***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 determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury ( SCI ) . DESIGN Double-blind , r and omized , placebo control study . SETTING SCI unit in a tertiary care medical center and community . PARTICIPANTS Eighty-seven persons with recent SCI . INTERVENTION Participants were r and omized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury . MAIN OUTCOME MEASURES Antibody concentrations were measured prior to intervention and 1 , 2 , and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae . Effects of demographic and injury-related variables on immune response were also evaluated . RESULTS Timing of vaccination did not influence mean antibody concentrations for any serotype ( p > .05 ) . Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35 % of placebo groups ( p < .01 ) . After 12 months , 93 % of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values . CONCLUSIONS Most participants developed an immune response to at least one serotype that was maintained for at least 12 months . Immune response varied according to serotype . Given the favorable immune response and no effect of timing , persons with SCI should receive pneumococcal vaccine during initial hospitalization OBJECTIVES To determine whether the addition of deep or superficial heating to stretching produces better clinical outcomes than stretching alone in the management of frozen shoulder . DESIGN A single-blinded , r and omized controlled study . SUBJECTS Thirty subjects suffering from the stiffness phase of frozen shoulder . METHODS Subjects were r and omly allocated to receive : ( i ) deep heating plus stretching ; ( ii ) superficial heating plus stretching ; or ( iii ) stretching alone . Both heating groups received the respective treatments 3 times per week for 4 weeks . All groups received a st and ard set of shoulder stretching exercises . The American Shoulder and Elbow Surgeons assessment form was recorded at the baseline , sessions 6 and 12 , and at the 4-week follow-up session . RESULTS A significant improvement was seen in all groups in all outcome measures except for that of shoulder flexion range . The improvement in the shoulder score index and in the range of motion was significantly better in the deep heating group than in the superficial heating group . CONCLUSION The addition of deep heating to stretching exercises produced a greater improvement in pain relief , and result ed in better performance in the activities of daily living and in range of motion than did superficial heating Investigators should properly calculate sample sizes before the start of their r and omised trials and adequately describe the details in their published report . In these a-priori calculations , determining the effect size to detect -- eg , event rates in treatment and control groups -- reflects inherently subjective clinical judgments . Furthermore , these judgments greatly affect sample size calculations . We question the br and ing of trials as unethical on the basis of an imprecise sample size calculation process . So-called underpowered trials might be acceptable if investigators use method ological rigor to eliminate bias , properly report to avoid misinterpretation , and always publish results to avert publication bias . Some shift of emphasis from a fixation on sample size to a focus on method ological quality would yield more trials with less bias . Unbiased trials with imprecise results trump no results at all . Clinicians and patients deserve guidance now OBJECTIVE To compare the efficacy of aquatic exercise and a l and -based exercise programme vs control in patients with knee osteoarthritis .  METHODS Primary outcome was change in pain , and in addition Knee Injury and Osteoarthritis Outcome Score question naire ( KOOS ) . St and ing balance and strength was also measured after and at 3-month follow-up . Seventy-nine patients ( 62 women ) , with a mean age of 68 years ( age range 40 - 89 years ) were r and omized to aquatic exercise ( n = 27 ) , l and -based exercise ( n = 25 ) or control ( n = 27 ) . RESULTS No effect was observed immediately after exercise cessation ( 8 weeks ) . At 3-month follow-up a reduction in pain was observed only in the l and -based exercise group compared with control ( -8.1 mm , ( 95 % confidence interval -15.4 to -0.4 ; p = 0.039 ) , but no differences between groups were observed for KOOS ; and no improvement following aquatic exercise . Eleven patients reported adverse events ( i.e. discomfort ) in l and -based exercise , while only 3 reported adverse events in the aquatic exercise . CONCLUSION Only l and -based exercise showed some improvement in pain and muscle strength compared with the control group , while no clinical benefits were detectable after aquatic exercise compared with the control group . However , aquatic exercise has significantly less adverse effects compared with a l and -based programme OBJECTIVE To compare individual , group and combined intervention formats for improving goal attainment and psychosocial function following acquired brain injury . DESIGN R and omized controlled trial , waiting list controls . PARTICIPANTS Thirty-five participants with a mean time of 5.29 years ( st and ard deviation = 3.9 ) since acquired brain injury were r and omly allocated into 6 groups involving an intervention or waiting list control condition for 1 of 3 intervention formats . METHODS Interventions were 3 h/week for 8 weeks . Formats included : group-based support ( n = 12 ) , individual occupation-based support ( n = 11 ) , and a combined group and individual support intervention ( n = 12 ) . Participant outcomes were examined at pre- , post- , and 3-month follow-up assessment on the Canadian Occupational Performance Measure , Patient Competency Rating Scale , and Brain Injury Community Rehabilitation Outcome 39 Scales . RESULTS Overall , the findings indicated that the individual intervention component appeared to contribute particularly to gains in performance in goal -specific areas . The combined intervention was associated with maintained gains in performance and satisfaction . However , gains in behavioural competency and psychological well-being were more likely to occur after the group and individual interventions . CONCLUSION These findings generally support the efficacy of brief intervention formats following acquired brain injury , although further research is needed to examine clients ' suitability for particular interventions OBJECTIVE To determine whether progressive resistance training improves muscle strength , muscle endurance , and physical function in adults with Down syndrome . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Adults ( N=20 ) with Down syndrome ( 13 men , 7 women ; mean age , 26.8+/-7.8 y ) were r and omly assigned through a concealed allocation block r and omized method to either an intervention group ( n=9 ) or a control group ( n=11 ) . INTERVENTION The intervention was a supervised , group progressive resistance training program , consisting of 6 exercises using weight machines performed twice a week for 10 weeks . Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue . The control group continued with their usual activities . MAIN OUTCOME MEASURES The outcomes measured by blinded assessors were muscle strength ( 1-repetition maximum [ 1-RM ] ) , muscle endurance ( number of repetitions at 50 % of 1-RM ) for chest press and leg press , timed stairs test , and the grocery shelving task . RESULTS The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group ( mean difference in the number of repetitions of the chest press at 50 % of 1-RM was 16.7 , 95 % confidence interval , [ CI ] 7.1 - 26.2 ) ; and a trend toward an improvement in upper-limb muscle strength ( mean difference in chest press 1-RM , 8.6 kg ; 95 % CI , -1.3 to 18.5 kg ) and in upper-limb function ( mean difference in grocery shelving task , -20.3s ; 95 % CI , -45.7 to 5.2s ) . There were no significant differences between the groups for lower-limb muscle performance or physical function measures . No major adverse events for the intervention were noted . CONCLUSIONS Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome ( ACTR identifier ACTRN 012606000515594 . ) Objective : To determine whether protein supplementation could enhance neurological recovery in subacute patients with ischaemic stroke . Design : Alimentation-independent patients with ischaemic stroke were r and omly allocated to either 21 days of protein supplementation ( protein-supplemented group ; n=20 ) or to a spontaneous diet only ( control group ; n=21 ) in order to investigate the recovery of neurological changes ( measured using the National Institute of Health ( NIH ) Stroke Scale ) . Setting : Tertiary care rehabilitation in Italy . Participants : Forty-two patients ( 27 male and 15 female ; 66.4 ± 11 years ) 16 ±2 days after the acute event . Intervention : Supplementation with a hyperproteic nutritional formula ( 10 % protein ) . Main outcome measures : NIH Stroke Scale and protein intake . Results : At admission to rehabilitation , both groups of patients were homogeneous for demographic , clinical and functional characteristics . After 21 days from the start of the protocol , the NIH Stroke Scale was found to be enhanced in the group with supplemental proteins ( -4.4 ± 1.5 score versus -3 ± 1.4 of control group ; P<0.01 ) . When expressed as difference ( ▵ ) between baseline and 21 days , the NIH Stroke Scale correlated negatively with change in protein intake ( g/day ) ( r=-0.50 , P= 0.001 ) and positively with change in carbohydrate/protein ratio ( r=+0.40 , P=0.01 ) Conclusions : Protein supplementation may enhance neurological recovery in subacute patients with ischaemic stroke Objective : To investigate the effect of an additional vestibular stimulated exercise programme on balance for patients with benign paroxysmal positional vertigo . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-six subjects with benign paroxysmal positional vertigo involving the unilateral posterior semicircular canal . Interventions : Subjects were r and omized into experimental or control groups . Thirteen subjects in the experimental group received the canalith repositioning manoeuvre and vestibular stimulated exercise training three times a week for four weeks . Thirteen subjects in the control group received only the canalith repositioning manoeuvre . Main measures : Static balance tests , t and em walk test , Dynamic Gait Index and subjective rating of the intensity of vertigo were measured at baseline , two-week and four-week assessment s. Results : Compared with the control group , subjects in the experimental group demonstrated a statistically significant improvement in single leg stance with eyes closed at the two-week assessment ( P<0.05 ) . Furthermore , stance on foam surface with eyes closed , single-leg stance with eyes closed , and Dynamic Gait Index at the four-week assessment were also significantly improved ( P<0.05 ) . Conclusion : The present study demonstrated that additional exercise training , which emphasizes vestibular stimulation , can improve balance ability and functional gait performance among patients with benign paroxysmal positional vertigo who had already undergone the canalith repositioning manoeuvre OBJECTIVE To examine the physical function , gait , and quality of life of patients after total hip replacement ( THR ) r and omly assigned to either a targeted home- or center-based exercise program . DESIGN R and omized controlled trial . SETTING Rehabilitation research center in Australia . PARTICIPANTS Twenty-three patients with unilateral THR were r and omly assigned to a supervised center-based exercise group ( n=11 ) or an unsupervised home-based exercise group ( n=12 ) . INTERVENTION The center-based group completed an 8-week targeted exercise program while under the direct supervision of a physiotherapist . After initial instruction , the home-based group completed the 8-week targeted exercise program at home without further supervision . MAIN OUTCOME MEASURES Quality of life , physical function , and spatiotemporal measures of gait . RESULTS No significant interaction ( group by time ) or main effects of grouping were found . Within each group , quality of life , and stair climbing improved significantly ( P<.05 ) as did Timed Up & Go test and 6-minute walk test performances ( P<.05 ) . Walking speed increased by 16 cm/s ( P<.01 ) , cadence by 8 steps/min ( P<.05 ) , step length by 4.7 cm ( P<.05 ) , and double-support time reduced by a factor of 16 % . Step length symmetry showed significant improvement ( P<.05 ) over time . Step length differential between the affected and unaffected limbs reduced from 4.0 to 2.7 cm . CONCLUSIONS The targeted strengthening program was effective for both the home- and center-based groups . No group differences were found in the majority of the outcome measures . This finding is important because it shows that THR patients can achieve significant improvements through a targeted strengthening program delivered at a center or at home OBJECTIVE To test the efficacy of low-level laser therapy on lateral ankle sprains as an addition to a st and ardized treatment regimen , a trial was conducted in which high-dose laser (  
    Output:
    
The study outcome ( positive vs negative ) was not associated with the likelihood of sample size reporting .