***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 The effectiveness of an exercise intervention for people in early and midstage Parkinson 's disease ( stages 2 and 3 of Hoehn and Yahr ) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described . DESIGN AND SETTING Fifty-one men and women , aged 55 - 84 years , identified through advertisement , local support groups , and local neurologists were enrolled into a r and omized , controlled trial . Subjects were assigned r and omly to an intervention or a usual care arm ( i.e. , no specific exercise ) . Of the original 51 participants , 46 completed the r and omized , controlled trial . Participants in the exercise arm ( n = 23 ) received individual instruction three times per week for 10 weeks . Participants in the usual care arm ( n = 23 ) were " wait listed " for intervention . MEASUREMENTS Changes over 10 weeks in spinal flexibility ( i.e. , functional axial rotation ) and physical performance ( i.e. , functional reach , timed supine to st and ) were the primary outcome measures . RESULTS MANOVA conducted for the three primary outcome variables demonstrated significant differences ( P < or = .05 ) between the two groups . Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group . There was no significant difference in supine to sit time . CONCLUSION Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD The purpose of this study was to determine if a balance and strength training program could improve equilibrium and strength in persons with stage I-III Parkinsonism . Subjects were pre-tested on strength and balance ( EquiTest ) and r and omized into either a treatment or a control group . The treatment subjects participated in 10 weeks of lower limb strength training and balance exercises design ed to challenge a stable posture and increase limits of stability . Both groups were then posttested on balance , knee flexion , knee extension , and ankle inversion strength . Subjects who received strength and balance training demonstrated significantly improved equilibrium and modest gains in knee flexion and extension strength , while the control group showed no improvement in conditions of destabilizing balance environments and significant declines in strength . Results indicate that 10 weeks of balance and strength training lead to improved equilibrium by producing positive changes in two different control mechanisms . One , training altered the ability to control the motor system when vestibular cues had to be the primary source of reliable feedback ; and two , training helped subjects to override faulty proprioceptive feedback and utilize reliable visual or vestibular cues Objective : To determine whether the Alex and er Technique , alongside normal treatment , is of benefit to people disabled by idiopathic Parkinson 's disease . Design : A r and omized controlled trial with three groups , one receiving lessons in the Alex and er Technique , another receiving massage and one with no additional intervention . Measures were taken pre and post-intervention , and at follow-up , six months later . Setting : The Polyclinic at the University of Westminster , Central London . Subjects : Ninety-three people with clinical ly confirmed idiopathic Parkinson 's disease . Interventions : The Alex and er Technique group received 24 lessons in the Alex and er Technique and the massage group received 24 sessions of massage . Main outcome measures : The main outcome measures were the Self- assessment Parkinson 's Disease Disability Scale ( SPDDS ) at best and at worst times of day . Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale . Results : The Alex and er Technique group improved compared with the no additional intervention group , pre-intervention to post-intervention , both on the SPDDS at best , p = 0.04 ( confidence interval ( CI ) –6.4 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.5 to –1.8 ) . The comparative improvement was maintained at six-month follow-up : on the SPDDS at best , p = 0.04 ( CI –7.7 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.8 to –0.9 ) . The Alex and er Technique group was comparatively less depressed post-intervention , p = 0.03 ( CI –3.8 to 0.0 ) on the Beck Depression Inventory , and at six-month follow-up had improved on the Attitudes to Self Scale , p = 0.04 ( CI –13.9 to 0.0 ) . Conclusions : There is evidence that lessons in the Alex and er Technique are likely to lead to sustained benefit for people with Parkinson 's disease BACKGROUND Baseline data collected on each patient at r and omisation in controlled clinical trials can be used to describe the population of patients , to assess comparability of treatment groups , to achieve balanced r and omisation , to adjust treatment comparisons for prognostic factors , and to undertake subgroup analyses . We assessed the extent and quality of such practice s in major clinical trial reports . METHODS A sample of 50 consecutive clinical -trial reports was obtained from four major medical journals during July to September , 1997 . We tabulated the detailed information on uses of baseline data by use of a st and ard form . FINDINGS Most trials presented baseline comparability in a table . These tables were often unduly large , and about half the trials inappropriately used significance tests for baseline comparison . Methods of r and omisation , including possible stratification , were often poorly described . There was little consistency over whether to use covariate adjustment and the criteria for selecting baseline factors for which to adjust were often unclear . Most trials emphasised the simple unadjusted results and covariate adjustment usually made negligible difference . Two-thirds of the reports presented subgroup findings , but mostly without appropriate statistical tests for interaction . Many reports put too much emphasis on subgroup analyses that commonly lacked statistical power . INTERPRETATION Clinical trials need a predefined statistical analysis plan for uses of baseline data , especially covariate-adjusted analyses and subgroup analyses . Investigators and journals need to adopt improved st and ards of statistical reporting , and exercise caution when drawing conclusions from subgroup findings The aim of this study was to evaluate the effects of orofacial physiotherapeutic treatment ( OPT ) on the facial mobility of Parkinson 's disease ( PD ) sufferers . Sixteen participants with PD were allocated r and omly to either the Treatment group or the Control group . A short interview between the physiotherapist and each subject was videotaped , and 10 r and om frames of the videotape were selected to be used in the facial expression assessment . The quantification of facial expressions was achieved by using an objective microcomputer-based measurement system , based on a mathematical model of the face ( FACEM ) . A facial outline is obtained , as well as 12 facial measures , which represent distances between key facial l and marks . The facial assessment was performed on 3 separate occasions , that is , baseline ( pretreatment ) , posttreatment , and follow-up ( 4 weeks later ) . A repeated measures analysis of variance ( MANOVA ) revealed a significant main effect of Time and a significant interaction effect between Time and Group for the Mouth-Opening Measure , suggesting that after treatment , members of the Treatment group opened their mouths to a greater degree than members of the Control group . Within the Treatment group , significant differences between pretreatment and posttreatment scores ( MANOVA ) were found for Mouth-Opening Measure and Mid-Top-Lip Measure . Similarly , Mouth-Opening Measure , Mid-Top-Lip Measure , Lower-Lip Thickness Measure , Top Eyelid/Iris Intersect Measure and Lower Eyelid/Iris Intersect Measure were significant across time from baseline to follow-up in the Treatment group only . No significant differences were found on any of the facial measures during the same period for members of the Control group . These findings suggest that OPT can improve facial movement and that this benefit extends in time , beyond the period of OPT itself . Such an increase in facial mobility can be expected to modify the " Parkinsonian facies " and facilitate the display of facial expressions Rhythmic auditory stimulation ( RAS ) was used as a pacemaker during a 3-week home-based gait-training program for Parkinson 's disease ( PD ) patients ( n = 15 ) .  Electromyogram ( EMG ) patterns and stride parameters were assessed before and after the test without RAS to evaluate changes in gait patterns . Data were compared with those of two control groups ( n = 11 ) , who either did not participate in any gait training or who participated in an internally self-paced training program . RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music . Patients who trained with RAS significantly ( p < 0.05 ) improved their gait velocity by 25 % , stride length by 12 % , and step cadence by 10 % more than self-paced subjects who improved their velocity by 7 % and no-training subjects whose velocity decreased by 7 % . In the RAS-group , timing of EMG patterns changed significantly ( p < 0.05 ) in the anterior tibialis and vastus lateralis muscles . Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2 % margin of error without RAS Objectives : To accurately establish the incidence of falls in Parkinson 's disease ( PD ) and to investigate predictive risk factors for fallers from baseline data . Methods : 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data , disease specific rating scales , physiotherapy assessment , tests of visual , cardiovascular and autonomic function , and bone densitometry . Patients were then prospect ively followed up for one year using weekly prepaid postcards along with telephone follow up . Results : Falls occurred in 68.3 % of the subjects . Previous falls , disease duration , dementia , and loss of arm swing were independent predictors of falling . There were also significant associations between disease severity , balance impairment , depression , and falling . Conclusions : Falls are a common problem in PD and some of the major risk factors are potentially modifiable . There is a need for future studies to look at interventions to prevent falls in PD In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed Abstract We studied prospect ively the epidemiology , clinical impact and prediction of falls in 59 moderately affected patients with Parkinson 's disease ( PD ) ( mean UPDRS motor score 31.5 ; mean age 61 years ) and 55 controls ( mean age 60 years ) . At baseline , balance and gait were evaluated extensively . The retropulsion test ( response to sudden shoulder pull ) was executed first unexpectedly and five more times following prior warning . All persons used st and ardised scoring forms to document their falls during six months . Thirty patients ( 50.8 % ) and eight controls ( 14.5 % ) fell at least once ( relative risk [ RR ] 6.1 ; 95 % confidence interval [ CI ] 2.5–15.1 , p < 0.001 ) . Recurrent ( ≥ 2 ) falls occurred in 15 patients ( 25.4 % ) , but in only two controls ( RR 9.0 ; 95 % CI 2.0–41.7 ; p=0.001 ) . Recurrent falls were more common among persons taking benzodiazepines ( RR 5.0 ; 95 % CI 1.6–15.5 ; p < 0.01 ) . Sixty-two percent of the falls in patients caused soft tissue injuries , but no fractures occurred . A fear of future falls was common ( 45.8 % of patients ) and was accompanied by restriction of daily activities ( 44.1 % of patients ) . Seventy percent of falls reported by patients were ‘ intrinsic ’ ( due to patient-related factors ) , but falls in controls were mainly ( 50 % ) ‘ extrinsic ’ ( due to environmental factors ) . None of the baseline posture and gait variables predicted falls adequately . The first ‘ unexpected ’ retropulsion test was more often abnormal than all subsequent ( predictable ) tests . Irrespective of its method of execution , the retropulsion test did not predict falls . A combination of asking for prior falls , disease severity and the Romberg test yielded the best overall diagnostic utility ( sensitivity 65 % and specificity 98 % ) . Recurrent fallers were best predicted by disease severity ( RR for Hoehn and Yahr stage 3 was > 100 ; 95 % CI 3.1–585 ) and asking for prior falls ( RR 5.0 ; 95 % CI 1.2–20.9 ) . We conclude that falls are common and disabling , even in relatively early stage PD . Recurrent fallers were best predicted by disease severity and presence of prior falls . Strategies to prevent falls in PD should particularly focus at intrinsic ( patient-related ) factors , such as minimising the use of benzodiazepines Gibberd and others ( 11 April , p 1196 ) and sympathise over the problems they encountered . In a similar controlled trial ' we 
    Output:
    
The studies illustrate that a wide range of approaches are being employed by physiotherapists to treat Parkinson 's disease .
This was confirmed by the UK survey of physiotherapists .