***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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    ***EXAMPLES*** 
    Input: PURPOSE Individuals with osteoarthritis can experience difficulty walking and poor strength , possibly leading to falls and fractures . Exercise has been found to increase strength and bone mineral density . The purpose of this study was to determine the effects of 6 months of t'ai chi on knee muscle strength , bone mineral density , and fear of falling in older women with osteoarthritis . METHODS Eighty-two ( 82 ) women with osteoarthritis , recruited from outpatient clinics and community health centers , were r and omly assigned to either a t'ai chi group and took part in a t'ai chi program , or a control group . Of these , 30 subjects ( mean age = 63 years ) in the t'ai chi group and 35 ( mean age = 61 years ) in the control group completed post-test measures at 6 months . RESULTS After the 6-month study period , subjects in the t'ai chi program had significantly greater knee extensor endurance ( pre- to post-test mean increase = 36.4 W/kg , versus 1.1 W/kg for the controls ) , and significantly greater bone mineral density in the neck of the proximal femur ( mean change = 0.09 , versus -0.10 for the controls ) , Ward 's triangle ( mean change = 0.04 , versus -0.04 for the controls ) , and trochanter ( mean change = 0.07 , versus -0.05 for the controls ) than the controls . However , knee extensor and flexor strength did not differ significantly between the groups . The fear of falling during daily activities reduced significantly more in the t'ai chi group ( mean change = -2.40 , versus 0.66 for the controls ) . CONCLUSIONS T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis , and decreased their fear of falling during daily activities . Further study with long-term follow-up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture OBJECTIVE To determine the effectiveness of a manual therapy program compared with an exercise therapy program in patients with osteoarthritis ( OA ) of the hip . METHODS A single-blind , r and omized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital . The manual therapy program focused on specific manipulations and mobilization of the hip joint . The exercise therapy program focused on active exercises to improve muscle function and joint motion . The treatment period was 5 weeks ( 9 sessions ) . The primary outcome was general perceived improvement after treatment . Secondary outcomes included pain , hip function , walking speed , range of motion , and quality of life . RESULTS Of 109 patients included in the study , 56 were allocated to manual therapy and 53 to exercise therapy . No major differences were found on baseline characteristics between groups . Success rates ( primary outcome ) after 5 weeks were 81 % in the manual therapy group and 50 % in the exercise group ( odds ratio 1.92 , 95 % confidence interval 1.30 , 2.60 ) . Furthermore , patients in the manual therapy group had significantly better outcomes on pain , stiffness , hip function , and range of motion . Effects of manual therapy on the improvement of pain , hip function , and range of motion endured after 29 weeks . CONCLUSION The effect of the manual therapy program on hip function is superior to the exercise therapy program in patients with OA of the hip OBJECTIVE To compare the responsiveness of the condition-specific Western Ontario and McMaster Universities osteoarthritis ( OA ) index ( WOMAC ) and the generic Short Form-36 ( SF-36 ) in patients with OA of the legs undergoing a comprehensive inpatient rehabilitation intervention .  METHODS A prospect i ve follow up study of consecutively referred in patients of a rehabilitation clinic was made . The patients included fulfilled the American College of Rheumatology criteria for knee or hip OA and underwent both passive and , particularly , active physical therapy for three to four weeks .  Responsiveness assessment was performed using the st and ardised response mean ( SRM ) , effect size , and Guyatt 's responsiveness statistic between admission and discharge ( end of rehabilitation ) and then again between admission and three months later . For pain and function the SRMs were stratified by sex and OA joint . Effects were tested by the t test and SRMs of different scales were compared by the jack knife test . RESULTS At the three month follow up , complete data were obtained for 223 patients . In general , the three responsiveness statistics showed a similar order of responsiveness . For both instruments , the pain scales were more responsive than the function scales . The responsiveness of the pain scale of both instruments was comparable ( SRM=0.723 for WOMAC and SRM=0.528 for SF-36 at the end of rehabilitation ; SRM=0.377 for WOMAC and SRM=0.468 for SF-36 at the three month follow up ) . In the measurement of function , the WOMAC was significantly more responsive than the SF-36 ( SRMs , end of rehabilitation : 0.628 v 0.249 ; three month follow up : 0.235 v -0.001 ) . Responsiveness tended to be higher in women and in knee OA than in men and hip OA . CONCLUSIONS Both instruments , the WOMAC and the SF-36 , capture improvement in pain in patients undergoing comprehensive inpatient rehabilitation intervention . Functional improvement can be detected better by the WOMAC than by the SF-36 . All the other scales of both instruments were more weakly responsive The feasibility and efficacy of an additional progressive home-based strengthening exercise program ( PHSEP ) on subjects that already attended supervised institutional exercise therapy  was investigated . Thirty-six hip patients with hip osteoarthritis ( OA ) and /or total hip replacement in at least one hip joint were r and omly assigned to an intervention group ( IG ) or a control group ( CG ) . IG ( 18 patients , mean age 64.9 , st and ard deviation ( SD ) 7.5 ) followed an 8-week PHSEP in addition to their weekly institutional exercise therapy , while CG ( 18 patients , mean age 64.7 , SD 9 ) solely continued the weekly institutional exercise sessions . Before and after the intervention period , strength of hip muscles was quantified applying isokinetic concentric and isometric measurements , and health-related quality of life was monitored using the SF36 question naire . Adherence to the exercise program was evaluated using exercise logs . The PHSEP was feasible for all subjects in IG with an adherence of 99 % . Exercise logs reported that pain result ing from the PHSEP was low . Increased strength in isokinetic concentric hip adduction ( 13 % ) and isometric hip abduction ( 9 % ) , adduction ( 12 % ) , and flexion ( 7 % ) was found in IG in comparison to CG . The results of the SF36 did not change during the intervention period . Consequently , supervised institutional exercise therapy supplemented by a PHSEP could increase hip muscle strength in patients with hip OA and /or total hip replacement . However , further research should evaluate the optimal frequency and duration of such supplementary sessions and their potential to increase physical function and reduce pain QUESTION Does behavioural grade d activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee ? DESIGN Analysis of secondary outcomes of a cluster-r and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Two hundred patients with hip and /or knee osteoarthritis . INTERVENTION Experimental group received 18 sessions of behavioural grade d activity over 12 weeks and up to 7 booster sessions over the next year . The control group received 18 sessions of usual care over 12 weeks according to the Dutch physiotherapy guideline . OUTCOME MEASURES Exercise adherence was measured using a question naire and physical activity was measured using the SQUASH question naire at baseline , 13 , and 65 weeks . RESULTS Adherence to recommended exercises was significantly higher in the experimental group than in the control group at 13 weeks ( OR 4.3 , 95 % CI 2.1 to 9.0 ) and at 65 weeks ( OR 3.0 , 95 % CI 1.5 to 6.0 ) . Significantly more of the experimental than the control group met the recommendations for physical activity at 13 weeks ( OR 5.3 , 95 % CI 1.9 to 14.8 ) and at 65 weeks ( OR 2.9 , 95 % CI 1.2 to 6.7 ) . CONCLUSION Behavioural grade d activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee , both in the short- and long-term . TRIAL REGISTRATION NCT00522106 OBJECTIVES To obtain prevalence rates of hip and knee pain in elderly people and compare combinations of symptoms with overall health status . METHODS We performed a cross-sectional postal survey of a r and om sample of 5500 Oxfordshire residents aged 65 yr and older . Prevalence estimates were based on the screening question : ' During the past 12 months , have you had pain in or around either of your hip/knee joints on most days for one month or longer ? ' Overall health status was assessed with the  SF-36 question naire . RESULTS The  response rate was 66.3 % ( 3341/5039 eligible people ) , and was highest ( approximately reverse similar 72 % ) for the 65 - 74 yr age-group . The percentage reporting hip pain was 19.2 % [ 95 % confidence interval ( CI ) 17.9 - 20.6 ] , and 32.6 % ( 95 % CI 31.0 - 34.3 ) reported knee pain . The percentage reporting hip and knee pain was 11.3 % , and 40.7 % reported hip or knee pain . Less than half ( 48 % ) of the symptomatic respondents had unilateral problems affecting one hip or knee joint only . SF-36 scores worsened as the number of symptomatic hip and knee joints increased ( P<0.001 for physical function , physical role limitation and bodily pain ) . CONCLUSIONS Patterns of hip and knee symptoms are complex in older people . Amongst the symptomatic , most have more than one hip/knee affected . This has implication s for treatment and health status measurement . In the absence of hip and knee symptoms , general health status scores of elderly people are similar to those of people aged under 65 yr OBJECTIVE To study the hip muscle strength and cross sectional area ( CSA ) in men with hip osteoarthritis ( OA ) compared to age and sex matched healthy controls . METHODS Based on the American College of Rheumatology criteria regarding classification of hip OA , 27 men ( aged 47 - 64 yrs ) with unilateral or bilateral hip OA and 30 age matched r and omly selected healthy male controls were studied . The maximal isometric hip abductor , adductor , flexor , and extensor strength ( Nm ) at 0 degree of hip flexion in the supine position was determined with a dynamometer . The isokinetic hip flexion and extension strength ( peak torque , Nm ) was determined using angular velocities of 60 degrees /s and 120 degrees /s . The subjective severity of hip pain was rated by visual analog scale prior to the muscle strength test . CSA of the pelvic and thigh muscles was measured from magnetic resonance images . RESULTS The reliability of intraclass correlation coefficients for repeated measures of muscle strength varied from 0.70 to 0.94 in controls and from 0.84 to 0.98 in subjects with OA . Hip isometric adductor and abductor strength was 25 % and 31 % lower ( p < 0.001 ) in OA subjects than in controls , respectively . The hip isometric and isokinetic flexion strength was 18 - 22 % lower ( p < 0.01 ) in OA subjects than in controls , but extension strength did not differ between groups . In OA subjects , the hip flexion and extension isometric and isokinetic strength values were 13 - 22 % lower ( p < 0.05 ) on the more deteriorated side compared to the better side . CSA of the pelvic and thigh muscles did not differ between the groups . However , in OA subjects , the CSA of the pelvic and thigh muscles was 6 - 13 % less ( p < 0.05 to < 0.001 ) on the more severely affected hip compared to the better hip . CONCLUSION Men with hip OA have significantly lower abduction , adduction , and flexion muscle strength than controls . The decrease of muscle size and hip pain may contribute to the decrease of muscle strength in hip OA . Other possible underlying causes of the muscle weakness need to be studied BACKGROUND Diary recording of pain and disabling activities in osteoarthritis ( OA ) is widely recommended , but , to our knowledge , its impact on symptoms has not been investigated . Exercise programmes have been shown to be effective when patients are closely supervised by nurses or physiotherapists ; however , data are lacking on the efficacy of an unsupervised home based exercise regimen in patients with OA . OBJECTIVES To evaluate the clinical efficacy of patient administered assessment tools and an unsupervised home based exercise programme alone or in combination in patients with OA . METHODS The study was a 24 week , open cluster r and omised controlled trial with a factorial design . Rheumatologists ( n = 867 ) were assigned to four groups according to the treatment given : st and ardised tools ( ST ; n =  
    Output:
    
Pooling the results of these 10 RCTs demonstrated that l and -based therapeutic exercise programmes can reduce pain and improve physical function among people with symptomatic hip OA