***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: Background Low back pain ( LBP ) is a major cause of disability throughout the world . However , longitudinal evidence to relate low back pain and functional limitations is mostly confined to Western countries . In this study , we investigate the associations between low back pain and functional limitations in a prospect i ve cohort of Thai adults . Methods We analysed information from the Thai Cohort Study of adult Open University adults which included 42,785 participants in both 2009 and 2013 , with the majority aged 30 to 65 years and residing nationwide . We used multivariate logistic regression to explore the longitudinal associations between LBP in 2009 and 2013 ( ‘ never ’ : no LBP in 2009 or 2013 ; ‘ reverting ’ : LBP in 2009 but not in 2013 ; ‘ incident ’ : no LBP in 2009 but LBP in 2013 ; and ‘ chronic ’ : reporting LBP at both time points ) and the outcome of functional limitations relating to Activities of Daily Living ( ADL ) in 2013 . Results Low back pain was common with 30 % of cohort members reporting low back pain in both 2009 and 2013 ( ‘ chronic LBP ’ ) . The ‘ chronic LBP ’ group was more likely than the ‘ never ’ back pain group to report functional limitations in 2013 : adjusted odds ratios 1.60 [ 95 % Confidence Interval : 1.38–1.85 ] for difficulties getting dressed ; 1.98 [ 1.71–2.30 ] for walking ; 2.02 [ 1.71–2.39 ] for climbing stairs ; and 3.80 [ 3.38–4.27 ] for bending/kneeling . Those with ‘ incident LBP ’ or ‘ reverting LBP ’ both had increased odds of functional limitations in 2013 but the odds were not generally as high . Conclusions Our nationwide data from Thail and suggests that LBP is a frequent public health problem among economically productive age groups with adverse effects on the activities of daily living . This study adds to the limited longitudinal evidence on the substantial impact of low back pain in Southeast Asia Objective : Numerous studies have documented rates of chronic pain in developed western nations ; however , little is known about its prevalence or correlates in rapidly developing countries , where much of the world ’s population lives . This study was design ed to assess the prevalence of chronic pain among adults in Chongqing , China and the correlates of chronicity among respondents with pain and degree of impairment within the subgroup reporting chronic pain . Design : A structured telephone interview was used within a cross-sectional design . Chronic pain was defined as the pain that had persisted for ≥3 months . Participants : Adults from a r and om sample of 1003 Chongqing households completed a structured telephone interview on pain experiences of themselves and other family members over the past 6 months  . Results : Overall , 42.2 % of interviewees reported pain for at least 1 day during the past 6 months and 25.8 % experienced pain lasting for at least 3 months . The most common complaints were back pain ( 17.6 % ) , headache ( 14.2 % ) , joint pain , ( 10.5 % ) , and abdominal pain ( 10.4 % ) . Among those who reported pain , correlates of a chronic duration included older age , presence of back pain , heightened impairment , use of Chinese medicine , and greater numer of interventions used for pain management . For interviewees whose pain was chronic , increased functional impairment was related to older age , presence of pain every day , and increased likelihood of consulting physicians and using Chinese medicine to manage pain . Conclusions : Rates of chronic pain in Chongqing appear to approximate to those reported in western countries . A significant minority of those affected report substantial or severe impairment and are more likely than less impaired cohorts to have sought medical interventions to manage pain Manual therapy , exercise and education target distinct aspects of chronic low back pain and probably have distinct effects . This study aim ed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies . By concealed r and omisation , 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners . The dependent variables of interest were pain and disability . Assessors were blind to treatment group . Outcome data from 49 subjects ( 86 % ) showed a significant treatment effect . The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale ( 95 % CI 0.7 to 2.3 ) and 3.9 points on the 18-point Rol and Morris Disability Question naire ( 95 % CI 2 to 5.8 ) , respectively . The number needed to treat in order to gain a clinical ly meaningful change was 3 ( 95 % CI 3 to 8) for pain , and 2 ( 95 % CI 2 to 5 ) for disability . A treatment effect was maintained at one-year follow-up . The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients OBJECTIVE To observe the clinical efficacy differences between modified lateral position and prone position in patients treated with electroacupuncture ( EA ) for lumbar herniated disc ( LHD ) . METHODS Seventy-six patients with LHD were r and omly divided into a lateral position group and a prone position group , 38 cases in each one . The acupoint selection and treatment method were identical in the two groups except the position . Mingmen ( GV 4 ) , Yaoyangguan ( GV 3 ) , Dachangshu ( BL 25 ) , Xiaochangshu ( BL 27 ) , Zhibian ( BL 54 ) and Huantiao ( GB 30 ) were selected . EA was given three times a week , ten times were taken as one course and totally 20 times were given . The visual analogue scale ( VAS ) and Japanese orthopaedic association ( JOA ) scale were taken as efficacy criteria , which were evaluated before and after treatment as well as one month after treatment . RESULTS After treatment , VAS and JOA were significantly improved in the two groups ( lateral position group : JOA 10.60±2.60 vs 18.92±3.87 , VAS 8.13±0.99 vs 2.34±0.81 ; prone position group : JOA 10.94±2.06 vs 17.02±3.96 , VAS 8.02±1.05 vs 2.86±0.96 , all P<0.01 ) ; the VAS and JOA in the lateral position group were higher than those in the prone position group ( both P<0.05 ) . One month after treatment , VAS and JOA were significantly improved in the two groups ( all P<0.01 ) , which was more significant in the lateral position group ( both P<0.05 ) . CONCLUSIONS The treatment position could influence the efficacy of EA for LHD , and lateral position pre-sents certain advantages to prone position group Objective To test the predictive utility of the Örebro Musculoskeletal Pain Screening Question naire in identifying patients at risk for developing persistent back pain problems . Design Prospect i ve , where participants completed the question naire and their cases were followed for 6 months to assess outcome with regard to pain , function , and absenteeism due to sickness . Participants One hundred seven patients , recruited from seven primary care units . Results Discriminant analyses showed that the items on the question naire were significantly related to future problems . For absenteeism due to sickness , 68 % of the patients were correctly classified into one of three groups , whereas an even distribution would have produced 33 % . The analyses for function correctly classified 81 % , and for pain 71 % , into one of two groups , compared with a chance level of 50 % . A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89 % and a specificity of 65 % for absenteeism due to sickness , and a sensitivity of 74 % and a specificity of 79 % for functional ability . Conclusions The results underscore that psychological variables are related to outcome 6 months later , and they replicate and extend earlier findings indicating that the Örebro Screening Question naire is a clinical ly reliable and valid instrument . The total score was a relatively good predictor of future absenteeism due to sickness as well as function , but not of pain . The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors OBJECTIVE To determine the prevalence of serious pathology in patients presenting to primary care setting s with acute low back pain , and to evaluate the diagnostic accuracy of recommended " red flag " screening questions . METHODS An inception cohort of 1,172 consecutive patients receiving primary care for acute low back pain was recruited from primary care clinics in Sydney , Australia . At the initial consultation , clinicians recorded responses to 25 red flag questions and then provided an initial diagnosis . The reference st and ard was a 12-month followup supplemented with a specialist review of a r and om sub sample of participants . RESULTS There were 11 cases ( 0.9 % ) of serious pathology , including 8 cases of fracture . Despite the low prevalence of serious pathology , most patients ( 80.4 % ) had at least 1 red flag ( median 2 , interquartile range 1 - 3 ) . Only 3 of the red flags for fracture recommended for use in clinical guidelines were informative : prolonged use of corticosteroids , age > 70 years , and significant trauma . Clinicians identified 5 of the 11 cases of serious pathology at the initial consultation and made 6 false-positive diagnoses . The status of a diagnostic prediction rule containing 4 features ( female sex , age > 70 years , significant trauma , and prolonged use of corticosteroids ) was moderately associated with the presence of fracture ( the area under the curve for the rule score was 0.834 [ 95 % confidence interval 0.654 - 1.014 ] ; P = 0.001 ) . CONCLUSION In patients presenting to a primary care provider with back pain , previously undiagnosed serious pathology is rare . The most common serious pathology observed was vertebral fracture . Approximately half of the cases of serious pathology were identified at the initial consultation . Some red flags have very high false-positive rates , indicating that , when used in isolation , they have little diagnostic value in the primary care setting Study Design . The Oswestry Disability Index v2.0 ( ODI ) , SF36 Physical Function Domain ( SF-36 PFD ) , and PROMIS Physical Function CAT v1.2 ( PF CAT ) question naires were prospect ively collected from 1607 patients complaining of back or leg pain , visiting a university-based spine clinic . All question naires were collected electronically , using a tablet computer . Objective . The aim of this study was to compare the psychometric properties of the PROMIS PF CAT with the ODI and SF36 Physical Function Domain in the same patient population . Summary of Background Data . Evidence -based decision-making is improved by using high- quality patient-reported outcomes measures . Prior studies have revealed the shortcomings of the ODI and SF36 , commonly used in spine patients . The PROMIS Network has developed measures with excellent psychometric properties . The Physical Function domain , delivered by Computerized Adaptive Testing ( PF CAT ) , performs well in the spine patient population , though to- date direct comparisons with common measures have not been performed . Methods . St and ard Rasch analysis was performed to directly compare the psychometrics of the PF CAT , ODI , and SF36 PFD . Spearman correlations were computed to examine the correlations of the three instruments . Time required for administration was also recorded . Results . One thous and six hundred seven patients were administered all assessment s. The time required to answer all items in the PF CAT , ODI , and SF-36 PFD was 44 , 169 , and 99 seconds . The ceiling and floor effects were excellent for the PF CAT ( 0.81 % , 3.86 % ) , while the ceiling effects were marginal and floor effects quite poor for the ODI ( 6.91 % and 44.24 % ) and SF-36 PFD ( 5.97 % and 23.65 % ) . All instruments significantly correlated with each other . Conclusion . The PROMIS PF CAT outperforms the ODI and SF-36 PFD in the spine patient population and is highly correlated . It has better coverage , while taking less time to administer with fewer questions to answer . Level of Evidence : Description The American College of Physicians ( ACP ) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain . Methods Using the ACP grading system , the committee based these recommendations on a systematic review of r and omized , controlled trials and systematic review s published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain . Up date d search es were performed through November 2016 . Clinical outcomes evaluated included reduction or elimination of low back pain , improvement in back-specific and overall function , improvement in health-related quality of life , reduction in work disability and return to work , global improvement , number of back pain episodes or time between episodes , patient satisfaction , and adverse effects . Target Audience and Patient Population The target audience for this guideline includes all clinicians , and the target patient population includes adults with acute , subacute , or chronic low back pain . Recommendation 1 Given that most patients with acute or subacute low back pain improve over time regardless of treatment , clinicians and patients should select nonpharmacologic treatment with superficial heat ( moderate- quality evidence ) , massage , acupuncture , or spinal manipulation ( low- quality 
    Output:
    
This study will evaluate the efficacy and safety of Tuina intervention for low back pain , which could provide reliable evidence for clinical decision making for patients with low back pain .