***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 investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function . METHODS Thirty-six patients with definite rheumatoid arthritis participated in the r and omized , controlled , cross-over design study of 3 commercial wrist extensor orthoses . Dominant-h and dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted . Functional impact was assessed using a written question naire . RESULTS All 3 commercial orthoses reduced grip strength when first donned . After a 1-week adjustment period , one orthosis , the Smith and Nephew Roylan D-Ring ( Roylan ) , afforded splinted grip strength equal to that of the nonsplinted grip strength . The other 2 orthoses continued to reduce grip strength , and afforded splinted grip strength significantly below that of the Roylan . The Roylan was deemed comfortable by more subjects than the other orthoses . CONCLUSIONS The belief that commercial orthotic use increases grip strength , either immediately or after 1 week , is not supported by this study 's data . Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength OBJECTIVE In rheumatoid arthritis , education programmes successfully impart knowledge but , notwithst and ing issues of empowerment , this knowledge has to be translated into behavioural change to have a chance of improving disease outcome . Arguably , behavioural change must also occur early if outcomes are to be improved . For these reasons , we planned a study of patient education in early disease , with radiological damage and quality of life as the main outcome variables . METHODS We performed a r and omized controlled trial in people with rheumatoid arthritis of < 5 yr duration . The main intervention was a 4 week education programme , each weekly session lasting 2 h. Assessment s were made at entry , at 4 weeks and at 12 months . The main outcome variables were the modified Larsen radiological score for the h and s and the SF-36 quality of life question naire . Secondary outcome variables were the Health Assessment Question naire ( HAQ ) , Ritchie Articular Index ( RAI ) , Patient Knowledge Question naire ( PKQ ) , Compliance Question naire ( CQ ) , plasma viscosity ( PV ) , pharmaceutical changes and consulting behaviour . RESULTS The patient numbers were 34 ( 10 male , 24 female ) for the control group and 43 ( 16 male , 27 female ) for the education group . The groups were matched for age ( 56.5 yr for control , 55 yr for education ) , disease duration ( 3.5 yr vs 3.0 yr ) and duration of second-line drug therapy ( 14 months vs 12 months ) . We found no significant difference between the groups for Larsen scores at 12 months , although scores for the education group were lower ( 39.5 vs 43.0 , P = 0.13 ) . The ' social functioning ' and ' general health perception ' subscales of the SF-36 showed a significant improvement in the education group , but no significant differences between groups were seen . No significant differences were found for the HAQ , RAI , PV and CQ , but the education group had more disease-specific knowledge than the control group at 12 months ( PKQ scores : 17 vs 21 , P = 0.0002 ) . No differences were found for out-patient visits and in-patient admissions , but the education group had slightly more changes in second-line drugs during the study ( 0.43 changes/person in the control group , 0.51 changes/person in the education group ) . CONCLUSIONS We found no significant difference between the groups in our primary outcome measures , but a trend in favour of the education group was found in radiological progression . Further studies of this kind , using larger patient numbers , are required since the difference may result from improved self-care , better compliance with joint protection strategies and , possibly , improved drug compliance Group counseling and education were studied in patients with rheumatoid arthritis ( RA ) . Patients were matched and r and omly assigned to a control ( CG ) or experimental ( EG ) group . Each group attended an educational session but only the EG participated in 12 weekly group counseling sessions . A test of knowledge about RA and psychological tests were administered before and after these sessions . The EG improved their scores in 2 areas of self-concept and in factual knowledge . There was no increase in depression level . These results provide evidence that formal educational sessions and group counseling may be important in the management of patients with RA To examine the effectiveness of a  cognitive-behavioral pain management program for patients with rheumatoid arthritis , three patient groups were studied : a cognitive-behavioral group ( CB ) , an attention-placebo group , and a control group .  The CB group received a comprehensive , 12-month pain management program that taught coping strategies such as problem-solving techniques , relaxation training , strategies for attention diversion , and training in family dynamics and communication . Dependent measures included pain , coping strategies , psychological status , functional status , and disease status . Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies . Specifically , the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain . The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis We examined the effectiveness of 2 models of arthritis self-care intervention , the home study model and the small group model . The effects of disease diagnosis and duration , self-care behavior , perceived helplessness , social support , treatment choice , and formal education level on outcomes among persons with arthritis who participated in these programs were evaluated . A pretest-posttest control group design was utilized in the initial experimental study ; comparison group design s were used in the longitudinal studies . Three hundred seventy-four subjects completed the interventions and 12 months of research followup . We found that the intervention models had a statistically significant positive impact on arthritis knowledge , self-care behavior , perceived helplessness , and pain . These findings did not vary when the effects of education level , disease diagnosis and duration , informal social support , and treatment choice were controlled . The small group intervention was more effective in bringing about initial improvements in pain and depression , whereas the home study intervention was more effective in maintaining improvements in perceived helplessness . Changes in perceived helplessness and self-care behavior appear to explain in part the observed improvement in pain OBJECTIVE The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise . It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately . METHODS One hundred thirty-nine patients with chronic rheumatoid arthritis were r and omly assigned to hydrotherapy , seated immersion , l and exercise , or progressive relaxation . Patients attended 30-minute sessions twice weekly for 4 weeks . Physical and psychological measures were completed before and after intervention , and at a 3-month followup . RESULTS All patients improved physically and emotionally , as assessed by the Arthritis Impact Measurement Scales 2 question naire . Belief that pain was controlled by chance happenings decreased , signifying improvement . In addition , hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement ( women only ) . At followup , hydrotherapy patients maintained the improvement in emotional and psychological state . CONCLUSIONS Although all patients experienced some benefit , hydrotherapy produced the greatest improvements . This study , therefore , provides some justification for the continued use of hydrotherapy OBJECTIVE To test the effects ( on coping , social interactions , loneliness , functional health status , and life satisfaction ) of an intervention aim ed at teaching people with rheumatic diseases to cope actively with their problems . METHODS A total of 168 patients with chronic rheumatic disorders affecting the joints were r and omly assigned to a coping intervention group , a mutual support control group , or a waiting list control group . Measurements were by self-report question naires . RESULTS Post-intervention measurements showed that the coping intervention increased action-directed coping and functional health status , but these effects did not persist up to 6-months followup . In patients who attended at least half of the 10 sessions , the coping intervention contributed to decreased loneliness at post-intervention and to improvements in social interactions and life satisfaction at 6-months followup . CONCLUSION Teaching patients with rheumatic diseases to cope actively with their problems had positive impacts . Consequently it is recommended that the coping intervention be incorporated into regular care . Maintenance sessions are advisable OBJECTIVE To determine whether a patient education programme ( PE ) would improve rates of adherence to a slow acting antirheumatic drug and to assess any subsequent effect on patient outcome . METHODS A r and omly controlled study comprising 100 patients with rheumatoid arthritis ( 49 control CG ; 51 experimental EG ) requiring D-penicillamine ( DPA ) .  The same practitioner saw patients on seven occasions , for the same length of time . The EG received 7 x 30 minute one to one sessions of PE , while the CG received st and ard management . The primary measure of adherence was a  pharmacological marker ( phenobarbitone ) encapsulated with the DPA assayed at monthly intervals for six months . Plasma viscosity ( PV ) , C reactive protein , articular index , morning stiffness , and pain score were used to assess outcome . RESULTS 454 blood sample s were collected and assayed and the pharmacological marker showed the EG to be significantly more adherent on more occasions than the CG ( p<0.05 ) . Patterns of adherence over time showed that at 12 weeks 86 % ( 38/44 ) of those in the EG compared with 64 % ( 29/45 ) of the CG remained adherent ( p=0.01 ) . These trends continued and by the end of the study 85 % ( 29/34 ) of the EG compared with 55 % ( 23/42 ) of the CG were taking their DPA as prescribed . Fifteen patients ( 12 from the EG ) experienced side effects requiring study withdrawal and 14 patients requested study withdrawal ( two from the EG ) . On study entry patients in the CG had significantly higher levels of PV than the EG and this remained so throughout the research . However , on completion , the health status of patients in both groups had improved significantly ( p<0.01 ) . CONCLUSIONS PE significantly increased adherence to DPA and its effects persisted over a period of six months . No additional clinical benefit was detected in the EG in comparison with the CG Twenty-two men with rheumatoid arthritis were r and omly assigned to either a patient education group , receiving st and ard inpatient medical care in addition to a formal education program , or a control group receiving only the inpatient medical care . Members of the groups were not significantly different in terms of age , degree of life stress , socioeconomic status , educational level , or years since onset of rheumatoid arthritis . Dependent measures included the Arthritis Knowledge Inventory ( AKI ) , the Arthritis Impact Measurement Scales ( AIMS ) , and the Beck Depression Inventory ( BDI ) , and they were collected preeducation , posteducation , and at a three-month followup . Results from the AIMS revealed improvement in dexterity , social role , depression , and overall health status for both groups . The BDI also revealed significantly less depression for both groups , reflecting a general improvement following medical intervention . Although the patient education group revealed significantly higher scores on the knowledge measure , they also revealed significantly more impairment of activity levels and significantly higher pain scores . Education was effective for increasing rheumatoid arthritis knowledge , but such topics as joint protection and disease process may adversely affect how patients view their physical capacities and interpret their pain 
    Output:
    
Primary studies of interventions for rheumatoid arthritis generally reported few variables necessary to answer questions about health inequalities .
Most CMSG systematic review s failed to assess those variables even when described in the primary studies .