***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: BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Background Chronic non-specific low-back pain ( LBP ) is one of the most common and expensive musculoskeletal disorders in industrialized countries . Similar to other countries in the world , LBP is a common health and socioeconomic problem in Iran . One of the most widely used modalities in the field of physiotherapy for treating LBP is therapeutic ultrasound . Despite its common use , there is still inconclusive evidence to support its effectiveness in this group of patients . This r and omised trial will evaluate the effectiveness of continuous ultrasound in addition to exercise therapy in patients with chronic LBP . Methods and design A total of 46 patients , between the ages 18 and 65 years old who have had LBP for more than three months will be recruited from university hospitals . Participants will be r and omized to receive continuous ultrasound plus exercise therapy or placebo ultrasound plus exercise therapy . These groups will be treated for 10 sessions during a period of 4 weeks . Primary outcome measures will be functional disability and pain intensity . Lumbar flexion and extension range of motion , as well as changes in electromyography muscle fatigue indices , will be measured as secondary outcomes . All outcome measures will be measured at baseline , after completion of the treatment sessions , and after one month . Discussion The results of this trial will help to provide some evidence regarding the use of continuous ultrasound in chronic LBP patients . This should lead to a more evidence -based approach to clinical decision making regarding the use of ultrasound for LBP.Trial registration Netherl and s Trial Register ( NTR ) : Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain , spinal mobility , disability , psychological state , and aerobic capacity .  Sixty patients with chronic low back pain were r and omized to three groups : group 1 , aerobic exercise + home exercise ; group 2 , physical therapy ( hot pack , ultrasound , TENS ) + home exercise ; group 3 , home exercise only .  Spinal mobility , pain severity , disability , and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up . Aerobic capacities of the patients were measured before and after treatment . All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up , and there was no significant difference between the groups . In group 2 , a significant decrease in Beck Depression Inventory scores was observed with treatment . At 1-month follow-up , group 1 and 2 showed significant decreases in General Health Assessment Question naire scores . In group 2 , there was also a significant improvement in Rol and Morris Disability scores . There were similar improvements in exercise test duration and the MET levels in all the three groups . All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain . On the other h and , physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance OBJECTIVE --To compare the effectiveness of manipulative therapy , physiotherapy , treatment by the general practitioner , and placebo therapy in patients with persistent non-specific back and neck complaints . DESIGN --R and omised clinical trial . SETTING -- Primary health care in the Netherl and s. PATIENTS --256 patients with non-specific back and neck complaints of at least six weeks ' duration who had not received physiotherapy or manipulative therapy in the past two years . INTERVENTIONS --At the discretion of the manipulative therapists , physiotherapists , and general practitioners . Physiotherapy consisted of exercises , massage , and physical therapy ( heat , electrotherapy , ultrasound , shortwave diathermy ) . Manipulative therapy consisted of manipulation and mobilisation of the spine . Treatment by general practitioners consisted of drugs ( for example , analgesics ) , advice about posture , home exercises , and (bed)rest . Placebo treatment consisted of detuned shortwave diathermy ( 10 minutes ) and detuned ultrasound ( 10 minutes ) . MAIN OUTCOME MEASURES --Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients . RESULTS --Many patients in the general practitioner and placebo groups received other treatment during follow up . Improvement in the main complaint was larger with manipulative therapy ( 4.5 ) than with physiotherapy ( 3.8 ) after 12 months ' follow up ( difference 0.9 ; 95 % confidence interval 0.1 to 1.7 ) . Manipulative therapy also gave larger improvements in physical functioning ( difference 0.6 ; -0.1 to 1.3 ) . The global perceived effect after six and 12 months ' follow up was similar for both treatments . CONCLUSIONS --Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment . Furthermore , manipulative therapy is slightly better than physiotherapy after 12 months Background Non-specific chronic low back pain ( NSCLBP ) is one of the most common musculoskeletal disorders around the world including Iran . One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound ( US ) . Despite its common use , there is still inconclusive evidence to support its effectiveness in patients with NSCLBP . The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP . Methods In this single blind placebo controlled study , 50 patients with NSCLBP were r and omized into two treatment groups : 1 ) continuous US ( 1 MHz & 1.5 W/cm2 ) plus exercise 2 ) placebo US plus exercise . Patients received treatments for 4 weeks , 10 treatment sessions , 3 times per week , every other day . Treatment effects were assessed in terms of primary outcome measures : 1 ) functional disability , measured by Functional Rating Index , and 2 ) global pain , measured by a visual analog scale . Secondary outcome measures were lumbar flexion and extension range of motion ( ROM ) , endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test . All outcome variables were measured before , after treatment , and after one-month follow-up . An intention to treat analysis was performed . Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA . Results Analysis showed that both groups had improved regarding function ( FRI ) and global pain ( VAS ) ( P < .001 ) . Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group ( P > .05 ) . Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US ( P < .05 ) . Conclusions The study showed that adding continuous US to a semi supervised exercise program significantly improved function , lumbar ROM and endurance time . Further studies including a third group of only exercise and no US can establish the possible effects of placebo US.Trial registration Study Design . Multicenter r and omized , controlled trial . Objective . To compare two physical therapy programs for patients with lumbar spinal stenosis . Summary of Background Data . Scant evidence exists regarding effectiveness of nonsurgical management programs for lumbar spinal stenosis . Methods . Fifty-eight patients with lumbar spinal stenosis were r and omized to one of two 6-week physical therapy programs . One program included manual physical therapy , body weight supported treadmill walking , and exercise ( Manual Physical Therapy , Exercise , and Walking Group ) , while the other included lumbar flexion exercises , a treadmill walking program , and subtherapeutic ultrasound ( Flexion Exercise and Walking Group ) . Perceived recovery was assessed with a global rating of change scale . Secondary outcomes included : Oswestry , a numerical pain rating scale , a measure of satisfaction , and a treadmill test . Testing occurred at baseline , 6 weeks , and 1 year . Perceived recovery , pain , and other healthcare re sources used were collected with a long-term follow-up question naire . Results . A greater proportion of patients in the manual physical therapy , exercise , and walking group reported recovery at 6 weeks compared with the flexion exercise and walking group ( P = 0.0015 ) , with a number needed to treat for perceived recovery of 2.6 ( confidence interval , 1.8–7.8 ) . At 1 year , 62 % and 41 % of the manual therapy , exercise , and walking group and the flexion exercise and walking group , respectively , still met the threshold for recovery . Improvements in disability , satisfaction , and treadmill walking tests favored the manual physical therapy , exercise , and walking group at all follow-up points . Conclusions . Patients with lumbar spinal stenosis can benefit from physical therapy . Additional gains may be realized with the inclusion of manual physical therapy interventions , exercise , and a progressive body-weight supported treadmill walking program For ultrasound to be effective , a conducting medium must be placed between the soundhead and the skin . Little research has been performed to test whether or not these mediums actually work . The purpose of this study was to compare the effect of tap water immersion and ultrasound gel conducting mediums on tissue temperature rise in the human leg . A 23-gauge hypodermic needle microprobe was inserted 3 cm deep into the medial portion of the gastrocnemius muscle of 20 subjects . Each subject participated in two r and om order treatments using tap water immersion and topical gel conducting mediums . Each treatment consisted of continuous ultrasound delivered topically at 1.5 W/cm2 for 10 minutes . During both treatments , the soundhead was moved at a speed of 4 cm per second , and the temperature was recorded every 30 seconds . A significant difference was found between the two treatment methods [ t(19 ) = 9.18 , p < .001 ] . The topical gel increased tissue temperature 4.8 degrees C , whereas the underwater treatment increased tissue temperature only 2.1 degrees C. Therefore , at a tissue depth of 3 cm , ultrasound gel is a better conducting medium than water . Also , the authors discovered that it took nearly 8 minutes for the temperature to reach therapeutic levels during the gel technique . These findings should be of clinical significance to clinicians who regularly use ultrasound OBJECTIVES Some occupations are more prone to low back pain ( LBP ) due to their static work postures and work place design . Multidisciplinary pain programs have shown their effectiveness in the management of LBP in general population but which treatment and which segment of the population will be benefited more was not investigated yet . This study determines the effect of two treatment protocol s on five occupationally subgrouped male LBP patients . METHODS A total of 102 occupational male , 20 - 4 
    Output:
    
The studies comparing therapeutic ultrasound versus placebo or versus exercise alone did not report on overall satisfaction with treatment , or quality of life .
There was low quality evidence that spinal manipulation reduces pain and functional disability more than ultrasound over the short to medium term .
There is also very low quality evidence that there is no clear benefit on any outcome measure between electrical stimulation and therapeutic ultrasound ; and that phonophoresis results in improved SF-36 scores compared to therapeutic ultrasound .
None of the included studies reported on adverse events related to the application of therapeutic ultrasound .
AUTHORS ' CONCLUSIONS No high quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP .
There is some evidence that therapeutic ultrasound has a small effect on improving low-back function in the short term , but this benefit is unlikely to be clinical ly important .