***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 . Prospect i ve cohort study . Objective . To evaluate whether the DASH is not only a valid and responsive instrument to measure patients with shoulder , arm , and h and complaints , but also to evaluate patients with neck complaints . Summary of Background Data . The DASH has shown to be a valid and responsive question naire to evaluate disability in patients with shoulder , arm , and h and complaints . However , patients with shoulder , arm , or h and complaints frequently report neck complaints as well . Therefore , a valid and responsive question naire design ed for the whole upper extremity , including the neck , would be very useful and practical in upper-extremity research . Methods . Six hundred seventy-nine patients visiting their general practitioner with a new episode of nontraumatic complaints of the neck and upper extremity were evaluated by use of question naires at baseline and at 6-months follow-up . Six (sub)groups were formulated according to the location of complaints , including a subgroup with complaints in the shoulder-arm-h and region only and a group with complaints of the neck only . Disability ( DASH ) , general health [ SF-12 ( physical and mental component ) ] , severity , and persistence of complaints were assessed . Construct validity , floor and ceiling effects , and responsiveness were studied . Results . Correlations between the DASH  and the other measures within the 6 (sub)groups at baseline ( construct validity ) , for the change scores at 6-months follow-up ( responsiveness ) , and the responsiveness ratios were classified as acceptable . No floor and ceiling effects were found . Conclusion . The DASH performed well with regard to the a priori hypotheses . This study has shown acceptable validity and responsiveness of the DASH for use in patients with nontraumatic neck complaints in addition to shoulder , arm , and h and complaints . We would caution against using the DASH in patients with neck complaints only , since fewer of the hypotheses could be confirmed in this subgroup OBJECTIVE To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain . DESIGN Blinded comparison between spine kinematic variables , Oswestry disability question naire scores , and work status . SETTING Multidisciplinary occupational rehabilitation clinic of a university hospital . PATIENTS Population -based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain . INTERVENTIONS This study was part of a population -based r and omized clinical trial . Patients were r and omized to 4 different methods of management : usual care , rehabilitation , ergonomics , or rehabilitation and ergonomics . MAIN OUTCOME MEASURES Oswestry disability question naire , kinematic analysis of the spine during flexion and extension of the trunk , and work status were collected at weeks 4 , 12 , 24 , and 52 after the back accident . RESULTS Kinematic variables were poorly to moderately related to work status and Oswestry question naire scores . Kinematic variables were also unresponsive to change in work status and Oswestry question naire scores over time . CONCLUSION Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care Background : Epidemiological research in the field of soft tissue neck and upper limb disorders has been hampered by the lack of an agreed system of diagnostic classification . In 1997 , a United Kingdom workshop agreed consensus definitions for nine of these conditions . From these criteria , an examination schedule was developed and vali date d in a hospital setting . Objective : To investigate the reliability of this schedule in the general population . Methods : Ninety seven adults of working age reporting recent neck or upper limb symptoms were invited to attend for clinical examination consisting of inspection and palpation of the upper limbs , measurement of active and passive ranges of motion , and clinical provocation tests . A doctor and a trained research nurse examined each patient separately , in r and om order and blinded to each other 's findings . Results : Between observer repeatability of the schedule was generally good , with a median κ coefficient of 0.66 ( range 0.21 to 0.93 ) for each of the specific diagnoses considered . Conclusion : As expected , the repeatability of tests is poorer in the general population than in the hospital clinic , but the Southampton examination schedule is sufficiently reproducible for epidemiological research in the general population Objective : To investigate whether poor outcome after spinal pain episodes is linked with the cl aim process and , if so , whether this link is independent of other potential risk factors of chronic pain and disability in patients with spine‐related leg or arm pain . Methods : A 1‐year prospect i ve outcome study with internal control groups in two Danish secondary care , public , multidisciplinary , non‐surgical spine clinics . Patients with low back pain ( LBP ) radiating to the leg ( n = 1243 ) or with neck and arm pain thought to emanate from the neck ( n = 202 ) were referred to the clinics by their general practitioners . Rheumatologists , physiotherapists , and nurses examined , treated , and informed the patients based on cognitive principles . Follow‐up data were collected with a postal question naire . Cl aim , defined as seeking some sort of financial compensation or filing any sort of financial cl aim , such as workers ' compensation , was the main independent variable . Potential confounders examined were : age , sex , social class , smoking , duration and severity of pain and disability . The main outcome measures were : global assessment ( main outcome variable ) , pain , disability , and intake of analgesics . Results : Financial cl aims were registered by 31 % of patients . After adjustment for covariates , the odds ratio for cl aim and no improvement was calculated to be 4.2 ( 95 % CI 2.8–6.2 ) for the LBP/leg patients and 17.4 ( 95 % CI 5.1–60.1 ) for the neck/arm patients . Conclusion : A cl aim for financial compensation is strongly and independently linked with a poor prognosis for Danish patients with pain radiating from the low‐back or neck Incidence densities in primary care are often based on disease or region-specific code registration ( e.g. ' epicondylitis ' , ' shoulder symptom ' ) according to the International Classification of Primary Care ( ICPC ) . Few estimates are available on arm , neck and shoulder complaints . Unknown , is the proportion missed due to registration with a non-region-specific code ( e.g. ' muscle pain ' ) . Therefore , we estimated the incidence in non-traumatic arm , neck and shoulder complaints in the age-group 18 - 64 years , and determined the contribution of non-specific codes to the total figure . In this prospect i ve registration study , 21 general practitioners ( GPs ) from 13 Dutch general practice s  classified and registered patient 's symptoms and diagnoses according to ICPC at each consultation during 12 consecutive months . Incidence densities were calculated . The incidence density was 97.4/1000 person-years ( 95 % CI : 91.2 - 103.7 ) . This results in 147 ( 95 % CI : 138 - 157 ) incident cases/year for an average-sized GP- practice ( 2350 patients ) . Main contributors were : shoulder ( L92 , L08 ) and neck complaints ( L01 , L83 ) . Of all incident consultations , 23 % were registered with non-region-specific codes , mainly ' other musculoskeletal disease ' ( L99 ) . Non-traumatic complaints of arm , neck and shoulder are frequently consulted for in Dutch primary care . When estimating morbidity in primary care , based on diagnostic codes , one should be aware of possible underestimation of morbidity and corresponding workload , when excluding codes not specific for that region or disease 
    Output:
    
There is a strong relationship between  neck pain ( NP ) and upper limb disability ( ULD ) .