***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: Background Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : Objectives To describe the incidence and extent of lying on the floor for a long time after being unable to get up from a fall among people aged over 90 ; to explore their use of call alarm systems in these circumstances . Design 1 year follow-up of participants in a prospect i ve cohort study of ageing , using fall calendars , phone calls , and visits . Setting Participants ’ usual place of residence ( own homes or care homes ) , mostly in Cambridge . Participants 90 women and 20 men aged over 90 ( n=110 ) , surviving participants of the Cambridge City over-75s Cohort , a population based sample . Main outcome measures Inability to get up without help , lying on floor for a long time after falling , associated factors ; availability and use of call alarm systems ; participants ’ views on using call alarms  to summon help if needed after falling . Results In one year ’s intensive follow-up , 54 % ( 144/265 ) of fall reports described the participant as being found on the floor and 82 % ( 217/265 ) of falls occurred when the person was alone . Of the 60 % who fell , 80 % ( 53/66 ) were unable to get up after at least one fall and 30 % ( 20/66 ) had lain on the floor for an hour or more . Difficulty in getting up was consistently associated with age , reported mobility , and severe cognitive impairment . Cognition was the only characteristic that predicted lying on the floor for a long time . Lying on the floor for a long time was strongly associated with serious injuries , admission to hospital , and subsequent moves into long term care . Call alarms were widely available but were not used in most cases of falls that led to lying on the floor for a long time . Comments from older people and carers showed the complexity of issues around the use of call alarms , including perceptions of ir relevance , concerns about independence , and practical difficulties . Conclusions Lying on the floor for a long time after falling is more common among the “ oldest old ” than previously thought and is associated with serious consequences . Factors indicating higher risk and comments from participants suggest practical implication s. People need training in strategies to get up from the floor . Work is needed on access and activation issues for design of call alarms and information for their effective use . Care providers need better underst and ing of the perceptions of older people to provide acceptable support services Frequent or recurrent fallers are more likely to have chronic medical conditions and physiological impairments , exhibit functional decline and have poor outcomes , than single fallers [ 1 ] . Fractures are also more common in recurrent fallers than single fallers [ 2 ] . Modern surgery for hip fracture can no longer improve on its outcomes [ 3 ] and therefore , effective prevention of falls [ 4 , 5 ] is the key to preventing disability and death . There is still no published evidence that a single intervention ( tailored group exercise ) can prevent falls or injuries in a high risk group of frequent fallers . This r and omised controlled trial ( RCT ) aim ed to investigate the impact of a 36 week individualised and tailored group and home exercise intervention , compared with a control intervention , in reducing falls and injuries in communitydwelling , independent-living , frequent falling women aged 65 years and over . Preliminary results have been published in abstract form [ 6 ] . The primary outcome was falls and fallrelated injuries . The secondary outcome was the number of frequent fallers who had died , had moved into residential care or were in hospital compared with the group they were in OBJECTIVES To determine the effect of a 2-week ( six-session ) training intervention to improve the ability of disabled older adults  to rise from the floor . DESIGN Prospect i ve intervention trial . SETTING Congregate housing in Michigan . PARTICIPANTS Subjects aged 65 and older who admitted to requiring assistance ( such as from a person , equipment , or device ) in performing at least one of the following mobility-related activities of daily living : transferring , walking , bathing , and toileting . INTERVENTION Participants were r and omly allocated to individual training ( n = 17 , mean age 81 ) in strategies to rise from the floor ( using for example , certain key intermediate body positions ) or a control chair-based flexibility intervention  ( n = 18 , mean age 80 ) . MEASUREMENTS At baseline and postintervention , residents were queried regarding their rise difficulty ( difficulty scale ) and symptoms ( symptoms scale ) associated with the rise and were tested in their ability to perform timed floor-rise tasks . These tasks varied in starting position ( supine vs all fours ) and in use of a support to assist in rising ( no support , use of an end table , use of a chair ) . RESULTS Using baseline performance as the covariate , by analysis of covariance ( ANCOVA ) , the training group showed a significant ( P < .05 ) improvement in mean number of rise tasks completed ( baseline mean 6.6 , postintervention mean 7.3 ) versus essentially no improvement in the controls . Similarly , by ANCOVA , the training group ( compared with controls ) showed a significant ( P < .05 ) improvement on the difficulty and symptoms scales . There was no intervention effect for rise time . CONCLUSIONS A short-term , strategy -based intervention improved floor-rise ability and perceived difficulty and symptoms associated with the rise . This approach , focusing on key intermediate body positions , may be useful in training floor-rise skills , particularly in older adults at risk for falls OBJECTIVES To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise , exposure therapy , cognitive restructuring , and a home safety evaluation , conducted by a physical therapist , in reducing fear of falling and activity avoidance . To collect preliminary evidence of efficacy . DESIGN R and omized pilot study comparing the intervention to time- and attention-equivalent fall prevention education . SETTING Participants ' homes . PARTICIPANTS 42 older adults with disproportionate fear of falling ( high fear , low to moderate objective fall risk ) . MEASUREMENTS Falls Efficacy Scale-International , modified Activity Card Sort , satisfaction , falls . RESULTS Relative to education , the intervention reduced fear of falling ( d = 1.23 ) and activity avoidance ( d = 1.02 ) at 8 weeks , but effects eroded over a 6-month follow-up period . The intervention did not increase falls , and participants rated the exercise , exposure therapy , and non-specific elements as most helpful . CONCLUSIONS An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling , but modifications to the intervention or its duration may be needed to maintain participants ' gains BACKGROUND Depression and cognitive functioning have a negative impact on functional recovery after  hip fracture surgery in older people , and the same has been suggested for pain and fear of falling . These variables , however , have never been studied together , nor has the timing of psychiatric assessment been taken into account . METHOD Two parallel , r and omized controlled trials were undertaken aim ing to prevent and treat depression after hip fracture surgery in older people .  Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms ( 15-item Geriatric Depression Scale , GDS ) , pain ( Wong-Baker pain scale ) , cognitive functioning ( Mini-mental State Examination , MMSE ) and fear of falling ( Modified Falls Efficacy Scale , MFES ) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months . Main outcome measures were performance-based measures ( up- and -go test , gait test , functional reach ) and the self-report Sickness Impact Profile ( SIP ) question naire to assess the impact of the hip fracture on activities of daily living ( ADL ) . RESULTS Two hundred and ninety-one patients participated and outcome measures for 187 ( 64 % ) patients were available at 6 months . All mental health variables interfered with functional recovery . However , in the final multivariate model , cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery , whereas pain and depressive symptoms were no longer significant . CONCLUSION Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery . Rehabilitation strategies should take this into account BACKGROUND To determine the respective efficacy of two different instruction programmes design ed to aid the elderly in rising unassisted after an incidental fall . METHODS The 12-week study covered 120 recent fallers ( age range : 80 - 90 years ) r and omly split into two study groups : Group I ( 61 subjects ; 41F , 20 M ) , Group II ( 59 subjects 37F , 22 M ) . Group I followed a programme combining safe postural shifts and the backward-chaining method , whereas Group II ( controls ) took part in conventional training to rise unassisted after a fall . The duration of the instructional programmes was 12 weeks . The Timed " Up & Go " and Tinetti tests were applied at baseline and on completion of the programmes to assess individual ability to rise unassisted after an incidental fall . The results in both groups were assessed with the t-Student test and the Wilcoxon test . RESULTS Statistically significant improvements were only noted in Group I ( p<0.05 ) in the Timed " Up & Go " test score ( 27 vs. 20 sec. ) , Tinetti score ( 40 % of subjects ) , as well as in individual ability to rise unassisted after a fall ( 20%-40 % ) . No statistically quantifiable improvements were observed in the control group . CONCLUSIONS The instructional programme involving the backward-chaining method enhances individual functional capabilities , as well as tangibly aids the elderly in rising unassisted after an incidental fall BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Background and aims : Older age , higher morbidity and lower functional capacity are associated with fall injuries . Inability to get up from the floor is associated with older age , higher morbidity and 
    Output:
    
Emerging evidence shows that BCM  significantly improves the ability to get up unassisted from the floor , as well as mobility with reduced fall incidence in older people .
Furthermore , it can potentially reduce fear of falling .
BCM provides a promising intervention in fall-related recovery strategies for older adults and is most effective when offered to older adults at risk of falling .