***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: OBJECTIVE To compare the effects of manual therapy and stretching exercise on neck pain and disability . DESIGN An examiner-blinded r and omized cross-over trial . PATIENTS A total of 125 women with non-specific neck pain . METHODS PATIENTS were r and omized into 2 groups . Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week . After 4 weeks the treatments were changed . The follow-up times were after 4 and 12 weeks . Neck pain ( visual analogue scale ) and disability indices were measured . RESULTS Mean value ( st and ard deviation ) for neck pain was 50 mm ( 22 ) and 49 mm ( 19 ) at baseline in Group 1 and Group 2 , respectively , and decreased during the first 4 weeks by 26 mm ( 95 % Confidence Interval 20 - 33 ) and 19 mm ( 12 - 27 ) , respectively . There was no significant difference between groups . Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy ( p=0.01 ) as well as neck stiffness ( p=0.01 ) . CONCLUSION Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain . The difference in effectiveness between the 2 treatments was minor . Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain , at least in the short-term Study Design . A prospect i ve r and omized controlled trial . Objectives . To examine the effectiveness of combined manipulative treatment , stabilizing exercises , and physician consultation compared with physician consultation alone for chronic low back pain . Summary of Background Data . Strong evidence exists that manual therapy provides more effective short-term pain relief than does placebo treatment in the management of chronic low back pain . The evidence for long-term effect is lacking . Methods . Two hundred four chronic low back pain patients , whose Oswestry disability index was at least 16 % , were r and omly assigned to either a manipulative-treatment group or a consultation group . All were clinical ly examined , informed about their back pain , provided with an educational booklet , and were given specific instructions based on the clinical evaluation . The treatment included four sessions of manipulation and stabilizing exercises aim ing to correct the lumbopelvic rhythm . Question naires inquired about pain intensity , self-rated disability , mental depression , health-related quality of life , health care costs , and production costs . Results . At the baseline , the groups were comparable , except for the percentage of employees ( P = 0.01 ) . At the 5- and 12-month follow-ups , the manipulative-treatment group showed more significant reductions in pain intensity ( P < 0.001 ) and in self-rated disability ( P = 0.002 ) than the consultation group . However , we detected no significant difference between the groups in health-related quality of life or in costs . Conclusions . The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone . The present study showed that short , specific treatment programs with proper patient information may alter the course of chronic low back pain The aim of our study was to assess the effectiveness of thoracic manipulation ( TM ) on patients with chronic neck pain . 120 patients aged between 18 and 55 were r and omly allocated into two groups : an experimental group which received TM and a control group without the manipulative procedure . Both groups received infrared radiation therapy ( IRR ) and a st and ard set of educational material . TM and IRR were given twice weekly for 8 sessions . Outcome measures included craniovertebral angle ( CV angle ) , neck pain ( Numeric Pain Rating Scale ; NPRS ) , neck disability ( Northwick Park Neck Disability Question naire ; NPQ ) , health-related quality of life status ( SF36 Question naire ) and neck mobility . These outcome measures were assessed immediately after 8 sessions of treatment , 3-months and at a 6-month follow-up . Patients that received TM showed significantly greater improvement in pain intensity ( p = 0.043 ) , CV angle ( p = 0.049 ) , NPQ ( p = 0.018 ) , neck flexion ( p = 0.005 ) , and the Physical Component Score ( PCS ) of the SF36 Question naire ( p = 0.002 ) than the control group immediately post-intervention . All these improvements were maintained at the 6-month follow-ups . This study shows that TM was effective in reducing neck pain , improving dysfunction and neck posture and neck range of motion ( ROM ) for patients with chronic mechanical neck pain  up to a half-year post-treatment OBJECTIVE To study the effect of manual therapy and stretching on neck function in women with chronic neck pain . METHODS A total of 125 women were r and omized into 2 groups . Group 1 received manual therapy twice a week for 4 weeks followed by stretching exercises . Group 2 performed stretching 5 times a week for 4 weeks followed by manual therapy .  Neck function was assessed by isometric neck strength and mobility measurements , and spontaneous neck pain during the past week and strain-evoked pain during the neck strength trials using a visual analogue scale . RESULTS Both neck muscle strength ( 11 - 14 % ) and mobility ( 7 - 15 % ) improved similarly in both groups , with the exception of greater passive flexion-extension mobility ( p = 0.019 ) in group 1 at week 4 . Pain during the neck strength trials decreased from the baseline to week 4 by 26 - 35 % and to week 12 by 39 - 61 % similarly in both groups . Average neck pain during the past week decreased by 64 % and 53 % in groups 1 and 2 , respectively , during the first 4 weeks , remaining rather stable thereafter . The decreases in neck pain during both the past week and strength trials showed association with the changes in neck strength results ( r = 0.20 - 0.29 ) . CONCLUSION Both manual therapy and stretching were effective short-term treatments for reducing both spontaneous and strain-evoked pain in patients with chronic neck pain . It is possible that the decrease in pain reduced inhibition of the motor system and in part improved neck function . However , the changes in neck muscle strength were minor , showing that these treatments alone are not effective in improving muscle strength Objectives The authors ' goals were to compare the effectiveness of manual therapy ( MT ; mainly spinal mobilization ) , physical therapy ( PT ; mainly exercise therapy ) , and continued care by the general practitioner ( GP ; analgesics , counseling and education ) over a period of 1 year . Methods One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were r and omized to receive a 6-week treatment strategy of MT once a week , PT twice a week , or GP care once every 2 weeks . The primary outcome measures were perceived recovery , severity of physical dysfunctioning , pain intensity , and functional disability . Results The differences between groups considered over 1 year were statistically significant ( repeated measurements analyses P<0.001 to P=0.02 ) for all outcomes but borderline for the Neck Disability Index ( P=0.06 ) . Higher improvement scores were observed for MT for all outcomes , followed by PT and GP care . The success rate , based on perceived recovery after 13 weeks , was 72 % for MT , which was significantly higher than the success rate for continued GP care ( 42 % , P=0.001 ) but not significantly higher compared with PT treatment ( 59 % , P=0.16 ) . The difference between PT and GP approached statistical significance ( P=0.06 ) . After 1 year the success rates were 75 % , 63 % , and 56 % , respectively , and no longer significantly different . Conclusions Short-term results ( at 7 weeks ) have shown that MT speeded recovery compared with GP care and , to a lesser extent , also compared with PT . In the long-term , GP treatment and PT caught up with MT , and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up OBJECTIVE To conduct a pilot study in preparation for a full-scale r and omized clinical trial assessing conservative treatments for acute and subacute neck pain . Study design Prospect i ve , r and omized pilot study . SETTING Primary contact chiropractic and medical clinics . PATIENTS Ages 21 to 65 with current episode of neck pain less than 12 weeks in duration . Outcome measures Patient self-report question naires and cervical spine motion were assessed at baseline and 3 and 12 weeks post-r and omization . INTERVENTIONS Chiropractic spinal manipulation , prescription medications , and self-care education . RESULTS Recruitment took place over a 1-month period . Twenty-eight patients were r and omized to treatment , and 1 patient ( medical care group ) refused their treatment assignment and was lost to further follow-up . Twenty-three patients were either " very satisfied " or " completely satisfied " with the care they received in the study . More than half the patients reported 75 % or 100 % improvement ( n = 17 ) . No between-group comparisons were planned or performed due to the small sample size . CONCLUSION Recruitment of patients appears feasible for a full-scale r and omized clinical trial evaluating chiropractic spinal manipulation , medical care , and self-care education for acute and subacute neck pain . Patient and provider compliance with study protocol s was excellent , and the pilot study allowed us to further develop and optimize our data collection processes . Although pilot studies such as these require substantial time , money , and effort , they provide valuable information for future research efforts Background Evidence indicates that supervised home exercises , combined or not with manual therapy , can be beneficial for patients with non-specific chronic neck pain ( NCNP ) . The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy ( SMT ) compared to a no treatment group in NCNP patients . Another objective is to assess the efficacy of SMT with and without a home exercise program . Methods Ninety-eight patients underwent a short symptomatic phase of treatment before being r and omly allocated to either an attention-group ( n = 29 ) , a SMT group ( n = 36 ) or a SMT + exercise group ( n = 33 ) . The preventive phase of treatment , which lasted for 10 months , consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms ( attention-control group ) , 1 monthly SMT session ( SMT group ) or 1 monthly SMT session combined with a home exercise program ( SMT + exercise group ) . The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale ( VAS ) , active cervical ranges of motion ( cROM ) , the neck disability index ( NDI ) and the Bournemouth question naire ( BQ ) . Exploratory outcome measures were scored on the Fear-avoidance Behaviour Question naire ( FABQ ) and the SF-12 Question naire . Results Our results show that , in the preventive phase of the trial , all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-r and omised , symptomatic phase . No group difference was observed for the primary , secondary and exploratory variables . Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial . However , no significant change in health related quality of life ( HRQL ) was associated with the preventive phase . Conclusions This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial . This hypothesis was not supported by the study results . Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies . Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP . Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.Trial registration Clinical Trials.gov : Objective : To compare the effects of an isolated application of cervical spine thrust joint manipulation vs. the application of cervical , cervico-thoracic junction and thoracic manipulation on neck pain , disability and cervical range of motion in chronic neck pain . Design : R and omized clinical trial . Setting : Clinical practice . Participants : Eighty-two patients ( 41 females ) with chronic mechanical neck pain . Interventions : Patients were r and omly assigned to a cervical spine manipulation group or a full manipulative group who received mid-cervical , cervico-thoracic and thoracic joint manipulations . Measurements : Neck pain intensity ( 11-point numeric pain rating scale ) , self-reported disability ( Neck Disability Index ) and cervical range of motion were collected at baseline and one week after the intervention by an assessor blinded to the allocation of the patients . Results : A significant Group * Time interaction for Neck Disability Index ( P = 0.022 ) , but not for neck pain ( P = 0.612 ) , was found : patients in the full manipulative group exhibited greater reduction in disability than those who received the cervical spine manipulation alone , whereas both groups experienced similar decreases in neck pain . Patients in both groups experienced similar increases in cervical range of motion ( P > 0.4 ) . No effect of gender was observed ( P > 0.299 ) . Conclusions : In patients with chronic mechanical neck pain , manipulation of the cervical and thoracic spine leads to a greater reduction in disability at one week than after manipulation of the cervical spine alone , whereas changes in pain and range of motion are not affected differently Abstract Objective : to review and up date the evidence for different forms of manual therapy ( MT ) for patients with different stages of non-specific low back pain ( LBP ) . Data sources : MEDLINE , Cochrane-Register-of-Controlled-Trials , PEDro , EMBASE . 
    Output:
    
Evidence for ASNP : MODERATE- evidence : In favour of ( i ) MT1 to the cervical spine ( Cx ) combined with exercises when compared to MT1 to the thoracic spine ( Tx ) combined with exercises ; ( ii ) MT3 to the Cx and Tx combined with exercise compared to MT2 to the Cx with exercise or compared to usual medical care  for pain and satisfaction with care from short to long-term .
Evidence for CNP : STRONG- evidence : Of no difference of efficacy between MT2 at the symptomatic Cx level(s ) in comparison to MT2 on asymptomatic Cx level(s ) for pain and function .
MODERATE- evidence : In favour ( i ) of MT1 as compared to MT2 and MT4 , all applied to the Cx , for neck mobility , and pain in the very short term ; ( ii ) of MT2 using sof-tissue-techniques to the Cx and Tx or MT3 to the Cx and Tx in comparison to no-treatment in the short-term for pain and disability .
Two majors points could be highlighted , the first one is that combining different forms of MT with exercise is better than MT or exercise alone , and the second one is that mobilization need not be applied at the symptomatic level(s ) for improvements of NP patients .