***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 
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    Input: STUDY DESIGN A controlled clinical trial . OBJECTIVES To assess the effects of an integrated back stability ( IBS ) programme on a chronic low back pain ( CLBP ) population in a time restricted private clinic environment . BACKGROUND Studies assessing stability training CLBP have reported inconsistent results . Methods used within trials vary , with some authors focusing on muscle isolation and others using whole body movements . IBS uses an exercise progression beginning with posturally based exercise and progressing from muscle isolation through to complex movements . METHODS AND MEASURES Fifty-nine chronic low back patients were divided into control ( n=32 ) and intervention ( n=27 ) groups . Participants in the intervention group were prescribed a 6 week individualized exercise programme in three stages . In stage 1 , exercises addressed posture and movement dysfunction and activated the core stabilizing muscles . In stage 2 , ' back fitness ' was enhanced using progressive exercise principles . Stage 3 emphasized technique specific actions . Participants in the control group received a backcare advice leaflet only . RESULTS Pre- and post-test scores were analysed for each of the outcome measures within the control group using a Wilcoxin signed ranks test . At an alpha level of p < or=0.0071 , no differences were observed . For the intervention group , a Mann-Whitney U-test showed significant differences between groups in the Rol and and Morris Disability Question aire ( RMDQ ) , short form McGill Pain Question naire ( SF-MPQ ) , and the Tampa Scale of Kinesiophobia ( TSK ) ( p < or=0.0071 ) . Patient satisfaction was assessed by question naire , 89 % of patients considering their level of pain and functional impairment acceptable following the programme . CONCLUSION IBS significantly reduced pain and disability in the subject group studied . Patients reported a positive experience of the programme 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 Background The evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled . Objective The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain . Design This was a r and omized , placebo-controlled trial . Setting The study was conducted in an outpatient physical therapy department in Australia . Patients The participants were 154 patients with chronic low back pain of more than 12 weeks ’ duration . Intervention Twelve sessions of motor control exercise ( ie , exercises design ed to improve function of specific muscles of the low back region and the control of posture and movement ) or placebo ( ie , detuned ultrasound therapy and detuned short-wave therapy ) were conducted over 8 weeks . Measurements Primary outcomes were pain intensity , activity ( measured by the Patient-Specific Functional Scale ) , and patient 's global impression of recovery measured at 2 months . Secondary outcomes were pain ; activity ( measured by the Patient-Specific Functional Scale ) ; patient 's global impression of recovery measured at 6 and 12 months ; activity limitation ( measured by the Rol and -Morris Disability Question naire ) at 2 , 6 , and 12 months ; and risk of persistent or recurrent pain at 12 months . Results The exercise intervention  improved activity and patient 's global impression of recovery but did not clearly reduce pain at 2 months . The mean effect of exercise on activity ( measured by the Patient-Specific Functional Scale ) was 1.1 points ( 95 % confidence interval [CI]=0.3 to 1.8 ) , the mean effect on global impression of recovery was 1.5 points ( 95 % CI=0.4 to 2.5 ) , and the mean effect on pain was 0.9 points ( 95 % CI=−0.01 to 1.8 ) , all measured on 11-point scales . Secondary outcomes also favored motor control exercise . Limitation Clinicians could not be blinded to the intervention they provided . Conclusions Motor control exercise produced short-term improvements in global impression of recovery and activity , but not pain , for people with chronic low back pain . Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Summary Background A number of studies have evaluated exercise interventions compared with other treatment strategies for subjects with recurrent low back pain ( LBP ) ; however , subject pain level and balance were not carefully considered . The purpose of this study was to investigate the effectiveness of spinal stabilization exercises ( SSE ) for managing pain and increasing balance strategy changes following unexpected perturbations in patients diagnosed with recurrent LBP . Material / Methods Twenty-one age- and gender-matched patients participated in a supervised SSE or control exercise program 5 times a week over a 4-week period . The Million Visual Analogue Scale ( MVAS ) and Oswestry Disability Index ( ODI ) were used to measure each patient ’s level of pain and disability . Balance measurements were derived from recordings of the anterior-posterior ( A/P ) and medio-lateral ( M/L ) center of pressure ( COP ) displacements during 3 consecutive , unexpected r and om perturbations . Results The level of reported pain and disability significantly decreased following treatment for both groups . Although the M/L sway was not significantly different in either group ( p=0.86 ) , there was a significant difference between group and measurement time during A/P sway ( p=0.04 ) . The A/P displacement of the SSE group significantly decreased compared with the control group . The decreased A/P displacement can be linked to the SSE intervention , which helps prevent further injury by limiting an individual ’s response rate to external perturbations . Conclusions Clinicians might consider SSE for LBP patients as a possible rehabilitation strategy to reduce A/P displacement OBJECTIVE : To contrast the efficacy of two exercise programs , segmental stabilization and strengthening of abdominal and trunk muscles , on pain , functional disability , and activation of the transversus abdominis muscle ( TrA ) , in individuals with chronic low back pain . DESIGN : Our sample consisted of 30 individuals , r and omly assigned to one of two treatment groups : segmental stabilization , where exercises focused on the TrA and lumbar multifidus muscles , and superficial strengthening , where exercises focused on the rectus abdominis , abdominus obliquus internus , abdominus obliquus externus , and erector spinae . Groups were examined to discovere whether the exercises created contrasts regarding pain ( visual analogical scale and McGill pain question naire ) , functional disability ( Oswestry disability question naire ) , and TrA muscle activation capacity ( Pressure Biofeedback Unit = PBU ) . The program lasted 6 weeks , and 30‐minute sessions occurred twice a week . Analysis of variance was used for inter‐ and intra‐group comparisons . The significance level was established at 5 % . RESULTS : As compared to baseline , both treatments were effective in relieving pain and improving disability ( p<0.001 ) . Those in the segmental stabilization group had significant gains for all variables when compared to the ST group ( p<0.001 ) , including TrA activation , where relative gains were 48.3 % and ‐5.1 % , respectively . CONCLUSION : Both techniques lessened pain and reduced disability . Segmental stabilization is superior to superficial strengthening for all variables . Superficial strengthening does not improve TrA activation capacity The objective of the study was to establish the specific use of advice and exercise by physiotherapists , for the management of  chronic low back pain ( LBP ) . A question naire was mailed to a r and om sample of 600 members of the Irish Society of Chartered Physiotherapists . Open and closed questions were used to obtain information on treatments provided to chronic LBP patients . Respondents ' treatment goals were also investigated , along with the typical methods used to assess treatment outcome . Four hundred and nineteen of the sample returned the question naire ; 280/419 ( 67 % ) indicated that they currently treated LBP of which 76 % ( n=214 ) were senior grade therapists .  Advice and exercise  , respectively , were the treatments most frequently used for chronic LBP : advice was most commonly delivered as part of an exercise programme , with strengthening ( including core stability ) the most frequently used exercise type .  Supervision of exercise and follow-up advice  were underutilised with respect to the recommendations of relevant clinical guidelines . Pain relief was an important treatment goal . Emphasis on exercise programme  supervision , incorporating reassurance that its safe to stay active and ' hurt does not mean harm ' , must be more effectively disseminated and promoted in practice . The influence of follow-up advice on  exercise adherence warrants further investigation Study Design . A r and omized controlled trial . Objective . To investigate feed-forward activation or timing of abdominal muscle activation in response to rapid shoulder flexion after 8 weeks with core stability exercises , sling exercises , or general exercises in chronic nonspecific low back pain ( LBP ) patients . Summary of Background Data . Delayed onset in abdominal muscles has been associated with LBP . Low load exercises to volitionally activate the transversus abdominis were introduced to restore trunk muscle activation deficits . More forceful co-contraction exercises have been advocated by others . This study explored whether abdominal muscle onset changed after low-load core stability exercises , high-load sling exercises , or general exercises . Methods . Subjects ( N = 109 ) with chronic nonspecific LBP of at least 3 months ' duration were r and omly assigned to 8 weekly treatments with low-load core stability exercises , high-load stabilizing exercises in slings , or general exercises in groups . Primary outcome was onset recorded bilaterally by m-mode ultrasound imaging in the deep abdominal muscles in response to rapid shoulder flexion . Results . No or small changes were found in onset after treatment . Baseline adjusted between group differences showed a 15 ms ( 95 % confidence interval [ CI ] , 1–28 ; P = 0.03 ) and a 19 ms ( 95 % CI , 5–33 ; P < 0.01 ) improvement with sling relative to core stability and general exercises , respectively , but on 1 side only . There was no association between changes in pain and onset over the intervention period ( R2 ⩽ 0.02 ) . Conclusion . Abdominal muscle onset was largely unaffected by 8 weeks of exercises in chronic LBP patients . There was no association between change in onset and LBP . Large individual variations in activation pattern of the deep abdominal muscles may justify exploration of differential effects in subgroups of LBP Abstract Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head‐to‐head comparisons of these interventions . We conducted a r and omized controlled trial to compare effects of general exercise , motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain . Two hundred and forty adults with non‐specific low back pain ⩾3 months were allocated to groups that received 8 weeks of general exercise , motor control exercise or spinal manipulative therapy . General exercise included strengthening , stretching and aerobic exercises . Motor control exercise involved retraining specific trunk muscles using ultrasound feedback . Spinal manipulative therapy included joint mobilization and manipulation . Primary outcomes were patient‐specific function ( PSFS , 3–30 ) and global perceived effect ( GPE , −5 to 5 ) at 8 weeks . These outcomes were also measured at  
    Output:
    
The difference between groups was clinical ly insignificant .
When compared with alternative forms of exercise , there was no statistical or clinical ly significant difference .
Conclusion There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term .