***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: Background This systematic review up date d and extended the " UK evidence report " by Bronfort et al. ( Chiropr Osteopath 18:3 , 2010 ) with respect to conditions/ interventions that received an ' inconclusive ’ or ' negative ’ evidence rating or were not covered in the report . Methods A literature search of more than 10 general medical and specialised data bases was conducted in August 2011 and up date d in March 2013 . Systematic review s , primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included . Study quality was assessed using st and ardised instruments , studies were summarised , and the results were compared against the evidence ratings of Bronfort . These were either confirmed , up date d , or new categories not assessed by Bronfort were added . Results 25,539 records were found ; 178 new and additional studies were identified , of which 72 were systematic review s , 96 were r and omised controlled trials , and 10 were non-r and omised primary studies . Most ' inconclusive ’ or ' moderate ’ evidence ratings of the UK evidence report were confirmed . Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases ( manipulation/mobilisation [ with exercise ] for rotator cuff disorder ; spinal mobilisation for cervicogenic headache ; and mobilisation for miscellaneous headache ) . In addition , evidence was identified on a large number of non-musculoskeletal conditions not previously considered ; most of this evidence was rated as inconclusive . Conclusions Overall , there was limited high quality evidence for the effectiveness of manual therapy . Most review ed evidence was of low to moderate quality and inconsistent due to substantial method ological and clinical diversity . Areas requiring further research are highlighted OBJECTIVE Many cl aims have been made regarding the therapeutic efficacy of acupuncture . However , most controlled clinical studies have been limited to treatment of pain-related disorders and do not provide objective , quantifiable data for analysis . Traditional acupuncture has been applied to chronic obstructive pulmonary disease ( COPD ) . However , only a few studies have been performed to determine the efficacy of this treatment . This study was conducted to determine whether a combination of traditional acupuncture treatment and conservative treatment for COPD improves dyspnea on exercise . METHODS This was a prospect i ve trial with matched-pair parallel groups of patients from the departments of respiratory internal medicine of Gifu University of Medicine , Meiji University of Oriental Medicine , and Gifu Red Cross Hospital , Japan . Thirty patients were divided into the acupuncture group ( n = 15 ) and the control group ( n = 15 ) . The control group received conservative treatment with medication only . The acupuncture group received acupuncture treatments once a week for 10 weeks , in addition to conservative treatment with medication . The main outcome measure was the Modified Borg dyspnea scale after the 6-minute walk test . RESULTS The acupuncture group had significantly better results on the Borg scale than the control group after 10 weeks ( 2.2 + /- 2.7 versus 6.4 + /- 3.4 , p = 0.0001 , 95 % confidence interval , -5.10 to -2.35 , paired t-test ) . The 6-minute walk distance and oxygen saturation at the minimum rate improved significantly in the acupuncture group compared with the control group . CONCLUSIONS This study demonstrated that acupuncture contributed to the reduction of COPD -related dyspnea on exercise in 15 matched-pair parallel subjects BACKGROUND Dyspnea on exertion ( DOE ) is a major symptom of chronic obstructive pulmonary disease ( COPD ) and is difficult to control . This study was performed to determine whether acupuncture is superior to placebo needling in improving DOE in patients with COPD who are receiving st and ard medication . METHODS Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving st and ard medication participated in a r and omized , parallel-group , placebo-controlled trial ( July 1 , 2006 , through March 31 , 2009 ) in which the patients , evaluators , and statistician were unaware of the r and om allocation . Participants were r and omly assigned to traditional acupuncture ( real acupuncture group , n=34 ) or placebo needling ( placebo acupuncture group , n=34 ) . Both groups received real or placebo needling at the same acupoints once a week for 12 weeks . The primary end point was the modified Borg scale score evaluated immediately after the 6-minute walk test . Measurements were obtained at baseline and after 12 weeks of treatment . RESULT After 12 weeks , the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group ( mean [ SD ] difference from baseline by analysis of covariance , -3.6 [ 1.9 ] vs 0.4 [ 1.2 ] ; mean difference between groups by analysis of covariance , -3.58 ; 95 % CI , -4.27 to -2.90 ) . Patients with COPD who received real acupuncture also experienced improvement in the 6-minute walk distance during exercise , indicating better exercise tolerance and reduced DOE . CONCLUSION This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD . TRIAL REGISTRATION umin.ac.jp/ctr Identifier : UMIN000001277 OBJECTIVE The purpose of this preliminary study was to demonstrate the feasibility of a study that measures the short-term effects of a course of manual therapy ( MT ) and exercise ( Ex ) in people with moderate chronic obstructive pulmonary disease ( COPD ) . METHODS Fifteen participants ( 9 males ; mean age , 56.1 years ) , with moderate COPD ( mean % predicted forced expiratory volume in the first second [ FEV1 % predicted ] , 61.8 % ) , were r and omly allocated to 1 of 3 groups : soft tissue therapy only ( ST ) ; ST and spinal manipulation ( SM ) ; or ST , SM , and Ex . The intervention continued for 4 weeks . Outcome measures included FEV1 , forced vital capacity ( FVC ) , chronic respiratory question naire ( CRQ-SAS ) scores , distance walked in a 6-minute walking test , and monitoring for adverse events . RESULTS There was an increase in FVC for the SM + ST + Ex group compared with ST only and ST + SM ( 1.01 and 1.00 L , respectively ) . Distance walked increased in the ST + SM and ST + SM + Ex groups compared with ST only ( 120.0 and 168.0 m , respectively ) . Dyspnea levels decreased in the ST + SM and ST + SM + Ex groups compared with ST only ( 0.64 and 0.44 , respectively ) . There were no major or moderate adverse events reported following ST or SM interventions . CONCLUSIONS For this small group of patients , combining MT with Ex produced short improvements in FVC , distance walked , and dyspnea levels , with no major or moderate adverse events . This preliminary study showed that a larger study evaluating the clinical outcomes of MT for people with moderate COPD appears feasible OBJECTIVES Few and contrastingly data are available about use of osteopathic manipulative treatment ( OMT ) in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Comparing the effects of the combination of pulmonary rehabilitation and OMT compared with pulmonary rehabilitation ( PR ) in patients with severely impaired COPD . SETTING Rehabilitative pulmonary department . INTERVENTIONS Patients underwent exercise training , OMT , educational support and nutritional and psychological counselling . MAIN OUTCOMES MEASURES Exercise capacity through 6 min walk test ( 6MWT-- primary outcome ) and pulmonary function test ( secondary outcomes ) were evaluated at the beginning and at the end of the training . Patients were r and omly assigned to receive PR+soft manipulation ( G1 ) or OMT+PR ( G2 ) for 5 days/week for 4 weeks . RESULTS 20 stable COPD patients ( 5 female -- mean age , 63.8±5.1 years ; FEV1 26.9±6.3 % of predicted ) referred for in-patient pulmonary rehabilitation were evaluated . Respect to the baseline , 6 MWT statistically improved in both group . In particular , G2 group gained 72.5±7.5 m ( p=0.01 ) and G1 group 23.7±9.7 m. Between group comparison showed a difference of 48.8 m ( 95 % CI : 17 to 80.6 m , p=0.04 ) . Moreover , in G2 group we showed a decrease in residual volume ( RV -- from 4.4±1.5 l to 3.9±1.5 l , p=0.05 ) . Between group comparison showed an important difference ( -0.44 l ; 95 % CI : -0.26 to -0.62 l , p=0.001 ) . Furthermore , only in G2 group we showed an increase in FEV1 . CONCLUSIONS This study suggests that OMT+PR may improve exercise capacity and reduce RV in severely impaired COPD patients with respect to PR alone UNLABELLED The central purpose of pulmonary rehabilitation is to reduce morbidity by improving functional capacity through exercise . It is still unknown if improvements in functional capacity are maintained in the long-term and if this leads to increased physical activity levels as measured by a free-living activity monitor . The hypothesis of this study was that pulmonary rehabilitation would lead to a sustained increase in st and ard outcome measures and in daily physical activity . METHODS A prospect i ve study of 47 subjects with COPD was performed , registered at Clinical Trials.gov ( Clinical Trial Number NCT 0112943 ) . The primary outcome was a maintained improvement in st and ard outcome measures with a secondary aim of an increase in daily physical activity . A convenient sample of the cohort ( n = 17 ) was re-evaluated at a third time point at 1 year . RESULTS A seven week hospital based outpatient pulmonary rehabilitation program led to a significant reduction in total energy expenditure ( p < 0.044 ) and breathlessness ( Borg , p < 0.011 ) and improved exercise capacity ( ISWT , p > 0.001 , 6MWT , p > 0.002 ) PiMax ( p > 0.007 ) and quality of life scores ( SGRQ , p > 0.001 , EQ5D , 0.025 ) . However , pulmonary rehabilitation did not significantly change the average number of daily steps taken , time spent sedentary activity , METs consumed or daily physical activity . Indeed , all of the st and ard and freeliving values had returned towards the baseline value at 1 year . DISCUSSION These findings show that while pulmonary rehabilitation increased exercise capacity this was not transmitted into increased daily physical activity . Hence , alternative methods to alter/affect behavioural change need to be addressed Study design : R and omized clinical trial . Objective : To investigate the effect of including manual therapy ( MT ) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease ( COPD ) . Background : The primary source of exercise limitation in people with COPD is dyspnea . The dyspnea is partly caused by changes in chest wall mechanics , with an increase in chest wall rigidity ( CWR ) contributing to a decrease in lung function . As MT is known to increase joint mobility , administering MT to people with COPD carries with it the potential to influence CWR and lung function . Methods : Thirty-three participants with COPD , aged between 55 and 70 years ( mean = 65·5±4 years ) , were r and omly assigned to three groups : pulmonary rehabilitation ( PR ) only , soft tissue therapy ( ST ) and PR , and ST , spinal manipulative therapy ( SM ) , and PR . Outcome measures including forced expiratory volume in the 1st second ( FEV1 ) , forced vital capacity ( FVC ) , 6-minute walking test ( 6MWT ) , St. George 's respiratory question naire ( SGRQ ) , and the hospital anxiety and depression ( HAD ) scale were recorded at 0 , 8 , 16 , and 24 weeks . Results : There was a significant difference in FVC between the three groups at 24 weeks ( P = 0·04 ) . For the ST+SM+PR group versus PR only the increase was 0·40 l ( CI : 0·02 , 0·79 ; P = 0·03 ) . No major or moderate adverse events ( AE ) were reported following the administration of 131 ST and 272 SM interventions . Discussion : The increase in FVC is a unique finding . Although the underlying mechanisms responsible for this outcome are not yet understood , the most likely explanation is the synergistic effect result ing from the combination of interventions . These results support the call for a larger clinical trial in the use of MT for COPD In this pilot study , the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma . The research followed a pretest-posttest crossover design wherein each subject served as her own control . Blinded examiners recorded respiratory excursion , peak expiratory flow rates , and subjective measures of asthma symptoms . Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures . Changes in peak expiratory flow rates and asthma symptoms were not statistically significant OBJECTIVE The objective of this case series is to report the results of spinal manipulative therapy ( SMT ) for 
    Output:
    
This review provides a method ologic evaluation of the evidence for using SMT with and without other therapies in the management of COPD .