***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: OBJECTIVES To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain ( CLBP ) when managed in a hospital by either a regional pain clinic or a chiropractor .  DESIGN The study was a pragmatic , r and omized , controlled trial . SETTING The trial was performed at a National Health Service ( NHS ) hospital outpatient clinic ( pain clinic ) in the United Kingdom . SUBJECTS AND INTERVENTIONS Patients with CLBP ( i.e. , symptom duration of > 12 weeks ) referred to a regional pain clinic ( outpatient hospital clinic ) were assessed and r and omized to either chiropractic or pain-clinic management for a period of 8 weeks . The study was pragmatic , allowing for normal treatment protocol s to be used . Treatment was administered in an NHS hospital setting . OUTCOME MEASURES The Rol and -Morris Disability Question naire ( RMDQ ) and Numerical Rating Scale were used to assess changes in perceived disability and pain . Mean values at weeks 0 , 2 , 4 , 6 , and 8 were calculated . The mean differences between week 0 and week 8 were compared across the two treatment groups using Student 's t-tests . Ninety-five percent ( 95 % ) confidence intervals ( CIs ) for the differences between groups were calculated . RESULTS R and omization placed 12 patients in the pain clinic and 18 in the chiropractic group , of which 11 and 16 , respectively , completed the trial . At 8 weeks , the mean improvement in RMDQ was 5.5 points greater for the chiropractic group ( decrease in disability by 5.9 ) than for the pain-clinic group ( 0.36 ) ( 95 % CI 2.0 points to 9.0 points ; p = 0.004 ) . Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group ( p = 0.023 ) . CONCLUSIONS This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a sub population of patients with CLBP Abstract Objective To estimate the effect of adding exercise classes , spinal manipulation delivered in NHS or private premises , or manipulation followed by exercise to “ best care ” in general practice for patients consulting with back pain . Fig 1 Progress of the UK BEAM trial Design Pragmatic r and omised trial with factorial design . Setting 181 general practice s in Medical Research Council General Practice Research Framework ; 63 community setting s around 14 centres across the United Kingdom . Participants 1334 patients consulting their general practice s about low back pain . Main outcome measures Scores on the Rol and Morris disability question naire at three and 12 months , adjusted for centre and baseline scores . Results All groups improved over time . Exercise  improved mean disability question naire scores at three months by 1.4 ( 95 % confidence interval 0.6 to 2.1 ) more than “ best care . ” For manipulation the additional improvement was 1.6 ( 0.8 to 2.3 ) at three months and 1.0 ( 0.2 to 1.8 ) at 12 months . For manipulation followed by exercise the additional improvement was 1.9 ( 1.2 to 2.6 ) at three months and 1.3 ( 0.5 to 2.1 ) at 12 months . No significant differences in outcome occurred between manipulation in NHS premises and in private premises . No serious adverse events occurred . Conclusions Relative to “ best care ” in general practice , manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months ; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months ; and exercise achieved a small benefit at three months but not 12 months OBJECTIVE To gain information on the issue of scope of chiropractic practice , particularly in relation to primary care and prevention . DESIGN A survey was administered by mail to a r and om sample of 753 U.S. chiropractors . SETTING The sampling frame was stratified into eight geographic regions with approximately equal numbers of D.C. 's to ensure that all areas of the U.S. were represented . PARTICIPANTS Chiropractors listed in the National Directory of Chiropractic , 1993 - 4 edition , comprised the sampling frame . RESULTS Of the 753 D.C. 's sample d , 492 completed surveys , for a response rate of 65.3 % . The majority of respondents ( 90.4 % ) considered themselves primary care practitioners . Over 80 % were accessible to patients at all times . Only 4.1 % accepted payment in cash only . Fifty-eight percent did a regional physical exam , 29.0 % a complete physical , and 71 % a complete health history on every patient . Referrals to M.D.'s/D.O. 's were made by 78.1 % and received by 46.0 % within the last 3 months , although fewer than 20 % included reports with referrals . Prevention practice s related directly to musculoskeletal problems were most often design ated as important to discuss with patients : lifting techniques ( 78.0 % ) , postural education ( 76.4 % ) , fitness exercise ( 69.3 % ) and injury prevention ( 68.3 % ) . CONCLUSIONS In general , respondents demonstrated a number of practice characteristics associated with primary care . However , it appears that they could further strengthen their position by routinely accompanying referrals with reports , and by increasing their emphasis on prevention , especially in areas not directly related to musculoskeletal conditions 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 Study Design . A r and omized controlled clinical trial was conducted . Objective . To compare medication , needle acupuncture , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain . Summary of Background Data . Between February 1999 and October 2001 , 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital ’s multidisciplinary spinal pain unit . Methods . One of three separate intervention protocol s was used : medication , needle acupuncture , or chiropractic spinal manipulation . Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index ( Oswestry ) , the Neck Disability Index ( NDI ) , the Short-Form-36 Health Survey question naire ( SF-36 ) , visual analog scales ( VAS ) of pain intensity and ranges of movement . These instruments were administered again at 2 , 5 , and 9 weeks after the beginning of treatment . Results . R and omization proved to be successful . The highest proportion of early ( asymptomatic status ) recovery was found for manipulation ( 27.3 % ) , followed by acupuncture ( 9.4 % ) and medication ( 5 % ) . Manipulation achieved the best overall results , with improvements of 50 % ( P = 0.01 ) on the Oswestry scale , 38 % ( P = 0.08 ) on the NDI , 47 % ( P < 0.001 ) on the SF-36 , and 50 % ( P < 0.01 ) on the VAS for back pain , 38 % ( P < 0.001 ) for lumbar st and ing flexion , 20 % ( P < 0.001 ) for lumbar sitting flexion , 25 % ( P = 0.1 ) for cervical sitting flexion , and 18 % ( P = 0.02 ) for cervical sitting extension . However , on the VAS for neck pain , acupuncture showed a better result than manipulation ( 50%vs 42 % ) . Conclusions . The consistency of the results provides , despite some discussed shortcomings of this study , evidence that in patients with chronic spinal pain , manipulation , if not contraindicated , results in greater short-term improvement than acupuncture or medication . However , the data do not strongly support the use of only manipulation , only acupuncture , or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain . The results from this exploratory study need confirmation from future larger studies OBJECTIVE To investigate how chronic pain patients respond to treatment with Bio-Energetic Synchronization Technique ( BEST ) . METHODS Twenty-four adult patients with chronic pain-related conditions that failed to respond to previous chiropractic care were recruited . Subjects were given baseline assessment s including pain Visual Analog Scale , Profile of Mood States , and the Global Well-being Scale . The 5-week treatment program consisted of an initial 3-day session with BEST therapy , followed by a single treatment session for the following 4 weeks . Patients were reevaluated at the end of the 3-day session and at weekly intervals throughout the course of care . At the end of week 5 , patients were asked to assess their degree of satisfaction with the treatment . RESULTS Patients had 3 main categories of pain : headache ( n = 8 , mean duration 15 years ) , neck pain ( n = 18 , mean duration 11 years ) , and low back pain ( n = 17 , mean duration 10 years ) .  Global Well-Being Scale scores significantly improved at the end of the 3-day session ( P > .05 ) but not subsequently . The Profile of Mood States reflected favorable changes in all areas . Significant improvement in vigor ( P > .003 ) and fatigue ( P > .006 ) existed at the end of 5 weeks ( P < .01 ) . The reduction of pain was significant at both the end of the 3-day session and at follow-up ( P = .0003 ) . A statistically significant decrease in depression ( P = .004 ) was noted after 3 days , and a substantial although not significant ( P = .06 ) decrease in depression existed at the end of 1 month . Eighty-two percent reported satisfaction with BEST ( 47 % reported being " extremely satisfied " and 35 % " satisfied " ) . CONCLUSION In this group of chronic pain patients , improvement in patient outcome measures was seen after 5 weeks of therapy . These patients also responded with a high degree of satisfaction with care The purpose of this study was to assess the effects of two different treatment modalities on the rehabilitation process of chronic sacroiliac joint patients . The treatment modalities included spinal manipulative therapy given by a chiropractor and a program of back school therapy given by a physiotherapist . The rehabilitation process was assessed using clinical and biomechanical measures . It was found that back school therapy was a better treatment modality than the spinal manipulative therapy , according to the clinical measures of rehabilitation . Precisely the opposite result was found for the biomechanical measures OBJECTIVE This r and omized controlled study was design ed to determine the pain-relieving effect of Biofreeze ( Performance Health Inc. , Export , PA ) body surface application and chiropractic adjustments on subjects with acute low back pain ( LBP ) . METHODS The data were collected at the baseline , 2 weeks after treatment , and 4 weeks after treatment for final analyses . Diversified manual adjustments were provided by licensed chiropractors twice a week for 4 weeks to both control and experimental groups . Biofreeze was applied to the lower back area 3 times a day for 4 weeks in the experimental group . Outcome assessment s included visual analog scale , Rol and Morris Disability Question naire , heart rate variability for stress , and electromyography for low back muscle activity . RESULTS A total of 36 subjects were recruited in the study ( 25 male ) . The average age was 34 years . Significant pain reduction was found after each week of treatment in the experimental group ( P < .05 ) . The Rol and Morris Disability Question naire did not show significant changes in both groups . There were no significant differences for pain reduction in the control group . Heart rate variability analysis showed no significant change ( P > .05 ) in the experimental group after 4 weeks of Biofreeze and chiropractic adjustments . There were no statistically significant changes in the electromyography readings between the 2 groups . CONCLUSION Biofreeze combined with chiropractic adjustment showed significant reduction in LBP OBJECTIVES To evaluate the proposed manual placebo in terms of success in blinding patients to treatment group assignment and outcomes between the treatment 
    Output:
    
There was no difference in medium- and long-term disability .
No difference was demonstrated for combined chiropractic interventions for chronic LBP and for studies that had a mixed population of LBP .
Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP .
However , there is currently no evidence that supports or refutes that these interventions provide a clinical ly meaningful difference for pain or disability in people with LBP when compared to other interventions .