***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 Musicians are frequently affected by playing-related musculoskeletal disorders ( PRMD ) . Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs , but their results are sometimes disappointing . OBJECTIVE To study the effects of self-administered exercises based on Tuina techniques on the  pain intensity caused by PRMD of professional orchestra musicians , using numeric visual scale ( NVS ) . DESIGN , SETTING , PARTICIPANTS AND INTERVENTIONS We performed a prospect i ve , controlled , single-blinded , r and omized study with musicians suffering from PRMD . Participating musicians were r and omly distributed into the experimental ( n=39 ) and the control ( n=30 ) groups . After an individual diagnostic assessment , specific Tuina self-administered exercises were developed and taught to the participants . Musicians were instructed to repeat the exercises every day for 3 weeks . MAIN OUTCOME MEASURES Pain intensity was measured by NVS before the intervention and after 1 , 3 , 5 , 10 , 15 and 20 d of treatment . The procedure was the same for the control group , however the Tuina exercises were executed in points away from the commonly-used acupuncture points . RESULTS In the treatment group , but not the control group , pain intensity was significantly reduced on days 1 , 3 , 5 , 10 , 15 and 20 . CONCLUSION The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD . Although our results are very promising , further studies are needed employing a larger sample size and double blinding design Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size OBJECTIVE To compare clinical efficacy differences among electroacupuncture ( EA ) , transcutaneous electrical nerve stimulation ( TENS ) therapy and acupoint massage ( AM ) on periarthritis of shoulder . METHODS One hundred and twenty cases were r and omly divided into an EA group , a TENS group and an AM group , 40 cases in each one . The selection of acupoints in the three groups were all the same , which were Jianqian ( Extra ) , Xiabai ( LU 4 ) , Jianyu ( LI 15 ) , Binao ( LI 14 ) , Jianliao ( TE 14 ) , Naohui ( TE 13 ) , Xiaohai ( SI 8) and Houxi ( SI 3 ) . EA was applied in the EA group with dense-disperse wave for 30 min , TENS therapy with dense-disperse wave for 30 min in the TENS group and AM combined with mobilization manipulation of Tuina on the shoulder in the AM group . All of the treatment was given once a day , six times a week and totally 4 weeks were required . The score of visual analogue scale ( VAS ) and improvement of shoulder joint activities in the three groups before and after the treatment were observed . RESULTS After the treatment , the VAS score and activities of shoulder joint were all improved in the three groups ( all P < 0.001 ) and AM group had more obvious improvement than TENS group and EA group ( all P < 0.05 ) . The effective and curative rate was 61.50 ( 24/39 ) in the AM group , which was superior to 42.9 % ( 15/35 ) in the EA group and 44.4 % ( 16/36 ) in the TENS group ( both P < 0.05 ) . The effective and curative rate of shoulder joint activities in the AM group was 61.5 % ( 24/39 ) , which was superior to 48.6 % ( 17/35 ) in the EA group and 44.4 % ( 16/36 ) in the TENS group ( both P < 0.05 ) . CONCLUSION The acupoint massage has obvious clinical efficacy on periarthritis of shoulder , which could effectively relieve the pain and improve activities of shoulder joint , and it is superior to EA and TENS therapy OBJECTIVE To compare clinical effects of spinal leveraging manipulation and medicine for the treatment of degenerative scoliosis in pain and function . METHODS From July 2010 to June 2013 , 38 patients with degenerative scoliosis were r and omly divided into spinal leveraging manipulation group and medicine group by coin tossing . In manipulation group , there were 9 males and 11 females aged from 58 to 74 years old with an average of ( 66.63±7.73 ) , the courses of diseases ranged from 3 to 8 months with an average of ( 5.65±2.58 ) , spinal leveraging manipulation(following meridian to straighten tendon , relieving spasm , osteopathy and massage , clearing and activating the channels and collaterals ) were performed for 30 min , once a day , 4 days for a period treatment , totally 9 courses . In medicine group , there were 8 males and 10 females aged from 57 to 70 years old with an average of ( 63.51±6.61 ) the courses of diseases ranged from 3 to 5 months with an average of  ( 4.82±1.43 ) , celecoxib with eperisone hydrochloride were orally taken , 4 days for a period treatment , totally 9 courses . VAS score , Cobb angle and ODI score were measured . RESULTS After treatment , VAS score in manipulation group was ( 5.38±0.99 ) , ( 6.36±1.31 ) in medicine group , and had significant meaning ( t=2.618 , P<0.05 ) ; there was significant differences in Cobb angle between manipulation group ( 16.51±4.89 ) ° and medicine group ( 19.85±5.03 ) ° ( t=2.074,P<0.05 ) ; and had obviously meaning in ODI score between manipulation group ( 20.20±2.93 ) and medicine group ( 26.01±3.11 ) ( t=5.592 , P<0.05 ) . CONCLUSION Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both side of spine , correct coronal imbalances in spine , recover normal sequence of spine , reduce and remove opperssion and stimulation of nerve root , relieve pain in leg and waist and further improve quality of life BACKGROUND Total knee replacement surgery is commonly used in end-stage diseases of the knee . It is important for improving surgical efficacy and patient satisfaction by promoting early rehabilitation of patients and improving knee function . OBJECTIVE To observe the effects of early application of Tuina treatment on quadriceps surface electromyography ( EMG ) in patients with rheumatoid arthritis having undergone total knee arthroplasty . DESIGN , SETTING , PARTICIPANTS AND INTERVENTION The study was performed at the Orthopedic Department of Huashan Hospital , Fudan University , and the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine from June 2010 to September 2011 . A total of 66 patients with rheumatoid arthritis who had undergone total knee replacement surgery were r and omly divided into control group and observation group , 33 cases in each . The patients in the control group were administered with continuous passive training ( CPM ) , and the patients in the observation group were treated with CPM combined with Tuina , from prior surgery to four weeks post-surgery . MAIN OUTCOME MEASURES The knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire at baseline and 4 weeks after the surgery . Quadriceps surface EMG was also detected at the same time points . RESULTS After 4 weeks of Tuina and comprehensive rehabilitation intervention , the WOMAC question naire score of the observation group was decreased compared with the control group ( P<0.01 ) ; median frequency and integrated electromyography of the rectus femoris and vastus medialis muscles , which were recorded by EMG , in the observation group were higher than those in the control group ( P<0.01 ) . CONCLUSION Tuina can improve the recovery of patients who have undergone total knee replacement by increasing quadriceps EMG OBJECTIVE To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen . METHODS 92 cases were divided r and omly into the treatment group ( treated by acupuncture-moxibustion and Chinese Tuina ) and the control group ( treated by acupuncture-moxibustion ) . RESULTS The therapeutic effect of the treatment group was obviously superior to that of the control group ( the CHI2 test showed P < 0.01 ) . CONCLUSIONS The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen OBJECTIVE To observe the therapeutic effect of digital acupoint pressure for treatment of the nerve root type of cervical spondylosis . METHODS Four hundred cases were r and omly divided into a digital acupoint pressure group ( DAP group ) and a medicine group , 200 cases in each group . Acupoints of Quepen ( ST 12 ) , Jianjing ( GB 21 ) and Tianzong ( ST 11 ) etc . were used for digital pressing in the DAP group ; and Chinese herb medicine of Gentongping was routinely taken in the medicine group . After three treatment courses , the symptoms of pain and numbness , the signs of pressure measurement by compression of head , brachial plexus drawer test and arm myodynamia , as well as the total cumulative scores of daily living capability , were compared . RESULTS After treatment , the total cumulative scores of numbness , pressure measurement by compression of head , brachial plexus drawer test , arm myodynamia and daily living capability in both groups were obviously better than those of before treatment ( all P<0.01 ) ; but there was a significant difference on the total cumulative score of the symptoms and signs between the two groups . The cured rate of 78.0 % and total effective rate of 99.0 % in the DAP group were better than those of 61.0 % and 87.0 % in the medicine group , respectively ( both P<0.01 ) . CONCLUSION Digital acupoint pressure plays an active role in improving the symptoms and signs on patients with nerve root type of cervical spondylosis , which is better than Chinese herb medicine of Gentongping BACKGROUND Cervical spondylotic radiculopathy is a commonly encountered and frequently occurring disease . Traditional Chinese osteopathic manipulations may have better therapeutic efficacy than that of other methods in treating patients with cervical spondylotic radiculopathy . OBJECTIVE To evaluate the clinical therapeutic effects of cervical fixed-point traction manipulation in treating patients with cervical spondylotic radiculopathy . DESIGN , SETTING , PARTICIPANTS AND INTERVENTIONS A prospect i ve , r and omized controlled trial was adopted . Eighty-four patients with cervical spondylotic radiculopathy were r and omly divided into treatment group ( n=42 ) and control group ( n=42 ) . All patients were enrolled from the outpatient service of Department of Rehabilitation of Chinese PLA General Hospital of China . Patients received oral and written information about clinical procedures before giving their written informed consent . The patients were treated with cervical fixed-point traction manipulation ( treatment group ) or cervical computer traction ( control group ) . Cervical fixed-point traction was performed once every other day for a total of seven treatment periods and cervical computer traction was performed  
    Output:
    
Conclusions This systematic review suggests that C(T)MT is safe and effective for pain reduction and functional improvement for musculoskeletal diseases ; however , the evidence for functional improvement was not as strong as for pain reduction .