***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: Purpose The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain . Methods A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting .  Pain was measured with the visual analogue scale and disability with the Lysholm scale . The psychological variables , such as anxiety , depression , pain coping strategies , catastrophizing and fear to movement beliefs , were studied by using self-administered question naires . Results Among the pain coping strategies , only the catastrophizing subscale showed a significant reduction . Similarly , anxiety , depression and kinesiophobia were significantly reduced after treatment . Those patients who decreased the catastrophizing , kinesiophobia , anxiety and depression showed a greater improvement in pain and disability after a purely biomedical treatment . A multiple regression analysis revealed that changes in catastrophizing predicted the amount of improvement in pain severity and that changes in both catastrophizing and anxiety predicted changes in disability after treatment . Conclusion What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia . Therefore , co- interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results .Level of evidence Prospect i ve Cohort Study , Level I for prognosis BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters OBJECTIVE To determine if in knee osteoarthritis ( KOA ) , one session of active electrical intramuscular stimulation ( a-EIMS ) compared with sham causes an effect on the motor cortex excitability parameters [ motor evoked potential ( MEP ; the primary outcome ) , short intracortical inhibition ( SICI ) , intracortical facilitation ( ICF ) and cortical silent period ( CSP ) ] and pain measurements [ pain pressure threshold ( PPT ) ; visual analog scale ( VAS ) and change in numerical pain scale ( NPS0 - 10 ) during the conditioned pain modulation (CPM)-task ] . This study also set out to determine if serum brain-derived neurotrophic factor ( BDNF ) mediates the effect of treatment on the cortical spinal system as assessed by MEP and PPT . DESIGN R and omized clinical trial . SUBJECTS AND METHODS Women with KOA , 50 - 75-years old received a 30-min session of either sham ( n = 13 ) or a-EIMS ( n = 13 ) with 2 Hz . The pain measures and excitability parameters were measured before and immediately after a-EIMS or sham . RESULTS The a-EIMS group compared with sham decreased the MEP by 31,67 % [ confidence interval ( CI ) 95 % , 2.34 - 60.98 ] . For the secondary outcomes , the a-EIMS reduced the ICF and increased the CSP but not changed the SICI . The a-EIMS improved the pain reported on VAS , the PPT , and the score of the NPS ( 0 - 10 ) during the CPM-task The BDNF was negatively correlated with the PPT ( r = -0.56 ) . CONCLUSIONS The serum BDNF revealed an inverse relationship with PPT independent of the treatment group . These results suggest that a-EIMS enhanced the corticospinal inhibitory systems in cortical and infracortical pain processing sites most likely by bottom-up regulation mechanisms Background Patients with painful knee osteoarthritis ( OA ) demonstrate hyperalgesia and altered pain-modulatory responses . While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures , it is unknown whether individual variability in quantitative sensory testing ( QST ) responses at baseline can prospect ively predict analgesic treatment responses . Method Patients with knee OA ( n = 35 ) were compared on QST responses to a demographically-matched  pain-free control group ( n = 39 ) , after which patients completed a month-long treatment study of diclofenac sodium topical gel ( 1 % ) , applied up to 4 times daily . Results OA patients demonstrated reduced pain thresholds at multiple anatomic sites , as well as reduced conditioned pain modulation ( CPM ) and enhanced temporal summation of pain . The most pain-sensitive patients tended to report the most intense and neuropathic OA pain . Following diclofenac treatment , the knee OA cohort showed a roughly 30 % improvement in pain , regardless of the presence or absence of neuropathic symptoms . Baseline CPM scores , an index of endogenous pain-inhibitory capacity , were prospect ively associated with treatment-related changes in clinical pain . Specifically , participants with higher CPM at baseline ( i.e. , better functioning endogenous pain-inhibitory systems ) showed more reduction in pain at the end of treatment ( p < .05 ) . Conclusions These results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients . Moreover , the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample . Finally , the prospect i ve association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes .Trial registration Clinical Trials . Gov Identifier : NCT01383954 . Registered June 22 , 2011 STUDY DESIGN An experimental laboratory study with a repeated- measures crossover design . BACKGROUND Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways . Impaired conditioned pain modulation ( CPM ) has been found experimentally in persons with knee and hip osteoarthritis , indicating impaired inhibition of central nociceptive pathways . We hypothesized increased effectiveness of CPM following application of joint mobilization , determined via measures of deep tissue hyperalgesia . OBJECTIVE To examine the effect of joint mobilization on impaired CPM . METHODS An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 ( 73 % ) with impaired CPM . The subjects were r and omized to receive 6 minutes of knee joint mobilization ( intervention ) or manual cutaneous input only , 1 week apart . Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the h and at baseline , postintervention , and post-CPM testing . Further , vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing . RESULTS Joint mobilization , but not cutaneous input intervention , result ed in a global increase in pressure pain threshold , indicated by diminished hyperalgesic responses to pressure stimulus . Further , CPM was significantly enhanced following joint mobilization . Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention , but not at the contralateral knee . Resting pain was also significantly lower following the joint intervention . CONCLUSION Conditioned pain modulation was enhanced following joint mobilization , demonstrated by a global decrease in deep tissue pressure sensitivity . Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis QUESTION Does Kinesio Taping reduce pain and swelling , and increase muscle strength , function and knee-related health status in older people with knee osteoarthritis ? DESIGN R and omised , controlled trial with concealed allocation , intention-to-treat analysis and blinded assessment . PARTICIPANTS Seventy-six older people with knee osteoarthritis . INTERVENTION The experimental group received three simultaneous Kinesio Taping techniques to treat pain , strength and swelling . The control group received sham taping . All participants kept the taping on for 4 days . OUTCOME MEASURES The outcomes were : concentric muscle strength of knee extensors and flexors , measured by isokinetic dynamometry with an angular velocity of 60 deg/second normalised for body mass [ ( Nm/kg ) x 100 ( % ) ] ; pressure pain threshold via digital pressure algometry ( kgf/cm(2 ) ) ; lower-limb swelling via volumetry ( l ) and perimetry ( cm ) ; physical function via the Lysholm Knee Scoring Scale ( 0 = worst to 100=best ) ; and knee-related health status via the Western Ontario and McMaster ( WOMAC ) osteoarthritis index ( 0=best to 96=worst ) . Outcomes were measured at Day 4 ( end of the taping period ) and Day 19 ( follow-up ) after the start of the treatment . RESULTS At Day 4 , there were no significant between-group differences for knee extensor muscle strength ( MD -1 % , 95 % CI -7 to 5 ) , knee flexor muscle strength ( MD 2 % , 95 % CI -3 to 7 ) , the pressure pain threshold at any measured point , volumetry ( MD 0.05 L , 95 % CI -0.01 to 0.11 ) , perimetry at any measured point , Lysholm score ( MD -4 points , 95 % CI -9 to 2 ) , or WOMAC score ( MD -2 points , 95 % CI -8 to 4 ) . The lack of significant between-group difference was also seen at the follow-up assessment on Day 19 . CONCLUSION The Kinesio Taping techniques investigated in this study provided no beneficial effects for older people with knee osteoarthritis on any of the assessed outcomes . TRIAL REGISTRATION Brazilian Registry of Clinical Trials , RBR-36r3t5 . [ Wageck B , Nunes GS , Bohlen NB , Santos GM , de Noronha M ( 2016 ) Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis : a r and omised trial . Journal of Physiotherapy62 : 153 - 158 ] Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow , whiplash and fibromyalgia . This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis , compared to healthy control subjects . Twenty-three subjects with knee osteoarthritis and 23 healthy controls , matched for age , gender and body mass index , were recruited for the study . Volunteers with any additional chronic pain conditions were excluded .  Pain thresholds to pressure , cold and heat were tested at the knee , ipsilateral heel and ipsilateral elbow , in r and omized order , using st and ardised methodology . Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure ( p = .018 ) and cold ( p = .003 ) stimuli , compared with controls . A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia . No significant differences were found between groups for heat pain threshold , although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain . This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis , suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients OBJECTIVE To report the efficacy of a 3-month treatment program consisting of neuromuscular exercise , education , diet , insoles and pain medication ( MEDIC-treatment ) compared to usual care ( two leaflets with information and treatment advice ) in reducing pain-related measures and sensitization in patients with knee osteoarthritis ( OA ) not eligible for total knee replacement ( TKR ) . METHOD A pre-defined ancillary analysis of the results at 3 months of a r and omized controlled trial ( RCT ) of 100 
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Conclusions Our meta- analysis provides evidence of pain sensitization in people with knee osteoarthritis ( strong evidence ) , people with patellofemoral pain ( moderate evidence ) , and postmeniscectomy patients ( very limited evidence ) .
However , conflicting evidence exists in patellar tendinopathy .
Metaregression indicates that pain is associated with pressure pain thresholds in knee osteoarthritis .
In people with knee osteoarthritis and patellofemoral pain , several interventions were found to reduce manifestations of pain sensitization .
This review highlights that pain sensitization may be amenable to treatment through exercise therapy , mobilization , and pharmacological and surgical intervention