***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: BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition Background Traction is commonly used for the treatment of low back pain ( LBP ) , predominately with nerve root involvement ; however its benefits remain to be established . The aim of this study was to test the feasibility of a pragmatic r and omized controlled trial to compare the difference between two treatment protocol s ( manual therapy , exercise and advice , with or without traction ) in the management of acute/sub acute LBP with ' nerve root ' involvement . Methods 30 LBP patients with nerve root pain were recruited and r and omly assigned to one of two treatment groups . Primary outcome measures were the : McGill pain question naire , Rol and Morris disability question naire , and the SF36 Question naire ; recorded at baseline , discharge , 3 and 6 months post-discharge . Results 27 patients completed treatment with a loss of another four patients at follow up . Intention to treat analysis demonstrated an improvement in all outcomes at follow up points but there appeared to be little difference between the groups . Conclusion This study has shown that a trial recruiting patients with ' nerve root ' problems is feasible . Further research based upon a fully powered trial is required to ascertain if the addition of traction has any benefit in the management of these patients .Trial Registration Registration number : IS RCT Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group The outcomes of vertebral axial decompression ( VAX-D ) therapy for patients with low back pain from various causes are reported . Data was collected from twenty-two medical centers for patients who received VAX-D therapy for low back pain , which was sometimes accompanied by referred leg pain . Only patients who received at least ten sessions and had a diagnosis of herniated disc , degenerative disc , or facet syndrome , which were confirmed by diagnostic imaging , were included in this study ; a total of 778 cases . The average time between the initial onset of symptoms and the beginning of this therapy was 40 months , and it was four months or more in 83 % of the cases . The data contained the patients ' quantitative assessment s of their own pain , mobility , and ability to carry out the usual ' activities of daily living ' . The treatment was successful in 71 % of the 778 cases , when success was defined as a reduction in pain to 0 or 1 , on a 0 to 5 scale . Improvements in mobility and activities of daily living correlated strongly with pain reduction . The causes of back pain and their relationship to this therapy are also discussed 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 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 Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain , however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group . The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy ( Exercise Program ) or a form of chiropractic care ( Flexion Distraction ) for chronic low back pain . Methods In this r and omized clinical trial follow up study , 195 participants were followed for one year after a four-week period of either a form of chiropractic care ( FD ) or a form of physical therapy ( EP ) . Weekly  structured telephone interview questions  regarded visitation of various health care practitioners and the practice of self-care for low back pain . Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care ( p < 0.05 ) . No group differences were noted in the number of visits to a chiropractor or physical therapist . Self-care was initiated by nearly every participant in both groups . Conclusion During a one-year follow-up , participants previously r and omized to physical therapy attended significantly more health care visits than those participants who received chiropractic care 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 The therapeutic modalities available for the conservative management of chronic cervical and lumbar pain include underwater traction , the usefulness of which is not universally acknowledged . No reports have been published on clinical trials evaluating underwater traction . This study was intended to ascertain any beneficial impact of weightbath therapy on the clinical parameters and quality of life of patients with cervical/lumbar discopathy . The study population comprised 72 subjects . Two groups of 18 patients each received underwater traction therapy of the cervical or lumbar spine with add-on McKenzie exercises and iontophoresis . The remaining two groups , treated with exercises and iontophoresis , served as controls . VAS and SF36 scores , range of motion were monitored to appraise therapeutic efficacy in cervical discopathy , whereas these parameters were supplemented by the Oswestry index in lumbar discopathy . A MRI scan was done at baseline and after 3 months of follow-up . Underwater cervical or lumbar traction therapy for discopathy achieved significant improvement of all study parameters , which was still evident 3 months later . Among the controls , significant improvement of just a single parameter was seen in patients with lumbar , and of two parameters in those with cervical discopathy . Underwater traction therapy effectively mitigates pain , enhances joint flexibility , and improves the quality of life of  patients with cervical or lumbar discopathy . The equipment required to administer weightbath therapy is simple to install and treatment technique is straightforward A controlled trial of continuous lumbar traction in the treatment of  back pain and sciatica  showed similar improvements in both the treated group ( weighted traction ) and the control group ( simulated traction ) . The findings of this study question the justification of admitting patients with back pain into hospitals for purpose s of traction alone 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 
    Output:
    
For people with mixed symptom patterns ( acute , subacute and chronic LBP with and without sciatica ) , there was low- to moderate- quality evidence that traction may make little or no difference in pain intensity , functional status , global improvement or return to work when compared to placebo , sham traction or no treatment .
Similarly , when comparing the combination of physiotherapy plus traction with physiotherapy alone or when comparing traction with other treatments , there was very-low- to moderate- quality evidence that traction may make little or no difference in pain intensity , functional status or global improvement .
For people with LBP with sciatica and acute , subacute or chronic pain , there was low- to moderate- quality evidence that traction probably has no impact on pain intensity , functional status or global improvement .
For chronic LBP without sciatica , there was moderate- quality evidence that traction probably makes little or no difference in pain intensity when compared with sham treatment .
These findings indicate that traction , either alone or in combination with other treatments , has little or no impact on pain intensity , functional status , global improvement and return to work among people with LBP .
Implication s for practice To date , the use of traction as treatment for non-specific LBP can not be motivated by the best available evidence .
These conclusions are applicable to both manual and mechanical traction .
Implication s for research Only new , large , high- quality studies may change the point estimate and its accuracy , but it should be noted that such change may not necessarily favour traction .