***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 examine the effects of a goal setting intervention on self-efficacy , treatment efficacy , adherence and treatment outcome in patients undergoing low back pain rehabilitation . Design : A mixed-model 2 ( time ) × 3 ( group ) r and omized controlled trial . Setting : A residential rehabilitation centre for military personnel . Subjects : UK military personnel volunteers ( N = 48 ) ; mean age was 32.9 ( SD 7.9 ) with a diagnosis of non-specific low back pain . Interventions : Subjects were r and omly assigned to either a goal setting experimental group ( Exp , n = 16 ) , therapist-led exercise therapy group ( C1 , n = 16 ) or non-therapist-led exercise therapy group ( C2 , n = 16 ) . Treatment duration for all groups was three weeks . Main measures : Self-efficacy , treatment efficacy and treatment outcome were recorded before and after the treatment period . Adherence was rated during regularly scheduled treatment sessions using the Sports Injury Rehabilitation Adherence Scale ( SIRAS ) . The Biering-Sørensen test was used as the primary measure of treatment outcome . Results : ANCOVA results showed that adherence scores were significantly higher in the experimental group ( 13.70 ± 1.58 ) compared with C2 ( 11.74 ± 1.35 ) , ( P < 0.025 ) . There was no significant difference for adherence between the experimental group and C1 ( P = 0.13 ) . Self-efficacy was significantly higher in the experimental group compared to both C1 and C2 ( P < 0.05 ) , whereas no significant difference was found for treatment efficacy . Treatment outcome did not differ significantly between the experimental and two control groups . Conclusions : The findings provide partial support for the use of goal setting to enhance adherence in clinical rehabilitation Background Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice . This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of " agenda- setting " on patients ' experiences with care . The agenda- setting intervention aim ed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient 's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which ( if any ) should be deferred to a subsequent visit . Methods Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda- setting intervention .  Eleven physicians matched on baseline scores , geography , specialty , and practice size were selected as controls . Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups . Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores . Results There was statistically significant improvement in intervention physicians ' ability to " explain things in a way that was easy to underst and " ( p = 0.02 ) and marginally significant improvement in the overall quality of physician-patient interactions ( p = 0.08 ) compared to control group physicians . Changes in patients ' experiences with organizational access , care coordination , and office staff interactions did not differ by experimental group . Conclusion A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality . It will be important to evaluate the effect of more extensive trainings , including those that work with physicians on a broader set of communication techniques Objectives : The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care . However , few protocol s exist to support this . One potentially useful method is goal setting , but little has been done to evaluate the added value of increasing patient participation in this way . Therefore , this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting . Design : The study was an AB optimised balance block design with each block lasting 3 months , over an 18 month period . Setting and participants : Patients ( n = 201 ) were recruited from an inpatient neurological rehabilitation unit . Interventions : Patients ( n = 100 ) recruited in phase A were involved in “ usual practice ” goal setting .  Patients ( n = 101 ) recruited in phase B were involved in “ increased participation ” goal setting , which included a protocol to help them define and prioritise their own goals . Main outcome measures : Patients ’ perceptions of the relevance of goal setting and their autonomy within the process ; the number , type and outcome of goals ; and level of functional ability . Results : Phase B patients ( “ increased participation ” ) set fewer goals , of which significantly more were participation related . These patients perceived the goals to be more relevant , and expressed greater autonomy and satisfaction with goal setting . There were no differences in functional outcomes between the groups . Conclusion : This study has shown that patients prefer increased participation in the goal setting process over st and ard procedures , perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains . Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities . As such , our findings suggest patients would benefit from greater participation in this aspect of clinical decision making 
    Output:
    
The literature showed various levels of patient involvement existing within goal - setting however few teams adopted an entirely patient-centred approach .