***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: Background : Monophasic high voltage stimulation ( MHVS ) is widely prescribed for the treatment of inflammation associated with muscle injury . However , limited scientific evidence exists to support its purported benefits in humans . Objective : To examine the efficacy of early initiation of MHVS treatment after muscle injury . Methods : In a r and omised , cross over design , 14 men performed repetitive eccentric contractions of the elbow flexor muscles followed by either MHVS or control treatment . MHVS treatments were applied five minutes and 3 , 6 , 24 , 48 , 72 , 96 , and 120 hours after eccentric contractions . Results : MHVS result ed in a significant reduction ( p<0.05 ) in delayed onset muscle soreness 24 hours after eccentric exercise compared with controls . Elbow extension was significantly increased immediately after administration of MHVS compared with controls . No significant differences were observed between MHVS treatment and controls for maximal isometric strength , flexed arm angle , or arm volume . Conclusions : Early and frequent application of MHVS may provide transient relief from delayed onset muscle soreness and short term improvements in range of motion after injurious exercise . However , MHVS treatment may not enhance recovery after muscle injury because of lack of improvements in strength and active range of motion PURPOSE This study aim ed to evaluate the benefit of using low-intensity running or electromyostimulation ( EMS ) to hasten the recovery process from eccentric-contraction-induced injury . METHODS Before and 30 min , 24 h , 48 h , and 96 h after a one-legged downhill run , electrical stimulations were applied to the femoral nerve of healthy volunteers . Superimposed twitches were delivered during isometric maximal voluntary contraction ( MVC ) to determine the voluntary activation level ( % VA ) . For 4 d after the exercise , each subject performed either ( i ) 30 min of running at 50 % VO2max , ( ii ) 30 min of low-frequency EMS on the lower limb extensor muscles , or ( iii ) passive recovery . RESULTS Recovery time courses of the different variables did not differ significantly among the three experimental conditions . MVC decreased 30 min after the exercise and did not recover thereafter ( P < 0.001 ) . Percent VA was depressed after the exercise ( P < 0.05 ) but did not contribute to MVC decrement thereafter . Mechanical responses to 80- and 20-Hz stimulation ( P80 and P20 , respectively ) were significantly reduced over time ( P < 0.01 and P < 0.001 , respectively ) . Interestingly , MVC , P20 , and P80 decrements were not statistically different ( -9.6 + /- 14.5 % , -13.2 + /- 14.2 % , and -12.3 + /- 11.3 % , respectively ) at 48 h , and the P20.P80(-1 ) ratio showed complete recovery at this time . CONCLUSIONS The different recovery modes had no significant effect on the recovery time course of contractile properties . The prolonged torque loss is mainly due to peripheral alterations . Our results suggest that an alteration of the excitation-contraction coupling might be involved during the first 2 d after the eccentric exercise . From 2 to 4 d , damage to force-generating structures could account for the remaining torque deficit OBJECTIVE To investigate the effects of two dosages of pulsed ultrasound therapy ( 1 MHz , spatial averaged peak intensity 0.8 W/cm2 , mark space ratio of 1:4 ) on  acute-stage delayed onset muscle soreness ( DOMS ) .  DESIGN Double-blind , placebo-controlled , r and omized trial . SETTING Laboratory of a university physiotherapy department . PARTICIPANTS Forty-eight healthy volunteers ( 24 men , 24 women ) with no arm pathology or pain at the time of the study . INTERVENTIONS Subjects were r and omly allocated to one of four treatment groups : control , placebo ( sham insonation ) , low-dosage pulsed ultrasound ( mean dosage 172.8 J ) , or high-dosage pulsed ultrasound ( mean dosage 345.6 J ) . DOMS was induced in the nondominant elbow flexors in a st and ardized fashion through repeated eccentric exercise until exhaustion . MAIN OUTCOME MEASURES Elbow extension , flexion , and resting angles ( universal goniometer ) , pain ( visual analogue scale ) , mechanical pain threshold/tenderness ( pressure algometer ) , and a McGill pain question naire . Measurements were taken before and after treatment each day except for the McGill pain question naire , which was completed at the end of the trial . RESULTS Significant differences were seen between groups in relation to range of flexion ( p = .0032 ) , with the control group losing least range of flexion . There were no other significant differences between the groups . CONCLUSION No convincing evidence was found to support the use of pulsed ultrasound therapy in the management of DOMS at the parameters discussed here At present , there is no consensus on the effectiveness of post-exercise recovery interventions on subsequent daily performances . The purpose of this study was to compare the effectiveness of 20 min low-intensity water exercises , supine electrostimulation , and passive ( sitting rest ) recovery modalities on physiological ( oxygen consumption , blood lactate concentration , and percentage of hemoglobin saturation in the muscles ) , psychological ( subjective ratings of perceived exertion , muscle pain , and feeling of recovery ) , and performance ( countermovement , bouncing jumping ) parameters . During three experimental sessions , 8 men ( age : 21.9+/-1.3 yrs ; height : 175.8+/-10.7 cm ; body mass : 71.2+/-9.8 kg ; VO(2max ) : 57.9+/-5.1 ml x kg x min(-1 ) ) performed a morning and an afternoon submaximal running test . The recovery interventions were r and omly administered after the first morning tests . Activity and dietary intake were replicated on each occasion . ANOVA for repeated measures ( p<0.05 ) showed no difference between the morning and afternoon physiological ( ratios : range 0.90 - 1.18 ) and performance parameters ( ratios : range 0.80 - 1.24 ) , demonstrating that post-exercise recovery interventions do not provide significant beneficial effects over a limited time period . Conversely , subjects perceived water exercises ( 60 % ) and electrostimulation ( 40 % ) as the most effective interventions , indicating that these recovery strategies might improve the subjective feelings of wellbeing of the individual Athletic trainers have a variety of therapeutic agents at their disposal to treat musculoskeletal pain , but little objective evidence exists of the efficacy of the modalities they use . In this study ,  delayed onset muscle soreness  ( DOMS ) served as a model for musculoskeletal injury in order to : ( 1 ) compare the changes in perceived pain , elbow extension range of motion , and strength loss in subjects experiencing DOMS in the elbow flexor muscle group following a single treatment with either transcutaneous electrical nerve stimulation ( TENS ) , cold , a combination of TENS and cold , sham TENS , or 20 minutes of rest ; ( 2 ) compare the effects of combining static stretching with these treatments ; and ( 3 ) determine if decreased pain is accompanied by a restoration of strength . DOMS was induced in the non-dominant elbow flexor muscle group in 40 females ( age = 22.0 + /- 4.3 yr ) with repeated eccentric contractions . Forty-eight hours following exercise , all subjects presented with pain , decreased elbow extension range of motion , and decreased strength consistent with DOMS . Subjects were r and omly assigned to 20-minute treatments followed by static stretching . Cold , TENS , and the combined treatment result ed in significant decreases in perceived pain . Treatments with cold result ed in a significant increase in elbow extension range of motion . Static stretching also significantly reduced perceived pain . Only small , nonsignificant changes in muscle strength were observed following treatment or stretching , regardless of the treatment group . These results suggest that the muscle weakness associated with DOMS is not the result of inhibition caused by pain . The results suggest that these modalities are effective in treating the pain and muscle spasm associated with DOMS , and that decreased pain may not be an accurate indicator of the recovery of muscle strength This study investigated the acute effects of NMES on blood lactate ( BLa ) and performance parameters in trained male triathletes . On three separate days , 13 trained male triathletes performed six 30 s Wingate tests ( 30 WanT ) on a cycle ergometer . Each session consisted of performing 3 × 30 WanT ( bouts 1–3 ) followed by a r and omly assigned 30 min recovery intervention of either : ( i ) passive ( seated ) , ( ii ) active ( cycling at 30 % VO2max ) or ( iii ) NMES ( 1 Hz/500 μs-ON : OFF 2:6 s ) . The 3 × 30 WanT bouts were then repeated ( bouts 4–6 ) and compared to bouts 1–3 for peak power ( PP ) , mean power ( MP ) and fatigue index ( FI ) . BLa and heart rate ( HR ) were recorded at design ated time points throughout . Data were analyzed using repeated measures ANOVA with Tukey ’s honestly significant difference post hoc test . BLa decreased significantly faster during the active recovery intervention ( P < 0.001 ) , however , there were no significant differences between interventions for PP ( P = 0.217 ) , MP ( P = 0.477 ) and FI ( P = 0.234 ) when the post intervention bouts ( 4–6 ) where compared to the pre intervention bouts ( 1–3 ) . NMES during recovery was not more effective than active or passive recovery for improving subsequent performance . Despite BLa clearing at a significantly faster rate for the active recovery intervention , PP , MP or FI did not improve significantly compared to NMES and passive . In conclusion , NMES does not appear to be more effective than traditional methods for enhancing short-term recovery from supra-maximal exercise bouts in trained male triathletes Background “ Patient-Reported Outcome ” ( PRO ) is used as an umbrella term for different concepts for measuring subjectively perceived health status e. g. as treatment effects . Their common characteristic is , that the appraisal of the health status is reported by the patient himself . In order to describe the informative value of PRO in Health Technology Assessment ( HTA ) first an overview of concepts , classifications and methods of measurement is given . The overview is complemented by an empirical analysis of clinical trials and HTA-reports on rheumatoid arthritis and breast cancer in order to report on type , frequency and consequences of PRO used in these documents . Methods For both issues systematic review s of the literature have been performed . The search for method ological literature covers the publication period from 1990 to 2009 , the search for clinical trials of rheumatoid arthritis and breast cancer covers the period 2005 to 2009 . Both search es were performed in the medical data bases of the German Institute of Medical Documentation and Information ( DIMDI ) . The search for HTA-reports and method ological papers of HTA-agencies was performed in the CRD- Data bases ( CRD = Centre for Review s and Dissemination ) and by h and search ing the websites of INAHTA member agencies ( INAHTA = International Network of Agencies for Health Technology Assessment ) . For all issues specific inclusion and exclusion criteria were defined . The method ological quality of r and omized controlled trials ( RCT ) was assessed by a modified version of the Cochrane Risk of Bias Tool . For the method ological part information extraction from the literature is structured by the report ’s chapters , for the empirical part data extraction sheets were constructed . All information is summarized in a qualitative manner . Results Concerning the method ological issues the literature search retrieved 158 documents ( 87 documents related to definition or classification , 125 documents related to operationalisation of PRO ) . For the empirical analyses 225 RCT ( rheumatoid arthritis : 77 ; breast cancer : 148 ) and 40 HTA-reports and method papers were found . The analysis of the method ological literature confirms the role of PRO as an umbrella term for a variety of different concepts . The newest classification system facilitates the description of PRO measures by construct , target population and the method of measurement . Steps of operationalisation involve defining a conceptual framework , instrument development , exploration of measurement properties or , possibly , the modification of existing instruments . Seven out of 59 RCT analysing the effects of antibody therapy for rheumatoid arthritis define PRO as the primary endpoint , 38 trials utilize composite measures ( ACR , DAS ) and ten trials report clinical or radiological parameters as the primary endpoint . Six out of 123 chemotherapy trials for breast cancer define PRO as the primary endpoint , while 98 trials report clinical endpoints ( survival , tumour response , progression ) in their primary analyses . Discrepancies in the number of trials result from inaccurate specifications of endpoints in the publications . This distribution is reflected in the HTA-reports : while almost all reports on rheumatoid arthritis refer to PRO , this is only the case in about half of the reports on breast cancer . Conclusions As definition and classification of PRO are concerned , coherent concepts are found in the literature . Their operationalisation and implementation must be guided by scientific principles . The type and frequency of PRO used in clinical trials largely depend on the disease analysed . The HTA-community seems to pursue the utilization of PRO proactively – in case of missing data the need for further research is stated Neric , FB , Beam , WC , Brown , LE , and Wiersma , LD . Comparison of swim recovery and muscle stimulation on lactate removal after sprint 
    Output:
    
The meta- analysis showed no evidence in favor of NMES vs. active ( ACT ) and mixed evidence vs. passive ( PAS ) recovery for BLa .
In conclusion , although there may be some subjective benefits for postexercise recovery , evidence is not convincing to support NMES for enhancing subsequent performance