three treatment groups for 12 weeks :  eccentric exercises , a night splint or a combination of both treatments . Pain and function were evaluated at 6 , 12 , 26 and 52 weeks by the Foot and Ankle Outcome Score . At 6 weeks , the eccentric group reported a significant pain reduction ( 27 % compared with baseline , P = 0.007 ) which lasted for 1 year ( 42 % , P = 0.001 ) . The two groups treated with a night splint also reported significant but less pain reduction than the eccentric group . Differences between all the three groups were not significant . At 12 weeks , the eccentric group reported significantly less pain than the splint-only group ( P = 0.04 ) . More patients in the eccentric group than in the splint group returned to sport after 12 weeks . We conclude that eccentric exercises seem to reduce pain and improve function in patients with Achilles tendinopathy . Our results are in line with previous studies and strengthen the recommendation that patients should undergo an eccentric exercise program prior to considering other treatments such as surgery Sclerosing injections targeting neovascularisation have been demonstrated to give promising clinical results in patients with chronic painful Achilles tendinosis . In this study , fifteen elite or recreational athletes ( 12 men and three women ) with the diagnosis patellar tendinosis/Jumper ’s knee in 15 patellar tendons were included . All the patients had a long duration of pain symptoms ( mean = 23 months ) from the patellar tendon , and ultra-sonography + colour doppler examination showed structural tendon changes with hypo-echoic areas and a neovascularisation , corresponding to the painful area . The patients were treated with ultrasound and colour doppler-guided injections of the sclerosing substance Polidocanol , targeting the area with neovascularisation . At follow-up ( mean = 6 months ) after a mean amount of three treatments , there was a good clinical result in 12/15 tendons . The patients were back to their previous ( before injury )  sport activity level , and the amount of pain recorded on a VAS-scale had decreased significantly ( VAS from 81 to 10 ) . Our findings indicate that treatment with sclerosing injections , targeting the area with neovessels in patellar tendinosis , has the potential to cure the pain in the tendons and also allow the patients to go back to full patellar-tendon loading activity Background : Little information is available on the long-term outcome of jumper 's knee , a common problem among athletes . Purpose : Our aim was to determine the 15-year prognosis of jumper 's knee . Study Design : Prospect i ve case control . Methods : The prognosis for jumper 's knee was studied using two groups : athletes with jumper 's knee and nonsymptomatic control athletes . At baseline , all subjects participated in st and ardized clinical examinations and measurements , and 15 years later they were asked to respond to a question naire . Results : Twenty athletes with jumper 's knee and 16 ath 
    Output:
    
Similarly , the RCTs demonstrated that strength-related measures improved over time , but none revealed significant differences relative to the control treatment .