***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: Objective : This study was planned to investigate the efficacy of neuromuscular rehabilitation and Johnstone Pressure Splints in the patients who had ataxic multiple sclerosis . Methods : Twenty-six out patients with multiple sclerosis were the subjects of the study . The control group ( n = 13 ) was given neuromuscular rehabilitation , whereas the study group ( n = 13 ) was treated with Johnstone Pressure Splints in ad dition . Results : In pre- and posttreatment data , significant differences were found in sensation , anterior balance , gait parameters , and Exp and ed Disability Status Scale ( p < 0.05 ) . An important difference was observed in walking-on-two-lines data within the groups ( p < 0.05 ) . There also was a statistically significant difference in pendular movements and dysdiadakokinesia ( p < 0.05 ) . When the posttreatment values were compared , there was no significant difference between sensation , anterior balance , gait parameters , equilibrium and nonequilibrium coordination tests , Exp and ed Disability Status Scale , cortical onset latency , and central conduction time of somatosensory evoked potentials and motor evoked potentials ( p > 0.05 ) . Comparison of values re vealed an important difference in cortical onset-P37 peak amplitude of somatosen sory evoked potentials ( right limbs ) in favor of the study group ( p < 0.05 ) . Conclu sions : According to our study , it was determined that physiotherapy approaches were effective to decrease the ataxia . We conclude that the combination of suitable phys iotherapy techniques is effective multiple sclerosis rehabilitation . Key Words : Multi ple sclerosis — Ataxia — Physical therapy Objective : Low vitamin D status has been associated with multiple sclerosis ( MS ) prevalence and risk , but the therapeutic potential of vitamin D in established MS has not been explored . Our aim was to assess the tolerability of high-dose oral vitamin D and its impact on biochemical , immunologic , and clinical outcomes in patients with MS prospect ively . Methods : An open-label r and omized prospect i ve controlled 52-week trial matched patients with MS for demographic and disease characteristics , with r and omization to treatment or control groups . Treatment patients received escalating vitamin D doses up to 40,000 IU/day over 28 weeks to raise serum 25-hydroxyvitamin D [ 25(OH)D ] rapidly and assess tolerability , followed by 10,000 IU/day ( 12 weeks ) , and further downtitrated to 0 IU/day . Calcium ( 1,200 mg/day ) was given throughout the trial . Primary endpoints were mean change in serum calcium at each vitamin D dose and a comparison of serum calcium between groups . Secondary endpoints included 25(OH)D and other biochemical measures , immunologic biomarkers , relapse events , and Exp and ed Disability Status Scale ( EDSS ) score . Results : Forty-nine patients ( 25 treatment , 24 control ) were enrolled [ mean age 40.5 years , EDSS 1.34 , and 25(OH)D 78 nmol/L ] . All calcium-related measures within and between groups were normal . Despite a mean peak 25(OH)D of 413nmol/L , no significant adverse events occurred . Although there may have been confounding variables in clinical outcomes , treatment group patients appeared to have fewer relapse events and a persistent reduction in T-cell proliferation compared to controls . Conclusions : High-dose vitamin D ( ∼10,000 IU/day ) in multiple sclerosis is safe , with evidence of immunomodulatory effects . Classification of evidence : This trial provides Class II evidence that high-dose vitamin D use for 52 weeks in patients with multiple sclerosis does not significantly increase serum calcium levels when compared to patients not on high-dose supplementation . The trial , however , lacked statistical precision and the design requirements to adequately assess changes in clinical disease measures ( relapses and Exp and ed Disability Status Scale scores ) , providing only Class level IV evidence for these outcomes This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence Background : Preservation of locomotor activity in multiple sclerosis ( MS ) patients is of utmost importance . Robotic-assisted body weight-supported treadmill training is a promising method to improve gait functions in neurologically impaired patients , although its effectiveness in MS patients is still unknown . Objective : To compare the effectiveness of robot-assisted gait training ( RAGT ) with that of conventional walking treatment ( CWT ) on gait and generalized functions in a group of stable MS patients . Methods : A prospect i ve r and omized controlled trial of 12 sessions of RAGT or CWT in MS patients of EDSS score 5–7 . Primary outcome measures were gait parameters and the secondary outcomes were functional and quality of life parameters . All tests were performed at baseline , 3 and 6 months post-treatment by a blinded rater . Results : Fifteen and 17 patients were r and omly allocated to RAGT and CWT , respectively . Both groups were comparable at baseline in all parameters . As compared with baseline , although some gait parameters improved significantly following the treatment at each time point there was no difference between the groups . Both FIM and EDSS scores improved significantly post-treatment with no difference between the groups . At 6 months , most gait and functional parameters had returned to baseline . Conclusions : Robot-assisted gait training is feasible and safe and may be an effective additional therapeutic option in MS patients with severe walking disabilities 
    Output:
    
Conclusion : We did not identify any risk factor interventions with significant effects on MS progression , but the overall QoE was limited .