***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: Objectives : To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain . Design : A cluster r and omised controlled trial comparing an active strategy with st and ard dissemination . Setting : Primary care physiotherapy practice s. Participants : 113 physiotherapists were r and omly allocated to receive the guidelines by mail ( control group ) or to receive an additional active strategy ( intervention group ) which consisted of a multifaceted programme including education , discussion , role playing , feedback , and reminders . Main outcome measures : Adherence to the guidelines was measured by means of individual patients ’ forms recording the treatment completed by the physiotherapist . The forms were assessed using an algorithm based on the number of treatment sessions , treatment goals , interventions , and patient education . Results : Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain ( OR 2.39 ; 95 % CI 1.12 to 5.12 ) , more often set functional treatment goals ( OR 1.99 ; 95 % CI 1.06 to 3.72 ) , more often used mainly active interventions ( OR 2.79 ; 95 % CI 1.19 to 6.55 ) , and more often gave adequate patient education ( OR 3.59 ; 95 % CI 1.35 to 9.55 ) . They also adhered more to all four criteria ( OR 2.05 ; 95 % CI 1.15 to 3.65 ) . Conclusions : The active strategy moderately improved adherence to the guidelines . Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain Abstract Objective To examine the extent and nature of outcome reporting bias in a broad cohort of published r and omised trials . Design Retrospective review of publications and follow up survey of authors . Cohort All journal articles of r and omised trials indexed in PubMed whose primary publication appeared in December 2000 . Main outcome measures Prevalence of incompletely reported outcomes per trial ; reasons for not reporting outcomes ; association between completeness of reporting and statistical significance . Results 519 trials with 553 publications and 10 557 outcomes were identified . Survey responders ( response rate 69 % ) provided information on unreported outcomes but were often unreliable — for 32 % of those who denied the existence of such outcomes there was evidence to the contrary in their publications . On average , over 20 % of the outcomes measured in a parallel group trial were incompletely reported . Within a trial , such outcomes had a higher odds of being statistically non-significant compared with fully reported outcomes ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.7 ) for efficacy outcomes ; 1.9 ( 1.1 to 3.5 ) for harm outcomes ) . The most commonly reported reasons for omitting efficacy outcomes included space constraints , lack of clinical importance , and lack of statistical significance . Conclusions Incomplete reporting of outcomes within published articles of r and omised trials is common and is associated with statistical non- significance . The medical literature therefore represents a selective and biased subset of study outcomes , and trial protocol s should be made publicly available BACKGROUND AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved Objectives To provide information on the frequency and reasons for outcome reporting bias in clinical trials . Design Trial protocol s were compared with subsequent publication(s ) to identify any discrepancies in the outcomes reported , and telephone interviews were conducted with the respective trialists to investigate more extensively the reporting of the research and the issue of unreported outcomes . Participants Chief investigators , or lead or co authors of trials , were identified from two sources : trials published since 2002 covered in Cochrane systematic review s where at least one trial analysed was suspected of being at risk of outcome reporting bias ( issue 4 , 2006 ; issue 1 , 2007 , and issue 2 , 2007 of the Cochrane library ) ; and a r and om sample of trial reports indexed on PubMed between August 2007 and July 2008 . Setting Australia , Canada , Germany , the Netherl and s , New Zeal and , the United Kingdom , and the United States . Main outcome measures Frequency of incomplete outcome reporting — signified by outcomes that were specified in a trial ’s protocol but not fully reported in subsequent publications— and trialists ’ reasons for incomplete reporting of outcomes . Results 268 trials were identified for inclusion ( 183 from the cohort of Cochrane systematic review s and 85 from PubMed ) . Initially , 161 respective investigators responded to our requests for interview , 130 ( 81 % ) of whom agreed to be interviewed . However , failure to achieve subsequent contact , obtain a copy of the study protocol , or both meant that final interviews were conducted with 59 ( 37 % ) of the 161 trialists . Sixteen trial investigators failed to report analysed outcomes at the time of the primary publication , 17 trialists collected outcome data that were subsequently not analysed , and five trialists did not measure a prespecified outcome over the course of the trial . In almost all trials in which prespecified outcomes had been analysed but not reported ( 15/16 , 94 % ) , this under-reporting result ed in bias . In nearly a quarter of trials in which prespecified outcomes had been measured but not analysed ( 4/17 , 24 % ) , the “ direction ” of the main findings influenced the investigators ’ decision not to analyse the remaining data collected . In 14 ( 67 % ) of the 21 r and omly selected PubMed trials , there was at least one unreported efficacy or harm outcome . More than a quarter ( 6/21 , 29 % ) of these trials were found to have displayed outcome reporting bias . Conclusion The prevalence of incomplete outcome reporting is high . Trialists seemed generally unaware of the implication s for the evidence base of not reporting all outcomes and protocol changes . A general lack of consensus regarding the choice of outcomes in particular clinical setting s was evident and affects trial design , conduct , analysis , and reporting OBJECTIVE To test if basic training for  dietitians  in motivational interviewing ( MI ) result ed in changes in dietitians ' counseling style and improvements in their patients ' diet and risk parameters . DESIGN A r and omized controlled trial . SETTING 9 home-care organizations in the Netherl and s. PARTICIPANTS 37 dietitians , 209 baseline patients , and 142 follow-up diabetes patients . INTERVENTION Dietitians were r and omly allocated to receive basic training in motivational interviewing ( MI dietitians , n=18 ) or not ( control dietitians , n=19 ) . MAIN OUTCOME MEASURES Counseling style of dietitians ; total self-reported saturated fat , fruit , and vegetable intake , measured body mass index ( BMI ) , waist circumference , and glycated hemoglobin ( Hemoglobin A(1c ) , HbA(1c ) ) of patients . ANALYSIS Analyses of variance and multiple linear regression analyses . Alpha = .05 RESULTS MI dietitians were significantly more empathetic , more often showed reflection during consultations , and were more likely than control dietitians to let their patients talk for the majority of the consultation . Patients of MI dietitians had significantly lower saturated fat intake levels at posttest compared to patients of control dietitians . No effects on HbA(1c ) , BMI , and waist circumference were found . CONCLUSIONS AND IMPLICATION S Basic training in MI changed the dietitians ' counseling style and result ed in lower saturated fat intakes in their patients INTRODUCTION Online data bases can support the implementation of evidence -based practice by providing easy access to research . OTseeker ( http://www.otseeker.com ) , an electronic evidence data base , was introduced in 2003 to assist occupational therapists to locate and interpret research . OBJECTIVES This study explored Australian occupational therapists ' use and perceptions of OTseeker and its impact on their knowledge and practice . METHODS A postal survey question naire was distributed to two sample s : ( i ) a proportionate r and om sample of 400 occupational therapists from all states and territories of Australia , and ( ii ) a r and om sample of occupational therapists working in 95 facilities in two Australian states ( Queensl and and New South Wales ) . RESULTS The question naire was completed by 213 participants . While most participants ( 85.9 % ) had heard of OTseeker , only 103 ( 56.6 % ) had accessed it , with lack of time being the main reason for non-use . Of the 103 participants who had accessed OTseeker  , 68.9 % had done so infrequently , 63.1 % agreed that it had increased their knowledge and 13.6 % had changed their practice after accessing information on OTseeker . CONCLUSION Despite OTseeker being developed to provide occupational therapists with easy access to research , lack of time was the main reason why over half of the participants in this study had not accessed it . This exploratory research suggests , however , that there is potential for the data base to influence occupational therapists ' knowledge and practice about treatment efficacy through access to the research literature Objective The aim of this research was to assess the effects of a series of four training courses comprised of 13 synchronous videoconferences on the implementation of cognitive services in Spanish community pharmacies . Setting A phone survey to continuing training course attendants . Methods A r and om sample of 225 pharmacists registered in a 2004 videoconference course was selected . The phone-survey question naire included quality perception elements rated on a 5-point Likert scale , and a series of questions used to identify position in the Rogers 5-step innovation – decision model . An algorithm was used to translate the questions into Rogers ’ categories . To discover determinants of attendants position in these categories , bivariate analysis , simple correspondence analysis , and logistic regressions were performed . Main outcome measure Position in Rogers ’ diffusion of innovation steps regarding the adoption of pharmacotherapy follow-up . Results The perception of the course quality rated between good and very good for the majority of respondents . A significant association between having attended two or more of these four courses and the Persuasion/Decision step in Rogers ’s model appeared . No association was found between course attendance and the Implementation/Confirmation step of patient follow-up . Fifty percent of those who indicated they implemented the service reported following-up with less than 10 patients , and only 25 % reported following up with more than 20 patients . Conclusions Although participation in these courses was associated with higher steps in Rogers ’ model , significant association appeared only with Persuasion/Decision steps and not with the Implementation/Confirmation step , reflecting an attitude but not a performance change QUESTION Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash ? DESIGN Cluster-r and omised trial . PARTICIPANTS Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients ( 4 dropouts ) who presented to them with acute whiplash . INTERVENTION The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them . OUTCOME MEASURES The primary outcome was patient disability , measured using the Functional Rating Index , collected on admission to the trial and at 1.5 , 3 , 6 and 12 months . Physiotherapist knowledge about the guidelines was measured using a custom-made question naire . Physiotherapist practice and cost of care were measured by audit of patient notes . RESULTS There were no significant differences between groups for any of the patient outcomes at any time . The implementation patients had 0.6 points ( 95 % CI -7.8 to 6.6 ) less disability than the dissemination patients at 12 months ; 44 % more physiotherapists in the implementation group reported that they prescribed two out of the five guideline -recommended treatments ; and 32 % more physiotherapists actually prescribed them . The cost of care for patients in the implementation group was $ 255 ( 95 % CI -1505 to 996 ) less than for patients in the dissemination group . CONCLUSION Although the active implementation program increased guideline -consistent practice , patient outcomes and cost of care were not affected Summary .¶ Objectives : The periconceptional intake of 0.4 mg folic acid is recommended in many countries to prevent neural tube defects . This paper describes the poor implementation of corresponding guidelines in Germany , the effectiveness of an intervention-based on providing adequate information and the problems associated with the implementation.¶ Methods : Two cross sectional studies investigated knowledge , attitude , and behaviour of 
    Output:
    
Conclusions Across five allied health professions , equivocal results , low method ological quality , and outcome reporting bias limited our ability to recommend one KT strategy over another .