***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 
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    Input: Summary A total of 101 out patients with acute or subacute low-back pain was r and omly allocated to one of two treatment groups . One group was given st and ardised conventional and optimised activating treatment by primary health care teams . The other group received , according to a pragmatic approach , another treatment programme including manipulation , specific mobilisation , muscle stretching , autotraction and cortisone injections . The treatment effect was evaluated by st and ardised telephone interviews 3 , 7 , 14 , 21 and 90 days after the start of treatment . The two groups were similar in most of the pretrial variables , including age , sex , occupation , education , previous low-back pain problems , previous treatment , sickleave , findings at the physical examination , quality -of-life score , presence of common symptoms , disability rating and pain score . In the early phase as well as at the 90 days ' follow-up , the group receiving manual therapy had significantly less pain , less disability , faster rate of recovery and lower drug consumption , indicating that this type of treatment is superior to conventional treatment A total of 132 infants and children with grade s III and IV primary vesicoureteral reflux was entered into a prospect i ve trial comparing medical to surgical management .  Inclusion criteria were an age not exceeding 10 years and a glomerular filtration rate of at least 70 ml . per minute per 1.73 m.2 . Children with significant urinary tract malformations and clinical signs/symptoms of dysfunctional voiding were not accepted into the trial .  Medical therapy consisted of continuous low dose antibiotic prophylaxis until vesicoureteral reflux resolved . The type of surgical procedure used for the correction of reflux was left to the discretion of the surgeon . Outcome variables included the appearance or progression of renal lesions , rate of renal growth , recurrence rate of urinary tract infection or pyelonephritis , changes in total kidney glomerular filtration rate , development of hypertension and resolution rate of vesicoureteral reflux . Followup at 6 , 18 , 36 and 54 months after entry included , in addition to history and physical examination , voiding cystourethrography , excretory urography and a urine culture . Of the patients 68 were allocated to the medical group and 64 to the surgical group . They were stratified for age , sex and preexisting renal scarring . Of the patients 10 % were boys , 47 % were between 2 and 6 years old at entry , 93 % had a history of pyelonephritis , 67 % had either scarring or thinning of the parenchyma at entry , 87 % had grade IV vesicoureteral reflux in at least 1 unit and 56 % had bilateral reflux . There were no significant differences in the frequency distribution of entry characteristics between the patients allocated to either group . New renal scarring developed in 22 % of medical and 31 % of surgical patients ( p < 0.4 ) . Growth of kidneys with grade IV vesicoureteral reflux was slightly less than normal in the medical ( -0.67 + /- 0.15 st and ard deviation ) and surgical ( -0.42 + /- 0.11 st and ard deviation ) groups ( p < 0.7 ) . Pyelonephritis occurred in 15 medical patients versus 5 surgical patients ( p < 0.05 ) . There was no significant change in glomerular filtration rate within each treatment group and no difference in glomerular filtration rate between groups . No patient had hypertension during the followup period . The disappearance rate of vesicoureteral reflux in patients with grade IV reflux was approximately 8 % per year . Of the medical patients 75 % still had vesicoureteral reflux after 3 years of observation . ( ABSTRACT TRUNCATED AT 400 WORDS Objective : To evaluate if a comprehensive manual therapy programme reduces  sick leave due low back pain and facilitates return to work more than the conventional optimized activating care . Design : A r and omized controlled trial over a 10-week period with a two-year follow-up . Setting : Primary health care and Visby Hospital , Municipality of Gotl and , Sweden . Subjects : One hundred and sixty patients ( 70 women , 90 men , ages 20—55 years ) with acute or subacute low back pain with or without pain radiation into the legs . Interventions : St and ardized optimized activating care ( n = 71 ) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections ( n = 89 ) . Main measures : Sick leave measured as net sick leave volume , point prevalence and return to work . Results : After 10 weeks , significantly more manual therapy patients than reference patients had returned to work ( hazards ratio 1.62 , 95 % confidence interval ( CI ) 1.006—2.60 , P<0.05 ) , and among those on sick leave at baseline , significantly fewer were still on sick leave ( 8/58 versus 13/40 , ratio 0.35 , 95 % CI 0.13—0.97 , P<0.05 ) . For all other measures there were inconclusive differences in favour of the manual therapy group . No significant differences remained after two years . Conclusions : The manual therapy programme used in this study decreased sick leave and increased return to work more than the st and ardized optimized activating care only up to 10 weeks but not up to two years Study Design . A prospect i ve clinic‐based survey . Objectives . To study the type , frequency , and characteristics of unpleasant side effects after spinal manipulative therapy . Summary of Background Data . Spinal manipulative therapy is a commonly used treatment , but there is little knowledge of its side effects . Methods . Information regarding unpleasant reactions after spinal manipulative therapy was collected after 4712 treatments on 1058 new patients by 102 Norwegian chiropractors ( response rate , 70 % ) through structured interviews . Results . At least one reaction was reported by 55 % of the patients some time during the course of a maximum of six treatments . Of the reported reactions , the most common were local discomfort ( 53 % ) , headache ( 12 % ) , tiredness ( 11 % ) , or radiating discomfort ( 10 % ) . Reactions were mild or moderate in 85 % of patients . Sixty‐four percent of reactions appeared within 4 hours of treatment , and 74 % had disappeared within 24 hours . Uncommon reactions were dizziness , nausea , hot skin , or " other " complaints , each accounting for 5 % or less of reactions . It was unusual that symptoms commenced later than on the day of or the day after treatment , were of long duration ( not gone at the latest on the day after onset ) , described as severe , or that they result ed in reduced activities of daily living . There were no reports of serious complications in this study . Conclusions . Profiles now are described of common and uncommon reactions to spinal manipulative therapy and their latency , duration , and severity Background The safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy . The aim of this r and omized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists ( i.e. chiropractors , naprapaths , osteopaths , physicians and physiotherapists ) for patients seeking care for back and /or neck pain . In addition women and men were compared regarding the occurrence of adverse events . Methods Participants were recruited among patients , ages 18–65 , seeking care at the educational clinic of the Sc and inavian College of Naprapathic Manual Medicine in Stockholm . The patients ( n = 767 ) were r and omized to one of three treatment arms 1 ) manual therapy ( i.e. spinal manipulation , spinal mobilization , stretching and massage ) ( n = 249 ) , 2 ) manual therapy excluding spinal manipulation ( n = 258 ) and 3 ) manual therapy excluding stretching ( n = 260 ) . Treatments were provided by students in the seventh semester of total eight . Adverse events were measured with a question naire after each return visit and categorized in to five levels ; 1 ) short minor , 2 ) long minor , 3 ) short moderate , 4 ) long moderate and 5 ) serious adverse events , based on the duration and /or severity of the event . Generalized estimating equations were used to examine the association between adverse event and treatments arms . Results The most common adverse events were soreness in muscles , increased pain and stiffness . No differences were found between the treatment arms concerning the occurrence of adverse event . Fifty-one percent of patients , who received at least three treatments , experienced at least one adverse event after one or more visits . Women more often had short moderate adverse events ( OR = 2.19 ( 95 % CI : 1.52 - 3.15 ) ) , and long moderate adverse events ( OR = 2.49 ( 95 % CI : 1.77 - 3.52 ) ) compared to men . Conclusion Adverse events after manual therapy are common and transient . Excluding spinal manipulation or stretching do not affect the occurrence of adverse events . The most common adverse event is soreness in the muscles . Women reports more adverse events than men . Trial registration This trial was registered in a public registry ( Current Controlled Trials ) ( IS RCT N92249294 ) Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints . All suffered from regional low-back pain for less than 1 month , were ages 18–40 , had never previously undergone any form of spinal manipulation , and denied a prior episode of backache within the previous 6 months . R and omization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2–4 weeks . Outcome was monitored by a question naire assessing functional impairment . A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry . In the first week following manipulation , these patients improved to a greater degree ( P=.009 , t test ) and more rapidly ( P < .025 , Wilcoxon rank-sum test ) Spinal manipulative therapy ( SMT ) and exercise have demonstrated effectiveness for neck pain ( NP ) . Adverse events ( AE ) reporting in trials , particularly among elderly participants , is inconsistent and challenges informed clinical decision making . This paper provides a detailed report of AE experienced by elderly participants in a r and omized comparative effectiveness trial of SMT and exercise for chronic NP . AE data , consistent with CONSORT recommendations , were collected on elderly participants who received 12 weeks of SMT with home exercise , supervised plus home exercise , or home exercise alone .  St and ardized questions were asked at each treatment ; participants were additionally encouraged to report AE as they occurred . Qualitative interviews documented participants ' experiences with AE . Descriptive statistics and content analysis were used to categorize and report these data .  Compliance  was high among the 241 r and omized participants .  Non-serious AE were reported by 130/194 participants . AE were reported by three times as many participants in supervised plus home exercise , and nearly twice as many as in SMT with home exercise , as in home exercise alone . The majority of AE were musculoskeletal in nature ; several participants associated AE with specific exercises . One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm . One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home . Eight serious , non-related AE also occurred . Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP . As such , they should be expected and discussed when developing care plans IMPORTANCE Low back pain ( LBP ) is common in primary care . Guidelines recommend delaying referrals for physical therapy . OBJECTIVE To evaluate whether early physical therapy ( manipulation and exercise ) is more effective than usual care in improving disability  for patients with LBP fitting a decision rule . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial with 220 participants recruited between March 2011 and November 2013 . Participants with no LBP treatment in the past 6 months , aged 18 through 60 years ( mean age , 37.4 years [ SD , 10.3 ] ) , an Oswestry Disability Index ( ODI ) score of 20 or higher , symptom duration less than 16 days , and no symptoms distal to the knee in the past 72 hours were enrolled following a primary care visit . INTERVENTIONS All participants received education . Early physical therapy ( n = 108 ) consisted of 4 physical therapy sessions . Usual care ( n = 112 ) involved no additional interventions during the first 4 weeks . MAIN OUTCOMES AND MEASURES Primary outcome was change in the ODI score ( range : 0 - 100 ; higher scores indicate greater disability ; minimum clinical ly important difference , 6 points ) at 3 months . Secondary outcomes included changes in the ODI score at 4-week and 1-year follow-up , and change in pain intensity , Pain Catastrophizing Scale ( PCS ) score , fear-avoidance beliefs , quality of life , patient-reported success , and health care utilization at 4-week , 3-month , and 1-year follow-up . RESULTS One-year follow-up was completed by 207 participants ( 94.1 % ) . Using analysis of covariance , early physical therapy showed improvement relative to usual care in disability after 3 months ( mean ODI score : early physical therapy group , 41.3 [ 95 % CI , 38.7 to 44.0 ] at baseline to 6.6 [ 95 % CI , 4.7 to 8.5 ] at 3 months ; usual care group , 40.9 [ 9 
    Output:
    
Conclusions and Relevance Among patients with acute low back pain , spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks , with transient minor musculoskeletal harms .