***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: Abstract Objective To estimate the effect of adding exercise classes , spinal manipulation delivered in NHS or private premises , or manipulation followed by exercise to “ best care ” in general practice for patients consulting with back pain . Fig 1 Progress of the UK BEAM trial Design Pragmatic r and omised trial with factorial design . Setting 181 general practice s in Medical Research Council General Practice Research Framework ; 63 community setting s around 14 centres across the United Kingdom . Participants 1334 patients consulting their general practice s about low back pain . Main outcome measures Scores on the Rol and Morris disability question naire at three and 12 months , adjusted for centre and baseline scores . Results All groups improved over time . Exercise  improved mean disability question naire scores at three months by 1.4 ( 95 % confidence interval 0.6 to 2.1 ) more than “ best care . ” For manipulation the additional improvement was 1.6 ( 0.8 to 2.3 ) at three months and 1.0 ( 0.2 to 1.8 ) at 12 months . For manipulation followed by exercise the additional improvement was 1.9 ( 1.2 to 2.6 ) at three months and 1.3 ( 0.5 to 2.1 ) at 12 months . No significant differences in outcome occurred between manipulation in NHS premises and in private premises . No serious adverse events occurred . Conclusions Relative to “ best care ” in general practice , manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months ; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months ; and exercise achieved a small benefit at three months but not 12 months BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain , spinal mobility , disability , psychological state , and aerobic capacity .  Sixty patients with chronic low back pain were r and omized to three groups : group 1 , aerobic exercise + home exercise ; group 2 , physical therapy ( hot pack , ultrasound , TENS ) + home exercise ; group 3 , home exercise only .  Spinal mobility , pain severity , disability , and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up . Aerobic capacities of the patients were measured before and after treatment . All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up , and there was no significant difference between the groups . In group 2 , a significant decrease in Beck Depression Inventory scores was observed with treatment . At 1-month follow-up , group 1 and 2 showed significant decreases in General Health Assessment Question naire scores . In group 2 , there was also a significant improvement in Rol and Morris Disability scores . There were similar improvements in exercise test duration and the MET levels in all the three groups . All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain . On the other h and , physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance The efficacy of ultrasound therapy in the management of  back pain result ing from rupture of the intervertebral disc was evaluated in 3 groups : treatment , placebo , and control .  Range of motion of total flexion and extension , total side flexion and total rotation of the lumbar spine , and subjective assessment of pain were used as criteria to determine the efficacy of treatment . Group comparisons showed statistical significance in favor of the treatment group ( p 0.01 ) , leading to the conclusion that ultrasound therapy is significantly effective in the treatment of back pain result ing from prolapse of the lumbar intervertebral disc Study Design . A r and omized controlled trial . Objective . To investigate the effectiveness and cost of  usual care plus patient choice of acupuncture , chiropractic , or massage therapy ( choice ) compared with usual care alone in patients with acute low back pain ( LBP ) . Summary of Background Data . Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies . Methods . A total of 444 patients with acute LBP ( < 21 days ) were recruited from 4 clinical sites and r and omized into 2 groups : usual care or choice . Outcomes included symptoms ( bothersomeness ) , functional status ( Rol and ) , and satisfaction between baseline and 5 weeks , and cost of medical care in the 12 weeks after r and omization . Results . After 5 weeks , providing patients with a choice did not yield clinical ly important reductions in symptoms ( median −4 , [ interquartile range −7 , −2 ] for usual care , and −5 [ −7 , −3 ] for choice ; P = 0.002 ) or improvements in functional status ( −8 [ −13 , −2 ] for usual care , and −9 [ −15 , −4 ] for choice ; P = 0.15 ) . Although there was a significantly greater satisfaction with care in the choice group , this came at a net increase in costs of $ 244 per patient . This consisted of a $ 99 reduction in the average cost to the insurer for medical care but an additional cost of $ 343 , for an average of 6.0 complementary and alternative medicine treatments per patient . Conclusions . A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinical ly significant improvements in symptom relief or functional restoration . This model was associated with greater patient satisfaction but increased total costs . Future evaluations of this choice model should focus on patients with chronic conditions ( including chronic back pain ) for which conventional medical care is often costly and of limited benefit Background The causes of chronic low back pain ( CLBP ) remain obscure and effective treatment of symptoms remains elusive . A mechanism of relieving chronic pain based on the consequences of conflicting unpleasant sensory inputs to the central nervous system has been hypothesised . As a result a device was generated to deliver sensory discrimination training ( FairMed ) , and this r and omised controlled trial compared therapeutic effects with a comparable treatment modality , TENS . Methods 60 patients with CLBP were recruited from physiotherapy referrals to a single-blinded , r and omised controlled , non-inferiority trial . They were r and omised to receive either FairMed or TENS and asked to use the allocated device for 30 minutes , twice a day , for 3 weeks . The primary outcome variable measured at 0 and 3 weeks was pain intensity measured using a visual analogue scale averaged over 7 days . Secondary outcome measures were Oswestry Disability Index , 3 timed physical tests , 4 question naires assessing different aspects of emotional coping and a global measure of patient rating of change . Data were analysed for the difference in change of scores between groups using one-way ANOVA . Results Baseline characteristics of the two groups were comparable . The primary outcome , change in pain intensity ( VAS ) at 3 weeks showed a mean difference between groups of -0.1 , ( non significant p = 0.82 ) . The mean difference in change in ODI scores was 0.4 ; ( non significant p = 0.85 ) . Differences in change of physical functioning showed that no significant difference in change of scores for any of these test ( p = 0.58 – 0.90 ) . Changes in scores of aspects of emotional coping also demonstrated no significant difference in change scores between the groups ( p = 0.14 – 0.94 ) . Conclusion FairMed was not inferior to TENS treatment . The findings have implication s for further research on current chronic pain theories and treatments . Further work to explore these mechanisms is important to exp and our underst and ing of chronic pain and the role of neuro-modulation . Trial Registration UKCRN Study ID OBJECTIVE This study measures and compares the outcome of traction , ultrasound , and low-power laser ( LPL ) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation ( LDH ) . METHODS A total of 60 patients were enrolled in this study and r and omly assigned into 1 of 3 groups equally according to the therapies applied , either with traction , ultrasound , or LPL . Treatment consisted of 15 sessions over a period of 3 weeks . Magnetic resonance imaging examinations were done before and immediately after the treatment . Physical examination of the lumbar spine , severity of pain , functional disability by Rol and Disability Question naire , and Modified Oswestry Disability Question naire were assessed at baseline , immediately after , and at 1 and 3 months after treatment . RESULTS There were significant reductions in pain and disability scores between baseline and follow-up periods , but there was not a significant difference between the 3 treatment groups at any of the 4 interview times . There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment , but no differences between groups . CONCLUSIONS This study showed that traction , ultrasound , and LPL therapies were all effective in the treatment of this group of patients with acute LDH . These results suggest that conservative measures such as traction , laser , and ultrasound treatments might have an important role in the treatment of acute LDH Study Design . A r and omized controlled trial was conducted . Objective . To determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain . Summary of Background Data . Osteopathic manipulative treatment may be useful for acute or subacute low back pain . However , its role in chronic low back pain is unclear . Methods . This trial was conducted in a university-based clinic from 2000 through 2001 . Of the 199 subjects who responded to recruitment procedures , 91 met the eligibility criteria . They were r and omized , with 82 patients completing the 1-month follow-up evaluation , 71 completing the 3-month evaluation , and 66 completing the 6-month evaluation . The subjects were r and omized to osteopathic manipulative treatment , sham manipulation , or a no-intervention control group , and they were allowed to continue their usual care for low back pain . The main outcomes included the SF-36 Health Survey , a 10-cm visual analog scale for overall back pain , the Rol and –Morris Disability Question naire , lost work or school days because of back pain , and satisfaction with back care . Results . As compared with the no-intervention control subjects , the patients who received osteopathic manipulative treatment reported greater improvements in back pain , greater satisfaction with back care throughout the trial , better physical functioning and mental health at 1 month , and fewer cotreatments at 6 months . The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects . There were no significant benefits with osteopathic manipulative treatment , as compared with sham manipulation . Conclusions . Osteop 
    Output:
    
For acute patients with LBP and leg pain attributed to disc herniation , ultrasound , traction , and low-power laser obtained similar results .
For chronic LBP patients without leg pain , ultrasound was less effective than spinal manipulation , whereas a shock wave device and transcutaneous electrical nerve stimulation led to similar results .
The available evidence does not support the effectiveness of ultrasound or shock wave for treating LBP .