***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 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 Background Current evidence on electrotherapies for the management of chronic neck pain  is either lacking or conflicting . New therapeutic devices being introduced to the market should be investigated for their effectiveness and efficacy . The ENAR ® ( Electro Neuro Adaptive Regulator ) therapy device combines Western biofeedback with Eastern energy medicine . Methods A small , preliminary r and omised and controlled single-blinded trial was conducted on 24 participants ( ten males , 14 females ) between the ages of 18 to 50 years ( median age of 40.5 ) Consent was obtained and participants were r and omly allocated to one of three groups – ENAR , Transcutaneous Electrical Nerve Stimulation ( TENS ) , or control therapy – to test the hypothesis that ENAR therapy would result in superior pain reduction/disability and improvements in neck function compared with TENS or control intervention . The treatment regimen included twelve 15-minute treatment sessions over a six week period , followed by two assessment periods . Visual Analogue Scale ( VAS ) pain scores , Neck Disability Index ( NDI ) scores , Patient Specific Functional Scale ( PSFS ) scores and Short Form 36v1 ( SF-36 ) quality of life scores reported by participants were collected at each of the assessment s points throughout the trial ( 0 , 6 , 12 , 18 and 24 weeks ) . Results Eligible participants ( n = 30 ) were recruited and attended clinic visits for 6 months from the time of r and omisation . Final trial sample ( n = 24 ) comprised 9 within the ENAR group , 7 within the TENS group and 8 within the  control group . With an overall study power of 0.92 , the ENAR group showed a decrease in mean pain score from measurement at time zero ( 5.0 ± 0.79 95%CI ) to the first follow-up measurement at six weeks ( 1.4 ± 0.83 95%CI ) . Improvement was maintained until week 24 ( 1.75 ± 0.9 95%CI ) . The TENS and control groups showed consistent pain levels throughout the trial ( 3.4 ± 0.96 95%CI and 4.1 ± 0.9 95%CI respectively ) . Wald analysis for pain intensity was significant for the ENAR group ( p = 0.01 ) . Six month NDI scores showed the disability  level of the ENAR group ( 11.3 ± 4.5 95%CI ) was approximately half that of either the TENS ( 22.9 ± 4.8 95%CI ) or the control ( 29.4 ± 4.5 95%CI ) groups . NDI analysis using the Wald method , indicated significant reductions in disability only for the ENAR group ( p = 0.022 ) . PSFS results also demonstrated significantly better performance of ENAR ( p = 0.001 ) compared to both alternative interventions . Differential means analysis of the SF-36 results favoured ENAR for all of the subscales . Six of the initial 30 participants discontinued the trial protocol . Conclusion ENAR therapy participants reported a significant reduction in the intensity of neck pain ( VAS ) and disability ( NDI ) , as well as a significant increased function ( PSFS ) and overall quality of life ( SF-36 ) than TENS or control intervention participants . Due to the modest sample size and restricted cohort characteristics , future larger and more comprehensive trials are required to better evaluate the potential efficacy of the ENAR device in a more widely distributed sample population .Trial Registration This study has been registered with the Australian Clinical Trials Registry ( ACTR ) : ACTRN012606000438550 In the majority of patients with neck pain , symptoms will resolve spontaneously or quite quickly in response to therapy . However , some patients ' symptoms persist for a long period , irrespective of therapy . In this study , 20 patients with persistent ( greater than 8 weeks ) neck pain were enrolled in a double blind , placebo-controlled trial of low energy , pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries . For the first 3-week period , group A ( 10 patients ) received active PEMT units while group B ( 10 patients ) received facsimile placebo units . After 3 weeks , both pain ( visual analogue scale ( P less than .023 ) and range of movement ( P less than .002 ) had improved in the group on active treatment compared to the controls . After the second 3 weeks , during which both groups used active units , there were significant improvements in observed scores for pain and range of movement in both groups . PEMT , in the form described , can be used at home easily in the treatment of patients with neck pain . It is frequently successful and without side effects Successful treatment of torticollis with electromyographic ( EMG ) biofeedback has been reported in a number of single case and single group studies . The present investigation represents the first controlled outcome study . Twelve torticollis patients were r and omly assigned to EMG biofeedback or relaxation training and grade d neck exercises ( RGP ) . The procedure involved three sessions of baseline assessment , 15 sessions of EMG BF or RGP , 6 sessions of EMG BF or RGP plus home-management , 6 sessions of home-management alone , and follow-up 3 months after the end of treatment . A variety of outcome measures were used including physiological ( EMG from the two sternocleidomastoid muscles , skin conductance level ) , behavioral ( angle of head deviation , range of movement of the head ) , and self-report ( depression , functional disability , body concept ) , therapist and “ significant other ” reports and independent observer assessment of videos . In both groups , neck muscle activity was reduced from pre- to posttreatment . This reduction was greater in the EMG biofeedback group . There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group . Therefore , the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects . Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of “ arousal . ” Significant improvements of extent of head deviation , and range of movement of the head , as well as reductions of depression were present , which were not different in the two groups . At the end of treatment , no patient was asymptomatic . Any therapeutic benefit was generally maintained at follow-up . The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one . Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger sample s are required Abstract The aim of this study was to evaluate the short , medium and long – term effects of peripheral repetitive magnetic stimulation ( rMS ) on myofascial pain compared with transcutaneous electrical nerve stimulation (TENS).Fifty  – three subjects with myofascial trigger points ( TPs ) at the level of the superior trapezius muscle were allocated r and omly to three groups . The first group ( n = 17 ) was treated with rMS , the second ( n = 18 ) with TENS and the third ( n = 18 ) received a placebo treatment . Each treatment consisted of ten daily 20–minute sessions . Patients were evaluated before and immediately following treatment , and at one and three months after the end of treatment . Outcome measures were : the “ neck pain and disability visual analogue scale ” ( NPDVAS ) , an algometric evaluation of pain , an evaluation of the TP characteristics , and the range of cervical bending and rotation contralateral to the affected trapezius muscle . At the end of treatment , the rMS group showed a significant improvement in the NPDVAS , algometry , TP characteristics , and cervical contralateral rotation . This improvement also persisted at one and three months post – therapy . After treatment , the TENS group showed significant improvement in the same outcome measures except for algometry . At the one month follow – up visit , this improvement had returned to non significant levels in all outcome measures with the exception of NPDVAS.No significant effect of TENS was seen at the three – month follow – up visit . The placebo group showed no significant improvement in any measure . Our results strongly suggest that at medium and longer term intervals peripheral rMS may be more effective than TENS for the treatment of myofascial pain This study investigated effectiveness of manual therapy ( MT ) with transcutaneous electrical nerve stimulation ( TENS ) to reduce pain intensity in patients with mechanical neck disorder ( MND ) . A r and omized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region . Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage , 47 patients received MT and 43 TENS .  The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale ( VAS ) . Also disability , quality of life , adverse effects and sociodemographic and prognosis variables were measured . Three evaluations were performed ( before , when the procedure finished and six months after ) . Seventy-one patients ( 79 % ) completed the follow-up measurement at six months . In more than half of the treated patients the procedure had a clinical ly relevant " short term " result after having ended the intervention , when either MT or TENS was used . The success rate decreased to one-third of the patients 6 months after the intervention . No differences can be found in the reduction of pain , in the decrease of disability nor in the quality of life between both therapies . Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinical ly relevant OBJECTIVES To compare the efficacy of combined transcutaneous acupoint electrical stimulation ( TAES ) and electromagnetic millimeter wave ( EMMW ) therapy as an add-on treatment for pain relief and physical functional activity enhancement among adults with sub-acute non-specific spinal pain in either the low back or neck . DESIGN A non-blinded study with data obtained before , immediate , one week and three months after intervention . SETTING The Telehealth Clinic and Community Centre , Hong Kong . PARTICIPANTS Forty-seven subjects with either sub-acute neck or low back pain . INTERVENTION Subjects were r and omly allocated to either an intervention group ( n=23 ) or a control group ( n=24 ) . These groups were then divided into subgroups according to the site of their spinal pain-neck or back . The intervention group had eight treatments over a three-week period of TAES and EMMW . OUTCOME MEASURES Changes from baseline to the end of treatment were assessed at intervals of one week and three months on either neck or low back pain intensity [ by Visual Analogue Scale ( VAS ) ] ; stiffness level ; stress level ; neck or low back lateral flexion and forward flexion in cm , and interference with daily activities . RESULT 
    Output:
    
Very low quality evidence determined that pulsed electromagnetic field therapy ( PEMF ) and repetitive magnetic stimulation ( rMS ) were more effective than placebo , while transcutaneous electrical nerve stimulation ( TENS ) showed inconsistent results .Very low quality evidence determined that PEMF , rMS and TENS were more effective than placebo .
We can not make any definite statements on the efficacy and clinical usefulness of electrotherapy modalities for  neck pain .
Current evidence for PEMF , rMS , and TENS shows that these modalities might be more effective than placebo .
Galvanic current , iontophoresis , EMS , and a static magnetic field did not reduce pain or disability .