***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: While it seems intuitively appealing to promote participation in regular exercise in the management of  irritable bowel syndrome  , limited r and omised controlled trial evidence exists to support this recommendation . We examined the feasibility and effects of an exercise intervention upon quality of life and irritable bowel symptoms using a r and omised controlled trial methodology . Patients with a clinical ly confirmed diagnosis of irritable bowel syndrome according to Rome II criteria were r and omised to either an exercise consultation intervention or usual care for 12 weeks . Outcomes included irritable bowel specific quality of life , symptoms ( total symptoms , constipation , diarrhoea and pain ) and exercise participation .  The recruitment rate of eligible patients identified from hospital records was 18.3 % ( 56/305 ) . Analyses revealed no differences in quality life scores between groups at 12-week follow-up . The exercise group reported significantly improved symptoms of constipation ( mean difference=10.9 , 95 % CI= -20.1 , -1.6 ) compared to usual care at follow-up . The intervention group participated in significantly more exercise than usual care at follow-up ( mean difference=21.6 , 95 % CI=9.4 , 33.8 ) . Recruitment of eligible patients into this study was possible but rates were low . Findings highlight the possibility that exercise may be an effective intervention for symptom management in patients with irritable bowel syndrome ; this may be particularly the case for constipation predominant patients OBJECTIVE There are fundamental differences between the administration of medications and the application of manual procedures , such as those used by chiropractors . The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite , r and omized placebo-controlled trial of chiropractic care for women with chronic pelvic pain ( CPP ) . DESIGN Pilot study for a multisite , r and omized , placebo-controlled clinical trial . SETTING Three chiropractic research clinics in the midwest United States . SUBJECTS Thirty-nine ( 39 ) women with CPP of at least 6 months ' duration , diagnosed by board-certified gynecologists . INTERVENTIONS The active intervention consisted of the chiropractic technique , lumbar spine flexion-distraction , combined with manual Trigger Point Therapy . The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage ( light massage ) . OUTCOME MEASURES The primary outcome measure was the change in the Pain Disability Index ( PDI ) from baseline to the end of treatment ( 6 weeks ) , assessed by group and site . If the change score was in the same direction at all sites , the results were to be combined to estimate treatment effect size . RESULTS Patient characteristics were similar to those of patients with CPP in other studies . Recruitment methods , particularly in respect to the eligibility criteria and screening protocol s , would require modification in order to recruit an adequate sample for the planned r and omized controlled trial . Clinicians followed st and ardized procedures with apparently minimal deviation , patients in both groups were satisfied with their care and blinding appeared to be successful . PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated . CONCLUSIONS The technical and personnel re sources required to achieve adequate st and ardization of procedures at multiple sites may make a placebo-controlled trial unfeasible , given our current lack of knowledge about the active agent in manual chiropractic procedures Background Clinical evidence continues to exp and and is increasingly difficult to overview . We aim ed at conceptualizing a visual assessment tool , i.e. , a matrix for overviewing studies and their data in order to assess the clinical evidence at a glance . Methods A four-step matrix was constructed using the three dimensions of systematic error , r and om error , and design error . Matrix step I ranks the identified studies according to the dimensions of systematic errors and r and om errors . Matrix step II orders the studies according to the design errors . Matrix step III assesses the three dimensions of errors in studies . Matrix step IV assesses the size and direction of the intervention effect . Results The application of this four-step matrix is illustrated with two examples : peri-operative beta-blockade initialized in relation to surgery versus placebo for major non-cardiac surgery , and antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation .  When clinical evidence is deemed both internally and externally valid , the size of the intervention effect is to be assessed . Conclusion The error matrix provides an overview of the validity of the available evidence at a glance , and may assist in deciding which interventions to use in clinical practice BACKGROUND CONTEXT The impact of  lumbar spinal surgery  is commonly evaluated with three patient-reported outcome measures : Oswestry Disability Index ( ODI ) , the physical component summary ( PCS ) of the Short Form of the Medical Outcomes Study ( SF-36 ) , and pain scales . A minimum clinical ly important difference ( MCID ) is a threshold used to measure the effect of clinical treatments . Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method . PURPOSE This study has three purpose s. First , to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID . Second , to determine a statistically sound and clinical ly meaningful MCID for ODI , PCS , back pain scale , and leg pain scale in lumbar spine surgery patients . Third , to compare the discriminative ability of two anchors : a global health assessment and a rating of satisfaction with the results of the surgery . STUDY DESIGN This study is a review of prospect ively collected patient-reported outcomes data . PATIENT SAMPLE A total of 454 patients from a large data base of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study . OUTCOME MEASURES Preoperative and 1-year postoperative scores for ODI , PCS , back pain scale , leg pain scale , health transition item ( HTI ) of the SF-36 , and Satisfaction with Results scales . METHODS ODI , SF-36 , and pain scales were administered before and 1 year after spinal surgery . Several c and i date MCID calculation methods were applied to the data and the result ing values were compared . The HTI of the SF-36 was used as the anchor and compared with a second anchor ( Satisfaction with Results scale ) . RESULTS Potential MCID calculations yielded a range of values : fivefold for ODI , PCS , and leg pain , 10-fold for back pain . Threshold values obtained with the two anchors were very similar . CONCLUSIONS The minimum detectable change ( MDC ) appears as a statistically and clinical ly appropriate MCID value . MCID values in this sample were 12.8 points for ODI , 4.9 points for PCS , 1.2 points for back pain , and 1.6 points for leg pain & NA ; The current analysis compares changes in pain with changes in function and health status in individuals with painful diabetic peripheral neuropathy ( DPN ) . The post hoc analysis is based on a 12 week , multinational , placebo‐controlled trial of pregabalin in which 401 patients were r and omized to treatment . Study measures included the Brief Pain Inventory short‐form ( BPI‐sf ) , EQ‐5D and other patient‐reported outcomes . Cutpoints were derived on the BPI‐sf 0–10 average pain numeric rating scale [ NRS ] to classify pain grade s of “ mild ” ( 1–3 ) , moderate ( 4–6 ) and severe ( 7–10 ) , adjusting for geographical regions where data were collected . Two different metrics were used to classify the importance of change in pain severity from baseline to 12 weeks : changes in pain severity grade s ( defined by cutpoint categories ) and percent reduction in the NRS ( categories ranging from 0–9 % to ≥50 % ) . An improvement in one pain grade or a ≥30 % reduction in the NRS served as determinants of a clinical ly important difference . Patients with a one‐ grade reduction in pain severity , either from “ severe‐to‐moderate ” or “ moderate‐to‐mild , ” had a 3‐point improvement the BPI‐sf Pain Interference Index ( PII ; a composite measure of function ) ; a reduction from “ severe‐to‐mild ” pain corresponded to a 6‐point improvement in the PII . Similarly , a reduction in the NRS of ≥30 % and ≥50 % corresponded to a 3‐point and a 5‐point improvement in the PII , respectively . Changes in pain were also associated with changes in health status . Results suggest that patients whose pain is not reduced to a mild level of severity can still experience clinical ly important changes in function and health status OBJECTIVE The purpose of this study was to describe long-term outcomes for women with chronic pelvic pain ( CPP ) after evaluation in a CPP specialty clinic . STUDY DESIGN This was a prospect i ve observational cohort study of women treated for CPP at the UNC Pelvic Pain clinic between 1993 and 2000 . The primary outcome was improvement in pain and the main exposure was treatment group : primarily medical ( pharmacotherapy , psychotherapy , physical therapy , or combinations of the 3 ) or surgical ( hysterectomy , resection or ablative procedures , oophrectomy , diagnostic surgery , pain mapping , vulvar or vestibular repair ) . Univariate , bivariate , and multivariable analyses were performed to look for relationships between background characteristics , treatment group , and improvement in pain . RESULTS Of 370 participants ; 189 had surgical treatment and 181 had medical treatment . One year after evaluation , 46 % reported improvement in pain and 32 % improvement in depression . Improvement in pain was similar in both treatment groups and odds of improvement were equal even after adjusting for background characteristics , psychosocial comorbidity , and previous treatments . CONCLUSION One year after evaluation in a CPP specialty clinic , women experienced modest improvements in pain and depression after recommended surgical or nonsurgical treatment & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies PURPOSE We determined the feasibility of conducting a r and omized clinical trial design ed to compare 2 methods of manual therapy ( myofascial physical therapy and global therapeutic massage ) in patients with urological chronic pelvic pain syndromes . MATERIAL S AND METHODS We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers . Eligible patients were r and omized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each . Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment , adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment . Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods . RESULTS There were 23 ( 49 % ) men and 24 ( 51 % ) women r and omized during a 6-month period . Of the patients 24 ( 51 % ) were r and omized to global therapeutic massage , 23 ( 49 % ) to myofascial physical therapy and 44 ( 94 % ) completed the study . Therapist adherence to the treatment protocol s was excellent . The global response assessment response rate of 57 % in the myofascial physical therapy group was significantly higher than the rate of 21 % in the global therapeutic massage treatment group ( p = 0.03 ) . CONCLUSIONS We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study OBJECTIVE To evaluate the efficacy of intravaginal electrical stimulation in women with chronic pelvic pain ( CPP ) . STUDY DESIGN Between May 2002 and February 2004 , 24 women with CPP with no apparent cause were evaluated . They underwent 10 sessions of int 
    Output:
    
Narrative synthesis of the results , based on effect estimates and clinical ly relevant pain improvement , disclosed some evidence to support an effect of multidisciplinary intervention and Mensendieck somatocognitive therapy on female chronic pelvic pain .
There seems to be some evidence to support the use of a multidisciplinary intervention in the management of female chronic pelvic pain .