***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: Summary Use of the Chronic Pain Management Program was associated with significant decreases in pain‐related , functional , and mental health outcomes and an increase in pain knowledge . Abstract Internet‐based educational and therapeutic programs ( e‐health applications ) are becoming increasingly popular for a variety of psychological and physical disorders . We tested the efficacy of an online Chronic Pain Management Program , a comprehensive , fully self‐directed and self‐paced system that integrates social networking features and self‐management tools into an interactive learning environment . Of 305 adult participants ( 196 women , 109 men ) , a total of 162 individuals with chronic pain were r and omly assigned unsupervised access to the program  for approximately 6 weeks ; 143 were assigned to the wait‐listed control group with treatment as usual .  A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter . All recruitment , data collection , and participant involvement took place online . Participation was fully self‐paced , permitting the evaluation of program effectiveness under real‐world conditions . Intent‐to‐treat analysis that used linear growth models was used as the primary analytic tool . Results indicated that program utilization was associated with significant decreases in pain severity , pain‐related interference and emotional burden , perceived disability , catastrophizing , and pain‐induced fear . Further , program use led to significant declines in depression , anxiety , and stress . Finally , as compared to the wait‐listed control group , the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management . Study limitations are considered , including the recognition that not all persons with chronic pain are necessarily good c and i date s for self‐initiated , self‐paced , interactive learning Background Collaborative care interventions to treat depression have begun to be tested in setting s outside of primary care . However , few studies have exp and ed the collaborative care model to other setting s and targeted comorbid physical symptoms of depression . Purpose The aims of this report were to : ( 1 ) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention design ed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma ; and ( 2 ) share the lessons learned during the design , implementation , and evaluation of the trial . Methods The trial was a phase III r and omized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression , pain , and fatigue in patients diagnosed with advanced cancer . The intervention was compared to an enhanced usual care arm . The primary outcomes included the Center for Epidemiological Studies -Depression scale , Brief Pain Inventory , and Functional Assessment of Cancer Therapy (FACT)-Fatigue , and the FACT-Hepatobiliary . Sociodemographic and disease-specific characteristics were recorded from the medical record ; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum . Results and Discussion The issues addressed include : ( 1 ) development of collaborative care in the context of oncology ( e.g. , timing of the intervention , tailoring of the intervention , ethical issues regarding r and omization of patients , and changes in medical treatment over the course of the study ) ; ( 2 ) use of a website by chronically ill population s ( e.g. , design and access to the website , development of the website and intervention , ethical issues associated with website development , website usage , and unanticipated costs associated with website development ) ; ( 3 ) evaluation of the efficacy of intervention ( e.g. , patient preferences , proxy raters , changes in medical treatment , and inclusion of biomarkers as endpoints ) ; and ( 4 ) analyses and interpretation of the intervention ( e.g. , confounding factors , dose and active ingredients , and risks and benefits of collaborative care interventions in chronically ill patients ) . Limitations The limitations to the study , although not fully realized at this time as the trial is ongoing , include : ( 1 ) heterogeneity of the diagnoses and treatments of participants ; and ( 2 ) inclusion of caregivers as proxy raters but not as participants in the intervention . Conclusions Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible . However , research ers design ing and implementing interventions that are web-based , target multiple symptoms , and for oncology patients may benefit from previous experiences An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers . Sixty workers were r and omly assigned to either : 1 ) a control group ; 2 ) an office training group that received personal , ergonomic training and workstation adjustments or 3 ) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker 's current sitting posture together with the correct posture photo taken earlier during office training . Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment ( RULA ) method before , during and after the six weeks intervention . Both training methods provided effective short-term posture improvement ; however , sustained improvement was only attained with the photo-training method . Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain . The photo-training method had a greater positive effect on women than on men Acceptance and commitment therapy ( ACT ) interventions for persons with chronic pain have recently received empirical support . ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions , sensations , and thoughts . The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain . A total of 76 patients with chronic pain were included in the study and r and omized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum . Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness . Measurements were provided with the primary outcome variable Chronic Pain Acceptance Question naire which was in favour of the treatment group . Reductions were found on other measures of pain-related distress , anxiety and depressive symptoms . A six month follow-up showed maintenance of improvements . We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain We investigated the effectiveness and efficiency of a four-week myofeedback-based teletreatment service in subjects with non-specific neck and shoulder pain . Subjects were recruited in Belgium , Germany and the Netherl and s and r and omly allocated to the intervention or conventional care . Subjects in the intervention group received four weeks of myofeedback training .  Pain intensity and disability were evaluated by question naires at baseline , immediately after four weeks of treatment and at follow-up 3 months later . To investigate efficiency , the time-investment of both therapists and patients were assessed . Seventy-one subjects were included in the study ( 36 in the intervention group and 35 in the conventional care group ) . Myofeedback-based teletreatment was at least as effective clinical ly as conventional care .  Pain intensity and disability decreased after 4 weeks of treatment in both groups and part of the effect remained at 3 months ' follow-up . The teletreatment also increased efficiency for therapists by almost 20 % and patients experienced the benefits of less travel time and travel costs by remote consultation . Myofeedback-based teletreatment has the potential to ensure more efficient treatment for patients with non-specific neck and shoulder pain BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee . Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function . Access to high- quality rehabilitation services is not always possible , especially for those who live in rural or remote areas . The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty . METHODS this investigation was a single-blinded , prospect i ve , r and omized , controlled noninferiority trial . Sixty-five participants were r and omized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program . The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) measured at baseline and six weeks by a blinded independent assessor . Secondary outcomes included the Patient-Specific Functional Scale , the timed up- and -go test , pain intensity , knee flexion and extension , quadriceps muscle strength , limb girth measurements , and an assessment of gait . Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics . RESULTS baseline characteristics between groups were similar , and all participants had significant improvement on all outcome measures with the intervention ( p < 0.01 for all ) . After the six-week intervention , participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion , muscle strength , limb girth , pain , timed up- and -go test , quality of life , and clinical gait and WOMAC scores . Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group ( p < 0.05 ) . The telerehabilitation intervention was well received by participants , who reported a high level of satisfaction with this novel technology . CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation . LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence Background IBS affects 10 - 22 % of the UK population . Abdominal pain , bloating and altered bowel habit affect quality of life , social functioning and time off work . Current GP treatment relies on a positive diagnosis , reassurance , lifestyle advice and drug therapies , but many suffer ongoing symptoms . A recent Cochrane review highlighted the lack of research evidence for IBS drugs . Neither GPs , nor patients have good evidence to inform prescribing decisions . However , IBS drugs are widely used : In 2005 the NHS costs were nearly £ 10 million for mebeverine and over £ 8 million for fibre-based bulking agents . CBT and self-management can be helpful , but poor availability in the NHS restricts their use . We have developed a web-based CBT self-management programme , Regul8 , based on an existing evidence based self-management manual and in partnership with patients . This could increase access with minimal increased costs . Methods / Design The aim is to undertake a feasibility factorial RCT to assess the effectiveness of the commonly prescribed medications in UK general practice for IBS : mebeverine ( anti-spasmodic ) and methylcellulose ( bulking-agent ) and Regul8 , the CBT based self-management website.135  patients aged 16 to 60 years with IBS symptoms fulfilling Rome III criteria , recruited via GP practice s , will be r and omised to 1 of 3 levels of the drug condition : mebeverine , methylcellulose or placebo for 6 weeks and to 1 of 3 levels of the website condition , Regul8 with a nurse telephone session and email support , Regul8 with minimal email support , or no website , thus creating 9 groups . Outcomes : Irritable bowel symptom severity scale and IBS-QOL will be measured at baseline , 6 and 12 weeks as the primary outcomes . An intention to treat analysis will be undertaken by ANCOVA for a factorial trial . Discussion This pilot will provide valuable information for a larger trial . Determining the effectiveness of commonly used drug treatments will help patients and doctors make informed treatment decisions regarding drug management of IBS symptoms , enabling better targeting of treatment . A web-based self-management CBT programme for IBS developed in partnership with patients has the potential to benefit large numbers of patients with low cost to the NHS . Assessment of the amount of email or therapist support required for the website will enable economic analysis to be undertaken . Trial Registration Clinical Trials.gov Identifier ( NCT number ) : NCT00934973 Background Internet-based interventions using cognitive behavioral approaches can be effective in promoting self-management of chronic pain conditions .  Web-based programs delivered via smartphones are increasingly used to support the self-management of various health disorders , but research on smartphone interventions for persons with chronic pain is limited . Objective The aim of this trial was to study the efficacy of a 4-week smartphone-delivered intervention with written diaries and therapist feedback following an inpatient chronic pain rehabilitation program . Methods A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were r and omized into 2 groups : with or without a smartphone intervention after the rehabilitation . The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone . Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts , feelings , and activities . The registered diaries were immediately available to a therapist who su bmi tted personalized written feedback daily based on cognitive behavioral principles . Both groups were given access to a noninteractive website after discharge to promote constructive self-management . Outcomes were measured with self-reported question naires . The primary outcome measure of catastrophizing was determined using the pain catastrophizing scale ( score range 0 - 52 ) . Secondary outcomes included acceptance of pain , emotional distress , functioning , and symptom levels . Results Of the 140 participants , 112 completed the study : 48 in the intervention group and 64 in the control group . Immediately after the intervention period , the intervention group reported less catastrophizing ( mean 9.20 , SD 5.85 ) than the control group ( mean 15.71 , SD 9.11 , P< 
    Output:
    
There is insufficient evidence to make conclusions regarding the efficacy of psychological therapies delivered via the Internet in participants with headache conditions .
Psychological therapies reduced pain and disability post-treatment ; however , no clear evidence of benefit was found for depression and anxiety .
For participants with non-headache conditions , psychological therapies delivered via the Internet reduced pain , disability , depression , and anxiety post-treatment .
The positive effects on disability were maintained at follow-up .
These effects are promising , but considerable uncertainty remains around the estimates of effect .
These results are similar to those of review s of traditional face-to-face therapies for chronic pain