***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Study design : Retrospective analysis . Objectives : To evaluate the efficacy of intrathecal baclofen ( ITB ) for upper extremity spastic hypertonia in tetraplegia of spinal origin . Setting : University of Alabama at Birmingham hospital . Methods : The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were review ed . The effects of intrathecal baclofen on spasm frequency , deep tendon reflexes , and tone ( Ashworth scale ) were assessed for the upper and lower extremities for a 1-year follow-up period . Results : There were statistically significant declines in upper extremity spasm scores ( 1.8 points , P=0.012 ) , reflex scores ( 1.4 points , P<0.0001 ) and Ashworth scores ( 0.6 points , P<0.0001 ) for the 1-year follow-up period . For the lower extremities , all decreases were significant ( P<0.0001 ) . There was also a statistically significant ( P<0.0001 ) increase in  intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm frequency , reflexes and tone . Conclusions : Intrathecal baclofen is a safe and effective intervention for treating upper extremity hypertonia of spinal origin . In addition , the level of intrathecal catheter placement is felt to be of importance .Spinal Cord ( 2001 ) 39 , 413–419 The effects of intrathecal baclofen infusion were studied in 9 spinal cord injury patients whose spasticity had been refractory to oral medications . In a two stage , placebo controlled trial , baclofen was administered into the lumbar intrathecal space and subsequent clinical and neurophysiologic changes were assessed . In stage 1 , 9 patients underwent a 5 day percutaneous infusion of baclofen and placebo via an external pump . Ashworth and reflex scores were assessed at time of enrollment , after infusion of that amount of baclofen which provided optimal spasticity control and after intrathecal infusion of placebo .  The mean Ashworth grade decreased from 3.78 ± 1.34 to 1.16 ± 0.48 ( p < 0.001 ) while mean reflex score decreased from 3.57 ± 1.05 to 0.64 ± 0.87 ( p < 0.001 ) . These values differed significantly from those associated with placebo  therapy ( Ashworth grade —2.54 ± 1.04 , p < 0.001 ; reflex score—2.56 ± 1.04 , p < 0.01 ) . Objective improvements in functional abilities and independence were noted in 8 patients , while somatosensory and brainstem auditory evoked potentials were unchanged in all patients . Urodynamic evaluation revealed increased bladder capacity in 3 patients , while in 4 no change was observed . In Stage 2 , permanent programmable infusion pumps were implanted in 7 patients who demonstrated a good response during Stage 1 . In this group , mean Ashworth score decreased from 3.79 ± 0.69 to 2 ± 0.96 ( p < 0.001 ) and mean reflex score decreased from 3.85 ± 0.62 to 2.18 ± 0.43 ( p < 0.001 ) . Baclofen dosage increased from 182 ± 135 to 528 ± 266 mcg/day over the 3 - 22 month follow-up period . Most of the dosage increase occurred within the initial 12 months following infusion pump implantation and tended to plateau thereafter . Minor complications such as catheter dislodgement/kinking and nausea occurred infrequently while no device related infections were observed . There was no clinical evidence of any significant baclofen neurotoxicity either in Stage 1 or 2 . The only ambulatory patient developed marked lower extremity weakness during Stage 1 intrathecal baclofen infusion and was temporarily unable to walk . We conclude that continuous administration of intrathecal baclofen is an effective and safe modality for spasticity control in patients who are refractory to oral medications A total of 93 patients with intractable spasticity due to either spinal cord injury ( 59 cases ) , multiple sclerosis ( 31 cases ) , or other spinal pathology ( three cases ) were entered into a r and omized double-blind placebo-controlled screening protocol of intrathecal baclofen test injections . Of the 88 patients who responded to an intrathecal bolus of 50 , 75 , or 100 micrograms of baclofen , 75 underwent implantation of a programmable pump system for chronic therapy . Patients were followed for 5 to 41 months after surgery ( mean 19 months ) . No deaths or new permanent neurological deficits occurred as a result of surgery or chronic intrathecal baclofen administration . Rigidity was reduced from a mean preoperative Ashworth scale score of 3.9 to a mean postoperative score of 1.7 . Muscle spasms were reduced from a mean preoperative score of 3.1 ( on a four-point scale ) to a mean postoperative score of 1.0 . Although the dose of intrathecal baclofen required to control spasticity increased with time , drug tolerance was not a limiting factor in this study . Only one patient withdrew from the study because of a late surgical complication ( pump pocket infection ) . Another patient received an  intrathecal baclofen overdose because of a human error in programming the pump . The results of this study indicate that intrathecal baclofen infusion can be safe and effective for the long-term treatment of intractable spasticity in patients with spinal cord injury or multiple sclerosis OBJECTIVES To assess long-term efficacy and functional benefits of intrathecal baclofen for severe spinal spasticity . DESIGN A prospect i ve before-after trial . SETTING A neurological rehabilitation department of a university hospital .  Pump implantation was realized in neurosurgery ; follow-up was carried out mostly on an outpatient basis . PATIENTS Eighteen patients with severe and disabling spinal spasticity received intrathecal baclofen by an implantable pump ; average follow-up was 37.4 months ( range , 9 to 72 ) . MAIN OUTCOME MEASURES Spasticity ( Ashworth and spasms frequency scores ) ; disability ( Functional Independence Measure [ FIM ] ) . RESULTS A significant decrease in tone and spasms was observed in all patients . Tolerance appeared during the first 6 to 9 months . Later on , efficacy remained stable , except in cases of mechanical problems of the pump or catheter . Functional assessment found a highly significant ( p < .001 ) increase of FIM score ( particularly for bathing , dressing lower body , transfers , and in some cases , locomotion ) . This was particularly marked in patients with thoracic spinal cord lesion . In cases of severe upper limb dysfunction , FIM was only improved for wheelchair displacements , due to a better sitting position , but nursing became easier and life comfort was enhanced . Severe side effects ( overdose ) were observed in two cases . CONCLUSION Efficacy remained stable after 6 to 9 months . Marked improvement of functional independence was observed in paraplegic patients . Improvement was less spectacular in patients with severe upper limb dysfunction , but nevertheless appreciable in terms of life comfort and use of attendants A prospect i ve trial to demonstrate the efficacy of intrathecal baclofen therapy by implanted pump for adults with spasticity due to spinal cord injury or multiple sclerosis was initiated in our hospital . Of the 140 patients assessed , 7 met the following criteria for inclusion in the study : a modified Ashworth score > 3 , a spasm frequency score > 2 , and an inadequate response to oral anti-spasticity drugs , ( i.e. , baclofen , clonidine and cyproheptadine ) . All patients responded to intrathecal bolus injection of baclofen in the double blind , placebo-controlled screening phase ( mean bolus dose = 42.8 micrograms ) . Programmable Medtronic pumps were implanted in 4 patients while 3 patients received non-programmable Infusaid pumps . Post-implantation , a marked decrease in spasticity occurred with a significant reduction of the Ashworth score ( mean = 1.8 , p < .005 ) , a reduced spasm score ( mean = 0.8 , p < .005 ) , and an improved leg swing in the pendulum test . These effects were maintained during a follow-up of 24 - 41 months ( average infusion dose = 218.7 micrograms/day ) . The gross cost-savings due to reduced hospitalizations related to spasticity was calculated by comparing the cost for the two year period before pump implantation to the same period after treatment for 6 of the 7 patients . The cost of in-hospital implantation as well as the cost of the pumps were deducted from the gross savings . There was a net cost-saving of $ 153,120 . Our findings agree with the reported efficacy and safety of intrathecal baclofen treatment , and illustrate the cost-effectiveness of this treatment OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity This study assessed the safety and efficacy of intrathecal baclofen in the treatment of intractable spasticity caused by spinal cord injury or multiple sclerosis . Twenty-three patients with severe chronic spasticity underwent bolus test dosing with 50 , 75 , or 100 micrograms of intrathecal baclofen administered by lumbar puncture . All patients were either refractory to oral baclofen at a dose of 120 mg/d or side effects were unacceptable at a lower dose . There was a significant decrease in tone and spasticity in all 23 patients . Nineteen patients underwent implantation of a programmable pump and intrathecal catheter design ed to deliver baclofen directly to the spinal cord . Rigidity ( tone ) was decreased from a mean prebolus Ashworth score of 3.8 to a mean postbolus Ashworth score of 1.5 and spasms from a mean prebolus score of 3.5 to a mean postbolus score of 1.2 for a minimum of 4 hours . Patients have been observed for a mean of 16 months ( range 2 to 34 months ) . Ashworth scores have remained reduced to an acceptable level ( < or =  
    Output:
    
There was substantial level 4 evidence that intrathecal baclofen is effective in reducing spasticity .