***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: Abstract Whiplash‐associated disorders are common and incur considerable expense in social and economic terms . There are no known effective treatments for those people whose pain and disability persist beyond 3 months . We conducted a r and omized , assessor‐blinded , controlled trial at two centres in Australia . All participants received 3 advice sessions . In addition the experimental group participated in 12 exercise sessions over 6 weeks . Primary outcomes were pain intensity , pain bothersomeness and function measured at 6 weeks and 12 months . Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months . The effect of exercise on the 0–10 pain intensity scale was −1.1 ( 95%CI −1.8 to −0.3 , p = 0.005 ) at 6 weeks and −0.2 ( 0.6 to −1.0 , p = 0.59 ) at 12 months ; on the bothersomeness scale the effect was −1.0 ( −1.9 to −0.2 , p = 0.003 ) at 6 weeks and 0.3 ( −0.6 to 1.3 , p = 0.48 ) at 12 months . The effect on function was 0.9 ( 0.3 to 1.6 , p = 0.006 ) at 6 weeks and 0.6 ( −0.1 to 1.4 , p = 0.10 ) at 12 months . High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months . In the short‐term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash . Exercise is more effective for subjects with higher baseline pain and disability BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review OBJECTIVE To compare the effects of manual therapy and stretching exercise on neck pain and disability . DESIGN An examiner-blinded r and omized cross-over trial . PATIENTS A total of 125 women with non-specific neck pain . METHODS PATIENTS were r and omized into 2 groups . Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week . After 4 weeks the treatments were changed . The follow-up times were after 4 and 12 weeks . Neck pain ( visual analogue scale ) and disability indices were measured . RESULTS Mean value ( st and ard deviation ) for neck pain was 50 mm ( 22 ) and 49 mm ( 19 ) at baseline in Group 1 and Group 2 , respectively , and decreased during the first 4 weeks by 26 mm ( 95 % Confidence Interval 20 - 33 ) and 19 mm ( 12 - 27 ) , respectively . There was no significant difference between groups . Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy ( p=0.01 ) as well as neck stiffness ( p=0.01 ) . CONCLUSION Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain . The difference in effectiveness between the 2 treatments was minor . Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain , at least in the short-term OBJECTIVE --To assess the long term effect of early mobilisation exercises in patients with acute sprains of the neck after road accidents . DESIGN --Single blind r and omised prospect i ve study of patients receiving physiotherapy , advice on mobilisation , or on an initial period of rest followed up after two years by postal question naire . SETTING --Accident and emergency department in urban hospital . PATIENTS --247 Consecutive patients ( mean age at injury 30.6 years ) presenting within 48 hours after injury with no pre-existing disease of the neck or serious skeletal injury . Of these , 167 patients responded to the question naire ; 77 who responded but had not completed their treatment or review course were included in the analysis as a fourth group ( non-attenders ) . MAIN OUTCOME MEASURE -- Presence of symptoms after two years . RESULTS --Of the 167 patients ( 68 % ) responding , the percentage of patients still with symptoms was not significantly different in those receiving rest or physiotherapy ( 46 % , 12/26 v 44 % , 24/54 ) , but that in those receiving advice on early mobilisation was significantly lower ( 23 % , 11/48 , p = 0.02 ) . Of the 104 patients without symptoms , 94 ( 90 % ) recovered within six months and 62 ( 60 % ) within three months . Patients without symptoms who received advice or physiotherapy wore a collar  for a significantly shorter time than those with persistent symptoms ( mean duration 1.4 ( SD 0.7 ) months v 2.8 ( 1.6 ) months , p = 0.005 and 1.6 ( 1.1 ) months v 1.8 ( 1.3 ) months , p = 0.006 respectively ) . CONCLUSIONS --Advice to mobilise in the early phase after neck injury reduces the number of patients with symptoms at two years and is superior to manipulative physiotherapy . Prolonged wearing of a collar is associated with persistence of symptoms Background Noninvasive physical management is often prescribed for  headache and neck pain .  Systematic review s , however , indicate that the evidence of its efficacy is limited . Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing  headache and neck/shoulder pain . Methodology /Principal Findings Cluster-r and omized controlled trial . All municipal workers of the City of Turin , Italy , were invited to participate . Those who agreed were r and omly assigned , according to their departments , to the intervention group ( IG ) or to the control group and were given diaries for the daily recording of pain episodes for 1 month ( baseline ) . Subsequently , only the IG ( 119 departments , 923 workers ) began the physical and educational program , whereas the control group ( 117 departments , 990 workers ) did not receive any intervention . All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention . The primary outcome was the change in the frequency of headache ( expressed as the proportion of subjects with a ≥50 % reduction of frequency ; responder rate ) ; among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain . Differences between the two groups were evaluated using mixed-effect regression models . The IG showed a higher responder rate [ risk ratio , 95 % confidence interval ( CI ) ] for headache ( 1.58 ; 1.28 to 1.92 ) and for neck/shoulder pain ( 1.53 ; 1.27 to 1.82 ) , and a larger reduction of the days per month ( 95 % CI ) with headache ( −1.72 ; −2.40 to −1.04 ) and with neck/shoulder pain ( −2.51 ; −3.56 to −1.47 ) . Conclusions The program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary -care setting s. Further trials are needed to investigate the program effectiveness in a clinical setting , for highly selected patients suffering from specific headache types . Trial Registration Clinical Trials.gov The objective of this study was to investigate morphological and physiological characteristics of painful muscles in women with ( MYA , n= 42 ) and without ( CON , n = 20 ) trapezius myalgia , and assess changes in response to a 10-week , r and omized , controlled trial . MYA accomplished : ( 1 ) specific strength training ( SST ) ; ( 2 ) general fitness training ( GFT ) ; or ( 3 ) reference intervention ( REF ) . Differences in muscle morphology could not be detected by ultrasound imaging . Significantly lower pressure pain threshold ( PPT ) and shoulder torque were observed for MYA , indicating pain-related lack of full activation . After 10 weeks , increased shoulder torque and PPT of the painful trapezius were observed in SST solely . The PPT of a pain-free reference muscle was increased in response to both SST and GFT , indicating a general effect of physical activity on pain perception . This study shows clinical ly relevant improvement in pain sensitivity and muscle strength capacity in response to SST Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use . Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists . The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments . Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area . Our study investigates the effect of the latter approach . Methods / Design A r and omized controlled trial of 10 weeks duration is currently being conducted . Employed office workers with severe neck-shoulder pain are r and omized to  3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active . Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius . An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work . The first 100 positive replies entered the study . Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0 - 9 scale . Exclusion criteria were cardiovascular disease , trauma , hypertension , or serious chronic disease . Before and after the intervention period the participants replied to a question naire about musculoskeletal disorders and work disability , and underwent a st and ardized clinical examination of the neck and shoulder girdle . Further , on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week . The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination . Secondary outcomes are strength and work disability . Trial Registration Clinical Trials ( NCT ) : UNLABELLED This study compared the effect of 2 specific cervical flexor muscle exercise protocol s on immediate pain relief in the cervical spine of people with chronic neck pain . In addition , the study evaluated whether these exercise protocol s elicited any systemic effects by study ing sympathetic nervous system ( SNS ) function and pain at a location distant from the cervical spine . Participants were r and omly allocated into either a cranio-cervical flexion ( CCF ) coordination exercise group ( n = 24 ) or a cervical flexion ( CF ) endurance exercise group ( n = 24 ) . Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions .  Pain measures included visual analogue scale ( VAS ) ratings of neck pain at rest and during active cervical motion and pressure pain threshold ( PPT ) and thermal pain threshold ( TPT ) recordings over the cervical spine and at a remote site on the leg . Measures of SNS function consisted of blood flow , skin conductance , skin temperature , heart rate , and blood pressure . Immediately after 1 session of exercise , there was a reasonably sized increase of 21 % ( P < .001 , d = 0.88 ) and 7.3 % ( P = .03 , d = 0.47 ) in PPT locally at the neck for the CCF exercise and the CF exercise , respectively . There were no changes in local neck TPT with either exercise . Pressure pain threshold and TPT at the leg and SNS did not change after exercise . Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement ( change on 10-cm VAS : CCF , 0.42 cm ( P = .04 ) . This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain . PERSPECTIVE This study showed an immediate local mechanical hypoalgesic response to specific exercise of the cervical spine . Underst and ing the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocol s for patients with chronic neck pain Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use .  Specific strength training is a promising type of physical exercise for relieving  neck and shoulder pain in office workers . However , the optimal combination of frequency and exercise duration , as well as the importance of exercise supervision , is unknown . The VIMS study investigates in a cluster r and omized controlled design the effectiveness of different time wise 
    Output:
    
MAIN RESULTS Twenty-seven trials ( 2485 analyzed /3005 r and omized participants ) met our inclusion criteria .For acute neck pain only , no evidence was found .
For chronic neck pain , moderate quality evidence supports 1 ) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [ pooled SMD ( SMDp ) -0.71 ( 95 % CI : -1.33 to -0.10 ) ] and at short-term follow-up ; 2 ) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up ; 3 ) combined cervical , shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [ SMDp -0.33 ( 95 % CI : -0.55 to -0.10 ) ] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [ SMDp -0.45 ( 95%CI : -0.72 to -0.18 ) ] ; 4 ) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [ SMDp -14.90 ( 95 % CI:-22.40 to -7.39 ) ] ; 5 ) Mindfulness exercises ( Qigong )  minimally improved function but not global perceived effect at short term .
Low evidence suggests 1 ) breathing exercises ; 2 ) general fitness training ; 3 ) stretching alone ; and 4 ) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up .
Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up .
For chronic cervicogenic headache , moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain , function and global perceived effect at long-term follow-up .
Low grade evidence supports sustained natural apophyseal glides ( SNAG ) exercises .
For acute radiculopathy , low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises .
AUTHORS ' CONCLUSIONS No high quality evidence was found , indicating that there is still uncertainty about the effectiveness of exercise for neck pain .
Using specific strengthening exercises as a part of routine practice for chronic neck pain , cervicogenic headache and radiculopathy may be beneficial .
Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function .
However , when only stretching exercises were used no beneficial effects may be expected .