***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 posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness , which persist despite st and ard rehabilitation programs of occupational and physical therapy . We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury . We assessed the changes in leg muscle strength and lean body mass in severely burned children with > 40 % total body surface area burned . Patients were r and omized to a 12-wk st and ard hospital rehabilitation program supplemented with an exercise training program ( n = 19 ) or to a home-based rehabilitation program without exercise ( n = 16 ) . Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150 degrees /s . Lean body mass was assessed using dual-energy X-ray absorptiometry . We found that the participation in a resistance exercise program results in a significant improvement in muscle strength , power , and lean body mass relative to a st and ard rehabilitation program without exercise The purpose of this study was to compare the efficacy and effects of exercise programming ( Study group , n = 11 ) vs traditional outpatient therapy ( Home group , n = 10 ) in burned children ( > 40 % body surface area ) . This was a prospect i ve , r and omized , controlled trial in a hospital-based children 's wellness center . Twenty-one patients ( 13 boys and 8 girls ) averaging 10.6 + /- 0.9 years and TBSA = 59.7 + /- 3.1 % were evaluated 6 and 9 months postburn .  Moderate intensity , progressive resistance and aerobic exercise conducted 3 times weekly for 1 hour were a supplement to st and ard therapy over 12 weeks . Muscular strength and functional outcome significantly increased in both groups ( P < .05 ) . Improvements in strength ( 80.1 vs 37.7 % ) and distance walked ( 39.5 vs 12.5 % ) were significantly greater for Study vs Home groups , respectively , P < .05 . We conclude that exercise programming may be safely included in rehabilitation programs for severely burned children and can be effective in increasing muscular strength and functional outcome OBJECTIVES . Severe burns are associated with a significant loss of muscle and strength . Studies have reported that ox and rolone improves lean body mass in muscle-wasting conditions . Also shown previously in burned children is that an exercise program increases lean body mass and muscle strength . We hypothesized that ox and rolone , in combination with exercise , would increase lean body mass and muscle strength in severely burned children more than ox and rolone alone or exercise alone . METHODS AND PATIENTS . Fifty-one burned children ( ≥40 % total body surface area burned ) were r and omly assigned to receive ox and rolone alone ( 0.1 mg/kg per day orally ; n = 9 ) , ox and rolone and exercise ( n = 14 ) , placebo and no exercise ( n = 11 ) , or placebo and exercise ( n = 17 ) . Administration of ox and rolone was started at discharge and continued until 1 year after burn . The 12-week exercise training program was started 6 months after burn . Serum hormones , lean body mass , muscle strength , and peak cardiopulmonary capacity were assessed at 6 ( baseline ) and 9 months after burn . Data were analyzed using a 1-way analysis of variance , and significance was set at P < .05 . RESULTS . The mean percentage of change or increase in weight and lean body mass in the ox and rolone and exercise group was significant compared with placebo and exercise , as well as with the ox and rolone alone group or placebo and no exercise group . Furthermore , lean body mass was significantly improved in the ox and rolone and exercise , ox and rolone alone , and placebo and exercise group compared with the group only receiving placebo . Muscle strength significantly increased in ox and rolone and exercise , placebo and exercise , and the ox and rolone alone group when compared with the placebo and no exercise group . The peak cardiopulmonary capacity was significantly higher in both exercise groups . Insulin-like growth factor 1 was significantly increased in the ox and rolone alone group compared with placebo and exercise and placebo and no exercise . Both exercise groups showed significant changes in insulin-like binding-protein-3 when compared with groups without exercise . CONCLUSIONS . Ox and rolone , in combination with exercise , is beneficial in severely burned children , thus improving their rehabilitation QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists OBJECTIVE To report physical and psychologic outcomes for young adult survivors of pediatric burns . DESIGN Prospect i ve , correlational study . SETTING Acute and rehabilitation pediatric burn care facility . PARTICIPANTS Eighty-three young adult survivors of pediatric burns , who were 18 to 28 years of age , with total body surface area ( TBSA ) burns of 30 % or greater , and were at least 2 years postburn . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Physical outcomes were assessed by muscle strength tests , grip and pinch measurements , mobility levels , and self-care ( activities of daily living ) skills . Psychologic outcomes included behavioral problems , personality disorder , and incidence of psychiatric illness . An individually administered Structured Clinical Interview for Diagnosis , based on the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition , for psychiatric diagnosis , was used to assess mental health , and behavioral problems were assessed with the Young Adult Self-Report . Participants reported educational achievement , employment status , state of transition from family of origin ( home ) to independent living , and pair bonding . The  Short-Form 36-Item Health Survey and the Quality of Life Question  naire were used to assess each participant 's self-reported general health and quality of life . RESULTS The majority of subjects had physical and psychologic outcomes that were within the normal range when compared with age-mates who had not experienced burns . The areas that were most likely to be impaired involved peripheral strength ( wrist and grip ) . These deficits affected some self-care skills and correlated with TBSA . St and ardized diagnostic interviews showed that greater than 50 % of subjects qualified for a psychiatric diagnosis , with anxiety disorders as the most frequently occurring diagnosis . There were few significant correlations of the physical measurements or self-care skills with the burn size , psychologic problems , or social outcomes , and none appeared to be clinical ly important . CONCLUSIONS Most of the people in this sample were functioning physically and psychosocially within normal limits as they reached adulthood . Although they appeared to function well as measured by st and ardized assessment s , there were indications of private suffering that suggested they may not be functioning at an optimal level . The findings suggest that rehabilitation professionals could improve outcomes by including programs to develop overall muscle strength in severely burned children and by addressing concerns related to anxiety and other symptoms of psychologic distress OBJECTIVE The aim of this study was to investigate the effects of isokinetic training program on muscle strength , muscle size and gait parameters after healed pediatric burn . DESIGN R and omized controlled trial . SUBJECTS Thirty three pediatric burned patients with circumferential lower extremity burn with total body surface area ( TBSA ) ranging from 36 to 45 % , and ages from 10 to 15 years participated in the study and were r and omized into isokinetic group and a control group . Non-burned healthy pediatric subjects were assessed similarly to burned subjects and served as matched healthy controls . METHODS Patients in the isokinetic group ( n=16 ) participated in the isokinetic training program for 12 weeks for quadriceps dominant limb , 3 times per week , at angular velocity 150 ° /s , concentric mode of contraction , time rest between each set for 3 min , 3 sets/day and control group ( n=17 ) participated in home based physical therapy exercise program without isokinetic . MAIN MEASURES Assessment of quadriceps strength by isokinetic dynamometer , quadriceps size and gait parameters were performed at baseline and at the end of the training period for both groups . RESULTS Patients in isokinetic group showed a significant improvement in quadriceps strength , quadriceps size and gait parameters as compared with those in the control group . Quadriceps strength and percentage of improvement was 79.25 ± 0.93 Nm ( 68.40 % ) for isokinetic group and 51.88 ± 1.31 Nm ( 9.84 % ) for the control group . Quadriceps size and percentage of improvement was 31.50 ± 0.89 cm ( 7.47 % ) for isokinetic group and 29.26 ± 1.02 cm ( 1.02 % ) for the control group . Stride length , step length , velocity and cadence and percentage of improvement for isokinetic group was 135.50 ± 2.82 ( 53.97 % ) , 63.25 ± 2.97 ( 63.77 % ) , 135.94 ± 1.65 ( 81.42 % ) , 137.63 ± 1.36 ( 66.96 % ) and for the control group was 94.00 ± 2.69 ( 6.68 % ) , 43.76 ± 1.34 ( 15.15 % ) , 81.11 ± 1.91 ( 8.6 % ) , 90.35 ± 1.32 ( 9.01 % ) respectively . CONCLUSIONS Participation in the isokinetic training program result ed in a greater improvement in quadriceps muscle strength , size and gait parameters in pediatric burn 
    Output:
    
Conclusions There is no conclusive evidence to support the benefit of strength training for children and adolescents with burns injuries in terms of muscle strength and LBM .