***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: OBJECTIVE --To assess the long term effect of early mobilisation exercises in patients with acute sprains of the neck after road accidents . DESIGN --Single blind r and omised prospect i ve study of patients receiving physiotherapy , advice on mobilisation , or on an initial period of rest followed up after two years by postal question naire . SETTING --Accident and emergency department in urban hospital . PATIENTS --247 Consecutive patients ( mean age at injury 30.6 years ) presenting within 48 hours after injury with no pre-existing disease of the neck or serious skeletal injury . Of these , 167 patients responded to the question naire ; 77 who responded but had not completed their treatment or review course were included in the analysis as a fourth group ( non-attenders ) . MAIN OUTCOME MEASURE -- Presence of symptoms after two years . RESULTS --Of the 167 patients ( 68 % ) responding , the percentage of patients still with symptoms was not significantly different in those receiving rest or physiotherapy ( 46 % , 12/26 v 44 % , 24/54 ) , but that in those receiving advice on early mobilisation was significantly lower ( 23 % , 11/48 , p = 0.02 ) . Of the 104 patients without symptoms , 94 ( 90 % ) recovered within six months and 62 ( 60 % ) within three months . Patients without symptoms who received advice or physiotherapy wore a collar  for a significantly shorter time than those with persistent symptoms ( mean duration 1.4 ( SD 0.7 ) months v 2.8 ( 1.6 ) months , p = 0.005 and 1.6 ( 1.1 ) months v 1.8 ( 1.3 ) months , p = 0.006 respectively ) . CONCLUSIONS --Advice to mobilise in the early phase after neck injury reduces the number of patients with symptoms at two years and is superior to manipulative physiotherapy . Prolonged wearing of a collar is associated with persistence of symptoms 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 Objectives The authors ' goals were to compare the effectiveness of manual therapy ( MT ; mainly spinal mobilization ) , physical therapy ( PT ; mainly exercise therapy ) , and continued care by the general practitioner ( GP ; analgesics , counseling and education ) over a period of 1 year . Methods One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were r and omized to receive a 6-week treatment strategy of MT once a week , PT twice a week , or GP care once every 2 weeks . The primary outcome measures were perceived recovery , severity of physical dysfunctioning , pain intensity , and functional disability . Results The differences between groups considered over 1 year were statistically significant ( repeated measurements analyses P<0.001 to P=0.02 ) for all outcomes but borderline for the Neck Disability Index ( P=0.06 ) . Higher improvement scores were observed for MT for all outcomes , followed by PT and GP care . The success rate , based on perceived recovery after 13 weeks , was 72 % for MT , which was significantly higher than the success rate for continued GP care ( 42 % , P=0.001 ) but not significantly higher compared with PT treatment ( 59 % , P=0.16 ) . The difference between PT and GP approached statistical significance ( P=0.06 ) . After 1 year the success rates were 75 % , 63 % , and 56 % , respectively , and no longer significantly different . Conclusions Short-term results ( at 7 weeks ) have shown that MT speeded recovery compared with GP care and , to a lesser extent , also compared with PT . In the long-term , GP treatment and PT caught up with MT , and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up 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 PURPOSE To study whether the isolated intervention of high-speed , low-amplitude spinal manipulation in the cervical spine has any effect on cervicogenic headache . DESIGN Prospect i ve r and omized controlled trial with a blinded observer . SETTING Ambulatory outpatient facility in an independent research institution . PARTICIPANTS Fifty-three subjects suffering from frequent headaches who fulfilled the International Headache Society criteria for cervicogenic headache ( excluding radiological criteria ) . These subjects were recruited from 450 headache sufferers who responded to newspaper advertisements . INTERVENTION After r and omization , 28 of the group received high-velocity , low-amplitude cervical manipulation twice a week for 3 wk . The remaining 25 received low-level laser in the upper cervical region and deep friction massage ( including trigger points ) in the lower cervical/upper thoracic region , also twice a week for 3 wk . MAIN OUTCOME MEASURES The change from week 1 to week 5 in analgesic use per day , in headache intensity per episode and in number of headache hours per day , as registered in a headache diary . RESULTS The use of analgesics decreased by 36 % in the manipulation group , but was unchanged in the soft-tissue group ; this difference was statistically significant ( p = .04 , chi 2 for trend ) . The number of headache hours per day decreased by 69 % in the manipulation group , compared with 37 % in the soft-tissue group ; this was significant at p = .03 ( Mann-Whitney ) . Finally , headache intensity per episode decreased by 36 % in the manipulation group , compared with 17 % in the soft-tissue group ; this was significant at p = .04 ( Mann-Whitney ) . CONCLUSION Spinal manipulation has a significant positive effect in cases of cervicogenic headache OBJECTIVE To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thrust cervical manipulations in the treatment of  cervical spine dysfunction . DESIGN Prospect i ve , r and omized , comparative clinical trial . SETTING Outpatient chiropractic clinic , Technikon Natal , South Africa . PATIENTS Thirty patients diagnosed with neck pain and restricted cervical spine range of motion without complicating pathosis for at least 1 month were included in the study . INTERVENTIONS The patients were r and omized into 2 groups . Those in one group received mechanical force , manually assisted ( MFMA ) manipulation to the cervical spine , delivered by means of a h and -held instrument ( Activator II Adjusting Instrument ) . Those in the other group received specific contact high-velocity , low-amplitude ( HVLA ) manipulation consisting of st and ard Diversified rotary/lateral break techniques to the cervical spine . Each group received only the specific therapeutic intervention , no other treatment modalities or interventions ( including medication ) being used , until asymptomatic status was achieved or a maximum of 8 treatments had been received . MAIN OUTCOME MEASURES Both treatment groups were assessed through use of subjective ( Numerical Pain Rating Scale 101 , McGill Short-Form Pain Question naire , and Neck Disability Index ) and objective ( goniometer cervical range of motion ) measurement parameters at specific intervals during the treatment period and at 1-month follow-up . The data were assessed through use of 2-tailed nonparametric paired and unpaired analysis , descriptive statistics , and power analysis of the data . RESULTS The results indicate that both treatment methods had a positive effect on the subjective and objective clinical outcome measures , no significant difference being observed between the 2 groups ( P < .025 ) . The subjective data from all 3 question naires showed statistically significant changes from initial to final consultations as well as from initial consultation to 1-month follow-up ( P < .025 ) . The objective range of motion measures showed statistically significant changes in the MFMA group for left and right rotation and left and right lateral flexion from initial consultation to final consultations and for right rotation and right lateral flexion from initial consultation to 1-month follow-up . The HVLA group showed only the change in left rotation from initial to final consultations and from initial consultation to 1-month follow-up to be statistically significant . CONCLUSIONS The results of this clinical trial indicate that both instrumental ( MFMA ) manipulation and manual ( HVLA ) manipulation have beneficial effects associated with reducing pain and disability and improving cervical range of motion in this patient population . A r and omized , controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings Study Design . A multicenter , r and omized controlled trial with unblinded treatment and blinded outcome assessment was conducted . The treatment period was 6 weeks with follow-up assessment after treatment , then at 3 , 6 , and 12 months . Objectives . To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination , as compared with a control group . Summary of Background Data . Headaches arising from cervical musculoskeletal disorders are common . Conservative therapies are recommended as the first treatment of choice . Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term . There is no evidence for exercise , and no study has investigated the effect of combined therapies for cervicogenic headache . Methods . In this study , 200 participants who met the diagnostic criteria for cervicogenic headache were r and omized into four groups : manipulative therapy group , exercise therapy group , combined therapy group , and a control group . The primary outcome was a change in headache frequency . Other outcomes included changes in headache intensity and duration , the Northwick Park Neck Pain Index , medication intake , and patient satisfaction . Physical outcomes included pain on neck movement , upper cervical joint tenderness , a craniocervical flexion muscle test , and a photographic measure of posture . Results . There were no differences in headache-related and demographic characteristics between the groups at baseline . The loss to follow-up evaluation was 3.5 % . At the 12-month follow-up assessment , both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity , and the neck pain and effects were maintained ( P < 0.05 for all ) . The combined therapies was not significantly superior to either therapy alone , but 10 % more patients gained relief with the combination . Effect sizes were at least moderate and clinical ly relevant . Conclusion . Manipulative therapy and exercise can reduce the symptoms of cer 
    Output:
    
Single or multiple ( 3 - 11 ) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo , control groups , or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache .
Mobilization and /or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache .
Done alone , manipulation and /or mobilization were not beneficial ; when compared to one another , neither was superior .
There was insufficient evidence available to draw conclusions for neck disorder with radicular findings .
Factorial design would help determine the active agent(s ) within a treatment mix