***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: OBJECTIVE For long-term treatment effects , patients with subacute back pain need to adhere to treatment recommendations beyond the prescribed exercise treatment . Adherence rates are as low as 30 % , so we developed a cognitive-behavioural training programme to enhance patients ' self-efficacy , maximise severity perceptions and reduce barrier perceptions . METHOD A 2 x 4 ( group x time ) repeated measurement design was applied . Forty-seven patients with non-specific , subacute back pain were r and omly assigned to a training group ( exercise treatment plus cognitive-behavioural training programme ) or a control group ( exercise treatment only ) . RESULTS Repeated measures ANOVA revealed significant main and interaction effects ; the training group reported enhanced self-efficacy and severity perceptions , reduced barrier perceptions , and self-reported that they exercised more often than the control group over time . However , no group differences regarding pain intensity emerged . CONCLUSION Our findings demonstrate that a short and inexpensive cognitive-behavioural training programme is an effective tool to enable back pain patients to follow treatment recommendations on a regular basis . PRACTICE IMPLICATION S The short and simple intervention can easily be conducted by personnel , other than psychologists , i.e. , physiotherapists Abstract Objectives Firstly , to compare the effectiveness of a brief physiotherapy intervention with “ usual ” physiotherapy for patients with neck pain . Secondly , to evaluate the effect of patients ' preferences on outcome . Design Non-inferiority r and omised controlled trial eliciting preferences independently of r and omisation . Setting Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire . Participants 268 patients ( mean age 48 years ) with subacute and chronic neck pain , who were referred by their general practitioner and r and omly assigned to a brief physiotherapy intervention ( one to three sessions ) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy , at the discretion of the physiotherapist concerned . Main outcome measures The Northwick Park neck pain question naire ( NPQ ) , a specific measure of functional disability result ing from neck pain . Also , the short form 36 ( SF-36 ) question naire , a generic , health related , quality of life measure ; and the Tampa scale for kinesophobia , a measure of fear and avoidance of movement . Results At 12 months , patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group ( mean difference 1.99 , 95 % confidence interval 0.45 to 3.52 ; P = 0.01 ) . Although the result shows a significant inferiority of the intervention , the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention ( below 1.2 points of NPQ score ) . Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy . Conclusions Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain . Patients with a preference for the brief intervention may do at least as well with this approach . Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further STUDY OBJECTIVES To underst and reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee . DESIGN A qualitative study , nested within a r and omised controlled trial , examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis . In the intervention arm , participants undertook a series of simple exercises and repositioning of the kneecap using tape . In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions , guided by a topic schedule , to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy . Interviews were audiotaped , fully transcribed and analysed thematically according to the method of constant comparison . A model explaining factors influencing compliance was developed . SETTING Patients were interviewed at home . The study was nested within a pragmatic r and omised controlled trial . PARTICIPANTS Twenty participants in the intervention arm of the r and omised trial were interviewed three months after they had completed the physiotherapy programme . Eight were interviewed again one year later . MAIN RESULTS Initial compliance was high because of loyalty to the physiotherapist . Reasoning underpinning continued compliance was more complex , involving willingness and ability to accommo date exercises within everyday life , the perceived severity of symptoms , attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis . A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms . CONCLUSIONS Non-compliance with physiotherapy , as with drug therapies , is common . From the patient 's perspective , decisions about whether or not to comply are rational but often can not be predicted by therapists or research ers . Ultimately , this study suggests that health professionals need to underst and reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention Abstract Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head‐to‐head comparisons of these interventions . We conducted a r and omized controlled trial to compare effects of general exercise , motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain . Two hundred and forty adults with non‐specific low back pain ⩾3 months were allocated to groups that received 8 weeks of general exercise , motor control exercise or spinal manipulative therapy . General exercise included strengthening , stretching and aerobic exercises . Motor control exercise involved retraining specific trunk muscles using ultrasound feedback . Spinal manipulative therapy included joint mobilization and manipulation . Primary outcomes were patient‐specific function ( PSFS , 3–30 ) and global perceived effect ( GPE , −5 to 5 ) at 8 weeks . These outcomes were also measured at 6 and 12 months . Follow‐up was 93 % at 8 weeks and 88 % at 6 and 12 months . The motor control exercise group had slightly better outcomes than the general exercise group at 8 weeks ( between‐group difference : PSFS 2.9 , 95 % CI : 0.9–4.8 ; GPE 1.7 , 95 % CI : 0.9–2.4 ) , as did the spinal manipulative therapy group ( PSFS 2.3 , 95 % CI : 0.4–4.2 ; GPE 1.2 , 95 % CI : 0.4–2.0 ) . The groups had similar outcomes at 6 and 12 months . Motor control exercise and spinal manipulative therapy produce slightly better short‐term function and perceptions of effect than general exercise , but not better medium or long‐term effects , in patients with chronic non‐specific back pain Study Design . A prospect i ve clinical r and omized controlled trial . Objectives . To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain ( LBP ) . Summary of Background Data . There is agreement on the importance of exercise during the course of chronic LBP . However , it is well known that long-term adherence with exercises is particularly low . Methods . A total of 93 patients with LBP were r and omly assigned to the control group ( st and ard exercise program ) or the motivational group ( combined exercise and motivational program ) . Follow-up assessment s were performed at 3.5 weeks , 4 months , 12 months , and 5 years . Main outcome measures were disability scores , pain intensity , and working ability . In addition to classic statistics , the sophisticated linear partial credit model was used to test the effects of treatment on disability scores . Results . In both groups , significant improvements in the disability scores were found at all points of follow-up assessment , however , the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group . This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention . A significant , positive long-term effect at the 5-year re assessment in working ability was only seen in the motivational group . All statistically significant results were confirmed by intention-to-treat analyses . Conclusions . Regarding long-term efficacy , the combined exercise and motivation program was superior to the st and ard exercise program . Five years after the supervised combined exercise and motivational program , patients had significant improvements in disability , pain intensity , and working ability OBJECTIVE To determine whether manual therapy or pulsed shortwave diathermy , in addition to advice and exercise , provide better clinical outcome at 6 months than advice and exercise alone in primary care patients with nonspecific neck disorders . METHODS This was a multicenter , 3-arm r and omized controlled trial in 15 physical therapy departments . Of the 735 screened patients , 350 were recruited to the study ( mean age 51 years ) from July 2000 to June 2002 . Participants were r and omized to advice and exercise plus manual therapy , advice and exercise plus pulsed shortwave , or advice and exercise alone . Assessment s were undertaken at baseline , 6 weeks , and 6 months . The primary outcome was the Northwick Park Neck Pain Question naire . Analysis was by intention to treat . RESULTS Of the participants , 115 were allocated to advice and exercise , 114 to advice and exercise plus manual therapy , and 121 to advice and exercise plus pulsed shortwave ; 98 % received the allocated treatment . There was 93 % followup at 6 months . The mean + /- SD fall in Northwick Park score at 6 months was 11.5 + /- 15.7 for advice and exercise alone , 10.2 + /- 14.1 for advice and exercise plus manual therapy , and 10.3 + /- 15.0 for advice and exercise plus pulsed shortwave . There were no statistically significant differences in mean changes between groups . CONCLUSION The addition of pulsed shortwave or manual therapy to advice and exercise did not provide any additional benefits in the physical therapy treatment of neck disorders Paper diaries are commonly used in health care and clinical research to assess patient experiences . There is concern that patients do not comply with diary protocol s , possibly invalidating the benefit of diary data . Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features .  Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries . Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days . Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries ( defined by comparing the written times and the electronically-recorded times of diary use ) . Actual compliance was recorded by the electronic diary . Participants su bmi tted diary cards corresponding to 90 % of assigned times ( + /-15 min ) . However , electronic records indicated that actual compliance was only 11 % , indicating a high level of faked compliance . On 32 % of all study days the paper diary binder was not opened , yet reported compliance for these days exceeded 90 % . For the electronic diary , the actual compliance rate was 94 % . In summary , participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features . The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information BACKGROUND AND PURPOSE This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy .  We investigated whether patient compliance was related to characteristics of the patient or the patient 's illness , to the patient 's attitude , or to the physical therapist 's behavior . SUBJECTS AND METHODS Of a r and om sample of 300 physical therapists in private practice in the Netherl and s , 222 therapists responded to a question naire survey . Eighty-four respondents also made audio recordings . Material s of the study were 1,931 registration forms  , 1,837 audio-recorded sessions of physical therapy sessions  , and 1,681 patient question naires .  RESULTS The results show that the three main factors related to noncompliance were ( 1 ) the barriers patients perceive and encounter , ( 2 ) the lack of positive feedback , and ( 3 ) the degree of helplessness . The first factor , the barriers patients perceive and encounter , shows the strongest relation with noncompliance . The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness , a bad prognosis is negatively related to compliance , and much hindrance of the complaint is positively related to compliance . There was no difference between men and women with regard to patient compliance , but less educated patients were slightly more compliant than more highly educated patients . CONCLUSION AND DISCUSSION These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research . Future research should take into account the type and efficacy of therapeutic exercise for different diseases . For physical therapy practice , it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients Eight hundred ninety-five consecutive chronic low back pain patients were evaluated . Six hundred twenty-seven completed the program . One hundred sixty-one began , but dropped out , and 107 were recommended for treatment but did not undergo treatment for various reasons . Average duration of symptoms prior to evaluation was 26 months . Forty-seven percent of patients were workers ' compensation patients . The primary treatment was intensive , specific exercise using firm pelvic stabilization to isolate and rehabilitate the lumbar spine musculature . Patients were encouraged to work hard to achieve 
    Output:
    
There was strong evidence that adherence strategies are not effective at improving long-term adherence with home exercise .