***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: In a prospect i ve , r and omised , multicentre study , 112 patients with Achilles tendon rupture ( ATR ) were allocated to surgical treatment  ( n=59 ) , followed by early functional rehabilitation using a brace , and non-surgical treatment ( n=53 ) , i.e. eight weeks of plaster treatment . In this study , the results of the isokinetic muscle strength evaluation are presented for contractions in both the concentric and the eccentric mode , plantar flexion and dorsiflexion , two angular velocities and three different positions of the subject . The heel-raise test for endurance , maximum calf circumference and tendon width were also evaluated . The re-rupture rate was 20.8 % in the non-surgically-treated group and 1.7 % in the surgically-treated group . No significant differences were found between the treatment groups in terms of the isokinetic strength measurements and the endurance test among the patients who did not sustain a re-rupture . If a re-rupture is avoided , both surgical and non-surgical treatment for ATR produce good functional outcome ; however , the muscle function was not restored after two years in either group Background —There is no disease specific , reliable , and valid clinical measure of Achilles tendinopathy . Objective —To develop and test a question naire based instrument that would serve as an index of severity of Achilles tendinopathy . Methods —Item generation , item reduction , item scaling , and pretesting were used to develop a question naire to assess the severity of Achilles tendinopathy . The final version consisted of eight questions that measured the domains of pain , function in daily living , and sporting activity . Results range from 0 to 100 , where 100 represents the perfect score . Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy ( n = 45 ) , presurgical patients with Achilles tendinopathy ( n = 14 ) , and two normal control population s ( total n = 87 ) . Results —The VISA-A question naire had good test-retest ( r = 0.93 ) , intrarater ( three tests , r = 0.90 ) , and interrater ( r = 0.90 ) reliability as well as good stability when compared one week apart ( r = 0.81 ) . The mean ( 95 % confidence interval ) VISA-A score in the non-surgical patients was 64 ( 59–69 ) , in presurgical patients 44 ( 28–60 ) , and in control subjects it exceeded 96 ( 94–99 ) . Thus the VISA-A score was higher in non-surgical than presurgical patients ( p = 0.02 ) and higher in control subjects than in both patient population s ( p<0.001 ) . Conclusions —The VISA-A question naire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects . The continuous numerical result of the VISA-A question naire has the potential to provide utility in both the clinical setting and research . The test is not design ed to be diagnostic . Further studies are needed to determine whether the VISA-A score predicts prognosis AIMS Hydrotherapy , i.e. exercise in warm water , as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure ( CHF ) due to the increased venous return caused by the hydrostatic pressure . However , hydrotherapy has advantages compared to conventional training . We studied the applicability of an exercise programme in a temperature-controlled swimming pool , with specific reference to exercise capacity , muscle function , quality of life and safety . METHODS AND RESULTS Twenty-five patients with CHF ( NYHA II-III , age 72.1+/-6.1 ) were r and omised into either 8 weeks of hydrotherapy ( n=15 ) , or into a control group ( n=10 ) . The training program was well tolerated with no adverse events . Patients in the hydrotherapy group improved their maximal exercise capacity ( + 6.5 vs.-5.9 W , P=0.001 ) , isometric endurance in knee extension ( + 4 vs.-9 s , P=0.01 ) together with an improvement in the performance of heel-lift ( + 4 vs. -3 n.o . , P=<0.01 ) , shoulder abduction ( + 12 vs. -8 s , P=0.01 ) and shoulder flexion ( + 6 vs. + 4 , P=0.01 ) in comparison to patients in the control group . CONCLUSION Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF . This new approach broadens the variety of training regimes for older patients with CHF Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors , namely the soleus and gastrocnemius muscles forming the tendo Achilles . The Orthopaedic Research Institute-Ankle Strength Testing System ( ORI-ASTS ) was design ed to record objective measurements of force generated with a resisted ankle plantarflexion test . Testing normal subjects ( n=6 ) was used to establish the reliability of the ORI-ASTS for measuring ankle plantarflexion force . Testing patients with Achilles tendonitis ( n=5 ) over time and comparing Achilles tendon analogue pain scores to ankle plantarflexion force measurements was used to assess the validity of the ORI-ASTS for monitoring progression of Achilles tendinopathy . Inter-rater reliability of the ORI-ASTS with normal subjects was excellent , with single measure intraclass correlation coefficients ( ICC ) for right mean peak force of 0.92 , left mean peak force of 0.96 , right mean total force of 0.89 , left mean total force of 0.91 . The ORI-ASTS also had excellent intra-rater reliability for normal subjects with the following single measure ICC scores : right mean force 0.96 , left mean force 0.92 , right mean total force 0.97 , left mean total force 0.92 . The relative technical errors of measurement were calculated from these results , and ranged from 1.0 % to 2.7 % . Testing patients with Achilles tendinosis ( n=5 ) , and comparing analogue activity pain scores to ORI-ASTS testing demonstrated a strong negative relationship between the two parameters ( Spearman Rho −0.87 to −1.0 , Kendall tau b −0.82 to −1.0 ) . The relationship was statistically significant at the p=0.01 level for two of the five patients . The ORI-ASTS shows excellent reliability for testing ankle plantarflexor force , and appears valid for objective ly assessing and monitoring patients with Achilles tendinosis The purpose of this study was to document the intrarater reliability of manual muscle test ( MMT ) grade s in assessing muscle strength in patients with Duchenne 's muscular dystrophy ( DMD ) . Subjects were 102 boys , aged 5 to 15 years , who were participating in a double-blind , multicenter trial to document the effects of prednisone on muscle strength in patients with DMD . Four physical therapists participated in the study . Two identical ( duplicate ) evaluations were performed within 5 days of each other by the same examiner initially and after 6 and 12 months of treatment . A total of 18 muscle groups were tested on each patient , 16 of them bilaterally , using a modification of the Medical Research Council scale . Reliability of muscle strength grade s obtained for individual muscle groups and of individual muscle strength grade s was analyzed using Cohen 's weighted Kappa . The reliability of grade s for individual muscle groups ranged from .65 to .93 , with the proximal muscles having the higher reliability values . The reliability of individual muscle strength grade s ranged from .80 to .99 , with those in the gravity-eliminated range scoring the highest . We conclude the MMT grade s are reliable for assessing muscle strength in boys with DMD when consecutive evaluations are performed by the same physical therapist In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2–6 cm level in the tendon . In the present prospect i ve multicenter study ( Sundsvall and Umeå ) patients with painful chronic Achilles tendinosis at the 2–6 cm level in the tendon were r and omized to treatment with either an eccentric or a concentric training regimen for the calf muscles . The study included 44 patients , with 22 patients ( 12 men , 10 women ; mean age 48 years ) in each treatment group .  The amount of pain during activity ( jogging or walking ) was recorded by the patients on a visual analogue scale , and patient satisfaction was assessed before and after treatment . The patients were instructed to perform their eccentric or concentric training regimen on a daily basis for 12 weeks . In both types of treatment regimen the patients were told to do their exercises despite experiencing pain or discomfort in the tendon during exercise . The results showed that after the eccentric training regimen 82 % of the patients ( 18/22 ) were satisfied and had resumed their previous activity level ( before injury ) , compared to 36 % of the patients ( 8/22 ) who were treated with the concentric training regimen . The results after treatment with eccentric training was significantly better ( P<0.002 ) than after concentric training . The good clinical results previously demonstrated in the pilot study with eccentric calf muscle training on patients with chronic Achilles tendinosis , were thus reproduced in this multicenter , showing superior results to treatment with concentric training Abstract Reliability refers to the reproducibility of values of a test , assay or other measurement in repeated trials on the same individuals . Better reliability implies better precision of single measurements and better tracking of changes in measurements in research or practical setting s. The main measures of reliability are within-subject r and om variation , systematic change in the mean , and retest correlation . A simple , adaptable form of within-subject variation is the typical ( st and ard ) error of measurement : the st and ard deviation of an individual ’s repeated measurements . For many measurements in sports medicine and science , the typical error is best expressed as a coefficient of variation ( percentage of the mean ) . A biased , more limited form of within-subject variation is the limits of agreement : the 95 % likely range of change of an individual ’s measurements between 2 trials . Systematic changes in the mean of a measure between consecutive trials represent such effects as learning , motivation or fatigue ; these changes need to be eliminated from estimates of within-subject variation . Retest correlation is difficult to interpret , mainly because its value is sensitive to the heterogeneity of the sample of participants . Uses of reliability include decision-making when monitoring individuals , comparison of tests or equipment , estimation of sample size in experiments and estimation of the magnitude of individual differences in the response to a treatment . Reasonable precision for estimates of reliability requires approximately 50 study participants and at least 3 trials . Studies aim ed at assessing variation in reliability between tests or equipment require complex design s and analyses that research ers seldom perform correctly . A wider underst and ing of reliability and adoption of the typical error as the st and ard measure of reliability would improve the assessment of tests and equipment in our disciplines In a prospect i ve , r and omised , multicentre study , 112 patients ( 99 men and 13 women , aged between 21 and 63 years ) with acute , complete rupture of tendo Achillis were allocated either to surgical treatment followed by early functional rehabilitation , using a brace , or to non-surgical treatment , with plaster splintage for eight weeks . The period of follow-up was for two years . Evaluation was undertaken by independent observers and comprised interviews , clinical measurements , isokinetic muscle performance tests , heel-raise tests and an overall outcome score . The rate of rerupture was 20.8 % after non-surgical and 1.7 % after surgical treatment ( p < 0.001 ) . Surgical and non-surgical treatment produced equally good functional results if complications were avoided . However , the rate of rerupture after non-surgical treatment was unacceptably high Objective : To assess the relationship between muscle-tendon function and symptoms in patients with Achilles tendinopathy using a vali date d test battery . Design : A prospect i ve non-r and omised trial . Setting : Orthopaedic Department , Sahlgrenska University Hospital , Sweden . Patients : 37 patients with a clinical diagnosis of Achilles tendinopathy in the midportion of the tendon , with symptoms for > 2 months , were evaluated at the initiation of the study and after 1 year . Intervention : The patients were treated using a rehabilitation programme , under the supervision of a physical therapist , for 6 months . Main outcome measurements : The patients were evaluated using the  Swedish version of the Victorian Institute of Sports Assessment —Achilles question naire ( VISA-A-S ) for symptoms  , and a test battery for evaluation of the lower leg muscle-tendon function . Results : There were significant improvements in the VISA-A-S score ( p<0.00 , n = 37 ) and the test battery ( p<0.02 , n = 19 ) at the 1-year follow-up . The VISA-A-S question naire had an effect size of 2.1 and the test battery had an effect size of 0.73 . A low correlation ( r = 0.178 , p>0.05 ) was found between the VISA-A-S score and the test battery . A high correlation ( r = 0.611 , p<0.05 ) was found between the drop counter movement jump and the VISA-A-S score . All other tests in the test battery had low correlations ( r = −0.305 to 0.155 , p>0.05 ) with the VISA-A-S score . Only 25 % ( 4/16 ) of the patients who had full symptomatic recovery had achieved full recovery of muscle – tendon function as measured by the test battery . Conclusion : Full symptomatic recovery in patients with Achilles tendinopathy does not ensure full recovery of muscle 
    Output:
    
No definitive normative values could be established and the utility of the test in subjects with pathologies remained unclear .