***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: Abstract Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability , kinesiophobia , catastrophizing , pain , quality of life and gait disturbances in patients with chronic low back pain ( CLBP ) . Methods This was a parallel-group , r and omised , superiority-controlled pilot study in which 20 patients were r and omly assigned to a programme consisting of motor training ( spinal stabilising exercises plus usual-care ) and cognitive – behavioural therapy ( experimental group , 10 subjects ) or usual-care alone ( control group , 10 subjects ) . Before treatment , 8 weeks later ( post-treatment ) , and 3 months after the end of treatment , the Oswestry Disability Index , the Tampa Scale for Kinesiophobia , the Pain Catastrophizing Scale , a pain numerical rating scale , and the Short-Form Health Survey were assessed . Spatio-temporal gait parameters were also measured by means of an electronic walking mat . A linear mixed model for repeated measures was used for each outcome measure . Results The programme had significant group ( p = 0.027 ) , time ( p < 0.001 ) , and time-by-group interaction ( p < 0.001 ) effects on disability , with the experimental group showing an improvement after training of about 61 % ( 25 % in the control group ) . The analyses of kinesiophobia , catastrophizing , and the quality of life also revealed significant time , group , and time-by-group interaction effects in favour of the experimental group , and there was a significant effect of time on pain . Both groups showed a general improvement in gait parameters , with the experimental group increasing cadence significantly more . Conclusion The multidisciplinary rehabilitation programme including cognitive – behavioural therapy was superior to the exercise programme in reducing disability , kinesiophobia , catastrophizing , and enhancing the quality of life and gait cadence of patients with CLBP Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment This study examined the supplemental value of a cognitive coping skills training when added to an operant-behavioral treatment for chronic low-back pain patients . The complete treatment package ( OPCO ) was compared with an operant program + group discussion ( OPDI ) and a waiting-list control ( WLC ) . After the WL period , the WLC patients received a less protocol ized operant program usually provided in Dutch rehabilitation centers ( OPUS ) . Regression analyses showed that , compared with WLC , both OPCO and OPDI led to less negative affect , higher activity tolerance , less pain behavior , and higher pain coping and pain control . At posttreatment , OPCO led to better pain coping and pain control than OPDI . Calculation of improvement rates revealed that OPCO and OPDI had significantly more improved patients than OPUS on all the dependent variables . The discussion includes findings regarding treatment credibility , compliance , and contamination bias Study Design . A r and omized , controlled trial . Objective . To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain . Summary of Background Data . Sickness benefit is granted to a person who is incapable of working because of reduced functioning . Improved physical function and decrease of pain may be important in considering return to work . Methods . Physical performance ( five activities ) , disability , and pain ( self-reported question naires ) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients r and omized to an intervention group ( n = 81 ) and a control group ( n = 36 ) . Results . At the 1-year follow-up evaluation , 50 % had returned to work . Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work : in the intervention group on all tests and in the control group on all except two performance tests . Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test . In the intervention group , odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain ; in the control group , this appeared in high pain . Conclusions . Return to work was related to physical function and pain . More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work OBJECTIVE To compare the effect of function-centered treatment ( FCT ) and pain-centered treatment ( PCT ) on the number of work days , permanent disability , and the unemployment rate .  DESIGN R and omized controlled trial . SETTING Inpatient rehabilitation center . PARTICIPANTS Patients ( N=174 ; 79 % male ; mean age , 42 y ) with previous sick leave of 6 weeks or more . INTERVENTIONS FCT ( 4 h/d for 3 wk ) emphasized activity despite pain by using work simulation , strength , endurance , and cardiovascular training . PCT ( 2.5h/d for 3 wk ) emphasized pain reduction and included passive and active mobilization , stretching , strength training , and a 4-hour mini back school with education and exercise . Analysis was by intention to treat . MAIN OUTCOME MEASURES Work days , return to work , rate of patients receiving financial compensation for permanent disability , and unemployment rate . Effect sizes ( Cohen d ) were defined as small ( 0.2 - 0.5 ) , moderate ( 0.5 - 0.8 ) , and large ( > 0.8 ) . RESULTS After 1 year , the FCT group had significantly more work days ( mean , 118 ; median , 39.5 ; interquartile range [ IQR ] , 0 - 198 ) than the PCT group ( mean , 74 ; median , 0 ; IQR , 0 - 160 ; Mann-Whitney U test , P=.011 ) . The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 ( 95 % confidence interval , 1.1 - 3.9 ) . The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant . CONCLUSIONS FCT is more effective than PCT for increasing work days Objective To evaluate the effectiveness of an integrated care programme , combining a patient directed and a workplace directed intervention , for patients with chronic low back pain . Design Population based r and omised controlled trial . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) . Participants 134 adults aged 18 - 65 sick listed for at least 12 weeks owing to low back pain . Intervention Patients were r and omly assigned to usual care ( n=68 ) or integrated care ( n=66 ) . Integrated care consisted of a workplace intervention based on participatory ergonomics , involving a supervisor , and a grade d activity programme based on cognitive behavioural principles . Main outcome measures The primary outcome was the duration of time off work ( work disability ) due to low back pain until full sustainable return to work . Secondary outcome measures were intensity of pain and functional status . Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group ( P=0.003 ) . Integrated care was effective on return to work ( hazard ratio 1.9 , 95 % confidence interval 1.2 to 2.8 , P=0.004 ) . After 12 months , patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group ( P=0.01 ) . Improvement of pain between the groups did not differ significantly . Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life . Trial registration Current Controlled Trials IS RCT N28478651 Background Experimenter ’s allegiance ( EA ) refers to a personal confidence of the superiority of a specific psychotherapy treatment . This factor has been linked with larger treatment effects in favor of the preferred treatment . However , various studies have displayed contradictory results between EA and the pattern of treatment effects . Aims Using a systematic approach followed by meta- analysis , we aim ed to evaluate the impact of an allegiance effect on the results of psychotherapeutic studies . Method We considered the meta-analyses of r and omized controlled trials ( RCTs ) of different types of psychotherapies in the Cochrane Data base of Systematic Review s. Eligible articles included meta-analyses of RCTs with at least one study showing evidence of EA ( i.e. , allegiant study ) . Effect sizes in allegiant RCTs were compared with non-allegiant using r and om and fixed models and a summary relative odds ratio ( ROR ) were calculated . Heterogeneity was quantified with the I2 metric . Results A total of 30 meta-analyses including 240 RCTs were analyzed . The summary ROR was 1.31 [ ( 95 % confidence interval ( CI : 1.03–1.66 ) P = 0.30 , I2 = 53 % ] indicating larger effects when allegiance exists . The impact of allegiance did not differ significantly ( P > 0.05 ) when we compared psychiatric versus medical outcomes . Allegiance effect was significant for all forms of psychotherapy except for cognitive behavioral therapy . Moreover , the impact of allegiance was significant only when the treatment integrity of delivered psychotherapy was not assessed . Allegiance effect was even stronger where the experimenter was also both the developer of the preferred treatment and supervised or trained the therapists . No significant differences were found between allegiant and non-allegiant studies in terms of overall quality of studies . Conclusions Experimenter ’s allegiance influences the effect sizes of psychotherapy RCTs and can be considered non-financial conflict of interest introducing a form of optimism bias , especially since blinding is problematic in this kind of research . A clear reporting of EA in every single study should be given an opportunity to investigators of minimizing its overestimation effects & NA ; Since pain‐related fear may contribute to the development and maintenance of chronic low back pain ( CLBP ) , an exposure in vivo treatment ( EXP ) was developed for CLBP patients . We examined the effectiveness as well as specific mediating mechanisms of EXP versus operant grade d activity ( GA ) directly and 6 months post‐treatment in a multi‐centre r and omized controlled trial . In total , 85 patients suffering from disabling non‐specific CLBP reporting at least moderate pain‐related fear were r and omly allocated to EXP or GA . It was demonstrated that EXP , despite excelling in diminishing pain catastrophizing and perceived harmfulness of activities , was equally effective as GA in improving functional disability and main complaints , although the group difference almost reached statistical significance favouring EXP . Both treatment conditions did not differ in pain intensity and daily activity levels either . Nor was EXP superior to GA in the subgroup of highly fearful patients . Irrespective of treatment , approximately half the patients reported clinical ly relevant improvements in main complaints and functional disability , although for the latter outcome the group difference was almost significant favouring EXP . Furthermore , the effect of EXP relative to GA on functional disability and main complaints was mediated by decreases in catastrophizing and perceived harmfulness of activities . In sum , this study demonstrates that up to 6 months after treatment EXP is an effective treatment , but not more effective than GA , in moderately to highly fearful CLBP patients , although its superiority in altering pain catastrophizing and perceived harmfulness of activities is clearly established . Possible explanations for these findings are discussed Abstract Objectives To assess the clinical effectiveness of surgical stabilisation ( spinal fusion ) compared with intensive rehabilitation for patients with chronic low back pain . Design Multicentre r and omised controlled trial . Setting 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom . Participants 349 participants aged 18 - 55 with chronic low back pain of at least one year 's duration who were considered c and i date s for spinal fusion . Intervention Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy . Main outcome measure The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after r and omisation . The SF-36 instrument was used as a secondary outcome measure . Results 1 
    Output:
    
Subgroup meta- analysis showed that there were larger ES for pain and disability in RCTs with long-length , non-daily contact , and low intensity of treatment .
Larger ES were also observed for quality of life in RCTs with short-length , non-daily contact , and low intensity treatment .
Likewise , the summary RORs were not significant , indicating that the length , contact , and intensity of treatment did not have an overall effect on the investigated outcomes .
For the outcomes investigated here , IMPT dosage is not generally associated with better ES , and an optimal dosage was not determined