***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: Study Design . A prospect i ve , r and omized , single ( investigator ) blind , comparative efficacy trial was conducted . Objective . To compare the efficacy of continuous low-level heat wrap therapy ( 40 C , 8 hours/day ) with that of ibuprofen ( 1200 mg/day ) and acetaminophen ( 4000 mg/day ) in subjects with acute nonspecific low back pain . Summary of Background Data . The efficacy of topical heat methods , as compared with oral analgesic treatment of low back pain , has not been established . Methods . Subjects ( n = 371 ) were r and omly assigned to heat wrap ( n = 113 ) , acetaminophen ( n = 113 ) , or ibuprofen ( n = 106 ) for efficacy evaluation , or to oral placebo ( n = 20 ) or unheated back wrap ( n = 19 ) for blinding . Outcome measures included pain relief , muscle stiffness , lateral trunk flexibility , and disability . Efficacy was measured over two treatment days and two follow-up days . Results . Day 1 pain relief for the heat wrap ( mean , 2 ) was higher than for ibuprofen ( mean , 1.51;P = 0.0007 ) or acetaminophen ( mean , 1.32;P = 0.0001 ) . Extended mean pain relief ( Days 3 to 4 ) for the heat wrap ( mean , 2.61 ) also was higher than for ibuprofen ( mean , 1.68;P = 0.0001 ) or acetaminophen ( mean , 1.95;P = 0.0009 ) . Lateral trunk flexibility was improved with the heat wrap ( mean change , 4.28 cm ) during treatment ( P ≤ 0.009 vs acetaminophen [ mean change , 2.93 cm ] , P ≤ 0.001 vs ibuprofen [ mean change , 2.51 cm ] ) . The results were similar on Day 4 . Day 1 reduction in muscle stiffness with the heat wrap ( mean , 16.3 ) was greater than with acetaminophen ( mean , 10.5;P = 0.001 ) . Disability was reduced with the heat wrap ( mean , 4.9 ) , as compared with ibuprofen ( mean , 2.7;P = 0.01 ) and acetaminophen ( mean , 2.9;P = 0.0007 ) , on Day 4 . None of the adverse events were serious . The highest rate ( 10.4 % ) was reported in the ibuprofen group . Conclusion . Continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain BACKGROUND Management of degenerative spondylolisthesis with spinal stenosis is controversial . Surgery is widely used , but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials . METHODS Surgical c and i date s from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a  r and omized cohort or an  observational cohort . Treatment was st and ard decompressive laminectomy ( with or without fusion ) or usual nonsurgical care . The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey ( SF-36 ) bodily pain and physical function scores ( 100-point scales , with higher scores indicating less severe symptoms ) and the modified Oswestry Disability Index ( 100-point scale , with lower scores indicating less severe symptoms ) at 6 weeks , 3 months , 6 months , 1 year , and 2 years . RESULTS We enrolled 304 patients in the r and omized cohort and 303 in the observational cohort . The baseline characteristics of the two cohorts were similar . The one-year crossover rates were high in the r and omized cohort ( approximately 40 % in each direction ) but moderate in the observational cohort ( 17 % crossover to surgery and 3 % crossover to nonsurgical care ) . The intention-to-treat analysis for the r and omized cohort showed no statistically significant effects for the primary outcomes . The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years . The treatment effects at 2 years were 18.1 for bodily pain ( 95 % confidence interval [ CI ] , 14.5 to 21.7 ) , 18.3 for physical function ( 95 % CI , 14.6 to 21.9 ) , and -16.7 for the Oswestry Disability Index ( 95 % CI , -19.5 to -13.9 ) . There was little evidence of harm from either treatment . CONCLUSIONS In nonr and omized as-treated comparisons with careful control for potentially confounding baseline factors , patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically . ( Clinical Trials.gov number , NCT00000409 [ Clinical Trials.gov ] . ) BACKGROUND The SPORT ( Spine Patient Outcomes Research Trial ) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis , but the economic value of these surgeries is uncertain . OBJECTIVE To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis . DESIGN Prospect i ve cohort study . DATA SOURCES Re source utilization , productivity , and EuroQol EQ-5D score measured at 6 weeks and at 3 , 6 , 12 , and 24 months after treatment among SPORT participants . TARGET POPULATION Patients with image-confirmed spinal stenosis , with and without degenerative spondylolisthesis . TIME HORIZON 2 years . PERSPECTIVE Societal . INTERVENTION Nonoperative care or surgery ( primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis ) . OUTCOME MEASURES Cost per quality -adjusted life-year ( QALY ) gained . RESULTS OF BASE-CASE ANALYSIS Among 634 patients with stenosis , 394 ( 62 % ) had surgery , most often decompressive laminectomy ( 320 of 394 [ 81 % ] ) . Stenosis surgeries improved health to a greater extent than nonoperative care ( QALY gain , 0.17 [ 95 % CI , 0.12 to 0.22 ] ) at a cost of $ 77,600 ( CI , $ 49,600 to $ 120,000 ) per QALY gained . Among 601 patients with degenerative spondylolisthesis , 368 ( 61 % ) had surgery , most including fusion ( 344 of 368 [ 93 % ] ) and most with instrumentation ( 269 of 344 [ 78 % ] ) . Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care ( QALY gain , 0.23 [ CI , 0.19 to 0.27 ] ) , at a cost of $ 115,600 ( CI , $ 90,800 to $ 144,900 ) per QALY gained . RESULT OF SENSITIVITY ANALYSIS : Surgery cost markedly affected the value of surgery . LIMITATION The study used self-reported utilization data , 2-year time horizon , and as-treated analysis to address treatment nonadherence among r and omly assigned participants . CONCLUSION The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions . Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon Background Sciatica has a substantial impact on patients , and is associated with high healthcare and societal costs . Although there is variation in the clinical management of sciatica , the current model of care usually involves an initial period of ‘ wait and see ’ for most patients , with simple measures of advice and analgesia , followed by conservative and /or more invasive interventions if symptoms fail to resolve . A model of care is needed that does not over-treat those with a good prognosis yet identifies patients who do need more intensive treatment to help with symptoms , and return to everyday function including work . The aim of the SCOPiC trial ( SCiatica Outcomes in Primary Care ) is to establish whether stratified care based on subgrouping using a combination of prognostic and clinical information , with matched care pathways , is more effective than non-stratified care , for improving time to symptom resolution in patients consulting with sciatica in primary care . We will also assess the impact of stratified care on service delivery and evaluate its cost-effectiveness compared to non-stratified care . Methods / Design Multicentre , pragmatic , parallel arm r and omised trial , with internal pilot , cost-effectiveness analysis and embedded qualitative study . We will recruit 470 adult patients with sciatica from general practice s in Engl and and Wales , over 24 months . Patients will be r and omised to stratified care or non-stratified care , and treated in physiotherapy and spinal specialist services , in participating NHS services . The primary outcome is time to first resolution of sciatica symptoms , measured on a 6-point ordered categorical scale , collected using text messaging . Secondary outcomes include physical function , pain intensity , quality of life , work loss , healthcare use and satisfaction with treatment , and will be collected using postal question naires at 4 and 12-month follow-up . Semi-structured qualitative interviews with a sub sample of participants and clinicians will explore the acceptability of stratified care . Discussion This paper presents the details of the rationale , design and processes of the SCOPiC trial . Results from this trial will contribute to the evidence base for management of patients with sciatica consulting in primary care . Trial registration IS RCT N75449581 , date : 20.11.2014 The Beaver Dam Health Outcomes Study ( BDHOS ) is an ongoing longitudinal cohort study of health status and health-related quality of life for a r and om sample of adults ( age range at interview was 45 to 89 years ; mean = 64.1 , SD = 10.8 ) in a community population . In a face-to-face interview lasting approximately an hour , each participant responds to several batteries of questions . Included are a history of chronic medical conditions , current medi cations , and past surgeries ; the SF-36 ( a general health-status question naire ) ; the Quality of Well-being index ; self-rated health status on a five-point scale from " excellent " to " poor " ; and evaluation of current health using the method of time tradeoffs . The authors present results from 1,356 interviews on these four principal measures , reporting mean scores by sex , by age , and for persons reporting being affected by various medical conditions . They believe data from the BDHOS will provide research ers and policy makers a reference col lection of vital statistics for health-related quality of life . Additionally , the data provide a way to compare results from studies that utilize different indices from among the four principal measures of the BDHOS . Key words : health status ; quality of life ( health-related ) ; population study ; cohort study . ( Med Decis Making 1993;13:89 - 102 Background Interspinous spacers are a minimally invasive surgical alternative for patients with lumbar spinal stenosis ( LSS ) unresponsive to conservative care . The purpose of this prospect i ve , multicenter , r and omized , controlled trial was to compare 2-year clinical outcomes in patients with moderate LSS treated with the Superion ® ( Experimental ) or the X-Stop ®  , a FDA -approved interspinous spacer ( Control ) . Methods A total of 250 patients with moderate LSS unresponsive to conservative care were r and omly allocated to treatment with the Experimental ( n = 123 ) or Control ( n = 127 ) interspinous spacer and followed through 2 years post-treatment . Complication data were available for all patients and patient-reported outcomes were available for 192 patients ( 101 Experimental , 91 Control ) at 2 years . Results Zurich Claudication Question naire ( ZCQ ) Symptom Severity and Physical Function scores improved 34 % to 36 % in both groups through 2 years ( all p < 0.001 ) . Patient Satisfaction scores at 2 years were 1.8 ± 0.9 with Experimental and 1.6 ± 0.8 with Control . Axial pain decreased from 59 ± 26 mm at baseline to 21 ± 26 mm at 2 years with Experimental and from 55 ± 26 mm to 21 ± 25 mm with Control ( both p < 0.001 ) . Extremity pain decreased from 67 ± 24 mm to 14 ± 22 mm at 2 years with Experimental and from 63 ± 24 mm to 18 ± 23 mm with Control ( both p < 0.001 ) . Back function assessed with the Oswestry Disability Index similarly improved with Experimental ( 37 ± 12 % to 18 ± 16 % ) and Control ( 39 ± 12 % to 20 ± 16 % ) ( both p < 0.001 ) . Freedom from reoperation at the index level was 84 % for Experimental and 83 % for Control 
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Results revealed a poor st and ard of modelling in both conditions , particularly regarding modelling techniques , analytical methods , and data quality .
Specific issues relate to inappropriate representation of both conditions in terms of health states , insufficient time horizons , and use of inappropriate utility values .
Conclusion High- quality modelling studies , which reflect modelling best practice , as well as contemporary clinical underst and ings of both conditions , are required to enhance the economic evidence for treatments for both conditions