***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: Alignment is important for comfortable and stable gait of lower-limb prosthesis users . The magnitude of socket reaction moments in the multiple planes acting simultaneously upon the residual limb may be related to perception of comfort in individuals using prostheses through socket interface pressures . The aim of this study was to investigate the effect of prosthetic alignment changes on sagittal and coronal socket reaction moment interactions ( moment-moment curves ) and to characterize the curves in 11 individuals with transtibial amputation using novel moment-moment interaction parameters measured by plotting sagittal socket reaction moments versus coronal ones under various alignment conditions . A custom instrumented prosthesis alignment component was used to measure socket reaction moments during walking . Prosthetic alignment was tuned to a nominally aligned condition by a prosthetist , and from this position , angular ( 3 ° and 6 ° of flexion , extension , abduction or adduction of the socket ) and translational ( 5 mm and 10 mm of anterior , posterior , medial or lateral translation of the socket ) alignment changes were performed in either the sagittal or the coronal plane in a r and omized manner . A total of 17 alignment conditions were tested . Coronal angulation and translation alignment changes demonstrated similar consistent changes in the moment-moment curves . Sagittal alignment changes demonstrated more complex changes compared to the coronal alignment changes . Effect of sagittal angulations and translations on the moment-moment curves was different during 2nd rocker ( mid-stance ) with extension malalignment appearing to cause medio-lateral instability . Presentation of coronal and sagittal socket reaction moment interactions may provide useful visual information for prosthetists to underst and the biomechanical effects of malalignment of transtibial prostheses 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 Alignment of lower limb prostheses is important for the gait of amputees . Observed deviations in a particular plane are corrected by altering the prosthetic alignment of the same plane . The assumption is that observed deviations are due to alignment errors within the same plane , but no research has confirmed this assumption . Therefore , the aim of this study was to investigate the out-of-plane effect of systematic alignment changes on socket reaction moments measured by an instrumented prosthesis alignment component in the sagittal and coronal planes in eleven amputees with transtibial prostheses . Each subject walked at self-selected walking speed following r and omized controlled angular ( ±3 ° and ±6 ° ) and translational ( ±5 mm and ±10 mm ) alignment changes from the nominally aligned condition . The following socket reaction moment parameters were subsequently analyzed : 3 parameters ( maximum moment , minimum moment , moment at 45 % of stance phase ) in the sagittal plane and 2 parameters ( moment at 30 % and 75 % of stance phase ) in the coronal plane . A statistical comparison was performed between the nominally aligned and mal-aligned conditions using a repeated measures of ANOVA followed by Scheffe 's post-hoc tests . Significant differences were found between the nominally aligned ( -0.077±0.078 Nm/kg ) and 3 ° extension ( -0.033±0.075 Nm/kg ; P=0.0258 ) and 6 ° extension ( -0.029±0.071 Nm/kg ; P=0.0098 ) conditions in the coronal plane socket reaction moments measured at 30 % of stance . Our analysis suggests that the alignment of the transtibial prosthesis should be performed in the sagittal plane first followed by the coronal plane In this study , the influence of different prosthetic alignments and components on oxygen consumption and the important biomechanical characteristics of the normal gait pattern of leg amputees was investigated . With 15 transtibial and 12 transfemoral amputees  , the oxygen consumption during walking on a treadmill was analyzed and biomechanical parameters during walking on even ground at a self-selected speed were defined . The amputation of all patients was caused by trauma . Variations of the prosthetic alignment affect the energy consumption of transfemoral amputees more significantly than that of transtibial amputees . Comparison of different prosthetic feet worn by transtibial amputees did not show significant differences regarding metabolic parameters . Compared with conventional hydraulic knee controls , the oxygen consumption of transfemoral amputees provided with an electronically controlled hydraulic knee joint is reduced . All investigated variations can be clearly characterized by the sagittal moments acting on the joints of the prosthetic limb during gait 
    Output:
    
DISCUSSION The results demonstrate that alignment changes have a predictable influence on the included kinetic parameters .
However , the effect of alignment changes on spatio-temporal and kinematic gait parameters are generally unpredictable .