***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: Study Design . A question naire was mailed to 3000 r and omly selected 35‐45‐year‐old individuals in three communities in central Sweden . Objectives . To study the 1‐year prevalence of spinal pain and its ramifications in the form of pain , function , sick leave , and health care use . Summary of Background Data . Previous research ers have used a variety of definitions and population s , but primarily have investigated the occurrence of pain . Comprehensive data are needed concerning health care use , the degree of the pain problem , functional disturbances , and sick leave . Method . Participants in the study completed a question naire regarding spinal pain during the past year including the degree of their experienced pain , functional impairment , lost work days , and health care use . Results . A total of 2305 people ( 78.5 % ) responded to the question naire . Nonrespondents had similar characteristics but a slightly lower 1‐year prevalence rate than did respondents . For respondents , the prevalence of spinal pain during the past year was 66.3 % , with women having a slightly higher prevalence than men . Approximately 25 % of the respondents indicated that they had a substantial problem based on ratings of pain , functional impairment , and sick leave . Work absenteeism reported to the Public Social Insurance Office involved 19 % of those with pain , but an additional 15 % indicated unreported absenteeism . On average , those with pain visited health care providers three times during the past year , but a small number of those who experienced pain consumed large amounts of health care and illness benefits . An important gender difference was shown , such that when pain was at its worst , men took sick leave , whereas women sought health care . Conclusions . Taken together , these data indicate that spinal pain is common among 35‐45‐year‐old men and ‐ women , and that it is related to marked problems for approximately one fourth of those who experience pain . Gender differences exist in the pattern of sick leave and health care use , and a small proportion of those with pain consume very large amounts of the re sources . Consequently , there is a need for early , effective , preventive treatments Abstract The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment . The aims of the study were to identify prognostic factors for disability at 1‐year follow‐up in patients with back pain visiting primary care , and to compare the effect of these in two treatment strategies – chiropractic and physiotherapy . Data were taken from a r and omised trial on patients with back/neck pain visiting the general practitioner , in which patients were allocated to chiropractic and physiotherapy as primary management .  Three hundred and twenty‐three patients , aged 18–60 years , who had no contraindications to manipulation and who had not been treated within the previous month were included in the study . Multiple regression analysis was used to identify prognostic factors . Dependent variables were mean Oswestry score and mean change in Oswestry score at 12‐month follow‐up . The multiple regression analysis revealed five significant ( P<0.001–0.01 ) prognostic factors ; duration of current episode , Oswestry score at entry , expectations of treatment , number of localisations , and well‐being . Besides , the regression coefficients for the significant factors were compared between the two treatment strategies . No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies . Twelve per cent of the patients had poor prognostic factors ( duration ≥1 month , more than one localisation , low expectations of treatment and low well‐being ) at entry . These patients had a mean Oswestry score above 20 % at 1‐year follow‐up . Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospect ively evaluated We have conducted a prospect i ve trial of the management of 135 adult patients who had sustained soft-tissue injuries of the neck in vehicle accidents .  Early traction and physiotherapy was compared with rest in a collar and unsupervised mobilisation . No benefit from the active treatment could be identified ; moulded collars in slight flexion gave the best pain relief and are recommended From January 1993 to December 1996 , we treated 482 cases of cervical spondylopathy with a combined method of point-injection and needle-warming via moxibustion . Except for the cases of sympathetic nerve type and spinal cord type , the combined method was superior to traction therapy in the control group and reported as follows . Clinical Data The Criteria of Diagnosis and Curative Effect in TCM issued by the State Administrative Bureau of TCM and Pharmacy in 1994 was adopted for the enrollment of patients of cervical spondylopathy and the pathological typing . Only the patients who had completed the treatment and with complete records were collected for analysis A prospect i ve , controlled clinical trial was undertaken to assess the relative efficacies of physiotherapy and electroacupuncture in the treatment of cervical spondylosis . The results suggested that , while both methods were effective , electroacupuncture produced an earlier symptomatic improvement with increased neck movement , especially in patients with mild degenerative changes of the cervical spine A r and omized clinical trial was conducted to evaluate the efficacy of three commonly employed forms of traction in the treatment of cervical spine disorders . One hundred consenting men and women with disorders of the cervical spine were r and omly assigned to one of four treatment groups , static traction , intermittent traction , manual traction , or no traction . All patients , regardless of group assignment , were seen twice weekly . The four groups were shown to be similar with regard to age , sex , diagnosis , chronicity , and prescores on the seven outcome measures . Although the entire cohort of neck patients , regardless of group assignment , improved significantly on all the outcome variables over the 6-week period , patients receiving intermittent traction performed significantly better than those assigned to the no traction group in terms of pain ( P = 0.03 ) , forward flexion ( P = 0.01 ) , right rotation ( P = 0.004 ) and left rotation ( P = 0.05 ) Methods of sample size and power calculations are review ed for the most common study design s. The sample size and power equations for these design s are shown to be special cases of two generic formulae for sample size and power calculations . A computer program is available that can be used for studies with dichotomous , continuous , or survival response measures . The alternative hypotheses of interest may be specified either in terms of differing response rates , means , or survival times , or in terms of relative risks or odds ratios . Studies with dichotomous or continuous outcomes may involve either a matched or independent study design . The program can determine the sample size needed to detect a specified alternative hypothesis with the required power , the power with which a specific alternative hypothesis can be detected with a given sample size , or the specific alternative hypotheses that can be detected with a given power and sample size . The program can generate help messages on request that facilitate the use of this software . It writes a log file of all calculated estimates and can produce an output file for plotting power curves . It is written in FORTRAN-77 and is in the public domain Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases with age . More women experience high‐disability neck pain than men . Wave analysis suggests that the point prevalence and 6‐month prevalence of high‐intensity and low‐disability neck pain are overestimated in this survey . Conclusion . This cross‐sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) of the adult population A new design of cervical traction modality with closed loop traction weight control based on electromyographic ( EMG ) biofeedback was developed . It consists of the development of a high signal-to-noise ratio EMG scanner , on-line self-adjusted traction weight controller , computer interface hardware , and closed loop biofeedback control software . Six healthy , young adults received conventional cervical traction  to establish basic information of cervical EMG activities . Twenty-four patients with cervical radiculopathy were r and omly divided into two groups for clinical assessment by conventional and new EMG biofeedback traction modality . The average electromyographic activity in healthy subjects ranged from 2.41 to 3.49 microV , whereas EMG activity in patients with neck pain ranged from 4.75 to 6.97 microV. There was a significant decrease of EMG activity during the whole traction phase , especially at pull phase in healthy subjects , but it was not as significant in patients with cervical radiculopathy . There was no significant change of myoelectric activity in the paraspinal muscles at vertebral levels C1 - 2 , C3 - 4 , and C5 - 6 . Comparison of the average EMG activity of the paraspinal C-5 muscle in different phases of cervical traction showed a more significant decrease of EMG activity during the pull phase of traction as well as after traction in the high muscle tension group ( with EMG activity above 5 microV ) , especially with the biofeedback traction modality . The raised traction force from start to optimum was shortened from 4 to 2 wk to achieve the same effective outcome by biofeedback as conventional traction modality An intermittent cervical traction modality with closed-loop traction force control based on EMG biofeedback was developed and used for clinical study . This system consists of a EMG scanner , on-line self-adjusted traction force controller , audio/video alarm system , real time therapeutic status display , computer interface hardware , and control software . Twenty-four subjects with diagnosed cervical radiculopathy and muscle spasm symptom who were r and omly divided into two groups served as subjects in this study . The control and experimental groups were treated with conventional open loop and new EMG biofeedback closed loop traction control protocol s respectively . The results of this study indicate that the average reductions in paraspinal EMG signal during traction after 7 weeks treatment for experimental and control groups were 71 and 50 percent , respectively ( p < 0.001 ) . These results not only support the clinical use of intermittent , sitting traction to produce cervical paraspinal muscle relaxation , but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment . Through EMG biofeedback traction force control , muscle injury , neck soreness , or pain after traction may be avoided This study was design ed to determine a cost-effective use of psychologist re sources in multimodal cognitive-behavioural treatments ( MMCBT ) for chronic neck/shoulder pain . A r and omised controlled trial was conducted with 66 patients divided in two groups . The first group ( A ) was treated following the approach of MMCBT with the clinical psychologist only functioning as a " coach " to the other health professionals . In this group , the psychologist had on average 5 hours of input per patients . The second group ( B ) was treated with the same inpatient MMCBT but with the behavioural component administered by the clinical psychologist directly to the patients . In this second group the psychologist had on average 17 hours of input per patient in the entire intervention . The outcome variables included physical , emotional and social factors , and sick-leave . Both groups showed significant improvements over time . The improvements were evident only in sub-groups , specifically in women . The only significant difference between the groups was in " perceived helplessness " favouring the " psychologist contact " setting . It is concluded that in terms of input of clinical psychology , the treatment setting with the " coaching " technique proved to be the most cost-effective use of the psychologist in the two treatment setting s investigated A r and omised clinical trial was conducted in the Department of Physical Medicine , Chittagong Medical College Hospital from July , 2001 to June , 2002 . The objectives of the study were to find out the effects of cervical traction ( CT ) and exercise on the patients with chronic cervical spondylosis . A total of 199 patients with cervical spondylosis were included in the clinical trial . One hundred patients were treated with cervical traction plus exercise and 99 patients were treated with non-steroidal anti-inflammatory drug ( NSAID ) . Posture correction advice was given to all patients . The patients were treated for 6 weeks . There was a marked improvement in both the groups after treatment ( P<0.001 ) . But there was nearly significant difference regarding improvement in treatment with CT plus exercise  than with NSAID ( P 
    Output:
    
Our review revealed low- quality trials for mechanical neck disorders , showing evidence of benefit favouring intermittent traction for pain reduction .
Continuous traction showed no significant difference for defined outcomes .