***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 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 Objective . Many patients with nonerosive reflux disease ( NERD ) have insufficient relief on proton pump inhibitors ( PPIs ) . Some patients have a hypersensitive esophagus and may respond to transient receptor potential vanilloid 1 ( TRPV1 ) antagonists . Aim . To investigate the effect of the TRPV1 antagonist AZD1386 on experimental esophageal pain in NERD patients . Material and methods . Enrolled patients had NERD and a partial PPI response ( moderate-to-severe heartburn or regurgitation ≥3 days/week before enrolment despite ≥6 weeks ' PPI therapy ) . Fourteen patients ( 21–69 years , 9 women ) were block-r and omized into this placebo-controlled , double-blinded , crossover study examining efficacy of a single dose ( 95 mg ) of AZD1386 . On treatment days , each participant 's esophagus was stimulated with heat , distension , and electrical current at teaching hospitals in Denmark and Sweden . Heat and pressure pain served as somatic control stimuli . Per protocol results were analyzed . Results . Of 14 r and omized patients , 12 were treated with AZD1386 . In the esophagus AZD1386 did not significantly change the moderate pain threshold for heat [ –3 % , 95 % confidence interval ( CI ) , –22;20 % ] , distension ( –11 % , 95 % CI , –28;10 % ) , or electrical current ( 6 % , 95 % CI , –10;25 % ) . Mean cutaneous heat tolerance increased by 4.9 ° C ( 95 % CI , 3.7;6.2 ° C ) . AZD1386  increased the maximum body temperature by a mean of 0.59 ° C ( 95 % CI , 0.40–0.79 ° C ) , normalizing within 4 h. Conclusions . AZD1386 had no analgesic effect on experimental esophageal pain in patients with NERD and a partial PPI response , whereas it increased cutaneous heat tolerance . TRPV1 does not play a major role in heat- , mechanically and electrically evoked esophageal pain in these patients . Clinical Trials.gov identifier : D9127C00002 Objective : This article examines the effectiveness of manual therapy with specific adjuvant exercise for treating  chronic low back pain and disability .  Methods : A single blind , r and omized , controlled trial was employed . Patients were prescribed an exercise program that was tailored to treat their musculoskeletal dysfunctions or given a nonspecific program of general stretching and aerobic conditioning . In addition , patients received manual therapy or sham manual therapy . Participants were seen for 6 weekly sessions and were asked to perform their exercise program twice daily . Results : Seventy-two out of 100 patients completed the study . Multivariate tests conducted for measures of pain and disability revealed a significant group by time interaction ( P = 0.04 and P = 0.05 , respectively ) , indicating differential change in these measures pretreatment to posttreatment as a function of the treatment received . When controlling for pretreatment scores , patients receiving manual therapy with specific adjuvant exercise reported significant reductions in pain . No change in perceived disability was observed , with the exception that patients receiving sham manual therapy with specific adjuvant exercise reported significantly greater disability at posttreatment . Discussion : Manual therapy with specific adjuvant exercise appears to be beneficial in treating  chronic low back pain .  Despite changes in pain , perceived function did not improve . It is possible that impacting chronic low back pain alone does not address psychosocial or other factors that may contribute to disability . Further studies are needed to examine the long-term effects of these interventions and to address what adjuncts are beneficial in improving function in this population Data presented in this study were gathered through a national mail survey of 3000 r and omly selected osteopathic physicians . A total of 955 question naires were usable for analysis . Osteopathic physicians ' likelihood of using eleven osteopathic manipulative treatment ( OMT ) techniques ( articulatory , counterstrain , cranial , facilitated positional release , fascial ligamentous release , functional , high-velocity low-amplitude thrust , lymphatic , muscle energy , myofascial/integrated neuromuscular release , and soft tissue ) was determined . The relative frequency of use from most ( soft tissue ) to least ( cranial ) used was also determined . Respondents were more likely to use direct techniques than indirect or direct-indirect techniques . Demographic variables of gender , age , and specialty training were found to be related to the techniques used most . Female osteopathic physicians and older osteopathic physicians were more likely to use indirect techniques  , whereas male and younger physicians preferred direct techniques .  Moreover , OMT specialists used a broader range of techniques than other osteopathic physicians , and family physicians were more apt to use high-velocity low-amplitude thrust than other primary care or non- primary care osteopathic physicians . These results not only have implication s for curricular planning in all phases of osteopathic undergraduate medical education , graduate medical education , and continuing medical education programs , but also for research on the quality and effectiveness of various OMT techniques BACKGROUND Chronic low back pain ( LBP ) accounts for the majority of the disability and costs for LBP . However , the definition of chronicity is unclear . AIM To elicit practitioners ' definitions of chronic LBP patients , both in general and in the patients they were treating ; to assess the most common characteristics of these practitioners ' chronic LBP patients ; and to assess the stability of chronicity in a sample of the general population . METHOD Semi-structured interviews were conducted with 33 practitioners working in private practice , 71 LBP patients and their therapists , and 252 employees of a chain store who were assessed yearly in a prospect i ve study . RESULTS The therapists ' definitions of chronic LBP patients generally included psychosocial aspects . Only physical symptoms and signs were stressed in the patients they were treating . These patients displayed common characteristics with reference to pain , functional problems , and contact with health care services . Duration of symptoms was not sufficient to define chronicity . In the employee population , chronicity defined according to pain duration was unstable . However , the same was true when chronicity was measured according to the criteria defined in the patient population . CONCLUSION There is a discrepancy between theory and practice regarding the definition of chronic LBP . This discrepancy concerns not only the literature but also clinical practice itself . The term ' chronic ' LBP as currently used is therefore equivocal Abstract Muscle energy technique ( MET ) is a form of manual therapy frequently used to correct lumbopelvic pain ( LPP ) , herein the patient voluntarily contracts specific muscles against the resistance of the clinician . Studies on MET regarding magnitude and duration of effectiveness are limited . This study was a r and omized controlled trial in which 20 subjects with self-reported LPP were r and omized into two groups ( MET or control ) after magnitude of pain was determined . MET of the hamstrings and iliopsoas consisted of four 5-second hold/relax periods , while the control group received a sham treatment .  Tests for current and worst pain , and pain with provocation were administered at baseline , immediately following intervention and 24 hours after intervention . Separate 2x3 ANOVAs were used to assess results as change scores . Visual analog score ( VAS ) for worst pain reported in the past 24 hours decreased for the MET group ( 4.3mm±19.9 , p=.03 ) and increased for the sham ( control ) group ( 17.1mm±21.2 , p=.03 ) . Subjects receiving MET demonstrated a decrease in VAS worst pain over the past 24 hours , thereby suggesting that MET may be useful to decrease LPP over 24 hours OBJECTIVES To investigate the course of  low back pain ( LBP ) in a general population over 5 years . DESIGN Prospect i ve population -based survey by postal question naires in 1991 , 1992 , and 1996 . SETTING The municipal of Ebeltoft , Denmark . SUBJECTS Two thous and people aged 30 to 50 years , representative of the Danish population . Main outcome measure Number of days with low back pain during the past year . RESULTS One thous and three hundred seventy were recruited of whom 813 ( 59 % ) were followed to 5 years . The responders could be divided into 3 groups with regard to LBP : no pain , short-term pain , and long-lasting/recurring pain . More than one third of people who experienced LBP in the previous year did so for > 30 days . Forty percent of people with LBP > 30 days at baseline remained in that group 1 and 5 years later , and 9 % with LBP > 30 days in year 0 were pain free in year 5 . People with LBP in year 0 were 4 times more likely to have LBP in year 1 , and 2 times more likely to be affected in year 5 . CONCLUSIONS Low back pain should not be considered transient and therefore neglected , since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions . On the other h and , chronicity as defined solely by the duration of symptoms should not be considered chronic 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 OBJECTIVE The purpose of this study was to compare the effects of 2 exercise programs , segmental stabilization exercises ( SSEs ) and stretching of trunk and hamstrings muscles , on functional disability , pain , and activation of the transversus abdominis muscle ( TrA ) , in individuals with chronic low back pain . METHODS A total of 30 participants were enrolled in this study and r and omly assigned to 1 of 2 groups as a function of intervention . In the segmental stabilization group ( SS ) , exercises focused on the TrA and lumbar multifidus muscles , whereas in the stretching group ( ST ) , exercises focused on stretching the erector spinae , hamstrings , and triceps surae . Severity of pain ( visual analog scale and McGill pain question naire ) and functional disability ( Oswestry disability question naire ) and TrA muscle activation capacity ( Pressure Biofeedback Unit , or PBU ) were compared as a function of intervention . Interventions lasted 6 weeks , and sessions happened twice a week ( 30 minutes each ) . Analysis of variance was used for intergroup and intragroup comparisons . RESULTS As compared with baseline , both treatments were effective in relieving pain and improving disability ( P < .001 ) . Those in the SS group had significantly higher gains for all variables . The stretching group did not effectively activate the TrA ( P = .94 ) . CONCLUSION Both techniques improved pain and reduced disability . In this study , SS was superior to muscular stretching for the measured variables associated with chronic low back pain Study design Prospect i ve cohort study . OBJECTIVE To examine electromyography ( EMG ) activity , passive torque , and stretch perception during static stretch and contract-relax stretch . DESIGN Two separate r and omized crossover protocol s : ( 1 ) a constant angle protocol on the right side , and ( 2 ) a variable angle protocol on the left side . SUBJECTS 10 male volunteers . INTERVENTION Stretch-induced mechanical response in the hamstring muscles during passive knee extension was measured as knee flexion torque ( Nm ) while hamstring surface EMG was measured . Final position was determined by extending the knee to an angle that provoked a sensation similar to a stretch maneuver . Constant angle stretch : The knee was extended to 10 degree below final position , held 10sec , then extended to the final position and held for 80 sec. Variable angle stretch : The knee was extended from the starting position to 
    Output:
    
Studies conducted to date generally provide low- quality evidence that MET is not effective for patients with LBP .
There is not sufficient evidence to reliably determine whether MET is likely to be effective in practice .