***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 The rising costs of health care are of great concern , particularly for the chronically ill . Interventions that promote health status and well being while teaching appropriate use of the health care system have led to cost savings among patients with osteoarthritis . We carried out social support and education interventions with patients with fibromyalgia ( FM ) and assessed the effect on health care costs , psychosocial variables , and health status . METHODS Participants were 600 patients with FM who were members of a health maintenance organization . They were r and omly assigned to one of 2 experimental groups ( social support ; social support and education ) or to a no-treatment control group . Assessment s were conducted at baseline and following a one year intervention . Health care cost data were obtained directly from participants ' medical records . RESULTS Results indicated significant reductions in all groups ' costs of prescriptions , laboratory tests , and visits to a nurse , nurse practitioner and /or physicians ' assistant . All groups also showed improvements on variables assessing effect of FM , self-efficacy , depression , and knowledge of FM . The social support and education group was less helpless after one year than the other groups ; differential changes for all other variables were not significant . CONCLUSION The study did not reveal differential changes in health care costs among participants in the experimental and control groups . These findings emphasize the importance of using objective health care utilization data when calculating health care costs , as well as the value of including a no-treatment control group to prevent erroneous conclusions about treatment efficacy This pilot , r and omized controlled trial analyzed the effects of a cognitive behavioral therapy ( CBT , n = 20 ) for insomnia  vs a sleep hygiene ( SH , n = 20 ) program on the three attentional networks ( alertness , orienting , and executive function ) and other additional outcome measures ( sleep , pain , depression , anxiety , and daily functioning ) of fibromyalgia patients . The CBT group showed significant improvement in alertness ( F(1 , 28 ) = 11.84 , p = .0018 ) , executive functioning ( F(1 , 28 ) = 15.76 , p = .00059 ) , sleep quality ( F(1 , 38 ) = 6.33 , p = .016 ) , and a trend to improvement in daily functioning ( p > .06 ) , as compared with the SH group . The improvement in executive functioning was significantly related to the changes in sleep ( r = 0.40 , p = .026 ) . A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning Objectives : Published preliminary findings from a r and omized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms , functional deficits , and coping abilities in fibromyalgia . The primary aims of this study were to evaluate the same intervention ’s posttreatment effects in a wait-list group and to test the intervention ’s effects at 3-month follow-up in the immediate treatment group . Methods : Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment . Within-group paired t tests were performed to compare posttreatment data with 3-month follow-up data in the immediate treatment group . The primary outcome measure was the Fibromyalgia Impact Question naire Revised ( FIQR ) . Multilevel r and om-effects models were also used to examine associations between yoga practice rates and outcomes . Results : Posttreatment results in the wait-list group largely mirrored results seen at posttreatment in the immediate treatment group , with the FIQR Total Score improving by 31.9 % across the 2 groups . Follow-up results showed that patients sustained most of their posttreatment gains , with the FIQR Total Score remaining 21.9 % improved at 3 months . Yoga practice rates were good , and more practice was associated with more benefit for a variety of outcomes . Discussion : These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained ABSTRACT Objective : Fibromyalgia ( FM ) patients present with widespread chronic pain and other symptoms . Some studies in the literature have reported inconsistent results after a Qigong exercise intervention in patients with FM . The purpose of this study was to test the feasibility of a home-based Qigong exercise in patients with FM . Methods : A total of 14 subjects were r and omly assigned into one of two groups . The experimental group went through a six-week Qigong exercise program involving meditation , deep breathing , and synchronized rhythmic body movements . The control group took part in a sham Qigong exercise program using the same body movements also for six weeks . Clinical assessment s at baseline and end of intervention used the Short-Form McGill Pain Question naire , Multidimensional Fatigue Inventory , Pittsburgh Sleep Quality Index , and Fibromyalgia Impact Question naire . Results : Group mean scores of four measurements were significantly ( p < .0125 ) reduced in the intervention group , but not in the control group . The percentage changes in the four measurements were 44.2 % , 24.8 % , 37.3 % , and 44.3 % in the intervention group , and 10.1 % , 6.3 % , 9.9 % , and 11.8 % in the control group . Conclusion : Qigong exercise may potentially be an effective self-management approach in controlling FM symptoms . In this pilot study , regular daily Qigong exercise , accumulated number of exercise sessions , and the specific form of Qigong exercise may all be important factors for the significant improvement in the study subjects . Future research is required to determine whether the same benefit can be obtained in a larger sample Objectives : To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to st and ard medical care . Methods : Seventy-nine men and women were r and omly assigned to one of two groups . The intervention group consisted of a rheumatologist and physical therapist intake and discharge , 18 group supervised exercise therapy sessions , 2 group pain and stress management lectures , 1 group education lecture , 1 group dietary lecture , and 2 massage therapy sessions . The control group consisted of st and ard medical care with the patients ' family physician . Outcome measures included self-perceived health status , pain-related disability , average pain intensity , depressed mood , days in pain , hours in pain , prescription and nonprescription medication usage , and work status . Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up . Results : Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study . There were no statistically significant differences between the 2 groups prior to intervention . Intention-to-treat analysis revealed that the intervention group , in comparison to the control group , experienced statistically significant changes at intervention completion in self-perceived health status , average pain intensity , pain related disability , depressed mood , days in pain , and hours in pain , but no significant differences in nonprescription drug use , prescription drug use , or work status . At 15 months , all health outcomes retained their significance except health status . Nonprescription and prescription drug use demonstrated significant reductions at 15 months . Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status . Conclusions : Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost , group multidisciplinary intervention in a community-based , non clinical setting Objective The aim of this study was to compare 2 self-help-based interventions ; a coping-oriented approach , applied relaxation ( AR ) and an acceptance-oriented approach , acceptance and commitment therapy ( ACT ) , for persons with chronic pain . Method This study is a r and omized control trial ( N=90 ) with a mixed between-within participants design with repeated measures . Interventions in both conditions comprised an initial face-to-face session , a 7-week manual-based self-help intervention including weekly therapist telephone support and a concluding face-to-face session . Outcome measures included satisfaction with life , depression , anxiety , acceptance of chronic pain , level of function , and pain intensity . Effects were measured at preintervention and postintervention and at 6 and 12 months after the end of intervention . Results The results show that the ACT condition increased their level of acceptance significantly compared with the AR condition . There was also a marginally significant interaction effect regarding satisfaction with life in which the ACT condition had improved in comparison to the AR condition . Further , the ACT condition reported a higher level of function and decreased pain intensity compared with the AR condition . Both conditions improved significantly regarding depression and anxiety . Conclusions A manual-based self-help intervention with weekly therapist support in an ACT format adds value to the treatment repertoire for persons suffering with chronic pain Background : The presence and severity of the chronic pain syndrome fibromyalgia ( FM ) is associated with unresolved stress and emotional regulation difficulties . Written emotional disclosure is intended to reduce stress and may improve health of people with FM . Purpose : This study tests the effects of at-home , written emotional disclosure about stressful experiences on the health of people with FM and uses multiple follow-ups to track the time course of effects of disclosure . Methods : Adults with FM ( intention-to-treat , n = 83 ; completers , n = 72 ) were r and omized to write for 4 days at home about either stressful experiences ( disclosure group ) or neutral time management ( control group ) . Group differences in immediate mood effects and changes in health from baseline to 1-month and 3-month follow-ups were examined . Results : Written disclosure led to an immediate increase in negative mood , which did not attenuate across the 4 writing days . Repeated- measures analyses from baseline to each follow-up point were conducted on both intention-to-treat and completer sample s , which showed similar outcomes . At 1 month , disclosure led to few health benefits , but control writing led to less negative affect and more perceived support than did disclosure . At 3-month follow-up , these negative affect and social support effects disappeared , and written disclosure led to a greater reduction in global impact , poor sleep , health care utilization , and ( marginally ) physical disability than did control writing . Interpretation of these apparent benefits needs to be made cautiously , however , because the disclosure group had somewhat poorer health than controls at baseline and the control group showed some minor worsening over time . Conclusions : Written emotional disclosure can be conducted at home , and there is tentative evidence that disclosure benefits the health of people with FM . The benefits , however , may be delayed for several months after writing and may be of limited clinical significance The present study focused on the evaluation of the effects of operant behavioural ( OBT ) and cognitive behavioural ( CBT ) treatments for fibromyalgia syndrome ( FMS ) . One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to OBT ( n = 43 ) , CBT ( n = 42 ) , or an attention-placebo ( AP ) treatment ( n = 40 ) that consisted of discussion s of FMS-related problems . Assessment s of physical functioning , pain , affective distress , and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment . Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment ( all Fs > 3.89 , all Ps < 0.01 ) . In addition , the CBT group reported statistically significant improvements in cognitive ( all Fs > 7.95 , all P < 0.01 ) and affective variables ( all Fs > 2.99 , all Ps < 0.02 ) , and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables ( all Fs > 5.99 , all Ps < 0.001 ) compared with AP . The AP group reported no significant improvement but actually deterioration in the outcome variables . The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups . These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group . The AP group showed that unstructured discussion of FMS-related problems may be detrimental OBJECTIVE To evaluate the effects of body awareness therapy combined with qigong for patients with fibromyalgia . DESIGN A controlled r and omized pilot study . SUBJECTS Thirty-six female patients with fibromyalgia were r and omized to either qigong plus body awareness therapy ( n = 19 ) or a control group ( n = 17 ) . METHODS The programme was conducted once a week over a period of 3 months . The outcome measures were an observational method called the Body Awareness Rating Scale , the Fibromyalgia Impact Question naire and 2 tests of physical function . An interview was conducted with the patients in the treatment group . RESULTS Seven patients in each group ( 39 % ) were lost to the post-test examination . The inter-group analysis revealed a significant improvement in movement harmony for the treatment group ( p = 0.03 ) , while no differences were found in the Fibromyalgia Impact Question naire or the functional tests . The intra-group analysis revealed an improvement in movement harmony for the treatment group ( p = 0.01 ) , while the total score of the Fibromyalgia Impact Question naire deteriorated ( p = 0.04 ) in the control group . The interviews indicated that several patients had experienced exacerbation of symptoms while st and ing still , and /or difficulty in concentrating on the movements . CONCLUSIONS Although improvement in movement harmony occurred in the patients completing the treatment programme , no improvement was found for fibromyalgia symptoms or physical function Introduction Although exercise is therapeutic for adults with fibromyalgia ( FM ) , its symptoms often create obstacles that discourage exercise . 
    Output:
    
In view of the quality of evidence we can not be certain that biofeedback has a little or no effect on these outcomes .
However , the quality of the evidence was very low for pain and moderate for mood and number of withdrawals .
There was no advantage for physical functioning ( SMD -0.2 , 95 % CI -0.5 to 0.2 , -3.4 % absolute change , 2 point shift on a 0 to 100 scale ) , participant withdrawals ( RR 1.95 , 95 % CI 1.13 to 3.38 , 11 % absolute difference ) or adverse events ( RR 4.62 , 95 % CI 0.23 to 93.92 , 4 % absolute risk difference ) between the two groups , however rare adverse events may include worsening of pain .