***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 Objectives Firstly , to compare the effectiveness of a brief physiotherapy intervention with “ usual ” physiotherapy for patients with neck pain . Secondly , to evaluate the effect of patients ' preferences on outcome . Design Non-inferiority r and omised controlled trial eliciting preferences independently of r and omisation . Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire . Participants 268 patients ( mean age 48 years ) with subacute and chronic neck pain , who were referred by their general practitioner and r and omly assigned to a brief physiotherapy intervention ( one to three sessions ) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy , at the discretion of the physiotherapist concerned . Main outcome measures The Northwick Park neck pain question naire ( NPQ ) , a specific measure of functional disability result ing from neck pain . Also , the short form 36 ( SF-36 ) question naire , a generic , health related , quality of life measure ; and the Tampa scale for kinesophobia , a measure of fear and avoidance of movement . Results At 12 months , patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group ( mean difference 1.99 , 95 % confidence interval 0.45 to 3.52 ; P = 0.01 ) . Although the result shows a significant inferiority of the intervention , the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention ( below 1.2 points of NPQ score ) . Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy . Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain . Patients with a preference for the brief intervention may do at least as well with this approach . Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further Study Design . A question naire was mailed to 3000 r and omly selected 35‐45‐year‐old individuals in three communities in central Sweden . Objectives . To study the 1‐year prevalence of spinal pain and its ramifications in the form of pain , function , sick leave , and health care use . Summary of Background Data . Previous research ers have used a variety of definitions and population s , but primarily have investigated the occurrence of pain . Comprehensive data are needed concerning health care use , the degree of the pain problem , functional disturbances , and sick leave . Method . Participants in the study completed a question naire regarding spinal pain during the past year including the degree of their experienced pain , functional impairment , lost work days , and health care use . Results . A total of 2305 people ( 78.5 % ) responded to the question naire . Nonrespondents had similar characteristics but a slightly lower 1‐year prevalence rate than did respondents . For respondents , the prevalence of spinal pain during the past year was 66.3 % , with women having a slightly higher prevalence than men . Approximately 25 % of the respondents indicated that they had a substantial problem based on ratings of pain , functional impairment , and sick leave . Work absenteeism reported to the Public Social Insurance Office involved 19 % of those with pain , but an additional 15 % indicated unreported absenteeism . On average , those with pain visited health care providers three times during the past year , but a small number of those who experienced pain consumed large amounts of health care and illness benefits . An important gender difference was shown , such that when pain was at its worst , men took sick leave , whereas women sought health care . Conclusions . Taken together , these data indicate that spinal pain is common among 35‐45‐year‐old men and ‐ women , and that it is related to marked problems for approximately one fourth of those who experience pain . Gender differences exist in the pattern of sick leave and health care use , and a small proportion of those with pain consume very large amounts of the re sources . Consequently , there is a need for early , effective , preventive treatments OBJECTIVE To study the effect of manual therapy and stretching on neck function in women with chronic neck pain . METHODS A total of 125 women were r and omized into 2 groups . Group 1 received manual therapy twice a week for 4 weeks followed by stretching exercises . Group 2 performed stretching 5 times a week for 4 weeks followed by manual therapy .  Neck function was assessed by isometric neck strength and mobility measurements , and spontaneous neck pain during the past week and strain-evoked pain during the neck strength trials using a visual analogue scale . RESULTS Both neck muscle strength ( 11 - 14 % ) and mobility ( 7 - 15 % ) improved similarly in both groups , with the exception of greater passive flexion-extension mobility ( p = 0.019 ) in group 1 at week 4 . Pain during the neck strength trials decreased from the baseline to week 4 by 26 - 35 % and to week 12 by 39 - 61 % similarly in both groups . Average neck pain during the past week decreased by 64 % and 53 % in groups 1 and 2 , respectively , during the first 4 weeks , remaining rather stable thereafter . The decreases in neck pain during both the past week and strength trials showed association with the changes in neck strength results ( r = 0.20 - 0.29 ) . CONCLUSION Both manual therapy and stretching were effective short-term treatments for reducing both spontaneous and strain-evoked pain in patients with chronic neck pain . It is possible that the decrease in pain reduced inhibition of the motor system and in part improved neck function . However , the changes in neck muscle strength were minor , showing that these treatments alone are not effective in improving muscle strength We studied the clinical effectiveness of botulinum toxin type A for spasmodic torticollis and that for facial spasm by multicenter , non-blinded study . The freeze-dried crystalline botulinum toxin type A ( AGN 191622 ; Allergan Inc. , Irvine , CA ) was injected into the hyperactive muscles and the clinical course was followed for 22 weeks . Repeated injections were done , if necessary , with an interval of 4 weeks . The toxin was highly effective in both disorders . In spasmodic torticollis , clinical severity improved in 38 ( 63.3 % ) and the global improvement was seen in 39 ( 65.0 % ) out of 60 patients .  Subjective improvement was seen in 56 ( 93.3 % ) . In facial spasm , 52 ( 92.9 % ) out of 56 patients improved after the treatment . Unfavorable reactions , mainly consisting of neck muscle weakness and dysphagia in torticollis and facial weakness in facial spasm , were mostly due to the excessive action of the toxin . They were usually mild and transient . No patients discontinued the trial because of side effects . Botulinum toxin injection is a very useful and safe method for the symptomatic treatment of spasmodic torticollis and facial spasm Successful treatment of torticollis with electromyographic ( EMG ) biofeedback has been reported in a number of single case and single group studies . The present investigation represents the first controlled outcome study . Twelve torticollis patients were r and omly assigned to EMG biofeedback or relaxation training and grade d neck exercises ( RGP ) . The procedure involved three sessions of baseline assessment , 15 sessions of EMG BF or RGP , 6 sessions of EMG BF or RGP plus home-management , 6 sessions of home-management alone , and follow-up 3 months after the end of treatment . A variety of outcome measures were used including physiological ( EMG from the two sternocleidomastoid muscles , skin conductance level ) , behavioral ( angle of head deviation , range of movement of the head ) , and self-report ( depression , functional disability , body concept ) , therapist and “ significant other ” reports and independent observer assessment of videos . In both groups , neck muscle activity was reduced from pre- to posttreatment . This reduction was greater in the EMG biofeedback group . There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group . Therefore , the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects . Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of “ arousal . ” Significant improvements of extent of head deviation , and range of movement of the head , as well as reductions of depression were present , which were not different in the two groups . At the end of treatment , no patient was asymptomatic . Any therapeutic benefit was generally maintained at follow-up . The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one . Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger sample s are required PURPOSE To study whether the isolated intervention of high-speed , low-amplitude spinal manipulation in the cervical spine has any effect on cervicogenic headache . DESIGN Prospect i ve r and omized controlled trial with a blinded observer . SETTING Ambulatory outpatient facility in an independent research institution . PARTICIPANTS Fifty-three subjects suffering from frequent headaches who fulfilled the International Headache Society criteria for cervicogenic headache ( excluding radiological criteria ) . These subjects were recruited from 450 headache sufferers who responded to newspaper advertisements . INTERVENTION After r and omization , 28 of the group received high-velocity , low-amplitude cervical manipulation twice a week for 3 wk . The remaining 25 received low-level laser in the upper cervical region and deep friction massage ( including trigger points ) in the lower cervical/upper thoracic region , also twice a week for 3 wk . MAIN OUTCOME MEASURES The change from week 1 to week 5 in analgesic use per day , in headache intensity per episode and in number of headache hours per day , as registered in a headache diary . RESULTS The use of analgesics decreased by 36 % in the manipulation group , but was unchanged in the soft-tissue group ; this difference was statistically significant ( p = .04 , chi 2 for trend ) . The number of headache hours per day decreased by 69 % in the manipulation group , compared with 37 % in the soft-tissue group ; this was significant at p = .03 ( Mann-Whitney ) . Finally , headache intensity per episode decreased by 36 % in the manipulation group , compared with 17 % in the soft-tissue group ; this was significant at p = .04 ( Mann-Whitney ) . CONCLUSION Spinal manipulation has a significant positive effect in cases of cervicogenic headache OBJECTIVE This study evaluates the effectiveness of traditional bone setting ( TBS ) in  chronic neck pain ( cNP )  compared with conventional physiotherapy ( PT ) and massage ( M ) . METHODS This was a r and omized clinical trial . Working-aged employed subjects with cNP ( n = 105 ; 37 men and 68 women ; mean age , 41.5 years ) were r and omized into TBS , PT , and M groups . Follow-up times were 1 , 6 , and 12 months after the treatments . Neck pain intensity ( visual analog scale ) , perceived disability ( Neck Disability Index [ NDI ] ) , and neck spine mobility measurements were used as outcomes . Global assessment was evaluated by the subjects ( scale from -1 to + 10 ) . Data were analyzed using time ( pre and post ) by group ( TBS , PT and M ) , 2- way analysis of variance for repeated measures . RESULTS Neck pain decreased and NDI scores improved in all groups 1 month after the treatment ( P < .001 ) . The improvement of NDI and persons ' satisfaction were significantly better after TBS .  Neck spine mobility in rotation movements tended to improve significantly better and the frons-knee distance improved more after TBS . One year later , both NDI and neck pain were significantly better after TBS than in reference groups . A significant improvement was reported by 40 % to 45.5 % of subjects in the PT and M groups and by 68.6 % in the TBS group . Bone setters ' ability to communicate and to interact with patients was evaluated significantly higher . In the TBS group , the number of sick days was minimal as was the use of painkillers during 1-year follow-up compared to that in the reference groups . CONCLUSIONS Traditional bone setting , which is a soft manual mobilization technique focusing on the muscles , joints , and ligaments , appears to be effective in cNP . Two thirds of subjects experienced it as beneficial 
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Assessment of the clinical applicability of the trials showed that the participant characteristics were well reported , but neither the descriptions of the massage intervention nor the credentials or experience of the massage professionals were well reported .
Therefore , the role of massage in multimodal treatments remains unclear .