***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: The aim of this study was to investigate test – retest reliability of the Isernhagen Work System Functional Capacity Evaluation ( IWS FCE ) in a sample of patients ( n = 30 ) suffering from Chronic Low Back Pain ( CLBP ) and selected for rehabilitation treatment . The IWS FCE consists of 28 tests that reflect work-related activities like lifting , carrying , bending , etc . In this study , a slightly modified IWS FCE was used . Patients were included in the study if they were still at work or were less than 1 year out of work because of CLBP . Participants ' mean age was 40 years , the duration of low back pain ranged between 5 and 10 years . Fifteen patients ( 50 % ) were out of work for a mean of 17 weeks , and they all received financial compensation . Two FCE sessions were held with a 2-week interval in between . Means per session , 95 % confidence intervals of the mean difference , one-way r and om Intra Class Correlations ( ICC ) , limits of agreement , Cohen 's kappa and percentage of absolute agreement were calculated where appropriate . An ICC of 0.75 or more , a kappa value of more than 0.60 and a percentage of absolute agreement of 80 % were considered as an acceptable reliability . Tests of the IWC FCE were divided into tests with and tests without an acceptable test – retest reliability on the basis of the kappa values , the percentage of absolute agreement and the ICC values . Fifteen tests ( 79 % ) showed an acceptable test – retest reliability based on Kappa values and percentage of absolute agreement . Eleven tests ( 61 % ) showed an acceptable test – retest reliability based on ICC values Context Low back pain causes frequent disability and lost productive time . Contribution This r and omized trial compared a behavioral-oriented grade d activity program with usual care in 134 Dutch airline company workers who had missed work because of persistent low back pain .  Grade d activity consisted of biweekly 1-hour exercise sessions with physiotherapists who emphasized operant-conditioning principles . Over 6 months of follow-up , participants in the grade d activity program missed 58 days of work , while participants receiving usual care missed 87 days . Implication s A behavioral-oriented grade d activity program returned participants with low back pain to work more often than did usual care . The Editors Nonspecific low back pain is an uncomfortable medical condition that causes frequent disability and absence from work . Most episodes of low back pain resolve fairly quickly and cause only short periods of absence from work . However , some workers with low back pain miss work for several days to weeks and are at risk for more permanent disability ( 1 ) . To reduce the individual and socioeconomic burden related to this absenteeism , we need effective intervention strategies in occupational health care setting s that promote safe and rapid return to work . One promising and often-advocated intervention strategy for workers with prolonged nonspecific low back pain is active rehabilitation that is directed toward return to normal activity and work ( 2 ) . Examples are grade d activity interventions that include physical exercise , application of operant-conditioning behavioral principals , and promotion of improved functioning and safe return to work even if pain persists ( 3 - 6 ) . In a r and omized , controlled trial , Lindstrm and colleagues ( 3 , 4 ) found that a grade d activity intervention reduced absence from work more than did traditional care in Swedish workers employed in the automobile industry . We investigate , in a second r and omized , controlled trial , whether absence from work because of low back pain is reduced more with grade d activity intervention than with traditional care in an occupational health care setting in the Netherl and s. Methods Study Design and Sample The study was a single-blind , r and omized , controlled trial in an occupational health services center ( KLM Health , Safety and Environment ) at Schiphol Airport , Amsterdam , the Netherl and s. The center provides occupational health services for all employees of a major Dutch airline ( KLM Royal Dutch Airlines ) . The source sample ( n = 20 000 ) consisted of workers who were employed in the following organizational units of the airline : baggage and aircraft turnaround services , passenger services , engineering and maintenance , cargo , and cabin and cockpit . Workers who were listed as absent from work because of low back pain were invited for a consultation with the occupational physician . Those who were thought to be eligible for inclusion were referred to the research assistant , who judged whether they met the inclusion criteria : full or partial absence from work because of nonspecific low back pain and low back pain symptoms with a minimum duration of 4 weeks in succession . The exclusion criteria were low back pain with radiation below the knee with signs of nerve-root compression ( 7 ) ; cardiovascular contraindications for physical activity , as checked according to the Physical Activities Readiness Question naire ( 8 , 9 ) ; any conflict between worker and employer with legal involvement ; or pregnancy . Workers who met the inclusion criteria were informed of the purpose and procedures of the study and were enrolled after giving informed consent . The Medical Ethical Committee of the VU University Medical Center , Amsterdam , the Netherl and s , approved the study . Treatment Allocation The participants were assigned to grade d activity or usual care on the basis of block r and omization , after prestratification for the organizational unit in the workplace from which they were recruited ( the 5 organizational units listed earlier ) and for the severity of pain symptoms ( scored on a scale of 0 to 10 ; severity scores were < 6 or 6 points ) . This result ed in a total of 10 strata . R and omized , permuted blocks of 4 allocations were generated for each stratum through a computer-generated r and om-sequence table . Opaque , sequentially numbered , sealed envelopes were prepared for each stratum by a research er who was not involved in enrolling the participants or assigning them to their groups . The envelopes contained a sheet of paper that indicated 1 of the 2 interventions . Participants learned their group assignments after a research assistant completed the baseline measurements and delivered the sealed envelopes . Blinding The research assistants who collected the data were blinded to the treatment allocation . All participants were repeatedly asked not to reveal any information about their treatment allocation . The participants and treatment providers were not blinded to treatment allocation . Interventions In the Dutch occupational health care system , occupational physicians guide disabled workers who are absent from work through their disability period . These occupational physicians are employed by occupational health services that are paid for by the companies . The occupational physicians adhere to back pain management strategies that consist of advising workers on ergonomics , prevention , and return-to-work schedules and advising and communicating with other stakeholders ( such as health care providers and representatives of the workplace ) . Disabled workers who participated in the present study were assigned to either grade d activity or usual care within the context of the Dutch occupational health care setting . Grade d Activity The intervention group received the usual guidance from the occupational physician about work-related problems and barriers to return to work as well as the grade d activity intervention supervised by a physiotherapist .  Three physiotherapists who worked in a private practice at Schiphol Airport provided the treatment according to the grade d activity protocol . Two of those physiotherapists were also trained as manual therapists , and 1 was also a human movement scientist . Before the study , the physiotherapists had been specifically trained to treat patients with low back pain according to behavioral principles . A research physiotherapist who was experienced in treating patients with chronic pain in rehabilitation centers instructed the physiotherapists in three 2-hour sessions and practice d patienttherapist interactions with them through role-play . Before the study , the physiotherapists treated several patients according to the grade d activity protocol to gain more experience . The physiotherapists made audiotapes of the intervention sessions before and during the study period . The contents of these audiotapes were assessed and discussed with the research physiotherapist in 3 additional meetings . Furthermore , the physiotherapists summarized the treatment after each session , and research ers used these summaries to review the sessions . The same physiotherapist treated participants each time , except for temporary st and -in sessions that were supervised by colleagues because of holidays or other reasons . Specific therapists were not systematic ally selected to treat specific participants ; selection was based on pragmatic reasons , such as the time available in the work schedules of the physiotherapists or the days of treatment preferred by the participants . Table 1 presents the concept and content of the grade d activity intervention . The intervention consisted of 1-hour exercise sessions that participants attended twice per week until they returned completely to regular work or until the maximum therapy duration of 3 months was reached . At the start of the intervention , the physiotherapist inquired about the participant 's medical history and completed a brief physical examination consisting of flexion , extension , and lateroflexion of the lumbar spine and a brief screening for nerve-root pain ( 10 ) . The purpose of the physical examination was to confirm the diagnosis of benign , nonspecific low back pain and to reduce participants ' fears about any presumed underlying disease . The participants were reassured that despite the annoying pain , nothing was seriously wrong with their backs . Subsequently , the physiotherapist and participant decided on a set of general exercises and individually tailored exercises . Both types of exercises had to be performed during each session . The general exercises were aerobic exercises , such as cycling or rowing , and strengthening exercises for large muscle groups , and most were carried out in a gym while using exercise equipment . The strengthening exercises were a floor abdominal sit-up exercise , a dynamic back extension exercise , a leg-press exercise , a latissimus pull-down exercise , and st and ing up from a low chair .  Participants in the grade d activity group had to perform not only these general exercises but also individually tailored exercises , which imitated physical tasks at work or difficult and painful activities of daily living . For example , a participant who reported back problems while lifting and moving suitcases from a luggage wagon into an airplane might be given an exercise to practice lifting and moving a suitcase with a certain number of repetitions . During the first 3 sessions , the maximal performance ( for example , the maximum number of repetitions ) was assessed for each exercise separately , and the average score for each exercise over the 3 sessions was used as a baseline value for specifying a gradually progressive exercise scheme . Subsequently , the participant was asked to propose a date for full return to regular work , which would consequently be the end point of the physical exercise program . Before returning to full regular work , participants could return to work with modified hours and duties . Advised by the physiotherapist , the participant The objectives of this study were to investigate the maximum holding times ( MHT ) of two highly stressful postures : st and ing in a forward bend position and performing elevated work in a st and ing position . The relationship between perceived exertion and MHT was also studied . Subjects were 44 young adults , age 20–29 years ( 25 female , 19 male ) . A test-retest design was used to establish reliability . Mean maximum holding times for forward bending and elevated work were respectively 14.51 and 16.18 min with large interindividual variations . A logarithmic rather than a linear relation between perceived exertion and performance is found . It is not possible to reliably predict MHTs from subjective data . Test-retest correlation is high ( n = 19 , r = 0.716 and 0.813 , p < 0.001 ) , and the scores did not differ significantly ( p < 0.005 ) , indicating a reliable procedure . The average holding times of the population studied are higher than expected from literature . Neither generic formulas , curve estimations , or predictions can reliably predict an individual 's MHT . An individual 's MHTs are best tested through performance based testing OBJECTIVES To establish inter- and intra-rater reliability of observations in a functional capacity evaluation . BACKGROUND Functional capacity evaluations are used to assess a person 's functional capacity as it relates to work . Lifting and carrying are important aspects of a functional capacity evaluation . An evaluator determines the patient 's levels of effort through st and ardized observations . Questions remain with regards to the reliability of these observations . METHODS Four healthy subjects were videotaped while performing two lifts and four carries with progressive loads . The videotape was scrambled r and omly and viewed twice by 3 physical therapists and 2 occupational therapists . The evaluators determined the amount of effort it required ( light , medium , heavy , and maximum ) . The inter- and intra-rater reliability of the observations was expressed by means of percentage agreement . RESULTS Inter-rater reliability ranged 87 - 96 % , intra-rater reliability ranged 93 - 97 % . CONCLUSION The results indicate that by means of st and ardized observations , therapists can reliably determine effort level during lifting and carrying in healthy subjects , and thus affirm the findings of other studies of similar design The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders ( WRULD FCE ) . The study sample included 33 healthy adults , consisting of 14 males and 19 females with a mean age of 29.2 years . The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements , duration , working in awkward positions , forceful movements and static postures . Two FCE sessions were held with a 10-day interval . Means , 95 % confidence intervals , one-way r and om Intraclass Correlation Coefficients ( ICCs ) , 95 % limits of agreement and repeated measures were calculated . An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability . The results showed that 14 of 26 items ( 54 % ) had excellent reliability , 9 of 26 items ( 35 % ) had good reliability and 3 of 26 items ( 11 % ) had moderate reliability based on ICC values . Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test . It is concluded that the WRULD FCE is reliable in healthy adults BACKGROUND Systematic review s have confirmed the effectiveness of work-related rehabilitation with significant cognitive-behavioural components for patients with musculoskeletal disorders ( MSD 
    Output:
    
Conclusions Weight h and ling and strength tests were found to have consistently acceptable reliability .