***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: OBJECTIVES ( 1 ) To identify risk factors for chronic disability in people with acute whiplash associated disorders ( WAD ) . ( 2 ) To estimate the impact of the numbers of risk factors present . DESIGN Prospect i ve cohort study . Data were collected , on average , 32 days after injury ( SD=10.9 ) and 12 months later . Baseline measures of pain , disability , neck movement , psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis . SETTING National Health Service physiotherapy departments . PARTICIPANTS Participants ( n=599 ) with symptoms 3 weeks after injury , self-referred to physiotherapy as part of a r and omised controlled trial . 430 ( 72 % ) participants provided complete data for this analysis . MAIN OUTCOME MEASURES Chronic disability based on Neck Disability Index scores . RESULTS 136 ( 30 % ) participants developed chronic disability . High baseline disability ( OR 3.3 , 95 % CI 1.97 to 5.55 ) , longer predicted recovery time ( OR 2.4 , 95 % CI 1.45 to 3.87 ) , psychological distress ( OR 1.9 , 95%CI 1.05 to 3.51 ) , passive coping ( OR 1.8 , 95 % CI 1.07 to 2.97 ) and greater number of symptoms ( OR 1.7 , 95 % CI 1.07 to 2.78 ) were associated with chronic disability . One risk factor result ed in 3.5 times the risk ( 95 % CI 1.04 to 11.45 ) of chronic disability but this risk increased to 16 times ( 95%CI 5.36 to 49.27 ) in those with four or five risk factors . CONCLUSION Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important . Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD . The number of risk factors present should be considered when evaluating potential for poor outcome Introduction Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care . Their clinical course is variable but there are limited recommendations on prognostic factors . Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain . Methods A secondary analysis of data from adult participants ( N = 85 ) with an acute ankle sprain , enrolled in a r and omized controlled trial was undertaken . The predictive value of variables ( age , BMI , gender , injury mechanism , previous injury , weight-bearing status , medial joint line pain , pain during weight-bearing dorsiflexion and lateral hop test ) recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability . Recovery was determined from measures of subjective ankle function at short ( 4 weeks ) and medium term ( 4 months ) follow ups . Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery . Results Greater age , greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury ( p<0.01 ; adjusted R square=0.34 ) . Greater age , weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months ( p<0.01 ; adjusted R square=0.20 ) . Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months ( p < 0.01 ; adjusted R square=0.49 ) . Conclusion The results of the present study provide further evidence that ankle sprains have a variable clinical course . Age , injury grade , mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery . Clinical assessment variables at 4 weeks were the strongest predictors of recovery , explaining 50 % of the variance in ankle function at 4 months . Further prospect i ve research is required to highlight the factors that best inform the expected convalescent period , and risk of recurrence Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers BACKGROUND During the recovery period after acute ankle sprain , it is unclear whether conventional treatment should be supported by supervised exercise . AIM To evaluate the short- and long-term effectiveness of conventional treatment combined with supervised exercises compared with conventional treatment alone in patients with an acute ankle sprain . DESIGN R and omised controlled clinical trial . SETTING A total of 32 Dutch general practice s and the hospital emergency department . METHOD Adults with an acute lateral ankle sprain consulting general practice s or the hospital emergency department were allocated to either conventional treatment combined with supervised exercises or conventional treatment alone . Primary outcomes were subjective recovery ( 0 - 10 point scale ) and the occurrence of a resprain . Measurements were carried out at intake , 4 weeks , 8 weeks , 3 months , and 1 year after injury . Data were analysed using intention-to-treat analyses . RESULTS A total of 102 patients were enrolled and r and omised to either conventional treatment alone or conventional treatment combined with supervised exercise . There was no significant difference between treatment groups concerning subjective recovery or occurrence of resprains after 3 months and 1-year of follow-up . CONCLUSION Conventional treatment combined with supervised exercises compared to conventional treatment alone during the first year after an acute lateral ankle sprain does not lead to differences in the occurrence of resprains or in subjective recovery OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of ankle support compared with double layer tubular compression b and age . DESIGN A r and omised controlled trial , design ed to reflect practice in UK hospital emergency departments . SETTING Eight emergency departments in Engl and . PARTICIPANTS Aged 16 or over with acute severe ankle sprain , unable to weight bear , no fracture . INTERVENTIONS 584 participants were r and omised to one of four treatment arms : tubular b and age , below knee cast , Aircast ankle brace or Bledsoe boot , all applied 2 - 3 days after presentation to allow swelling to resolve . MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures ( Functional Limitations Profile , SF-12 and EQ-5D ) . RESULTS When adjusted for age , sex and baseline scores , the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.4 - 9.8 ) , foot- and ankle-related quality of life ( QoL ) ( FAOS QoL difference 5.9 ; 95 % CI 0.1 - 11.8 ) and the physical component of the SF-12 ( SF-12 score difference 2.2 ; 95 % CI 0.0 - 4.4 ) . Neither the Aircast brace nor the Bledsoe boot was statistically or clinical ly better . At 12 weeks the below knee cast was significantly better than tubular b and age in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.3 - 10.0 ) , activities of daily living ( FAOS ADL difference 3.5 ; 95 % CI 0.4 - 6.6 ) , sports ( FAOS sports difference 8.7 ; 95 % CI 1.6 - 15.7 ) and QoL ( FAOS QoL difference 8.7 ; 95 % CI 2.4 - 15.0 ) , and the Aircast brace was better only in terms of ankle-related QoL and mental health . The Bledsoe boot conferred no significant advantage over tubular b and age . By 9 months there were no significant differences . Based on mean direct health-care costs per participant , the Bledsoe boot was the most expensive ( 215 pounds ) and tubular b and age the least so ( 1 pound 44 pence ) . Inclusion of indirect costs ( sick leave ) raised overall costs substantially and removed any significant differences between the therapies . Cost-utility analysis demonstrated that the Aircast brace [ 301 pounds per quality -adjusted life-year ( QALY ) ] and below knee cast ( 339 pounds per QALY ) were more cost-effective than the Bledsoe boot ( 2116 pounds per QALY ) . However , inclusion of indirect costs produced different rank orders , depending on the assumptions made , and results should be treated with caution . CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular b and age for acute severe ankle sprain , the former having the advantage in terms of overall recovery at 3 months . As there were no differences in long-term outcome , practitioners should consider likely compliance and acceptability to patients when choosing a brace Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a st and ard protection , rest , ice , compression , and elevation intervention . Design R and omised controlled trial with blinded outcome assessor . Setting Accident and emergency department and university based sports injury clinic . Participants 101 patients with an acute grade 1 or 2 ankle sprain . Interventions Participants were r and omised to an accelerated intervention with early therapeutic exercise ( exercise group ) or a st and ard protection , rest , ice , compression , and elevation intervention ( st and ard group ) . Main outcome measures The primary outcome was subjective ankle function ( lower extremity functional scale ) . Secondary outcomes were pain at rest and on activity , swelling , and physical activity at baseline and at one , two , three , and four weeks after injury . Ankle function and rate of reinjury were assessed at 16 weeks . Results An overall treatment effect was in favour of the exercise group ( P=0.0077 ) ; this was significant at both week 1 ( baseline adjusted difference in treatment 5.28 , 98.75 % confidence interval 0.31 to 10.26 ; P=0.008 ) and week 2 ( 4.92 , 0.27 to 9.57 ; P=0.0083 ) . Activity level was significantly higher in the exercise group as measured by time spent walking ( 1.2 hours , 95 % confidence interval 0.9 to 1.4 v 1.6 , 1.3 to 1.9 ) , step count ( 5621 steps , 95 % confidence interval 4399 to 6843 v 7886 , 6357 to 9416 ) , and time spent in light intensity activity ( 53 minutes , 95 % confidence interval 44 to 60 v 76 , 58 to 95 ) . The groups did not differ at any other time point for pain at rest , pain on activity , or swelling . The reinjury rate was 4 % ( two in each group ) . Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function ; the group receiving this intervention was more active during that week than the group receiving st and ard care . Trial registration Current Controlled Trials IS RCT N13903946 The purpose of this study was to examine a young athletic population to up date the data regarding epidemiology and disability associated with ankle injuries . At the United States Military Academy , all cadets presenting with ankle injuries during a 2-month period were included in this prospect i ve observational study . The initial evaluation 
    Output:
    
Conclusions The associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive .
At present , there is insufficient evidence to recommend any factor as an independent predictor of outcome .