***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 Reflexology is an ancient , mild and non-invasive technique , used widely as one of the non-pharmacological methods for pain relief . The aim of this research was to determine the effect of reflexology on pain intensity as well as to determine the duration of labor  in primiparas . Methods In 2008 , a r and omized clinical trial study was conducted r and omly enrolling 120 parturient women with low risk pregnancy into three groups in Shahid Akbarabadi Hospital , Tehran , Iran . The first group received 40 minutes of reflexology at the beginning of active phase ( 4 - 5 cm cervical dilatation ) . Emotional support was offered for the second group in the same stage of pregnancy and with the same duration . The third group received only routine care during labor .  Pain severity was evaluated with visual analogue scale ( 0 to 10 cm ) . In all groups , pregnant women were asked to evaluate the severity of pain experienced before and after intervention and also at cervical dilatations of 6 - 7 cm and 8 - 10 cm respectively . Data were collected through the numerical pain scale . Results Pain intensity at all the three stages of cervical dilatation was significantly lower in the reflexology group . During the 4 - 5 cm dilatation stage , women in the supported group reported less severe pain compared to those receiving routine care , but no significant differences at the later stages of labor . This indicates that reflexology could decrease the duration of first , second and third stages of labor . Conclusion Our findings showed that reflexology can be useful to decrease the pain intensity as well as duration of labor CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient The objectives of this study is to examine the effects of neuromuscular therapy ( NMT ) on motor and nonmotor symptoms in Parkinson 's disease ( PD ) . Thirty-six subjects with PD were r and omly assigned to NMT or music relaxation ( MR , or active control ) . Subjects received treatment twice a week for 4 weeks . Testing was conducted at baseline , after final treatment , and 8 days after final treatment . Primary outcome measures were the Motor subscale of the United Parkinson Disease Rating Scale ( UPDRS ) and the Clinical Global Impression scale ( CGI-Change ) . Secondary outcome measures included a PD-specific quality of life scale ( PDQ-39 ) , quantitative measures of motor function , and severity scales for anxiety and depression symptoms . NMT result ed in a significant and sustained improvement in the Motor subscale of the UPDRS ( P < or = 0.0001 ) , most notable in the tremor scores . Also improved 1 week after the last treatment were the CGI scores ( P = 0.007 ) and the finger-tapping speed ( P = 0.001 ) . The MR active control group had a slight improvement in tremor but evidence d no other change in motor function . Both groups exhibited a modest improvement in quality of life immediately after the last treatment . This effect was sustained for 8 days only in the MR group . In the nonmotor domains , the MR group evidence d improvements in mood ( P = 0.001 ) and anxiety ( P = 0.002 ) , whereas NMT had no effect on mood ( P = 0.09 ) , and its initial effect on anxiety ( P = 0.0009 ) dissipated after 8 days ( P = 0.40 ) . Group differences for UPDRS motor score and patient CGI-Change were superior in the NMT compared to the MR group . There was no group difference in PDQ-39 scores or in nonmotor measures . The findings suggest that NMT can improve motor and selected nonmotor symptoms in PD and that this effect is more durable for the motor symptoms . The results of this pilot study warrant larger controlled studies to examine dose range , durability , and mechanisms of NMT in PD function Purpose To investigate the effects of massage and presenting an attendant  on  pain , anxiety and satisfaction during labor to clarify some aspects of using an alternative complementary strategy . Methods 120 primiparous women with term pregnancy were divided into massage , attendant and control groups r and omly . Massage group received firm and rhythmic massage during labor in three phases . After 30 min massage at each stage , pain , anxiety and satisfaction levels were evaluated . Self-reported present pain intensity scale was used to measure the labor pain . Anxiety and satisfaction were measured with the st and ard visual analog scale . Results Massage group had lower pain state in second and third phases ( p < 0.05 ) in comparison with attendant group but reversely , the level of anxiety was lower in attendant group in second and third phases ( p < 0.05 ) and satisfaction was higher in massage group in all four phases ( p < 0.001 ) . The massage group had lower pain and anxiety state in three phases in comparison with control group ( p < 0.05 ) . Data analysis of satisfaction level showed higher values in four phases in massage group compared with control ( p < 0.001 ) and comparison of attendant and control groups showed higher satisfaction in attendant group in phases 2 , 3 and 4 as well ( p < 0.001 ) . Duration of active phase was lower in massage group ( p < 0.001 ) . Conclusions Findings suggest that massage is an effective alternative intervention , decreasing pain and anxiety during labor and increasing the level of satisfaction . Also , the supportive role of presenting an attendant can positively influence the level of anxiety and satisfaction QUESTION Does massage relieve pain in the active phase of labour ? DESIGN R and omised trial with concealed allocation , assessor blinding for some outcomes , and intention-to-treat analysis . PARTICIPANTS 46 women pregnant at ≥ 37 weeks gestation with a single fetus , with spontaneous onset of labour , 4 - 5 cm of cervical dilation , intact ovular membranes , and no use of medication after admission to hospital . INTERVENTION Experimental group participants received a 30-min lumbar massage by a physiotherapist during the active phase of labour . A physiotherapist attended control group participants for the same period but only answered questions . Both groups received routine perinatal care . OUTCOME MEASURES The primary outcome was pain severity measured on a 100 mm visual analogue scale . Secondary outcomes included the Short Form McGill Pain Question naire , pain location , and time to analgesic medication use . After labour , a blinded research er also recorded duration of labour , route of delivery , neonatal outcomes , and the participant 's satisfaction with the physiotherapist during labour . RESULTS At the end of the intervention , pain severity was 52 mm ( SD 20 ) in the experimental group and 72 mm ( SD 15 ) in control group , which was significantly different with a mean difference of 20 mm ( 95 % CI 10 to 31 ) . The groups did not differ significantly on the other pain-related outcome measures . Obstetric outcomes were also similar between the groups except the duration of labour , which was 6.8hr ( SD 1.6 ) in the experimental group and 5.7hr ( SD 1.5 ) in the control group , mean difference 1.1hr ( 95 % CI 0.2 to 2.0 ) . Patients in both groups were satisfied with the care provided by the physiotherapist . CONCLUSION Massage reduced the severity of pain in labour , despite not changing its characteristics and location Background : Labor pain is one of the severest pains that cause many women request cesarean section for fear of pain . Thus , controlling labor pain is a major concern of maternity care . Nowadays , interest in non-pharmacological pain relief methods has been increased because of their lower side effects . The effects of discrete heat and cold on decreasing labor pain have been reported but there was no evaluation of the effects of simultaneous heat and cold . The aim of this study was to investigate the effect of intermittent heat and cold on pain severity and childbirth outcomes . Material s and Methods : This study was a r and omized controlled trial . Sixty-four nulliparous women with term , One fetus , and low-risk pregnancy were divided into the intervention ( 32 participants ) and the control group ( 32 participants ) by r and om allocation . Excluding criteria were : administration of pain relief drugs , skin disease in the field of intervention , fetal distress , bleeding , fever , and disagreement with participation in the study . Warm and cold packs were used intermittently on low back and lower abdomen during the first phase and on perineum during the second phase of labor . Pain intensity was assessed with Visual Analogue Scale . Descriptive statistic , chi square , and t-test were used for data analysis . Results : There were no significant differences in demographic and midwifery characteristics and the baseline pain between two groups . The pain was significantly lower in intervention group during the first and second phases of labor . Duration of the first and third phases of labor was shorter in the case group . There were no significant differences in type of delivery , perineal laceration , oxytocin uptake , fetal heart rate , and APGAR between two groups . Discussion : Local warming with intermittent cold pack can reduce labor pain without adverse effects on maternal and fetal outcomes . It is an inexpensive and simple method . Conclusion : Intermittent local heat and cold therapy is a no pharmalogical , safe and effective method to relief labor pain OBJECTIVE To determine the effect of breathing techniques and nurse-administered massage on the pain perception of pregnant woman during labour . SETTING AND PARTICIPANTS The present study was conducted among pregnant women ( 75 % primiparous ) admitted to the SSK Bakirkoy Women and Children 's Hospital ( Istanbul , Turkey ) between January 1 , and September 1 , 2000 . The patients were in their 38th to 42nd week of pregnancy , not at high risk and expected to have normal vaginal delivery . They were selected from volunteers by nonr and om sampling . STUDY DESIGN The present study involved 40 cases , with 20 in the experimental group and 20 in the control group . Data were obtained through the visual analogue scale , inspection form , observation form and postnatal interview form . The study investigators provided information about labour , breathing techniques and massage to the pregnant women assigned to the experimental group at the beginning of labour ( latent phase ) . A study investigator also accompanied them during labour . These women received nurse-administered massage and were encouraged to breathe and perform self-administered massage . They were also instructed to change their positions and to relax . RESULTS AND CONCLUSION Study results demonstrated that nursing support and patient-directed education concerning labour and nonpharmacological pain control methods ( eg , breathing and cutaneous stimulation techniques ) were effective in reducing the perception of pain by pregnant women ( when provided in the latent labour phase before delivery ) , leading to a more satisfactory birth experience AIM Reduction of labor pain is one of the most important aspects of obstetric care . Heat therapy , typically applied to the woman 's back , lower abdomen , groin , and /or perineum during last stage of labor , is an easy pain relief method that does not require highly skilled care . The effectiveness of heat ther 
    Output:
    
Massage may have a role in reducing pain , and improving women 's emotional experience of labour .