***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: & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy Rheumatoid arthritis ( RA ) is a systemic inflammatory and chronic disease of joints , which may result in irreversible deformities . To evaluate the effects of an exercise programme aim ed at improving the h and strength in individuals with h and deformities result ing from RA and to analyse the impact these exercises have on functionality .  Twenty women with RA h and deformities participated in the study . They were r and omly divided into two groups as follows : Group 1 ( n = 13 ) had women participating in the exercise programme  aim ed at improving h and grip ( HS ) and pinch strengths ( PS ) as well as the motor coordination of the h and ; Group 2 ( n = 7 ) had women with RA who received no treatment for their h and s ( control ) . The treatment programme for h and s consisted of 20 sessions , twice a week and at-home exercises . Both groups were su bmi tted to Health Assessment Question naire ( HAQ ) and evaluation of HS and PS by means of dynamometry . Re-evaluations were performed after 10 and 20 sessions in Group 1 and after 2 months in Group 2 . After 20 sessions of physiotherapy , Group 1 had a significant gain in HS and PS ( p < 0.05 ) in addition to the improvement of functionality as assessed by HAQ ( p = 0.016 ) . For Group 2 , no difference was found between the variables analysed ( p > 0.05 ) . The strengthening exercises for individuals with RA h and deformity are beneficial to improve h and grip and pinch strengths as well as functionality OBJECTIVE To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the h and s and feet in patients with rheumatoid arthritis ( RA ) . METHODS Data of the 281 completers of a 2 year r and omised controlled trial comparing the effects of usual care physical therapy ( UC ) with high intensity weightbearing exercises  were analysed for the rate of radiological joint damage ( Larsen score ) of the h and s and feet . Potential determinants of outcome were defined : disease activity , use of drugs , change in physical capacity and in bone mineral density , and attendance rate at exercise sessions . RESULTS After 2 years , the 136 participants in high intensity weightbearing exercises  developed significantly less radiological damage than the 145 participants in UC . The mean ( SD ) increase in damage was 3.5 ( 7.9 ) in the exercise group and 5.7 ( 10.2 ) in the UC group , p = 0.045 . Separate analysis of the damage to the h and s and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the h and s. The rate of damage was independently associated with less disease activity , less frequent use of glucocorticoids , and with an improvement in aerobic fitness . CONCLUSION The progression of radiological joint damage of the h and s and feet in patients with RA is not increased by long term high intensity weightbearing exercises . These exercises may have a protective effect on the joints of the feet OBJECTIVE To investigate the effects of a 21-week concurrent strength and endurance training protocol on physical fitness profile in women with early or longst and ing rheumatoid arthritis ( RA ) compared with healthy subjects . METHODS Twenty-three female patients with RA volunteered for the study . Twelve had early RA and eleven had longst and ing RA . Twelve healthy women served as controls . Maximal strength of different muscle groups was measured by  dynamometers  , walking speed with light cells  , and  vertical squat jump  on the force platform to mirror explosive force . Maximal oxygen uptake was measured by gas analyzer . Six training sessions ( 3 strength training and 3 endurance training ) were carried out in a 2-week period for 21 weeks . RESULTS The training led to large gains in maximal strength both in women with RA and in healthy women ( P < 0.043 - 0.001 ) . The strength gains were accompanied by increases in walking speed ( P < 0.034 - 0.001 ) and vertical squat jump ( P < 0.034 - 0.001 ) . Significant improvements also occurred in maximal aerobic capacity in all groups ( P < 0.023 - 0.014 ) . CONCLUSIONS Both early and longst and ing RA patients with stable disease can safely improve all characteristics of their physical fitness profile using a progressive concurrent strength and endurance training protocol OBJECTIVE To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the  rheumatoid h and . METHODS In a r and omized controlled trial , participants with rheumatoid arthritis ( RA ) recruited from a rheumatology department in Mid-Staffordshire , UK ( February 1999 to January 2001 ) were r and omized to three groups . All received joint protection ( JP ) information delivered by a therapist at baseline . Group 1 participants received a set of additional h and -strengthening and mobilizing home exercises , group 2 a different set of additional h and -stretching exercises and group 3 the JP information alone . The primary outcome was the Arthritis Impact Measurement Scales II ( AIMS II ) ( upper limb ; h and and finger function subscales ) . Outcomes were assessed at baseline and 1 , 3 and 6 months . Analysis was by intention to treat . RESULTS Sixty-seven participants ( mean age 59.6 yr ) were recruited : group 1 n = 21 , group 2 n = 24 and group 3 n = 22 . A 78 % follow-up was achieved at 6 months . There was a mean fall ( SD ) in AIMS II upper limb function 0 - 6 month change scores in group 1 of 1.00 ( 1.07 ) . In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 ( 1.54 ) and 0.30 ( 1.22 ) , respectively . The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant ( P = 0.007 ) and remained so after adjustment for multiple testing ( P = 0.012 ) . CONCLUSION Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening h and exercises in RA patients compared with simple stretches or advice alone BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . A series of experiments showed that , on  exercise of the inflamed human knee , intra-articular pressure rises above synovial capillary perfusion pressure , causing intra-articular hypoxia ; and that , on cessation of exercise , there is oxidative damage to lipids and IgG within the joint . These findings are consistent with the hypothesis that persistence of synovial inflammation can be due to exercise-induced hypoxic-reperfusion injury mediated by reactive oxygen species The primary objective of our study was to evaluate the effect of 6-week-long isotonic and isometric h and exercises on pain , h and functions , dexterity and quality of life in women diagnosed as rheumatoid arthritis ( RA ) . Our secondary objective was to assess the changes in h and grip strength and disease activity . This r and omized , parallel , single-blinded 6-week intervention study enrolled 52 female patients between 40 and 70 years of age , who were diagnosed with RA according to American College of Rheumatology criteria , had disease duration of at least 1 year and had a stage 1–3 disease according to Steinbrocker ’s functional evaluation scale . Patients were r and omized into isotonics and isometrics groups . Exercises were performed on sixth week . All patients were applied wax therapy in the first 2 weeks . Their pain was assessed with visual analog scale ( VAS ) , their h and functions with Duruöz H and Index ( DHI ) , dexterity with nine hole peg test ( NHPT ) and quality of life with Rheumatoid Arthritis Quality of Life question naire ( RAQoL ) . Dominant and non-dominant h and grip strengths ( HS ) were measured . Disease activity was determined by disease activity score ( DAS 28 ) . We evaluated the difference in the above parameters between baseline and 6 weeks by Wilcoxon paired t test . The study was completed with 47 patients ( isotonics n = 23 ; isometrics n = 24 ) . VAS , DHI , NHPT , and RAQoL scores significantly improved in both groups by the end of 6th week compared to the baseline scores of the study ( for isotonics p = 0.036 , p = 0.002 ; p = 0.0001 , p = 0.003 ; for isometrics p = 0.021 , p = 0.002 , p = 0.005 , p = 0.01 , respectively ) . DAS 28 scores decreased in both exercise groups ( p = 0.002 ; p = 0.0001 , respectively ) , while isometrics showed a significant increase in dominant HS ( p = 0.029 ) , and isotonics showed a significant increase in non-dominant HS ( p = 0.013 ) . This study showed that isometric and isotonic h and exercises  decrease pain and disease activity and improve h and functions , dexterity and quality of life as well as mildly increasing muscle strength in patients diagnosed as RA OBJECTIVE To study the short-term effects of physical therapy ( ice massage or wax packs , thermal baths , and faradic h and baths ) and exercise therapy on the rheumatoid h and . METHODS The effect of individual physical therapy and exercise therapy programs was evaluated in 50 r and omly selected rheumatoid arthritis in patients ( 38 women and 12 men ) . Mean patient age ( + /- SD ) was 47.94 + /- 11.22 years , and mean disease duration was 5.04 + /- 4.80 years . The control group consisted of 50 r and omly selected rheumatoid arthritis out patients ( 37 women and 13 men ; mean age 48.46 + /- 10.65 years , mean duration of disease 5.23 + /- 4.89 years ) who at the time of the investigation were not receiving any physical or exercise therapy .  The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate ( ESR ) , pain intensity , proximal interphalangeal ( PIP ) joint size , and Ritchie articular index . H and grip strength , palmar tip-to-tip and key pinch finger strength , finger range of motion , and activities of daily living ( ADL ) were the parameters used to assess the functional h and status . The study was single-blinded and of 3 weeks duration . RESULTS In the physical therapy treated group , there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance ( P < 0.01 and P < 0.005 ) after the 3-week study period . ESR and PIP joint size improved clinical ly but failed to reach statistical significance . Patients had a more significant improvement in h and pain , joint tenderness , and ADL score ( P < 0.005 ) than in 
    Output:
    
Grip strength in various grip types ( power grip , key pinch , precision pinch and tripod pinch ) was found to improve by h and exercise therapy without having adverse effects on pain or disease activity .
Adaptations in the range of motion in response to h and exercise therapy were less pronounced .
There appears to be some transfer from the improvements on the body functioning level to the level of daily functioning , with the largest improvements found on grip ability .
With regard to the intervention content , there was some evidence in favour of a longer therapy duration and a higher therapy intensity .
No conclusions could be drawn on the effectiveness of the different types of exercises .