***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: Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed Rheumatoid arthritis ( RA ) is a systemic inflammatory and chronic disease of joints , which may result in irreversible deformities . To evaluate the effects of an exercise programme aim ed at improving the h and strength in individuals with h and deformities result ing from RA and to analyse the impact these exercises have on functionality .  Twenty women with RA h and deformities participated in the study . They were r and omly divided into two groups as follows : Group 1 ( n = 13 ) had women participating in the exercise programme  aim ed at improving h and grip ( HS ) and pinch strengths ( PS ) as well as the motor coordination of the h and ; Group 2 ( n = 7 ) had women with RA who received no treatment for their h and s ( control ) . The treatment programme for h and s consisted of 20 sessions , twice a week and at-home exercises . Both groups were su bmi tted to Health Assessment Question naire ( HAQ ) and evaluation of HS and PS by means of dynamometry . Re-evaluations were performed after 10 and 20 sessions in Group 1 and after 2 months in Group 2 . After 20 sessions of physiotherapy , Group 1 had a significant gain in HS and PS ( p < 0.05 ) in addition to the improvement of functionality as assessed by HAQ ( p = 0.016 ) . For Group 2 , no difference was found between the variables analysed ( p > 0.05 ) . The strengthening exercises for individuals with RA h and deformity are beneficial to improve h and grip and pinch strengths as well as functionality The present study aim ed at assessing the effects of a set of yoga practice s on normal adults ( n = 37 ) , children ( n = 86 ) , and patients with rheumatoid arthritis ( n = 20 ) . An equal number of normal adults , children , and patients with rheumatoid arthritis who did not practice yoga  were studied under each category , forming respective control groups . Yoga and control group subjects were assessed at baseline and after varying intervals , as follows , adults after 30 days , children after 10 days and patients after 15 days , based on the duration of the yoga program , which they attended , which was already fixed . H and grip strength of both h and s , measured with a grip dynamometer , increased in normal adults and children , and in rheumatoid arthritis patients , following yoga , but not in the corresponding control groups , showing no re-test effect . Adult female volunteers and patients showed a greater percentage improvement than corresponding adult males . This gender-based difference was not observed in children . Hence yoga practice improves h and grip strength in normal persons and in patients with rheumatoid arthritis , though the magnitude of improvement varies with factors such as gender and age OBJECTIVE To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the h and s and feet in patients with rheumatoid arthritis ( RA ) . METHODS Data of the 281 completers of a 2 year r and omised controlled trial comparing the effects of usual care physical therapy ( UC ) with high intensity weightbearing exercises  were analysed for the rate of radiological joint damage ( Larsen score ) of the h and s and feet . Potential determinants of outcome were defined : disease activity , use of drugs , change in physical capacity and in bone mineral density , and attendance rate at exercise sessions . RESULTS After 2 years , the 136 participants in high intensity weightbearing exercises  developed significantly less radiological damage than the 145 participants in UC . The mean ( SD ) increase in damage was 3.5 ( 7.9 ) in the exercise group and 5.7 ( 10.2 ) in the UC group , p = 0.045 . Separate analysis of the damage to the h and s and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the h and s. The rate of damage was independently associated with less disease activity , less frequent use of glucocorticoids , and with an improvement in aerobic fitness . CONCLUSION The progression of radiological joint damage of the h and s and feet in patients with RA is not increased by long term high intensity weightbearing exercises . These exercises may have a protective effect on the joints of the feet The effects of evening exercises on arthrographic measures of elastic stiffness , subjective ratings of stiffness , and graphic goniometric measures of mobility were examined in 30 patients with rheumatoid arthritis . Measures were obtained on 2 consecutive mornings , one of which was r and omly determined to be preceded by evening exercise . Each morning ,  elastic stiffness and mobility were measured before and after morning exercise . After the final measurements of elastic stiffness and mobility on the second day , patients compared stiffness on the 2 days . Elastic stiffness and subjective ratings of stiffness were less and mobility was greater when evening exercises were performed ( p less than 0.001 ) . The relationships between elastic stiffness and subjective ratings of stiffness indicated that the effect of evening exercise was perceived as greater when elastic stiffness was greater , and 21 patients reported less stiffness with evening exercise ( p less than .05 ) Objectives The Stretching And strengthening for Rheumatoid Arthritis of the H and ( SARAH ) r and omised controlled trial evaluated the effectiveness of a h and exercise programme and demonstrated it was clinical ly effective and cost-effective at 12 months . The aim of this extended follow-up was to evaluate the effects of the SARAH programme beyond 12 months . Methods Using postal question naires , we collected the  Michigan H  and Question naire h and function ( primary outcome ) , activities of daily living and work subscales , pain troublesomeness , self-efficacy and health-related quality of life .  All participants were asked how often they performed h and exercises for their rheumatoid arthritis . Mean difference in h and function scores were analysed by a linear model , adjusted for baseline score . Results Two-thirds ( n=328/490 , 67 % ) of the original cohort provided data for the extended follow-up . The mean follow-up time was 26 months ( range 19–40 months ) . There was no difference in change in h and function scores between the two groups at extended follow-up ( mean difference ( 95 % CI ) 1.52 ( −1.71 to 4.76 ) ) . However , exercise group participants were still significantly improved compared with baseline ( p=0.0014 ) unlike the best practice usual care group ( p=0.1122 ) . Self-reported performance of h and exercises had reduced substantially . Conclusions Participants undertaking the SARAH exercise programme  had improved h and function compared with baseline > 2 years after r and omisation . This was not the case for the control group . However , scores were no longer statistically different between the groups indicating the effect of the programme had diminished over time . This reduction in h and function compared with earlier follow-up points coincided with a reduction in self-reported performance of h and exercises . Further intervention to promote long-term adherence may be warranted . Trial registration number IS RCT N89936343 ; Results BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s Etude sur 30 malades pendant 3 semaines . Les ultrasons et les bains faradiques ne semblent pas presenter d'avantages par rapport aux exercices conventionnels avec traitement par la cire fondue . Le traitement conventionnel est moins OBJECTIVE To investigate physical fitness and work capacity in women with rheumatoid arthritis ( RA ) . METHODS The 42 subjects were a subset of a prospect i ve trial of conditioning exercise in rheumatic disease . Assignment to an exercise or nonexercise group was determined by proximity to the intervention , a 3-month supervised group exercise program . Physical fitness and work capacity were assessed at baseline , 3 months , and 12 months . RESULTS At baseline , subjects were deconditioned and limited in h and function , lifting ability , and lower extremity mobility . Only the exercise group improved their aerobic capacity and exercise tolerance . There were no significant changes in measured work capacity in either group . Moderate to strong correlations were found between aerobic capacity , mobility , h and function , and work capacity . Grip strength was a strong and consistent correlate of work capacity . CONCLUSION Our findings suggest that physical capacity , particularly h and function , may be important in the complex phenomenon of work disability in RA BACKGROUND Occupational therapy ( OT ) aims at improving performance of daily living tasks , facilitating successful adjustments in lifestyle , and preventing losses of function . OBJECTIVE To evaluate the effects of a pragmatic , comprehensive OT programme on self management and health status of people with early rheumatoid arthritis ( RA ) ( < 2.5 years ) . METHODS A r and omised , controlled " assessor blinded " trial was conducted with assessment s made at entry , 6 , 12 , and 24 months . Main outcomes were AIMS 2 : physical function ( PF ) , pain visual analogue scale ( VAS ) , and Arthritis Self-Efficacy Scale ( ASES ) . RESULTS Groups had similar disease duration ( 9 months OT ( n = 162 ) v 10 months control ( n = 164 ) ) . The OT group received 7.57 ( SD 3.04 ) hours of therapy . Self management significantly increased in the OT group . Otherwise , there were no significant differences in any outcome measures , or between groups , by ACR functional class : AIMS 2 : PF ( F = 0.04 ; p = 0.96 ) ; pain VAS ( F = 0.29 ; p = 0.74 ) ; total ASES score ( F = 0.93 ; p = 0.39 ) . CONCLUSIONS OT improved self management but not health status in early RA . Functional ability remains reasonably good for many in the first five years , so preventive benefits of self management may not yet be apparent and longer follow up is needed . Although many considered the education and therapy useful , insufficient numbers in the OT group used self management sufficiently to make a difference . Behavioural approaches can improve adherence and , potentially , the long term benefits . Future research should evaluate OT as a complex intervention and develop programmes from a theoretical and evidence base OBJECTIVE We previously demonstrated the efficacy of a 6 week home based physical therapy ( PT ) intervention for people with moderate to severe rheumatoid arthritis ( RA ) . This followup study determined if short term 
    Output:
    
It is uncertain whether exercise improves h and function or pain in the short term .
It probably slightly improves function but has little or no difference on pain in the medium and long term .
It is uncertain whether exercise improves grip and pinch strength in the short term , and probably has little or no difference in the medium and long term .
People who received exercise with adherence strategies  were probably more adherent in the medium term than who did not receive exercise , but with little or no difference in the long term .
H and exercise probably does not lead to adverse events .