***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: A range of patient-oriented and practitioner-oriented outcomes were used to evaluate the efficacy of " gait plate " shoe inlays in controlling symptoms associated with in-toeing in otherwise healthy children . For 18 in-toeing children , parents completed a preintervention question naire . Then , during r and omized trials , foot placement angle was measured both with and without gait plate inlays in the children 's footwear . After the children had worn the gait plates for 1 month , a simple question naire was used to rate parental satisfaction with a range of factors associated with control of symptoms . The use of gait plate inlays result ed in a small but statistically significant reduction in the amount of in-toeing as measured by foot placement angle .  Gait plates reduced the reported frequency of tripping in 14 of the 18 cases . The reported parental satisfaction was high or very high in all but one case , suggesting that this intervention warrants further investigation as an alternative to " observational management " for symptomatic in-toeing OBJECTIVE . To compare the clinical efficacy of custom foot orthotics , prefabricated " off-the-shelf " shoe inserts , and supportive athletic shoes worn alone , on reducing pain and improving function for children with juvenile idiopathic arthritis ( JIA ) . METHODS Children with JIA and foot pain ( n = 40 ) were r and omized to one of 3 groups receiving : ( 1 ) custom-made semirigid foot orthotics with shock absorbing posts ( n = 15 ) , ( 2 ) off-the-shelf flat neoprene shoe inserts ( n = 12 ) , or ( 3 ) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone ( n = 13 ) . Foot pain and functional limitations were measured using the Pediatric Pain Question naire-visual analog scale ( VAS ) , Timed Walking , Foot Function Index ( FFI ) , and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory ( PedsQL ) . Measures were administered by personnel blinded to group status at baseline ( before wearing the assigned intervention ) and at 3 months ' followup . RESULTS Children in the orthotics group showed significantly greater improvements in overall pain ( p = 0.009 ) , speed of ambulation ( p = 0.013 ) , activity limitations ( p = 0.002 ) , foot pain ( p = 0.019 ) , and level of disability ( p = 0.024 ) when compared with the other 2 groups . Both children and parents in the orthotics group reported clinical ly meaningful improvement in child health-related quality of life , although the group by time interaction did not show statistical significance . Except for a reduction in pain for supportive athletic shoes ( paired t test , p = 0.011 ) , neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures . CONCLUSION In children with JIA , custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain , speed of ambulation , and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Background : Orthoses for children with flexible excess pronation are estimated to cost Australian parents millions of dollars per year ; however , there is no high-level evidence that orthoses improve function or reduce pain . Methods : A r and omized parallel , single-blinded , controlled trial of custom-made and ready-made orthoses was conducted in children between the ages of 7 and 11 years with bilateral flexible excess pronation . The diagnosis was based on calcaneal eversion and navicular drop . Outcomes included gross motor proficiency , self-perception , exercise efficiency , and pain . Measurements were taken at baseline , and at 3 and 12 months . Of the 178 children who participated at baseline , 160 continued to the end of the trial . Results : After r and omization , baseline characteristics were similar between the three treatment groups ( custom-made , ready-made , and control ) . Statistical modeling demonstrated that although for most outcome measures there were statistically significant trends over time , none of the group comparisons were statistically significant . A sub-group analysis of those presenting with pain found no significant differences at 3 or 12 months . Conclusions : This study found no evidence to justify the use of in-shoe orthoses in the management of flexible excess foot pronation in children In a survey of 6000 children between 9 and 10 years of age , 122 were found to have unilateral or bilateral hallux valgus . These children were r and omly assigned to no treatment or to the use of a foot orthosis . About three years later 93 again had radiography . The metatarsophalangeal joint angle had increased in both groups but more so in the treated group . During the study , hallux valgus developed in the unaffected feet of children with unilateral deformity , despite the use of the orthosis A Foot Function Index ( FFI ) was developed to measure the impact of foot pathology on function in terms of pain , disability and activity restriction . The FFI is a self-administered index consisting of 23 items divided into 3 sub-scales . Both total and sub-scale scores are produced . The FFI was examined for test-retest reliability , internal consistency , and construct and criterion validity . A total of 87 patients with rheumatoid arthritis were used in the study .  Test-retest reliability of the FFI total and sub-scale scores ranged from 0.87 to 0.69 . Internal consistency ranged from 0.96 to 0.73 . With the exception of two items , factor analysis supported the construct validity of the total index and the sub-scales . Strong correlation between the FFI total and sub-scale scores and clinical measures of foot pathology supported the criterion validity of the index . The FFI should prove useful for both clinical and research purpose Pes planovalgus is an extremely common deformity and still not completely understood . Its pathogenesis and the possibilities for treating it with shoe inserts are still under debate . While the controversy between abstentionists and interventionists remains a fact , since a certain number of flat feet persist into adult age and cause disability , a new type of orthosis is proposed . This has been tested on children affected with grade III pes planovalgus and with all the worst clinical , objective and prognostic parameters . The study was carried out with a control group using traditional Lelièvre insoles .  The results were extremely good and correction was achieved in a significantly higher number of patients than in the control group OBJECTIVE To assess the method ologic quality of approaches used to allocate participants to comparison groups in r and omized controlled trials from one medical specialty . DESIGN Survey of published , parallel group r and omized controlled trials . DATA SOURCES All 206 reports with allocation described as r and omized from the 1990 and 1991 volumes of four journals of obstetrics and gynecology . MAIN OUTCOME MEASURES Direct and indirect measures of the adequacy of r and omization and baseline comparisons . RESULTS Only 32 % of the reports described an adequate method for generating a sequence of r and om numbers , and only 23 % contained information showing that steps had been taken to conceal assignment until the point of treatment allocation . A mere 9 % described both sequence generation and allocation concealment . In reports of trials that had apparently used unrestricted r and omization , the differences in sample sizes between treatment and control groups were much smaller than would be expected due to chance . In reports of trials in which hypothesis tests had been used to compare baseline characteristics , only 2 % of reported test results were statistically significant , lower than the expected rate of 5 % . CONCLUSIONS Proper r and omization is required to generate unbiased comparison groups in controlled trials , yet the reports in these journals usually provided inadequate or unacceptable information on treatment allocation . Additional analyses suggest that nonr and om manipulation of comparison groups and selective reporting of baseline comparisons may have occurred 
    Output:
    
The evidence from r and omised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus .
Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus