***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: Introduction Low back pain ( LBP ) is the most common , costly and disabling musculoskeletal disorder worldwide , and is prevalent in healthcare workers . Posture is a modifiable risk factor for LBP shown to reduce the prevalence of LBP . Our feasibility research suggests that postural feedback might help healthcare workers avoid hazardous postures . The Effectiveness of Lumbopelvic Feedback ( ELF ) trial will investigate the extent to which postural monitor and feedback ( PMF ) can reduce exposure to hazardous posture associated with LBP . Methods This is a participant-blinded , r and omised controlled trial with blocked cluster r and om allocation . Participants will include volunteer healthcare workers recruited from aged care institutions and hospitals . A postural monitoring and feedback device will monitor and record lumbopelvic forward bending posture , and provide audio feedback whenever the user sustains a lumbopelvic forward bending posture that exceeds predefined thresholds . The primary outcome measure will be postural behaviour ( exceeding thresholds ) . Secondary outcome measures will be incidence of LBP , participant-reported disability and adherence . Following baseline assessment , we will r and omly assign participants to 1 of 2 intervention arms : a feedback group and a no-feedback control group . We will compare between-group differences of changes in postural behaviour by using a repeated measures mixed-effect model analysis of covariance ( ANCOVA ) at 6 weeks . Postural behaviour baseline scores , work-related psychosocial factors and disability scores will be input as covariates into the statistical models . We will use logistic mixed model analysis and Cox 's proportional hazards for assessing the effect of a PMF on LBP incidence between groups . Discussion Posture is a modifiable risk factor for low back disorders . Findings from the ELF trial will inform the design of future clinical trials assessing the effectiveness of wearable technology on minimising hazardous posture during daily living activities in patients with low back disorders . Trial registration number ACTRN12616000449437 The direct and indirect costs of low back pain , one of the most common symptoms in adults , are estimated at $ 60 billion annually in the United States [ 1 , 2 ] . Practice guidelines recently developed in the United States recommend spinal manipulation for patients with uncomplicated acute low back pain [ 3 ] . If followed , these guidelines can be expected to significantly increase the number of patients referred by medical physicians to chiropractors , who provide most manipulative therapy delivered in the United States [ 4 ] . Concerns have been raised about the quality of chiropractic care [ 5 ] , but systematic data are lacking . How are patients and medical physicians to have confidence in chiropractors in the absence of data on the quality of chiropractic care ? To assess the appropriateness of the use of spinal manipulation for patients with low back pain , we used a method for assessing appropriateness that has been used to study various medical procedures in North America and Europe [ 6 - 16 ] . In these studies , predetermined criteria for the appropriateness ( as defined by expected risk versus benefit ) of the study procedure ( for example , hysterectomy or coronary angioplasty ) are used to retrospectively assess the care delivered . We report the results of our evaluation of the use of chiropractic spinal manipulation at five geographic sites in the United States and one site in Canada . Methods Development of Appropriateness Criteria and Record Abstract ion System For our study , spinal manipulation was defined as a manual procedure that involves specific short-lever dynamic thrusts ( or spinal adjustments ) or nonspecific long-lever manipulation . Nonthrust procedures , such as flexion-distraction and mobilization , were not considered part of manipulative therapy . The development of appropriateness criteria for spinal manipulation for low back pain has been described in detail elsewhere [ 17 ] . In brief , we first performed a systematic review of the literature . A 9-member panel of back experts was convened , consisting of 3 chiropractors , 2 orthopedic spine surgeons , 1 osteopathic spine surgeon , 1 neurologist , 1 internist , and 1 family practitioner . Six panel members were in academic practice , 3 were in private practice , and 4 performed spinal manipulation as part of their practice . The panel members represented all major geographic regions of the United States . The panel used a scale of expected risk and benefit ( ranging from 1 to 9 ) to rate the appropriateness of a comprehensive array of indications , or clinical scenarios , in patients who might present to a chiropractor 's office . We defined appropriate as an indication for which the expected health benefits exceeded the expected health risks by a sufficiently wide margin that spinal manipulation was worth doing . We used a formal group-judgment process , which incorporated two rounds of ratings , a group discussion , and feedback of group ratings between rounds . Experts were to use their best clinical judgment in addition to the evidence from the systematic review we presented them . Panel disagreement on an indication occurred when two or more panelists rated the indication as appropriate and two or more panelists rated it as inappropriate . This definition of disagreement is arbitrary but is based on a face-value assessment of what constitutes disagreement among experts . The final result of the process is a rating of appropriate , inappropriate , or uncertain ( depending on net expected health benefits ) for each indication . Indications with a median panel rating of 7 to 9 , without disagreement , were classified as appropriate . Indications with a median panel rating of 1 to 3 , without disagreement , were classified as inappropriate . Indications with a median panel rating of 4 to 6 and all indications with disagreement were classified as uncertain . The panel of experts met in April 1990 , before the beginning of the Agency for Health Care Policy and Research ( AHCPR ) Low Back Problems Clinical Practice Guideline effort in 1992 . Four members of our panel later participated in the AHCPR process . The AHCPR guidelines cover patients with acute and subacute low back pain only and are similar to the appropriateness criteria created for our project . We developed a chiropractic record abstract ion system that allows collection of data from a chiropractic office record about the patient , history of the back problem , findings on physical examination and diagnostic studies , and treatment rendered . The system is design ed to collect sufficient information to allow the classification of delivered care as appropriate , inappropriate , or uncertain , according to the panel 's ratings . The abstract ion instrument collects data on more than 70 clinical variables that may be present in the record . The instrument uses skip-pattern logic so that only relevant clinical variables are sought . For example , if the patient 's onset of back pain was associated with trauma , additional information about the type of trauma was sought . We pilot-tested our system on numerous chiropractic records obtained from colleagues around the United States and pilot-tested our methods for data collection and analysis on a small sample of chiropractors in southern California [ 18 ] . Identification of Sample We chose San Diego , California ; Portl and , Oregon ; Vancouver , Washington ; Minneapolis-St . Paul , Minnesota ; Miami , Florida ; and Toronto , Ontario , Canada , as sites for our study because of their geographic diversity and because they reflect a varying concentration of practicing chiropractors and differ in the chiropractic scope of practice allowed . We also included the rural areas surrounding the Portl and , Minneapolis-St . Paul , and Toronto areas . We have previously shown that the base population s at the U.S. sites are similar to the general U.S. population in terms of the variables known to affect chiropractic use [ 19 ] . The geographic sampling area around Toronto encompasses 75 % of the population of Ontario . At each site , we constructed our sampling frame from a combination of the telephone book yellow pages , the state or provincial board licensing list , and the mailing list of the local chiropractic college , if any . The final list was the summation ( excluding duplicates ) of the individual lists . We drew a r and om sample from this list and sent the sample d chiropractors a letter that explained the study and invited them to participate . Each letter was accompanied by cover letters from the national chiropractic association and the local chiropractic association or chiropractic college , indicating support for the study . We followed this mailing with a telephone call to determine eligibility and request participation . To be eligible , a chiropractor must have been practicing in the geographic area since 1990 . Eligible chiropractors who declined our initial invitation were contacted by one or more influential state , provincial , or local chiropractors and were again urged to participate . Participating chiropractors and their staff were given , in total , a $ 130 ( in both U.S. and Canadian dollars ) honorarium for participation . Data Collection Trained chiropractic data collectors ( senior chiropractic students or recent graduates ) visited participating chiropractors during regular working hours . These data collectors underwent 2 days of training conducted by two of the authors . The data collectors were unaware of the details of the appropriateness criteria . The reliability and accuracy of the data collection were assessed in several ways . First , after classroom training , the data collectors abstract ed a common set of test records obtained from various different practice s and geographic areas . These were returned to one of the authors for correction , and any errors in abstract ion were review ed with the data collectors . Second , the same author accompanied the data collectors on a practice session with a local volunteer chiropractor , who agreed to let the collectors practice sampling and data abstract ion in his or her office during working hours . Again , errors in either process were review ed with the data collectors . Finally , the same author accompanied the data collectors on one of the early office visits to a chiropractor included in the sample at each geographic site . Here , the author review ed all abstract ed records ; if more than one data collector was working , both data collectors abstract ed a few records . Any discrepancies were review ed with this author . In all , about 4 % of records included in the sample were assessed for reliability and validity . We did not calculate formal reliability statistics . To select records , all office records were measured in inches as if they were books on a shelf . A r and om-number table was used to select a r and om number of inches measured from the start . To avoid fat-chart bias , we selected the record immediately to the right of the record located at the specified number of inches . This chart was then pulled and examined to see whether it described a first visit for low back pain that occurred between 1 January 1985 and 31 December 1991 . If so , data were abstract ed by using the research instrument . This process was repeated until 10 records for low back pain were abstract ed from each participating practitioner 's office . If more than one chiropractor practice d in the same office , we abstract ed data from the records of only one practitioner . Consultation with back pain experts suggested that 10 records per office is a sufficient number that is likely to fairly represent the diversity of that office 's practice . Data Analysis We compiled descriptive data on the patients and the care that they received . The care of patients was classified into appropriateness categories by using the criteria determined by the expert panel . This was done with a computer program that uses unique combinations of variables that define individual indications . The reliability of this program was verified by drawing a r and om sample of records and This paper investigates the trunk postural modifications induced by a wearable device which assesses the trunk sway and provides biofeedback information through sonification of trunk kinematics . The device is based on an inertial wearable sensing unit including three mono-axial accelerometers and three rate gyroscopes embedded and mounted orthogonally . The biofeedback device was tested on nine healthy subjects during quiet stance in different conditions of sensory limitation eyes closed on solid surface , eyes open on foam cushion surface , eyes closed on foam cushion surface . Five trials were performed for each condition ; the order of the trials was r and omized . The results reported in this paper show how subjects reduced their rotational kinetic energy by using the biofeedback information and how this reduction was related to the limitation of sensory information 
    Output:
    
The proposed wearables most commonly used Inertial Measurement Units ( IMUs ) as the underlying technology .
Conclusions This is the first and only study to specifically review wearable devices that monitor spinal posture .
Our findings suggest that currently available devices are capable of assessing spinal posture with good accuracy in the clinical setting .