***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: The aim of this Intervention was to evaluate the effect of training on patient-h and ling skills and prospect ively to assess the effect of skill on subsequent back pain and back injuries  in nursing . Of a total of 255 nurses , 199 were assessed for their skill in patient-h and ling .  One-half (  control  group ) received traditional training in patient-h and ling , and the other half ( trained group ) received a curriculum of instruction totaling 40 hours . The skills of both groups were assessed on graduation . The control group was rated as less competent in patient-h and ling .  Nurses in both groups were question ed about the prevalence of back pain and incidence of back injuries in the first year after graduation . In multiple regression analysis , the major risk Indicators for back injuries were poor patient-h and ling skill , low numbers of repetitions in the sit-up test , and high work-load scores . High score on the hysteria scale of Middlesex Hospital Question naire was a risk Indicator for all kinds of back pain . Though back pain was Independent of patient-h and ling skill , those rated as “ bad ” or “ poor ” had more back injuries ( 24 % ) than those who had been rated as “ good ” or “ excellent ” ( 2 % ) ( P < 0.001 ) , but the difference between the trained and control groups was not statistically significant . It was concluded that back Injuries may be prevented by the teaching of patient-h and ling skills A clinical trial , aim ed at secondary prevention of low-back pain , was performed in 142 hospital employees reporting at least three annual episodes of this condition . Participants were r and omly assigned to one of three groups : a calisthenics program ( CAL ) for 3 months with biweekly sessions of flexion exercises , a back school program ( 5 sessions ) , and a control group . The effectiveness of the two intervention programs was evaluated over a 1-year period . Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected . A monthly surveillance for the whole year showed a mean of 4.5 “ painful months ” in the CAL group versus 7.3 and 7.4 months in the back school and control groups , respectively ( P < 0.0001 ) . The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength . The increased trunk flexion was associated with the rate of participation in the CAL sessions . Further research is needed to answer the question of “ intensity versus type of exercise ” by comparing different intervention programs , with similar intensity OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES To evaluate the efficacy of training for three manual h and ling strategies , i.e. load tilting/h and s positioning , shoulders positioning and feet orientation based on the observation of the contrasted strategies of expert and novice workers and free practice using a search approach . DESIGN Ten novice male workers were tested at pre-training ( one trial ) and post-training with homogeneous boxes ( three trials ) and heterogeneous boxes ( two trials ) sample d from two sessions . Training took place with homogeneous boxes whereas heterogeneous boxes were new situations . BACKGROUND The effectiveness of training programs in safe h and ling and the repetition of specified techniques are contested ; they should rather be based on expert workers ' strategies . METHODS Pre-training and post-training trials were analyzed with five video cameras and a large force plate . The biomechanical variables included three safety criteria : net 3D result ing moments at L5/S1 , asymmetry of posture/efforts at L5/S1 and mechanical work on load ; kinematics and ergonomic variables were used as explicative variables . RESULTS Training produced safer strategies by reducing mechanical work and back extensor moments ; this occurred in both load conditions , an indication of the transfer of knowledge . These strategies consisted of changes in load maneuvers ( tilting/h and positioning ) and feet orientation . CONCLUSIONS Training programs should be based on observations of workers . RELEVANCE These results may guide the specialists involved in training programs . Training based on a search approach by the learner and anchored on observations of contrasted strategies ( load tilts/h and s positioning and feet orientation ) by experts and novices appears promising for safe h and ling The aim of this study was to evaluate the effect of a transfer technique education programme ( TT ) alone or in combination with physical fitness training ( TTPT ) compared with a control group , who followed their usual routine . Eleven clinical hospital wards were cluster r and omised to either intervention ( six wards ) or to control ( five wards ) . The intervention cluster was  individually r and omised to TT ( 55 nurses ) and TTPT ( 50 nurses ) , control ( 76 nurses ) . The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues . The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks . Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not , when compared to a control group , show any statistical differences according to self-reported low back pain ( LBP ) , pain level , disability and sick leave at a 12-month follow-up . However , the individual r and omised intervention subgroup ( transfer technique/physical training ) significantly improved the LBP-disability ( p = 0.001 ) . Although weakened by a high withdrawal rate , teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered . Other priorities such as physical training may be taken into consideration . The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP . However , physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel BACKGROUND Low back injuries are common and costly , accounting for 15 to 25 percent of injuries covered by workers ' compensation and 30 to 40 percent of the payments made under that program . The high costs of injury , the lack of effective treatment . and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and h and ling . The effectiveness of those programs , however , has received little rigorous evaluation . METHODS We evaluated an educational program design ed to prevent low back injury in a r and omized , controlled trial involving about 4000 postal workers . The program , similar to that in wide use in so-called back schools , was taught by experienced physical therapists . Work units of workers and supervisors were trained in a two-session back school ( three hours of training ) , followed by three to four reinforcement sessions over the succeeding few years . Injured subjects ( from both the intervention and the control groups ) were r and omized a second time to receive either training or no training after their return to work . RESULTS Physical therapists trained 2534 postal workers and 134 supervisors . Over 5.5 years of follow-up , 360 workers reported low back injuries , for a rate of 21.2 injuries per 1000 worker-years of risk . The median time off from work per injury was 14 days ( range , 0 to 1717 ) ; the median cost was $ 204 ( range , zero to $ 190,380 ) . After their return to work , 75 workers were injured again . Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury , the median cost per injury , the time off from work per injury , the rate of related musculoskeletal injuries , or the rate of repeated injury after return to work ; only the subjects ' knowledge of safe behavior was increased by the training . CONCLUSIONS A large-scale , r and omized , controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training The health care setting presents particular risks from manual h and ling and it is known that training in manual h and ling techniques is ineffective in reducing these risks when used as a st and -alone measure . The ' Manual H and ling Operations Regulations 1992 ' requires employers to consider hazardous manual h and ling , advising the use of an ergonomics approach . However , it is not known how well-equipped non-ergonomists in the health care setting are to deal with this approach . Therefore , the ability of non-ergonomists to make manual h and ling risk assessment s , with or without additional training , and to implement changes to the work environment was investigated . Twenty-five pairs of subjects from a broad cross section of departments in a busy teaching hospital were studied ;  training and a guide book were provided for one of each pair and the guide book only for the other . Subjects then independently prioritised three tasks in their department and undertook a full assessment of a specified task . All work was repeated by an ergonomist and the subjects ' assessment s were scored in comparison with the ergonomist . Each department was followed up after six months to assess progress with implementing recommendations . Trends in the data indicated that both groups appeared able to identify hazards though not necessarily to prioritise the tasks . The trained group tended to score better in assessment s although wide variation existed within both groups and inter-group differences were not significant at the 5 % level . Approximately half of staff assessment s were considered ' adequate ' to ' very good ' , in comparison with the ergonomist . Implementation of assessment recommendations ranged from nil to almost full compliance . Incomplete implementation seemed to be related to an apparent confusion in some departments over who was responsible for making changes , a lack of finances for changes and overstretched managers having other priorities This study measured the effect of a feedback training program on lumbar compression  during simulated occupational lifting . Two distinct types of feedback were compared : real-time electromyographic feedback , vs. an acceleration index delivered verbally post-lift .  Kinematic data were collected from 28 subjects during symmetrical sagittal plane lifts . Following a baseline session , two feedback training sessions were provided , with a 1-week interval between each session . A control group followed the same protocol s , but without receiving feedback training . A post-training session , using protocol s identical to the baseline session , was used to assess pre-to-post changes in the dependent variable : peak lumbosacral compression computed using a dynamic linked-segment model . All three groups showed reductions in peak compression from pre-to-post : on average the control group improved by 11.2 % , the EMG group by 16.7 % , and the acceleration group by 25.3 % . The results revealed an interaction between the improvement and the group ( p = 0.023 ) , and a difference between the improvement in the control group and that in the verbal acceleration feedback group ( p < 0.01 ) . These reductions in lumbosacral compression persisted after a 7-day interval without feedback training , suggesting that this approach could provide sustained risk-reduction during manual material s h and ling Thirty food service workers were r and omly assigned to two groups ; one group received body mechanics instruction while the other did not . The application of the instruction was measured by evaluating the subjects ' use of body mechanics on a novel lifting and lowering task and during performance on the job . Results indicated that the group which received instruction performed significantly better on the novel task than the group that received no instruction . However , no significant difference between groups was found in performance in the work environment . The role of the occupational therapist in a work-related safety program is also discussed This study examined the influence of a generalized physical fitness training program on manual material h and ling ( MMH ) capability .  Thirteen healthy women trained for 14 weeks , performing progressive resistance training three days per week and running with interval training two days per week . Subjects attended 85 + /- 6 % of the sessions . Compared to values obtained before training , subjects increased the maximum mass they could lift from floor to knuckle height by 19 % ( 68 - 81 kg , p < 0.001 ) and from floor to chest height by 16 % ( 49 - 57 kg , p < 0.001 ) . They improved by 17 % their ability to lift 15 kg as many times as possible in 10 min(167 - 195 lifts , p < 0.001 ) , while perception of effort 
    Output:
    
The review identified little evidence supporting the effectiveness of both  technique- and educational-based manual h and ling training .
In addition , there was considerable evidence supporting the idea that the principles learnt during training are not applied in the working environment .
The evidence collected indicates that manual h and ling training is largely ineffective in reducing  back pain and back injury .