***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: OBJECTIVE To evaluate the validity of the Qualis data base in identifying the levels of scientific evidence and the quality of r and omized controlled trials indexed in the Lilacs data base . METHODS We selected 40 open-access journals and performed a page-by-page h and search , to identify published articles according to the type of study during a period of six years . Classification of studies was performed by independent review ers assessed for their reliability . R and omized controlled trials were identified for separate evaluation of risk of bias using four dimensions : generation of allocation sequence , allocation concealment , blinding , and incomplete outcome data . The Qualis classification was considered to be the outcome variable . The statistical tests used included Kappa , Spearman 's correlation , Kendall-tau and ordinal regressions . RESULTS Studies with low levels of scientific evidence received similar Qualis classifications when compared to studies with high levels of evidence . In addition , r and omized controlled trials with a high risk of bias for the generation of allocation sequences and allocation concealment were more likely to be published in journals with higher Qualis levels . DISCUSSION The hierarchy level of the scientific evidence as classified by type of research design , as well as by the validity of studies according to the bias control level , was not correlated or associated with Qualis stratification . CONCLUSION Qualis classifications for journals are not an approximate or indirect predictor of the validity of r and omized controlled trials published in these journals and are therefore not a legitimate or appropriate indicator of the validity of r and omized controlled trials Fagnani F , Giombini A , Di Cesare A , Pigozzi F , Di Salvo V : The effects of a whole-body vibration program on muscle performance and flexibility in female athletes . Am J Phys Med Rehabil 2006;85:956–962 . Objective : This r and omized controlled study was design ed to investigate the short-term effects of an 8-wk whole-body vibration protocol on muscle performance and flexibility in female competitive athletes . Design : Twenty-six young volunteer female athletes ( ages 21–27 yrs ) were r and omized to either the vibration group or control group . The vibration intervention consisted of an 8-wk whole-body vibration 3 times a week employed by st and ing on a vertical vibration platform . As outcome measures , three performance tests ( counter-movement jump , extension strength of lower extremities with an isokinetic horizontal leg press , and a sit- and -reach test for flexibility ) were performed initially and after 8 wks . Results : A total of 24 athletes completed the study properly . In the vibration group ( n = 13 ) whole-body vibration induced significant improvement of bilateral knee extensor strength ( P < 0.001 ) , counter-movements jump ( P < 0.001 ) , and flexibility ( P < 0.001 ) after 8 wks of training . No significant changes were found for all the outcome measures for the control group ( n = 11 ) . Conclusions : Whole-body vibration is a suitable training method to improve knee extension maximal strength , counter-movement jump , and flexibility in a young female athlete if it is properly design ed . Not only do the optimal frequency , amplitude , and g-forces need to be identified but also the level of muscle activation that would benefit more from vibration stimulation . The improvement of flexibility is important not only for performance but also for the prevention of muscle-tendon injury OBJECTIVE To compare the cost of illness of three musculoskeletal conditions in relation to general wellbeing . METHODS Patients with fibromyalgia , chronic low back pain ( CLBP ) , and ankylosing spondylitis who were referred to a specialist and participated in three r and omised trials completed a cost diary for the duration of the study , comprising direct medical and non-medical re source utilisation and inability to perform paid and unpaid work . Patients rated perceived wellbeing ( 0 - 100 ) at baseline . Univariate differences in costs between the groups were estimated by bootstrapping . Regression analyses assessed which variables , in addition to the condition , contributed to costs and wellbeing . RESULTS 70 patients with fibromyalgia , 110 with chronic low back pain , and 111 with ankylosing spondylitis provided data for the cost analyses . Average annual disease related total societal costs per patient were 7813 euro for fibromyalgia , 8533 euro for CLBP , and 3205 euro for ankylosing spondylitis . Total costs were higher for fibromyalgia and CLBP than for ankylosing spondylitis , mainly because of cost of formal and informal care , aids and adaptations , and work days lost . Wellbeing was lower in fibromyalgia ( mean , 48 ) and low back pain ( mean , 42 ) than in ankylosing spondylitis ( mean , 67 ) . No variables other than diagnostic group contributed to differences in costs or wellbeing . CONCLUSIONS In patients under the care of a specialist , there were marked differences in costs and wellbeing between those with fibromyalgia or CLBP and those with ankylosing spondylitis . In particular , direct non-medical costs and productivity costs were higher in fibromyalgia and CLBP How should health care professionals choose among the many therapies cl aim ed to be efficacious for treating specific disorders ? The practice of evidence -based medicine provides an answer . Advocates of this approach urge health care professionals to base treatment choices on the best evidence from systematic research on both the efficacy and adverse effects of various therapeutic alternatives . Ideally , health care professionals would compare different treatments by referring to r and omized , double-blind , head-to-head trials that compared the treatment options . Although individual medications are typically well research ed when these placebo-controlled studies are performed , studies that directly compare treatments are rare . In the absence of direct head-to-head trials , other evidence comes from indirect comparisons of two or more therapies by examining individual studies involving each treatment . This article provides an introductory review of methods of such indirect comparisons of therapies across studies , provides examples of how these methods can be used to make treatment decisions , and presents a general overview of relevant issues and statistics for readers interested in underst and ing these methods more thoroughly Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIM Fibromyalgia ( FM ) is a chronic disorder characterized by widespread pain . Fibromyalgia is associated with balance problems and increased fall frequency . Whole-body vibration therapy had been used for improve balance in special population s but not in fibromyalgia . The main objective of this study was to analyze the effects of 12 weeks of tilting whole-body vibration therapy on static balance in fibromyalgia patients . METHODS Women with FM were r and omly and sequentially assigned to either the  vibration group ( N.=21 ) or the  control group ( N.=20 ) based on a r and omly generated number table , and a code number was assigned to each participant . All participants received st and ard care that included medical care through the public health system ( hospital and outpatient clinic , including primary care ) and social support through the local fibromyalgia association . Participants in the exercise group received whole-body vibration therapy ( 12 weeks , 12.5 Hz frequency and 3 mm amplitude ) . Outcome measure was determined using postural stability indices ( overall , anterior-posterior and medial-lateral ) assessed by the Biodex Balance System in a single dominant limb stance . RESULTS Treatment effect after 12-weeks of tilting whole body vibration therapy were 57.1 % on overall stability and 66.6 % on anterior-posterior stability . CONCLUSION Tilting whole-body vibration therapy effectively improves static balance in patients with FM OBJECTIVE The aim of this study was to investigate the effectiveness of a 6-week traditional exercise program with supplementary whole-body vibration ( WBV ) in improving health status , physical functioning , and main symptoms of fibromyalgia ( FM ) in women with FM . METHODS Thirty-six ( 36 ) women with FM ( mean + /- st and ard error of the mean age 55.97 + /- 1.55 ) were r and omized into 3 treatment groups : exercise and vibration ( EVG ) , exercise ( EG ) , and control ( CG ) . Exercise therapy , consisting of aerobic activities , stretching , and relaxation techniques , was performed twice a week ( 90 min/day ) . Following each exercise session , the EVG underwent a protocol with WBV , whereas the EG performed the same protocol without vibratory stimulus . The Fibromyalgia Impact Question naire ( FIQ ) was administered at baseline and 6 weeks following the initiation of the treatments . Estimates of pain , fatigue , stiffness , and depression were also reported using the visual analogue scale . RESULTS A significant 3 x 2 ( group x time)-repeated measures analysis of variance interaction was found for pain ( p = 0.018 ) and fatigue ( p = 0.002 ) but not for FIQ ( p = 0.069 ) , stiffness ( p = 0.142 ) , or depression ( p = 0.654 ) . Pain and fatigue scores were significantly reduced from baseline in the EVG , but not in the EG or CG . In addition , the EVG showed significantly lower pain and fatigue scores at week 6 compared to the CG , whereas no significant differences were found between the EG and CG ( p > 0.05 ) . CONCLUSION Results suggest that a 6-week traditional exercise program with supplementary WBV safely reduces pain and fatigue , whereas exercise alone fails to induce improvements The aim of this study was to analyze electromyography ( EMG ) responses of vastus lateralis muscle to different whole-body vibration frequencies . For this purpose , 16 professional women volleyball players ( age , 23.9 ± 3.6 years ; height , 182.5 ± 11.1 cm ; weight , 78.4 ± 5.6 kg ) voluntarily participated in the study . Vibration treatment was administered while st and ing on a vibrating platform with knees bent at 100 ° ( Nemes Bosco-system , Rome , Italy ) . EMG root mean square ( rms ) and was recorded for 60 seconds while st and ing on the vibrating plate in the following conditions : no vibrations and 30- , 40- , and 50-Hz vibration frequencies in r and om order . The position was kept for 60 seconds in each treatment condition . EMGrms was collected from the vastus lateralis muscle of the dominant leg . Statistical analysis showed that , in all vibration conditions , average EMGrms activity of vastus lateralis was higher than in the no-vibration condition . The highest EMGrms was found at 30 Hz , suggesting this frequency as the one eliciting the highest reflex response in vastus lateralis muscle during whole-body vibrations in half-squat position . An extension of these studies to a larger population appears worthwhile to further eluci date the responsiveness of the neuromuscular system to whole-body vibrations administered through vibrating platforms and to be able to develop individual treatment protocol CONTEXT Whole-body vibration machines are a relatively new technology being implemented in the athletic setting . Numerous authors have examined the proposed physiologic mechanisms of vibration therapy and performance outcomes . Changes have mainly been observed in the lower extremity after individual exercises , with minimal attention to the upper extremity and resistance training programs . OBJECTIVE To examine the effects of a novel vibration intervention directed at the upper extremity as a precursor to a supervised , multijoint dynamic resistance training program . DESIGN R and omized controlled trial . SETTING National Collegiate Athletic Association Division IA institution . PATIENTS OR OTHER PARTICIPANTS Thirteen female student-athletes were divided into the following 2 treatment groups : ( 1 ) whole-body vibration and resistance training or ( 2 ) resistance training only . INTERVENTION(S ) Participants in the vibration and resistance training group used an experimental vibration protocol of 2 x 60 seconds at 4 mm and 50 Hz , in a modified push-up position , 3 times per week for 10 weeks , just before their supervised resistance training session . MAIN OUTCOME MEASURE(S ) Isokinetic total work measurements of the rotator cuff were collected at baseline and at week 5 and week 10 . RESULTS No differences were found between the treatment groups ( P > .05 ) . However , rotator cuff output across time increased in both groups ( P < .05 ) . CONCLUSIONS Although findings did not differ between the groups , the use of whole-body vibration as a precursor to multijoint exercises warrants further investigation because of the current lack of literature on the topic . Our results indicate that indirectly strengthening the rotator cuff using a multijoint dynamic resistance training program is possible OBJECTIVE Fibromyalgia ( FM ) is characterized by widespread pain that can lead to significant patient disability , complex management decisions for physicians , and economic burden on society . We investigated the total costs of FM in an employer population . METHODS Administrative cl aims data of a Fortune 100 manufacturer were used to quantify direct ( i.e. , medical and pharmaceutical cl aims ) and indirect ( i.e. , disability cl aims and imputed absenteeism ) costs associated with FM . A total of 4699 patients with at least one FM cl aim between 1996 and 1998 were contrasted with a 10 % r and om sample of the overall beneficiary population . Employee-only subsets of both sample s also were drawn . RESULTS Medical utilization , receipt of prescription drugs , and annual total costs were proportionately similar yet significantly greater among FM cl aim ants than the overall sample ( all p < 0.0001 ) . Total annual costs for FM cl aim ants were $ 5945 versus $ 2486 for the typical beneficiary ( p < 0.0001 ) . Six percent of these costs were attrib 
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The results , based on very low quality of evidence , were inconclusive regarding pain , and showed no clinical ly important effects on the control of fatigue and improvement of quality of life .
Implication s for rehabilitation There is no evidence to support the use of whole-body vibration for pain treatment of women with fibromyalgia .
The use of whole-body vibration in women with fibromyalgia showed no clinical ly important effects in the control of fatigue and improvement of quality of life