***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: Four treatments for sciatic symptoms  -- traction , exercises , manipulation , and corset -- were assessed in a r and omised controlled trial in 322 out patients . The design was factorial . There were thus sixteen treatment groups , enabling a comparison of combinations of methods as well as of individual methods . Treatment lasted for four weeks . Patients were review ed at the end of this period and at four and sixteen months after entry to the trial . Progress was measured by the patient 's account of symptomatic improvement or deterioration and by return to work or normal activities . At four weeks each of the treatments was associated with a small degree of benefit over and above the high rate of spontaneous improvement . For manipulation , the benefit was statistically significant on one of the scales used to measure progress . There was a significant increase in symptomatic improvement with increasing numbers of treatments used in combination . This was complemented by a clear tendency for those who had received fewer types of treatment during the trial to have further treatment in the ensuing three months . There were no beneficial effects of treatment detectable at four or sixteen months . In the short-term , active physiotherapy with several treatments appears to be of value in the outpatient management of patients with sciatic symptoms , but it does not seem to confer any longer-term benefit BACKGROUND AND PURPOSE Since the release of acute low back pain management guidelines in 1994 , little was known about the effect of these guidelines on clinical practice . The purpose of this study was to examine physical therapists ' reported management of acute and subacute lumbar impairment . SUBJECTS One in 10 registered physical therapists who were r and omly selected from southern Ontario , Canada , ( n=454 ) and all registered physical therapists from northern Ontario ( n=331 ) were surveyed . METHODS In the question naire , case scenarios covered 3 areas related to the management of lumbar impairment : ( 1 ) physical examination , ( 2 ) treatment and recommendations , and ( 3 ) therapists ' beliefs regarding its management . RESULTS Five hundred sixty-nine question naires were returned ( response rate=72.5 % ) . Only data obtained for therapists ( n=274 ) whose weekly workload included more than 10 % of people with lumbar impairment were used in the analysis . Overall ,  patient education , exercise , and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment ( symptom onset of less than 5 weeks ) with or without sciatica , whereas exercise and work modification were preferred for subacute lumbar impairment ( symptom onset of 5 weeks or longer ) . There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness . Only 46.3 % of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment . DISCUSSION AND CONCLUSION Although the physical therapists surveyed , in general , followed the guidelines in managing acute lumbar impairment , they felt uncertain regarding the value of practice guidelines . Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines STUDY DESIGN A descriptive question naire of chartered physiotherapists . OBJECTIVE To investigate current physiotherapeutic management  of  low back pain throughout Britain and Irel and . SUMMARY OF BACKGROUND DATA Physiotherapists play a key role in low back pain management . Although clinical guidelines for best practice have been developed recently , there has been no large-scale attempt to describe current physiotherapeutic treatment approaches within Britain or Irel and . METHODS After semi-structured interviews ( n = 6 ) and two pilot studies ( n = 77 ) were done , postal question naires were distributed to four regional cluster sample s of the membership of two physiotherapy professional organizations ( n = 2654 ) . After two mailings , a r and om sample of 90 nonresponders were followed up . Data were analyzed using the Statistical Package for the Social Sciences ( SPSS Ltd. , Woking , Surrey , UK ) , and precision of the survey estimates was assessed by calculation of sampling errors and intraclass correlation coefficients for cluster sampling . RESULTS Results were received from 1548 therapists ( total response rate , 58.3 % ) ; of these , 813 reported that they were practicing in setting s in which they treated patients with low back pain . Analysis of the results indicated the overall popularity of the Maitl and mobilization and McKenzie approaches among physiotherapists . Although exercise per se was mentioned frequently by respondents , a marked difference in opinion among therapists regarding the optimal type of exercise for low back pain was obvious . Little evidence was demonstrated of the use of manipulation , fitness programs , or multidisciplinary efforts involving behavioral and physical aspects of treatment . Commonly used methods of electrotherapy were  interferential therapy , ultrasound , pulsed short-wave diathermy , and transcutaneous electrical nerve stimulation .  CONCLUSIONS The results of this study emphasize the need to evaluate further and improve the dissemination of findings regarding the effectiveness of specific physiotherapy approaches for low back pain management Traction therapy for  low back pain with sciatica has been evaluated in a double blind study . 60 patients hospitalized for sciatica with or without signs of sensory or motor deficiency were r and omized to 3 treatment groups : " placebo traction " ( 5 kg ) , " light traction " ( 15 kg ) and " normal traction " ( 50 kg ) . Clinical evaluation after 4 , 8 and 12 traction sessions showed no difference between the three groups Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear STUDY DESIGN A r and omized trial design ed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting . OBJECTIVE To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage . SUMMARY OF BACKGROUND DATA Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany . No reports of previous r and omized trials for the outcome from interferential therapy were found . METHODS Consenting patients were r and omly assigned into one of two groups . A pretreatment interview was performed by the patient using a computer-based question naire . It also incorporated the Oswestry Disability Index and a pain visual analog scale . Management consisted of six sessions over a 2- to 3-week period . Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment . RESULTS A total of 152 patients were recruited . The two treatment groups had similar demographic and clinical baseline characteristics . The mean Oswestry Disability Index before treatment was 30 for both groups ( n = 147 ) . After treatment , this had dropped to 25 , and , at 3 months , were 21 ( interferential therapy ) and 22 ( motorized lumbar traction and massage ) . The mean pain visual analog scale score before treatment was 50 ( interferential therapy ) and 51 ( motorized lumbar traction and massage ) . This had dropped , respectively , to 46 and 44 after treatment and to 42 and 39 at 3 months . CONCLUSIONS This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage . There was no difference in the improvement between the two groups at the end of treatment . Although there is evidence from several trials that traction alone is ineffective in the management of low back pain , this study could not exclude some effect from the concomitant massage Previous trials to assess the efficacy of lumbar traction for  back pain  have been method ologically flawed . To avoid these shortcomings , we conducted a r and omised controlled trial in which high-dose traction was compared with sham traction . The sham traction was given with a specially developed brace that tightens in the back during traction . To the patient , the experience is that of traction . The patients and outcome assessor were blinded for the assigned treatment . 151 patients with at least six weeks of non-specific low back pain were r and omised . Intention to treat analysis showed no differences between the groups on all outcome measures ( patients ' global perceived effect , severity of main complaints , functional status and pain ) ; all 95 % confidence intervals included the value zero . The number of withdrawals from treatment , loss to follow-up , and protocol deviations was low . Consequently , the per- protocol analysis showed results similar to the intention to treat analysis . Subgroup analyses did not show any group for which traction might seem promising . Our data do not support the cl aim that traction is effective for patients with low back pain Autotraction ( AT ) is a treatment for low-back pain syndrome of benign etiology that uses a specially design ed traction table divided into two movable sections . While lying on the table , the pelvis secured , the patient controls the traction forces by grasping and pulling the bars at the head of the table . There are controls for the therapist to apply , through movable sections of the table , rotation and bending forces to help restore mobility to the lumbar spine without inducing pain . The present study is based upon a r and omized treatment trial comparing conventional passive traction ( PT ) to AT . The following outcome indicators were used : ( 1 ) subjective response concerning overall improvement , ( 2 ) pain intensity ( visual analog scale , 0 - 100 ) , ( 3 ) qualitative pain severity ( McGill Pain Question naire , short-form , 0 - 45 ) , and ( 4 ) pain related disability ( Oswestry Low Back Pain Disability Score , 0 - 100 ) . The favorable response to AT was 75 % ( 30 of the 40 patients ) versus the 22 % ( 6 of 27 patients ) to PT ( p < 0.001 ) . After 3 months , 19 of the 30 responders to AT ( 63 % ) reported continued improvement . In these patients , pain ratings remained stable and the disability scores decreased to 0 to 23 % of the pretreatment value ( median and mean respectively , p < 0.001 ) Forty-nine patients with lumbago-sciatica and prolapsed lumbar intervertebral discs , comparable concerning anamnestical and clinical data were r and omized for autotraction and manual traction given by the same therapist for a period of one week while strict bed rest was prescribed . A blind overall assessment performed immediately after the traction period , after two weeks follow-up training and three months after hospitalization showed that the two traction modalities are equally efficient . As treatment for hospitalized patients with lumbar intervertebral disc prolapses the relatively simple manual traction variety should be preferred , if any . Traction is suggested to be used as a prognostical aid . Pain intensity was significantly reduced in all body parts . About one fourth of patients avoided operation . After two years there was no recurrence of symptoms Study Design A clinical study was conducted on 39 patients with acute , first‐episode , unilateral low back pain and unilateral , segmental inhibition of the multifidus muscle . Patients were allocated r and omly to a control or treatment group . Objectives To document the natural course of lumbar multifidus recovery and to evaluate the effectiveness of specific , localized , exercise therapy on muscle recovery . Summary of Background Data Acute low back pain usually resolves spontaneously , but the recurrence rate is high . Inhibition of multifidus occurs with acute , first‐episode , low back pain , and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms . Methods Patients in group 1 received medical treatment only . Patients in group 2 received medical treatment and specific , localized , exercise therapy . Outcome measures for both groups included 4 weekly assessment s of pain , disability , range of motion , and size of the multifidus cross‐sectional area . Independent examiners were blinded to group allocation . Patients were reassessed at a 10‐week follow‐up examination . Results Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1 . Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy ( P = 0.0001 ) . Other outcome measurements were similar for the two groups at the 4‐week examination . Although they resumed normal levels of activity , patients in group 1 still had decreased multifidus muscle size at the 10‐week follow‐up examination . Conclusions Multifidus muscle recovery is not spontaneous on remission of painful symptoms . Lack of localized , muscle support may be one reason for the high recurrence rate of low back pain following the initial episode A double-blind control study of  lumbar traction for sciatica has been carried out . Although there is a tendency for traction to produce improvement in pain and straight-leg raise the extent does not achieve statistical significance . Changing ' control ' patients to ' treatment ' seemed to produce worthwhile relief of pain for all who were not already improving . It is suggested that a large trial using more discriminating criteria might delineate a group of patients susceptible to help by traction This study investigates whether there is a difference in electromyographic activity in the lumbar sacrospinalis musculature during continuous and intermittent pelvic traction .  Twenty-nine normal subjects were r and omly assigned to a control group , a continuous traction group , or an intermittent traction group .  Electromyographic activity was recorded at specific timed intervals . Myoelectric activity increased with the onset of either type of traction , but by the third recording both groups had returned to their normal initial resting myoelectric recordings . The myoelectric patterns over time were similar for the two treatment groups . No significant difference in electromyographic activity of the lumbar sacrospinalis 
    Output:
    
The evidence for the use of traction in LBP remains inconclusive because of the continued lack of method ologic rigor and the limited application of clinical parameters as used in clinical practice .