***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: R and omized controlled clinical trials are conducted to determine whether differences of clinical importance exist between selected treatment regimens . When statistical analysis of the study data finds a P value greater than 5 % , it is convention to deem the assessed difference nonsignificant . Just because convention dictates that such study findings be termed nonsignificant , or negative , however , it does not necessarily follow that the study found nothing of clinical importance . Subject sample s used in controlled trials tend to be too small . The studies therefore lack the necessary power to detect real , and clinical ly worthwhile , differences in treatment . Freiman et al. found that only 30 % of a sample of 71 trials published in the New Engl and Journal of Medicine in 1978 - 79 with a P value greater than 10 % were large enough to have a 90 % chance of detecting even a 50 % difference in the effectiveness of the treatments being compared , and they found no improvement in a similar sample of trials published in 1988 . It is therefore wrong and unwise to interpret so many negative trials as providing evidence of the ineffectiveness of new treatments . One must instead seriously question whether the absence of evidence is a valid justification for inaction . Efforts must be made to look for quantification of an association rather than just a P value , especially when the risks under investigation are small . The authors cite a recent trial comparing octreotide and sclerotherapy in patients with variceal bleeding  , as well as the overview of clinical trials evaluating fibrinolytic treatment for preventing reinfa rct ion after acute myocardial infa rct ion as examples Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group BACKGROUND AND PURPOSE Since the release of acute low back pain management guidelines in 1994 , little was known about the effect of these guidelines on clinical practice . The purpose of this study was to examine physical therapists ' reported management of acute and subacute lumbar impairment . SUBJECTS One in 10 registered physical therapists who were r and omly selected from southern Ontario , Canada , ( n=454 ) and all registered physical therapists from northern Ontario ( n=331 ) were surveyed . METHODS In the question naire , case scenarios covered 3 areas related to the management of lumbar impairment : ( 1 ) physical examination , ( 2 ) treatment and recommendations , and ( 3 ) therapists ' beliefs regarding its management . RESULTS Five hundred sixty-nine question naires were returned ( response rate=72.5 % ) . Only data obtained for therapists ( n=274 ) whose weekly workload included more than 10 % of people with lumbar impairment were used in the analysis . Overall ,  patient education , exercise , and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment ( symptom onset of less than 5 weeks ) with or without sciatica , whereas exercise and work modification were preferred for subacute lumbar impairment ( symptom onset of 5 weeks or longer ) . There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness . Only 46.3 % of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment . DISCUSSION AND CONCLUSION Although the physical therapists surveyed , in general , followed the guidelines in managing acute lumbar impairment , they felt uncertain regarding the value of practice guidelines . Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines Traction therapy for  low back pain with sciatica has been evaluated in a double blind study . 60 patients hospitalized for sciatica with or without signs of sensory or motor deficiency were r and omized to 3 treatment groups : " placebo traction " ( 5 kg ) , " light traction " ( 15 kg ) and " normal traction " ( 50 kg ) . Clinical evaluation after 4 , 8 and 12 traction sessions showed no difference between the three groups A controlled trial of continuous lumbar traction in the treatment of  back pain and sciatica  showed similar improvements in both the treated group ( weighted traction ) and the control group ( simulated traction ) . The findings of this study question the justification of admitting patients with back pain into hospitals for purpose s of traction alone STUDY DESIGN A r and omized trial design ed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting . OBJECTIVE To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage . SUMMARY OF BACKGROUND DATA Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany . No reports of previous r and omized trials for the outcome from interferential therapy were found . METHODS Consenting patients were r and omly assigned into one of two groups . A pretreatment interview was performed by the patient using a computer-based question naire . It also incorporated the Oswestry Disability Index and a pain visual analog scale . Management consisted of six sessions over a 2- to 3-week period . Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment . RESULTS A total of 152 patients were recruited . The two treatment groups had similar demographic and clinical baseline characteristics . The mean Oswestry Disability Index before treatment was 30 for both groups ( n = 147 ) . After treatment , this had dropped to 25 , and , at 3 months , were 21 ( interferential therapy ) and 22 ( motorized lumbar traction and massage ) . The mean pain visual analog scale score before treatment was 50 ( interferential therapy ) and 51 ( motorized lumbar traction and massage ) . This had dropped , respectively , to 46 and 44 after treatment and to 42 and 39 at 3 months . CONCLUSIONS This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage . There was no difference in the improvement between the two groups at the end of treatment . Although there is evidence from several trials that traction alone is ineffective in the management of low back pain , this study could not exclude some effect from the concomitant massage Study Design . A r and omized clinical trial . Objectives . To assess the efficacy of motorized continuous traction for low back pain . Summary of Background Data . The available studies on the efficacy of lumbar traction do not allow clear conclusions because of severe method ologic flaws . The current trial aim ed to overcome these shortcomings . Methods . Patients with at least 6 weeks of nonspecific low back pain were selected .  High‐dose traction was compared with sham ( or low‐dose ) traction . Sham traction was given with a specially developed brace that becomes tighter in the back during traction . This was experienced as if real traction were exerted . The patients and the outcome assessor were unaware of treatment allocation . Outcome measures were : patient 's global perceived effect , severity of main complaints , functional status , pain , range of motion , work absence , and medical treatment . Results for the outcome measures at 12 weeks and 6 months after r and omization are presented . Results . One hundred and fifty‐one patients were r and omly allocated to one of the two treatment methods . Intention‐to‐treat analysis of the 12‐week and 6‐month results showed no statistically significant differences between the groups on all outcome measures ; all 95 % confidence intervals included the value zero . The number of patients lost to follow‐up study was very low . Other analyses showed the same results . Conclusions . Most common flaws of earlier studies on traction therapy could be overcome . This trial did not support the cl aim that traction is efficacious for patients with low back pain OBJECTIVE To identify the current use of traction and the types of patients , treatment parameters , and treatment modalities used in conjunction with traction . DESIGN Postal survey , with 4 sections : professional characteristics of respondent , current use of traction , patient selection , and treatment parameters . SETTING Musculoskeletal outpatient departments ( private and nonprivate practitioners ) . PARTICIPANTS R and om sample ( N=1491 ) of chartered physiotherapists in the UK who work in the management of low back pain ( LBP ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Descriptive analysis of information on current use and practice in applying traction . RESULTS A response rate of 83 % ( n=1239 ) was achieved ; 41 % ( n=507 ) use lumbar traction , which is most commonly used in the management of subacute LBP patients presenting with nerve root symptoms . Treatment parameters were established for weights ( 5 - 60 kg ) , frequency ( 2 - 3 times weekly ) , and length of treatment ( 4 wk ) . In addition , traction is commonly used with other modalities ( 87 % ) : mobilizations , advice , and exercise . CONCLUSIONS Survey results show the continued use of lumbar traction despite the recommendations of numerous guidelines . Results also clarify the types of patients and the parameters used in the application of traction OBJECTIVE To present the design of a trial on the efficacy of lumbar traction . DESIGN R and omized clinical trial . PATIENTS Patients with a minimum of 6 wk , nonspecific low back pain . INTERVENTION High-dose , motorized , continuous traction with a force between 35 % and 50 % of the total body weight was compared with sham or low-dose traction with a force between 0 and 20 % of body weight . The sham traction was given with a specially developed brace that becomes tighter in the back during traction . This is experienced by patients as if traction were exerted . OUTCOME MEASURES Primary measures were the patient 's global impression of the effect and the severity of three main complaints . Secondary effect measures were functional status , pain , range of motion , work absence and recurrences . The effect measures were rated before r and omization and 4 wk , 12 wk and 6 months later . CONCLUSION There have been a number of earlier trials on the efficacy of lumbar traction ; they suffer , however , from severe method ological flaws . This trial aim ed to avoid these shortcomings Previous trials to assess the efficacy of lumbar traction for  back pain  have been method ologically flawed . To avoid these shortcomings , we conducted a r and omised controlled trial in which high-dose traction was compared with sham traction . The sham traction was given with a specially developed brace that tightens in the back during traction . To the patient , the experience is that of traction . The patients and outcome assessor were blinded for the assigned treatment . 151 patients with at least six weeks of non-specific low back pain were r and omised . Intention to treat analysis showed no differences between the groups on all outcome measures ( patients ' global perceived effect , severity of main complaints , functional status and pain ) ; all 95 % confidence intervals included the value zero . The number of withdrawals from treatment , loss to follow-up , and protocol deviations was low . Consequently , the per- protocol analysis showed results similar to the intention to treat analysis . Subgroup analyses did not show any group for which traction might seem promising . Our data do not support the cl aim that traction is effective for patients with low back pain Autotraction ( AT ) is a treatment for low-back pain syndrome of benign etiology that uses a specially design ed traction table divided into two movable sections . While lying on the table , the pelvis secured , the patient controls the traction forces by grasping and pulling the bars at the head of the table . There are controls for the therapist to apply , through movable sections of the table , rotation and bending forces to help restore mobility to the lumbar spine without inducing pain . The present study is based upon a r and omized treatment trial comparing conventional passive traction ( PT ) to AT . The following outcome indicators were used : ( 1 ) subjective response concerning overall improvement , ( 2 ) pain intensity ( visual analog scale , 0 - 100 ) , ( 3 ) qualitative pain severity ( McGill Pain Question naire , short-form , 0 - 45 ) , and ( 4 ) pain related disability ( Oswestry Low Back Pain Disability Score , 0 - 100 ) . The favorable response to AT was 75 % ( 30 of the 40 patients ) versus the 22 % ( 6 of 27 patients ) to PT ( p < 0.001 ) . After 3 months , 19 of the 30 responders to AT ( 63 % ) reported continued improvement . In these patients , pain ratings remained stable and the disability scores decreased to 0 to 23 % of the pretreatment value ( median and mean respectively , p < 0.001 ) Forty-nine patients with lumbago-sciatica and prolapsed lumbar intervertebral discs , comparable concerning anamnestical and clinical data were r and omized for autotraction and manual traction given by the same therapist for a period of one week while strict bed rest was prescribed . A blind overall assessment performed immediately after the traction period , after two weeks follow-up training and three months after hospitalization showed that the two traction modalities are equally efficient . As treatment for hospitalized patients with lumbar intervertebral disc prolapses the relatively simple manual traction variety should be preferred , if any . Traction is suggested to be used as a prognostical aid . Pain intensity was significantly reduced in all body parts . About one fourth of patients avoided operation . After two years there was no recurrence of symptoms A double-blind control study of  lumbar traction for sciatica has been carried out . Although there is a tendency for traction to produce improvement in 
    Output:
    
For mixed groups of patients with LBP with and without sciatica , we found : ( 1 ) strong evidence that there is no statistically significant difference in short or long-term outcomes between traction as a single treatment , ( continuous or intermittent ) and placebo , sham , or no treatment ; ( 2 ) moderate evidence that traction as a single treatment is no more effective than other treatments ; and ( 3 ) limited evidence that adding traction to a st and ard physiotherapy program does not result in significantly different outcomes .
In the remaining comparisons , there were no statistically significant differences ; level of evidence is moderate regarding continuous or intermittent traction compared to placebo , sham , or no treatment , and is limited regarding different forms of traction .
CONCLUSION Based on the current evidence , intermittent or continuous traction as a single treatment for LBP can not be recommended for mixed groups of patients with LBP with and without sciatica .
Neither can traction be recommended for patients with sciatica because of inconsistent results and method ological problems in most of the studies involved .
However , because high- quality studies within the field are scarce , because many are underpowered , and because traction often is supplied in combination with other treatment modalities , the literature allows no firm negative conclusion that traction , in a generalized sense , is not an effective treatment for patients with LBP