***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: BACKGROUND AND PURPOSE The prescriptive validity of a treatment-oriented extension-mobilization category for patients with low back syndrome ( LBS ) was examined . SUBJECTS Of a total of 39 patients with LBS referred for physical therapy , 24 patients ( 14 male , 10 female ) , aged 14 to 50 years ( means = 31.3 , SD = 11.6 ) , were classified as having signs and symptoms indicating treatment with an extension-mobilization approach .  The remaining subjects were dismissed from the study . Patients in the extension-mobilization category were r and omly assigned to either an experimental ( treatment ) group ( n = 14 ) or a comparison group ( n = 10 ) . METHODS The experimental and comparison group subjects were treated with either mobilization and extension ( a treatment matched to the category ) or a flexion exercise regimen ( an unmatched treatment ) . Outcome was assessed with a modified Oswestry Low Back Pain Question naire administered initially and at 3 and 5 days after initiation of treatment . Data were analyzed with a 2 x 3 ( treatment group x treatment period ) analysis of variance . RESULTS The subjects ' rate of improvement , as indicated by the Oswestry question naire scores , was dependent on the treatment group to which they were assigned . Subjects treated with extension and mobilization positively responded at a faster rate than did those treated with a flexion-oriented program . CONCLUSION AND DISCUSSION This study illustrates that a priori classification of selected patients with LBS into a treatment category of extension and mobilization and subsequently treating the patients accordingly with specified interventions can be an effective approach to conservative management of selected patients Study Design A r and omized , placebo-controlled trial in which patients received either usual care by a general practitioner ( information and analgesics ) , or placebo physiotherapy given by a physiotherapist , or exercise therapy given by a physiotherapist . Objective To assess the efficacy of exercise therapy on sickness absence from work in patients with acute low back pain . Summary of Background Data Exercise therapy during the nonchronic phase of back pain is considered to reduce sickness absence , but this opinion is controversiel . Methods Patients with acute nonspecific low back pain and a paid job were included for analysis .  Sickness absence ( number of days ) was checked monthly during the 1-year follow-up period and compliance was also assessed . Results From 40 general practice s 363 patients who were gainfully employed were included . In the exercise therapy group the percentage of patients with sickness absence was higher and the duration of absence was longer than in the placebo and usual care groups , but these differences were not significant . Indications of more absence in the exercise therapy group appeared to be based largely on a greater number of patients with absences during the first 3 months . Patients in the exercise group who had not reported sick at entry had more sickness absences during the follow-up year than patients in the usual care and placebo group . Good compliance did not affect the results . Conclusions Exercise therapy for patients with acute low back pain does not reduce sickness absence Study Design . The study was carried out as an open , r and omized , multicenter , parallel‐group study with an observation period of 12 months . Four Norwegian physiotherapy institutes took part . Patients were subsequently followed for 12 months of home exercise on their own , without the supervision of a physiotherapist . Objectives . 1 ) To investigate and compare the effects of two different exercise programs on low back problems in patients after a 1‐year training program under the supervision of a physiotherapist . 2 ) To investigate the effect supervision by , and motivation from , physiotherapists has on training compliance and efficacy . Summary of Background Data . After ordinary physiotherapy treatment for low back problems , patients were r and omly allocated either to a conventional training program design ed by physiotherapists or to a training program using a new Norwegian‐developed training apparatus called the TerapiMaster . The study included 153 patients with low back problems , all of whom had been referred to physiotherapy by their general practitioners . One hundred twenty‐six patients were followed for an additional 12 months when performing home exercise programs on their own . Methods . Monitoring patient satisfaction with the training program , compliance with the program , and absenteeism from work during the training period . Results . Patient satisfaction with both training programs was high , with about 83 % of participating patients completing the study in accordance with the protocol . Mean absenteeism ( SD ) during the preceding year totaled 82.5 days ( 19.8 ) in the conventional training group and 61.6 days ( 14.7 ) in the TerapiMaster group . Significant reductions to 17.2 days ( 6.0 ) and 15.4 days ( 5.3 ) in the two groups , respectively , were recorded during the training period , corresponding to a 75 % to 80 % reduction compared with the preceding 1‐year period . Mean absenteeism showed a further significant decline during the 12‐month period without supervised training . The average values were 9.9 days ( 3.2 ) for conventional training and 9.3 days ( 3.1 ) for the TerapiMaster , respectively . Conclusions . Both exercise programs reduced absenteeism significantly ( 75‐80 % ) . No difference in the effects of the two different programs was discernible . Regular follow‐up through encouragement and variation in the training programs appear to be important factors for motivating patients to adhere to regular exercise programs for low back problems . This thesis was corroborated by the 12‐month study of unsupervised exercise OBJECTIVE To determine whether traditional bone- setting or continuous light exercise therapy could case back pain and improve function better than ordinary physiotherapy . DESIGN Observer-blinded , r and omized clinical trial with a 6-month follow-up . SETTING An outpatient institution for folk medicine research . PATIENTS Of 147 back pain patients recruited from local health centers and by newspaper announcements , 132 were found eligible ( non-retired-no contraindications to manipulation ) and entered . A final 114 ( one dropout ) with back pain for longer than 7 weeks were included in this intent to treat analysis . INTERVENTIONS Bone- setting , guidance for continuous light back movements or physiotherapy for up to ten 1-hour sessions during 6 weeks . MAIN OUTCOME MEASURES Spinal mobility and muscular performance . Back pain assessed by visual analog scales ( VAS ) . RESULTS The physical measures changed only modestly , from one tenth to half of st and ard deviation , while the VAS was halved . The thoracolumbar side-bending , the modified Schober , and the VAS were significantly better improved by bone- setting than by exercise but not better than by physiotherapy . CONCLUSION Neither bone- setting nor exercise differed significantly from physiotherapy , but bone- setting improved lateral and forward bending of the spine and back pain more than did exercise OBJECTIVE To evaluate a progressive fitness programme for patients with chronic low back pain . DESIGN Single blind r and omised controlled trial . Assessment s were carried out before and after treatment by an observer blinded to the study and included a battery of vali date d measures . All patients were followed up by postal question naire six months after treatment . SETTING Physiotherapy department of orthopaedic hospital . SUBJECTS 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy . The patients were r and omly allocated to a fitness programme or control group . INTERVENTION Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care . Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool . RESULTS Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index ( P < 0.005 ) , pain reports ( sensory P < 0.05 and affective P < 0.005 ) , self efficacy reports ( P < 0.05 ) , and walking distance ( P < 0.005 ) . No significant differences between the groups were found by the general health question naire or question naire on pain locus of control . A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months . CONCLUSION There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain . Further clinical trials , however , need to be established in other centres to confirm these findings Radiographic instability seemingly enjoys the status of a well-defined clinical syndrome . The concept is widely used , and specific treatments , usually spinal fusion , are routinely performed based on the diagnosis . The minimum st and ards necessary to establish radiographic instability as a legitimate clinical syndrome have not been established , however . The primary purpose of this study was to determine if treatment involving bracing , exercise , and education controlling either flexion or extension postures , would result in a distinctive pattern of favorable or unfavorable results , depending on the type of radiographic instability ( retrodisplacement or spondylolisthesis ) . Fifty-six patients meeting strict study inclusion and radiographic evaluation criteria were assigned signed to a bracing treatment ( flexion , extension , placebo-control ) according to a r and omization scheme , design ed to ensure equal representation of translation categories ( retro , normal , spondy ) across treatment groups , and assessed at admission and 1-month follow-up . The sample was relatively evenly divided between men ( 46 % ) and women ( 54 % ) , and by age . Translation classification was related to both gender and age , with men more likely classified as retro and women more likely spondy and patients in their 20s having lower incidence of spondy and higher incidence of normal translation . Translation classification was not related to selected indices of low-back pain history . Brace treatments were not shown to reduce patient range of motion or lessen trunk strength . A significant treatment by time interaction for the modified pain interference ( VAS ) scale indicated improvement for patients in extension compared with patients in flexion and control-placebo treatments . In conjunction with no significant three-way interaction between treatment , translation classification , and time , it was hypothesized that radiographic instability might more appropriately be considered a corroborative sign of advanced discogenic problems . Improvement in extension treatment , regardless of the type of radiographic abnormality , suggests that the treating clinician might consider extension treatment for chronic low-back pain patients . Causes and implication s for the failure of this study to provide support for considering radiographic instability as a clinical syndrome are considered and future directions for this area of research suggested The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave The effects of exercise for isolated lumbar extensor muscles were examined in 54 chronic low-back pain patients . Subjects were r and omly assigned to a 10-week exercise program ( N = 31 ) or a wait-list control group ( N = 23 ) . Results indicated a significant increase in isometric lumbar extension strength for the treatment group and a significant reduction in reported pain compared with the control group ( P 0.05 ) . Treated subjects reported less physical and psychosocial dysfunction whereas the control group increased in pain , and physical and psychosocial dysfunction . There were no concomitant changes in reported daily activity levels . These results show that lumbar extension exercise is beneficial for strengthening the lumbar extensors and results in decreased pain and improved perceptions of physical and psychosocial functioning in chronic back pain patients . However , these improvements were not related to changes in activities or psychological distress A study was conducted to compare the relative efficacy of conventional ( heat , pelvic tilt exercises , postural education and lifting instructions ) and manipulation therapy in  back pain management . Twenty-five females were in the conventional therapy group ( CTG ) and 26 females in the manipulation therapy group ( MTG ) .  Range of motion of total flexion and extension , total side-flexion and total rotation of the lumbar spine and the straight-leg-raising test were used as criteria to determine efficacy of treatment . The results showed that while the mean treatment time for CTG subjects was 160 minutes ( SD = 7.9 ) that for MTG patients was 121.2 ( SD = 10.2 ) with a significant difference p less than 0.001 . There were significant differences between the two groups with regards to post-treatment differences in total flexion and extension p less than 0.01 ; total side flexion p less than 0.05 ; and total rotation p less than 0.05 in favour of the MTG subjects . There was also significant difference in post-treatment straight-leg-raising values between the two groups p less than 
    Output:
    
There is strong evidence that  exercise therapy  is not more effective for acute low back pain than inactive or other active treatments with which it has been compared .
There is conflicting evidence on the effectiveness of  exercise therapy  compared with inactive treatments for chronic low back pain .
Exercise therapy  was more effective than usual care by the general practitioner and just as effective as conventional physiotherapy for chronic low back pain .
The evidence summarized in this systematic review does not indicate that specific exercises are effective for the treatment of acute low back pain .
Exercises may be helpful for patients with chronic low back pain to increase return to normal daily activities and work