***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: Summary A total of 101 out patients with acute or subacute low-back pain was r and omly allocated to one of two treatment groups . One group was given st and ardised conventional and optimised activating treatment by primary health care teams . The other group received , according to a pragmatic approach , another treatment programme including manipulation , specific mobilisation , muscle stretching , autotraction and cortisone injections . The treatment effect was evaluated by st and ardised telephone interviews 3 , 7 , 14 , 21 and 90 days after the start of treatment . The two groups were similar in most of the pretrial variables , including age , sex , occupation , education , previous low-back pain problems , previous treatment , sickleave , findings at the physical examination , quality -of-life score , presence of common symptoms , disability rating and pain score . In the early phase as well as at the 90 days ' follow-up , the group receiving manual therapy had significantly less pain , less disability , faster rate of recovery and lower drug consumption , indicating that this type of treatment is superior to conventional treatment BACKGROUND AND PURPOSE The prescriptive validity of a treatment-oriented extension-mobilization category for patients with low back syndrome ( LBS ) was examined . SUBJECTS Of a total of 39 patients with LBS referred for physical therapy , 24 patients ( 14 male , 10 female ) , aged 14 to 50 years ( means = 31.3 , SD = 11.6 ) , were classified as having signs and symptoms indicating treatment with an extension-mobilization approach .  The remaining subjects were dismissed from the study . Patients in the extension-mobilization category were r and omly assigned to either an experimental ( treatment ) group ( n = 14 ) or a comparison group ( n = 10 ) . METHODS The experimental and comparison group subjects were treated with either mobilization and extension ( a treatment matched to the category ) or a flexion exercise regimen ( an unmatched treatment ) . Outcome was assessed with a modified Oswestry Low Back Pain Question naire administered initially and at 3 and 5 days after initiation of treatment . Data were analyzed with a 2 x 3 ( treatment group x treatment period ) analysis of variance . RESULTS The subjects ' rate of improvement , as indicated by the Oswestry question naire scores , was dependent on the treatment group to which they were assigned . Subjects treated with extension and mobilization positively responded at a faster rate than did those treated with a flexion-oriented program . CONCLUSION AND DISCUSSION This study illustrates that a priori classification of selected patients with LBS into a treatment category of extension and mobilization and subsequently treating the patients accordingly with specified interventions can be an effective approach to conservative management of selected patients Abstract The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment . The aims of the study were to identify prognostic factors for disability at 1‐year follow‐up in patients with back pain visiting primary care , and to compare the effect of these in two treatment strategies – chiropractic and physiotherapy . Data were taken from a r and omised trial on patients with back/neck pain visiting the general practitioner , in which patients were allocated to chiropractic and physiotherapy as primary management .  Three hundred and twenty‐three patients , aged 18–60 years , who had no contraindications to manipulation and who had not been treated within the previous month were included in the study . Multiple regression analysis was used to identify prognostic factors . Dependent variables were mean Oswestry score and mean change in Oswestry score at 12‐month follow‐up . The multiple regression analysis revealed five significant ( P<0.001–0.01 ) prognostic factors ; duration of current episode , Oswestry score at entry , expectations of treatment , number of localisations , and well‐being . Besides , the regression coefficients for the significant factors were compared between the two treatment strategies . No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies . Twelve per cent of the patients had poor prognostic factors ( duration ≥1 month , more than one localisation , low expectations of treatment and low well‐being ) at entry . These patients had a mean Oswestry score above 20 % at 1‐year follow‐up . Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospect ively evaluated OBJECTIVE --To compare the effectiveness of manipulative therapy , physiotherapy , treatment by the general practitioner , and placebo therapy in patients with persistent non-specific back and neck complaints . DESIGN --R and omised clinical trial . SETTING -- Primary health care in the Netherl and s. PATIENTS --256 patients with non-specific back and neck complaints of at least six weeks ' duration who had not received physiotherapy or manipulative therapy in the past two years . INTERVENTIONS --At the discretion of the manipulative therapists , physiotherapists , and general practitioners . Physiotherapy consisted of exercises , massage , and physical therapy ( heat , electrotherapy , ultrasound , shortwave diathermy ) . Manipulative therapy consisted of manipulation and mobilisation of the spine . Treatment by general practitioners consisted of drugs ( for example , analgesics ) , advice about posture , home exercises , and (bed)rest . Placebo treatment consisted of detuned shortwave diathermy ( 10 minutes ) and detuned ultrasound ( 10 minutes ) . MAIN OUTCOME MEASURES --Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients . RESULTS --Many patients in the general practitioner and placebo groups received other treatment during follow up . Improvement in the main complaint was larger with manipulative therapy ( 4.5 ) than with physiotherapy ( 3.8 ) after 12 months ' follow up ( difference 0.9 ; 95 % confidence interval 0.1 to 1.7 ) . Manipulative therapy also gave larger improvements in physical functioning ( difference 0.6 ; -0.1 to 1.3 ) . The global perceived effect after six and 12 months ' follow up was similar for both treatments . CONCLUSIONS --Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment . Furthermore , manipulative therapy is slightly better than physiotherapy after 12 months Ninety-four patients with non-specific lumbar pain referred to hospital rheumatology and orthopaedic clinics participated in a double-blind controlled trial comparing mobilisation and manipulation with placebo physiotherapy . Results were assessed immediately after the tratment course , two months later , and at one year . Many patients showed improvement , but in contrast to a study on general-practitioner patients with nonspecific back pain no definite advantage could be associated with mobilisation and manipulation . The benefits of mobilisation and manipulation for low back pain are probably restricted to hastening recovery in patients likely rapidly to improve spontaneously . Hence patients whose severity and duration of symptoms warrant specialist referral are less likely to benefit from the technique OBJECTIVE To determine whether traditional bone- setting or continuous light exercise therapy could case back pain and improve function better than ordinary physiotherapy . DESIGN Observer-blinded , r and omized clinical trial with a 6-month follow-up . SETTING An outpatient institution for folk medicine research . PATIENTS Of 147 back pain patients recruited from local health centers and by newspaper announcements , 132 were found eligible ( non-retired-no contraindications to manipulation ) and entered . A final 114 ( one dropout ) with back pain for longer than 7 weeks were included in this intent to treat analysis . INTERVENTIONS Bone- setting , guidance for continuous light back movements or physiotherapy for up to ten 1-hour sessions during 6 weeks . MAIN OUTCOME MEASURES Spinal mobility and muscular performance . Back pain assessed by visual analog scales ( VAS ) . RESULTS The physical measures changed only modestly , from one tenth to half of st and ard deviation , while the VAS was halved . The thoracolumbar side-bending , the modified Schober , and the VAS were significantly better improved by bone- setting than by exercise but not better than by physiotherapy . CONCLUSION Neither bone- setting nor exercise differed significantly from physiotherapy , but bone- setting improved lateral and forward bending of the spine and back pain more than did exercise Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints . All suffered from regional low-back pain for less than 1 month , were ages 18–40 , had never previously undergone any form of spinal manipulation , and denied a prior episode of backache within the previous 6 months . R and omization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2–4 weeks . Outcome was monitored by a question naire assessing functional impairment . A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry . In the first week following manipulation , these patients improved to a greater degree ( P=.009 , t test ) and more rapidly ( P < .025 , Wilcoxon rank-sum test ) The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematic ally applied , aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients . The effect(s ) of the proposed stretching maneuver was evaluated . Twenty-eight chronic low-back pain patients were r and omly assigned to one of two groups . The control group underwent a multimodal rehabilitation program , and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation . The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors , with corresponding significant increase in back muscle myoelectric signals . Also , a significant decrease in their pain level was reported after 2 weeks of continuous treatment . The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group OBJECTIVE --To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin . DESIGN --R and omised controlled trial . Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic , length of current episode , history , and severity of back pain . Patients were followed up for up two years . SETTING --Chiropractic and hospital outpatient clinics in 11 centres . PATIENTS --741 Patients aged 18 - 65 who had no contraindications to manipulation and who had not been treated within the past month . INTERVENTIONS --Treatment at the discretion of the chiropractors , who used chiropractic manipulation in most patients , or of the hospital staff , who most commonly used Maitl and mobilisation or manipulation , or both . MAIN OUTCOME MEASURES --Changes in the score on the Oswestry pain disability question naire and in the results of tests of straight leg raising and lumbar flexion . RESULTS --Chiropractic treatment was more effective than hospital outpatient management , mainly for patients with chronic or severe back pain . A benefit of about 7 % points on the Oswestry scale was seen at two years . The benefit of chiropractic treatment became more evident throughout the follow up period . Secondary outcome measures also showed that chiropractic was more beneficial . CONCLUSIONS --For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile , long term benefit in comparison with hospital outpatient management . The benefit is seen mainly in those with chronic or severe pain . Introducing chiropractic into NHS practice should be considered 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 OBJECTIVE To compare prospect ively the effect of manual treatment such as manipulation , specific mobilization , muscle stretching , auto-traction , and cortisone injections with st and ardized conventional but optimized activating treatment by primary health care teams . DESIGN Prospect i ve controlled multicentre trial with four months ' follow-up . SETTING Kopparberg County , Sweden . Six primary health care or occupational health care centres , representing a catchment area of 56000 residents participated . PARTICIPANTS 101 out patients with acute or subacute low-back pain were , during the period February 1988 to April 1989 , r and omly allocated to one of two treatment groups . MAIN OUTCOME MEASURE Quality of life was assessed at baseline and at four months by means of visual analogue scales ( VAS ) . The occurrence of 27 different symptoms of a psychosomatic character was surveyed initially and at four months by questions answered by " yes " or " no " in a question naire . RESULTS There were significant differences concerning quality of life and presence of general symptoms in favour of the group receiving manual treatment with steroid injections . CONCLUSION Manual treatment with steroid injections was superior to conventional treatment in minimizing mental and somatic symptoms and increasing quality of life , in parallel with other measures of improvement The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy ( S 
    Output:
    
Spinal manipulative therapy had no statistically or clinical ly significant advantage over general practitioner care , analgesics , physical therapy , exercises , or back school .
Radiation of pain , study quality , profession of manipulator , and use of manipulation alone or in combination with other therapies did not affect these results .
REVIEW ER 'S CONCLUSIONS There is no evidence that spinal manipulative therapy is superior to other st and ard treatments for patients with acute or chronic low-back pain