***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: The impact of clinical ly diagnosed depression on recovery in activities of daily living over a 2-year follow-up was examined in a prospect i ve study of 63 stroke patients . Although impairment in activities of daily living , neurologic diagnoses and findings , lesion location and volume as measured on computed tomographic scan , demographic variables , cognitive impairment , and social functioning were comparable between depressed ( n = 25 ) and nondepressed ( n = 38 ) patients during their acute hospitalization , the two groups had different patterns of recovery in activities of daily living . At 2 years after suffering a stroke , patients with an in-hospital diagnosis of depression ( either major or minor depression ) were significantly more impaired in both physical activities and language functioning than were non-depressed patients . Among patients with major depression , this disparity in the recovery profile was present even after the depression had remitted . This study emphasizes the need for early recognition and treatment of poststroke depression Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background and Purpose — The efficacy and safety of the selective serotonin reuptake inhibitor fluoxetine have rarely been studied in the treatment of poststroke emotional disturbances . Methods — Stroke patients ( 152 ) who had poststroke depression ( PSD ) , emotional incontinence ( PSEI ) , or anger proneness ( PSAP ) were studied . PSD was evaluated by Beck Depression Inventory and Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , PSEI by Kim ’s criteria , and PSAP was assessed by Spielberger Trait Anger Scale . Subjects were r and omly given either fluoxetine 20 mg/day ( n=76 ) or placebo ( n=76 ) for 3 months . Follow-up evaluations were done 1 , 3 , and 6 months after the beginning of the treatment . The primary outcome measurement was the scores of emotional disturbances at each follow-up assessment . The secondary outcome measurements were the percentage changes of the scores and the subjective responses of the patients . Results — Although patients in the fluoxetine group more often dropped out because of adverse effects , fluoxetine administration was generally safe . Fluoxetine significantly improved PSEI and PSAP , whereas no definitive improvement of PSD was found . Improvement of PSAP was noted even at 3 months after the discontinuation of the treatment . Conclusions — Fluoxetine is efficacious in the treatment of PSEI and PSAP . Its effect on PSD is not solidly confirmed Background and Purpose — This prospect i ve study was design ed to examine the course , associates , and predictors of depressive symptoms during the first 18 months after stroke . Methods — A total of 100 patients were followed up for 18 months after stroke .  Depressive symptoms were assessed at 2 weeks and 2 , 6 , 12 , and 18 months after stroke with the  Beck Depression Inventory  and the  Hamilton Rating Scale for Depression , and diagnoses were performed using criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders , Third Edition-Revised . Stroke severity was assessed with the Sc and inavian Stroke Scale and cognitive functions with a comprehensive neuropsychological battery . Patients participated in a r and omized clinical trial of antidepressive medication . Results — In all , 54 % of patients felt at least mildly depressive at some time during the follow-up ; 46 % of those who were depressive during the first 2 months were also depressive at 12 and /or 18 months . Only 12 % of patients were depressive for the first time at 12 or 18 months . The male sex was associated with a more negative change in depressive symptoms during the follow-up . Older age was associated with depressive symptoms during the first 2 months , stroke severity from 6 to 12 months , and the male sex at 18 months . Depressive symptoms were unrelated to the lesion location . Conclusions — Depressive symptoms are frequent and they often have a chronic course . Depression is associated with stroke severity and functional impairment , and with the male sex at 18 months . Attention should be focused on the long-term prognosis of mood disturbances and adaptation OBJECTIVE The Regenerate pilot study explored whether a 10-week , community-based progressive resistance training ( PRT ) program could reduce depressive symptoms in depressed chronic stroke survivors . METHODS Participants were screened for depressive status using the PHQ-9 and confirmed by psychiatric assessment . Eligible people ( n = 45 ) were r and omised to PRT or a waiting-list comparison group .  The PRT program included two high intensity sessions/week for 10 weeks at a community-based gymnasium . Depressive status , physical and mental health and quality of life were measured at baseline , 10 weeks and 6 months . Muscle strength was assessed using 1 repetition maximum ( 1-RM ) for upper and lower limbs . RESULTS The participants ' median age was 69 years : 27 were male . The intervention group had lower depression scores than the comparison group at all time points . At 6-month follow-up , there was a trend for PRT participants to be more likely to be no longer depressed than the comparison group , but the difference was not significant after adjusting for baseline scores . There were modest improvements in health and wellbeing over time , but many scores were lower than reported in non-depressed people . Intervention participants demonstrated significant improvements in strength . Program adherence was good : on average 75 % of the 10-week program was completed . CONCLUSIONS The intervention appeared to be feasible within a community-based setting . To optimize stroke recovery and improve the quality of life of stroke survivors , health professionals should continue to focus on helping survivors ' mental health recovery as well their physical rehabilitation BACKGROUND Transcranial magnetic stimulation ( TMS ) is a noninvasive method to stimulate the cortex , and the treatment of depression is one of its potential therapeutic applications . Three recent meta analyses strongly suggest its benefits in the treatment of depression . The present study investigates whether repetitive TMS ( rTMS ) accelerates the onset of action and increases the therapeutic effects of amitriptyline . METHODS Forty-six out patients meeting DSM-IV criteria for nonpsychotic depressive episode were r and omly assigned to receive rTMS ( n = 22 ) or sham repetitive TMS ( sham ) ( n = 24 ) during 4 weeks over dorsolateral prefrontal cortex ( DLPFC ) in this double-blind controlled trial . All patients were concomitantly taking amitriptyline ( mean dose 110 mg/d ) . The rTMS group received 20 sessions ( 5 sections per week ) of 5 Hz rTMS ( 120 % of motor threshold and 1250 pulses per session ) . Sham stimulation followed the same schedule , however , using a sham coil . The efficacy variables were the Hamilton Depression Rating Scale-17 items ( HAM-D/17 ) , the Montgomery-Asberg Depression Rating Scale ( MADRS ) , a Visual Analogue Scale ( VAS ) , and the Clinical Global Impression ( CGI ) . Tolerability was assessed by clinical examination and a safety screening of TMS side effects . RESULTS Repetitive TMS had a significantly faster response to amitriptyline . There was a significant decrease in HAM-D/17 scores , already after the first week of treatment ( p < .001 compared with baseline and p < .001 compared with sham ) . The decrease in HAM-D/17 scores in the rTMS group was significantly superior compared with the sham group throughout the study ( p < .001 at fourth week ) . CONCLUSIONS Repetitive TMS at 5 Hz accelerated the onset of action and augmented the response to amitriptyline In previous studies , fast repetitive transcranial magnetic stimulation ( rTMS ) with a frequency > 1 Hz demonstrated substantial antidepressant effects compared to sham rTMS . However , it is not clear whether fast rTMS is superior to slow rTMS ( frequency < or = 1 Hz ) which is safe at therapeutically promising higher intensities . The aim of this double-blind study was to compare the action of fast , slow and sham rTMS .  Eighteen patients with pharmacotherapy-resistant major depression were r and omized to receive fast ( 10 Hz ) , slow ( 0.3 Hz ) or sham rTMS with 250 stimuli/day for 5 successive days . rTMS was applied at 90 % motor threshold intensity to the left dorsolateral prefrontal cortex . Scores on the Hamilton Depression Rating Scale ( HDRS ) , but not on the Montgomery-Asberg Depression Rating Scale ( MADRS ) , showed a statistically significant time x group interaction with a reduction of 19 % after slow rTMS . However , the effect was clinical ly marginal and not reflected by self-rating scores . Verbal memory and reaction performance were not impaired after rTMS , and there was even a statistically significant time x group interaction with improvement of verbal memory performance after fast rTMS . In conclusion , this study further supported the safety of rTMS but does not show any clinical ly meaningful antidepressant efficacy of rTMS at 250 daily stimuli over 5 days in pharmacotherapy-refractory major depression Objective : To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects . Design : Single-blinded r and omized control trial . Setting : Outpatient rehabilitation . Subjects : Forty-eight community-dwelling ischaemic stroke patients ( 38 independently mobile , 9 requiring assistance , 1 non-ambulatory ) were r and omly assigned to intervention or control groups by concealed allocation . Intervention : The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10 . Both groups continued usual care ( excluding aerobic exercise ) ; intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes . Main outcome measures : Cardiac risk score ( CRS ) ; VO2 ( mL O2/kg per minute ) and Borg Rate of Perceived Exertion ( RPE ) assessed during a st and ardized ergometry test ; Hospital Anxiety and Depression Scale ( HADS ) ; Frenchay Activity Index ; Fasting Lipid Profiles and Resting Blood Pressure . Results : Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 ( intervention 10.6 ±1.6 to 12.0 ± 2.2 , control 11.1 ±1.8 to 11.1 ±1.9 t=4.734 , P<0.001 ) and CRS ( intervention 13.4 ±10.1 to 12.4 ±10.5 , control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537 , P<0.05 ) . RPE rating decreased in intervention subjects ( 13.4 ±12.2 to 12.4 ±2.0 ) and increased in controls ( 13.8 ±1.8 to 14.4 ±1.6 ) ; Mann — Whitney U ( U = 173.5 , P<0.05 ) . Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone ( 5.1 ±3.4 to 3.0 ±2.8 ) ( Wilcoxon signed ranks test Z=-3.278 , P<0.001 ) . Conclusion : Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme . The intervention was associated with improvement in self-reported depression Objective : To study the timecourse of health-related global and domain-specific  quality of life ( QOL ) in patients presenting with stroke or transient ischemic attacks ( TIA ) up to one year after the ischemic event . Variables were identified that may predict poststroke life satisfaction . Patients and Methods : In this prospect i ve study , a cohort of 183 stroke/TIA patients was followed up at 3 , 6 , and 12 months . A total of 144 survivors completed the follow-up ( 65 women , 79 men , mean age 65.3 years ) .  Health-related QOL  was assessed by the Short Form 36 ( SF-36 ) question naire , the  neurological status by the European Stroke Scale ( ESS ) . Disability was evaluated by using the Barthel index and the modified Swedish Stroke Registry Follow-up Form ; depression was scored by the Montgomery-Asberg Depression Rating Scale ( MADRS ) . Results : One year after stroke/TIA , 66 % of patients reported a worsening of life satisfaction compared with the prestroke level . The SF-36 physical component summary was reduced throughout the observation period . The SF 
    Output:
    
Repetitive transcranial magnetic stimulation had the strongest evidence of effectiveness in improving mood followed by pharmacotherapy ; whereas exercise appeared to be effective in improving adjustment and coping among individuals in the chronic stage of stroke .
Conclusion : Overall , interventions provided in the chronic stage of stroke appear to be effective in improving mood and adjustment up to 3 months post intervention .
The use of multidisciplinary interventions and acceptance models may be important in the overall adjustment process