***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: STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers Background : Non-specific chronic low back pain disorders have been proven resistant to change , and there is still a lack of clear evidence for one specific treatment intervention being superior to another . Methods : This r and omized controlled trial aim ed to investigate the efficacy of a behavioural approach to management , classification-based cognitive functional therapy , compared with traditional manual therapy and exercise . Linear mixed models were used to estimate the group differences in treatment effects . Primary outcomes at 12-month follow-up were Oswestry Disability Index and pain intensity , measured with numeric rating scale .  Inclusion criteria were as follows : age between 18 and 65 years , diagnosed with non-specific chronic low back pain for > 3 months , localized pain from T12 to gluteal folds , provoked with postures , movement and activities . Oswestry Disability Index had to be > 14 % and pain intensity last 14 days > 2/10 . A total of 121 patients were r and omized to either classification-based cognitive functional therapy group n = 62 ) or manual therapy and exercise group ( n > = 59 ) . Results : The classification-based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group , both statistically ( p < 0.001 ) and clinical ly . For Oswestry Disability Index , the classification-based cognitive functional therapy group improved by 13.7 points , and the manual therapy and exercise group by 5.5 points . For pain intensity , the classification-based cognitive functional therapy improved by 3.2 points , and the manual therapy and exercise group by 1.5 points . Conclusions : The classification-based cognitive functional therapy produced superior outcomes for non-specific chronic low back pain compared with traditional manual therapy and exercise Musculoskeletal conditions represent a considerable burden worldwide , and are predominantly managed in primary care . Evidence suggests that many musculoskeletal conditions share similar prognostic factors . Systematic ally assessing patient ’s prognosis and matching treatments based on prognostic subgroups ( stratified care ) has been shown to be both clinical ly effective and cost-effective . This study ( Keele Aches and Pains Study ) aims to refine and examine the validity of a brief question naire ( Keele STarT MSK tool ) design ed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations . We also describe the subgroups of patients , and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice . The study design is mixed methods : a prospect i ve , quantitative observational cohort study with a linked qualitative focus group and interview study . Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice . Participating patients will complete a baseline question naire ( shortly after consultation ) , plus question naires 2 and 6 months later . A sub sample of patients , along with participating GPs and health care practitioners , will be invited to take part in qualitative focus groups and interviews . The Keele STarT MSK tool will be refined based on face , discriminant , construct , and predictive validity at baseline and 2 months , and vali date d using data from 6-month follow-up . Patient and clinician perspectives about using the tool will be explored . This study will provide a vali date d prognostic tool ( Keele STarT MSK ) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low- , medium- , and high-risk subgroups . The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages Abstract We assessed the effectiveness of a 6-month healthy lifestyle intervention , on pain intensity in patients with chronic low back pain who were overweight or obese . We conducted a pragmatic r and omised controlled trial , embedded within a cohort multiple r and omised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW , Australia . Eligible patients with chronic low back pain ( > 3 months in duration ) and body mass index ≥27 kg/m2 and < 40 kg/m2 were r and omly allocated , using a central concealed r and om allocation process , to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service , or usual care . The primary outcome was pain intensity measured using an 11-point numerical rating scale , at baseline , 2 weeks , and monthly for 6 months . Data analysis was by intention-to-treat according to a prepublished analysis plan . Between May 13 , 2015 , and October 27 , 2015 , 160 patients were r and omly assigned in a 1:1 ratio to the intervention or usual care . We found no difference between groups for pain intensity over 6 months ( area under the curve , mean difference = 6.5 , 95 % confidence interval −8.0 to 21.0 ; P = 0.38 ) or any secondary outcome . In the intervention group , 41 % ( n = 32 ) of participants reported an adverse event compared with 56 % ( n = 45 ) in the control group . Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit  patients with low back pain who were overweight or obese , compared with usual care . The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group BACKGROUND AND PURPOSE Patients with hip osteoarthritis have impairments in muscle function ( muscle strength and power ) and hip range of motion ( ROM ) , and it is commonly believed that effective clinical management of osteoarthritis should address these impairments to reduce pain and disability . Therefore , the purpose of this study was to compare the short- and long-term effects of 4 months of physiotherapist-supervised strength training , physiotherapist-supervised Nordic Walking ( NW ) , or unsupervised home-based exercise ( HBE ) on muscle function and hip ROM in patients diagnosed with hip osteoarthritis . METHODS Secondary outcome analyses from an observer-blinded three-armed parallel- design r and omized controlled trial in 60 + -year-old patients with clinical hip osteoarthritis ( American College of Rheumatology criteria ) who were not on a waiting list for hip replacement . One hundred and fifty-two patients were r and omized to either 4 months of physiotherapist-supervised , moderate , progressive , strength training ( n = 50 ) , physiotherapist-supervised NW ( n = 50 ) , or unsupervised HBE ( n = 52 ) . Maximal isometric hip and thigh muscle strength and leg extensor power and active hip ROM were assessed at baseline 2 , 4 , and 12 months . RESULTS Intention-to-treat-analyses did not show any significant between-group differences for improvements in muscle strength and power or ROM at any time points . Short-term significant ( p < .05 ) increases in muscle strength were present in the physiotherapist-supervised exercise groups and in the long-term for muscle power in the NW-group . All exercise modes result ed in significant increases of ROM but long-term improvements were only shown for NW and HBE . DISCUSSION Four months of physiotherapist-supervised , progressive , moderate , and strength training was less effective than hypothesized for improving muscle strength and power in patients with hip osteoarthritis who are not awaiting hip replacement . Our results may indicate that in these patients , improvements in disability are not necessarily dependent on improvements in strength and power or ROM OBJECTIVE To evaluate the effect of training and pain education vs pain education alone , on neck pain , neck muscle activity and postural sway in patients with chronic neck pain . METHODS Twenty women with chronic neck pain were r and omized to receive pain education and specific training ( neck-shoulder exercises , balance and aerobic training ) ( INV ) , or pain education alone ( CTRL ) . Effect on neck pain , function and Global Perceived Effect ( GPE ) were measured . Surface electromyography ( EMG ) was recorded from neck flexor and extensor muscles during performance of the Cranio-Cervical Flexion Test ( CCFT ) and three postural control tests ( two-legged : eyes open and closed , one-legged : eyes open ) . Sway parameters were calculated . RESULTS Fifteen participants ( CTRL : eight ; INV : seven ) completed the study . Per protocol analyses showed a larger pain reduction ( p = 0.002 ) for the INV group with tendencies for increased GPE ( p = 0.06 ) , reduced sternocleidomastoid activity during the CCFT ( p = 0.09 ) , reduced sway length ( p = 0.09 ) , and increased neck extensor activity ( p = 0.02 ) during sway compared to the CTRL group . CONCLUSION Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain . These results provide encouragement for a larger clinical trial to corroborate these observations Background Disturbed sleep and pain often co-exist and the relationship between the two conditions is complex and likely reciprocal . This 5-year prospect i ve study examines whether disturbed sleep can predict the onset of multi-site pain , and whether non-disturbed sleep can predict the resolution of multi-site pain . Methods The cohort ( n = 1599 ) was stratified by the number of self-reported pain sites : no pain , pain from 1–2 sites and multi-site pain ( ≥3 pain sites ) .  Sleep was categorized by self-reported sleep disturbance : sleep A ( best sleep ) , sleep B and sleep C ( worst sleep ) . In the no-pain and pain-from-1–2 sites strata , the association between sleep ( A , B and C ) and multi-site pain 5 years later was analysed . Further , the prognostic value of sleep for the resolution of multi-site pain at follow-up was calculated for the stratum with multi-site pain at baseline . In the analyses , gender , age , body mass index , smoking , physical activity and work-related exposures were treated as potential confounders . Results For individuals with no pain at baseline , a significantly higher odds ratio for multi-site pain 5 years later was seen for the tertile reporting worst sleep [ odds ratio ( OR ) 4.55 ; 95 % confidence interval ( CI ) 1.28–16.12 ] . Non-disturbed ( or less disturbed ) sleep had a significant effect when predicting the resolution of multi-site pain ( to no pain ) ( OR 3.96 ; 95 % CI 1.69–9.31 ) . Conclusion In conclusion , sleep could be relevant for predicting both the onset and the resolution of multi-site pain . It seems to be a significant factor to include in research on multi-site pain and when conducting or evaluating intervention programmes for pain & NA ; An association is demonstrated between genetic polymorphisms in the gene coding for a key regulatory molecule in the hypothalamic‐pituitary‐adrenal axis and persistent pain after trauma . & NA ; Individual vulnerability factors influencing the function of the hypothalamic‐pituitary‐adrenal axis may contribute to the risk of the development of persistent musculoskeletal pain after traumatic stress exposure . The objective of the study was to evaluate the association between polymorphisms in the gene encoding FK506 binding protein 51 , FKBP5 , a glucocorticoid receptor co‐chaperone , and musculoskeletal pain severity 6 weeks after 2 common trauma exposures . The study included data from 2 prospect i ve emergency department‐based cohorts : a discovery cohort ( n = 949 ) of European Americans experiencing motor vehicle collision and a replication cohort of adult European American women experiencing sexual assault ( n = 53 ) .  DNA was collected from trauma survivors  at the time of initial assessment . Overall pain and neck pain 6 weeks after trauma exposure were assessed using a 0–10 numeric rating scale . After adjustment for multiple comparisons , 6 FKBP5 polymorphisms showed significant association ( minimum P < 0.0001 ) with both overall and neck pain in the discovery cohort . 
    Output:
    
The results of this review found that the strongest treatment effects to date are those associated with exercise .
Strengthening exercises of the neck and upper quadrant have a moderate effect on neck pain in the short-term .
Lower quality evidence and smaller effects were found for other exercise approaches .
Other treatments , including education/advice and psychological treatment , showed only very small to small effects , based on low to moderate quality evidence .