***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: Background The purpose of this study was to assess the effect of 8-weeks ingestion of a commercialized joint pain dietary supplement ( InstaflexTM Joint Support , Direct Digital , Charlotte , NC ) compared to placebo on joint pain , stiffness , and function in adults with self-reported joint pain .  InstaflexTM is a joint pain supplement containing glucosamine sulfate , methylsufonlylmethane ( MSM ) , white willow bark extract ( 15 % salicin ) , ginger root concentrate , boswella serrata extract ( 65 % boswellic acid ) , turmeric root extract , cayenne , and hyaluronic acid . Methods Subjects included 100 men and women , ages 50 - 75 years , with a history ( > 3 months ) of joint pain , and were r and omized to Instaflex ™ or placebo ( 3 colored gel capsules per day for 8 weeks , double-blind administration ) . Subjects agreed to avoid the use of non-steroidal anti-inflammatory drugs ( NSAID ) and all other medications and supplements targeted for joint pain . Primary outcome measures were obtained pre- and post- study and included joint pain severity , stiffness , and function ( Western Ontario and McMaster Universities [ WOMAC ] ) , and secondary outcome measures included health-related quality of life ( Short Form 36 or SF-36 ) , systemic inflammation ( serum C-reactive protein and 9 plasma cytokines ) , and physical function ( 6-minute walk test ) . Joint pain symptom severity was assessed bi-weekly using a 12-point Likert visual scale ( 12-VS ) . Results Joint pain severity was significantly reduced in Instaflex ™ compared to placebo ( 8-week WOMAC , ↓37 % versus ↓16 % , respectively , interaction effect P = 0.025 ) , with group differences using the 12-VS emerging by week 4 of the study ( interaction effect , P = 0.0125 ) . Improvements in ability to perform daily activities and stiffness scores  in Instaflex ™ compared to placebo were most evident for the 74 % of subjects reporting knee pain ( 8-week WOMAC function score , ↓39 % versus ↓14 % , respectively , interaction effect P = 0.027 ; stiffness score , ↓30 % versus ↓12 % , respectively , interaction effect P = 0.081 ) . Patterns of change in SF-36 , systemic inflammation biomarkers , and the 6-minute walk test did not differ significantly between groups during the 8-week study Conclusions Results from this r and omized , double blind , placebo-controlled community trial support the use of the Instaflex ™ dietary supplement in alleviating  joint pain severity in middle-aged and older adults , with mitigation of difficulty performing daily activities most apparent in subjects with knee pain . Trial registration Clinical Trials.gov Identifier : Background The purpose of this study was to determine whether sedentary obese women with knee OA initiating an exercise and weight loss program  may experience more beneficial changes in body composition , functional capacity , and /or markers of health following a higher protein diet compared to a higher carbohydrate diet with or without GCM supplementation . Methods Thirty sedentary women ( 54 ± 9 yrs , 163 ± 6 cm , 88.6 ± 13 kg , 46.1 ± 3 % fat , 33.3 ± 5 kg/m2 ) with clinical ly diagnosed knee OA participated in a 14-week exercise and weight loss program . Participants followed an isoenergenic low fat higher carbohydrate ( HC ) or higher protein ( HP ) diet while participating in a supervised 30-minute circuit resistance-training program three times per week for 14-weeks . In a r and omized and double blind manner , participants ingested supplements containing 1,500 mg/d of glucosamine ( as d-glucosamine HCL ) , 1,200 mg/d of chondroitin sulfate ( from chondroitin sulfate sodium ) , and 900 mg/d of methylsulfonylmethane or a placebo . At 0 , 10 , and 14-weeks , participants completed a battery of assessment s. Data were analyzed by MANOVA with repeated measures . Results Participants in both groups experienced significant reductions in body mass ( -2.4 ± 3 % ) , fat mass ( -6.0 ± 6 % ) , and body fat ( -3.5 ± 4 % ) with no significant changes in fat free mass or resting energy expenditure . Perception of knee pain ( -49 ± 39 % ) and knee stiffness ( -42 ± 37 % ) was decreased while maximal strength ( 12 % ) , muscular endurance ( 20 % ) , balance indices ( 7 % to 20 % ) , lipid levels (-8 % to -12 % ) , homeostasis model assessment for estimating insulin resistance ( -17 % ) , leptin ( -30 % ) , and measures of physical functioning ( 59 % ) , vitality ( 120 % ) , and social function ( 66 % ) were improved in both groups with no differences among groups . Functional aerobic capacity was increased to a greater degree for those in the HP and GCM groups while there were some trends suggesting that supplementation affected perceptions of knee pain ( p < 0.08 ) . Conclusions Circuit style resistance-training and weight loss improved functional capacity in women with knee OA . The type of diet and dietary supplementation of GCM provided marginal additive benefits .Trial Registration Clinical Trials.gov : The aim of this study was to investigate the effects of focused low-intensity pulsed ultrasound ( FLIPUS ) therapy on the functional and health status of patients with knee osteoarthritis ( KOA ) . A total of 106 subjects with bilateral KOA were r and omized sequentially into two groups . Group I received FLIPUS + diclofenac sodium , and group II received sham FLIPUS + diclofenac sodium . The therapeutic effects of the interventions were evaluated by measuring changes in VAS pain , the WOMAC scores , and the LI scores after 10 days of treatment as well as changes in LI and VAS at follow-up , 4 and 12 weeks later . In addition , changes in the range of motion , ambulation speed , and the SF-36 in each group were recorded after 10 days of treatment . Compared with those in group II , patients in group Ishowed significant improvements in VAS , WOMAC , LI , ambulation speed , and most items in the SF-36 after 10 days of treatment . In addition , patients in group I showed significant improvements in LI and VAS at follow-up . There were no FLIPUS-related  adverse events during and after the interventions . In conclusion , FLIPUS is a safe and effective treatment modality for relieving pain and improving the functions and quality of life of patients with KOA Objectives : To estimate the effects of low level laser therapy in combination with a programme of exercises on pain , functionality , range of motion , muscular strength and quality of life in patients with osteoarthritis of the knee . Design : A r and omized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups . Setting : Special Rehabilitation Services . Subjects : Forty participants with knee osteoarthritis , 2–4 osteoarthritis degree , aged between 50 and 75 years and both genders . Intervention : Participants were r and omized into one of two groups : the laser group ( low level laser therapy dose of 3 J and exercises ) or placebo group ( placebo laser and exercises ) . Main measures : Pain was assessed using a visual analogue scale ( VAS ) , functionality using the Lequesne question naire , range of motion with a universal goniometer , muscular strength using a dynamometer , and activity using the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) question naire at three time points : ( T1 ) baseline , ( T2 ) after the end of laser therapy ( three weeks ) and ( T3 ) the end of the exercises ( 11 weeks ) . Results : When comparing groups , significant differences in the activity were also found ( P = 0.03 ) . No other significant differences ( P > 0.05 ) were observed in other variables . In intragroup analysis , participants in the laser group had significant improvement , relative to baseline , on pain ( P = 0.001 ) , range of motion ( P = 0.01 ) , functionality ( P = 0.001 ) and activity ( P < 0.001 ) . No significant improvement was seen in the placebo group . Conclusion : Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief , function and activity on patients with osteoarthritis of the knees Background Pharmacological treatment for osteoarthritis ( OA ) can be divided into two groups : symptom-modifying drugs and disease-modifying drugs . Symptom-modifying drugs are currently the prescription of choice for patients with OA , as disease-modifying drugs are not yet available in usual care . However , there has recently been a lot of debate about glucosamine sulphate ( GS ) , a biological agent that is thought to have both symptom-modifying and disease-modifying properties . This assumption has yet to be proved . The objective of this article is to present the design of a blind r and omised clinical trial that examines the long-term symptom-modifying and disease-modifying effectiveness of GS in patients with hip OA . This trial is ongoing and will finish in March 2006 . Methods / design Patients with hip OA meeting the ACR- criteria are r and omly allocated to either 1500 mg of oral GS or placebo for the duration of two years . The primary outcome measures , which are joint space narrowing ( JSN ) , and change in the pain and function score of the Western Ontario McMaster Universities Osteoarthritis index ( WOMAC ) , are determined at baseline and after two years of follow-up during the final assessment . Intermediate measures at three-month intervals throughout the trial are used to study secondary outcome measures . Secondary outcome measures are changes in WOMAC stiffness score , quality of life , medical consumption , side effects and differences in biomarker CTX-II The efficacy and safety of a once-daily extended-release formulation of tramadol hydrochloride ( tramadol ER ) was evaluated in patients with moderate to severe chronic pain of osteoarthritis ( OA ) . This was a r and omized , double-blind , placebo-controlled , parallel-group , 12-week study . Eligible patients with radiographically confirmed OA of the knee meeting the American College of Rheumatology diagnostic criteria , defined by knee pain and presence of osteophytes , plus at least age > 50 years , morning stiffness < 30 minutes in duration , and /or crepitus , entered a 2 - 7 day washout period during which all analgesics were discontinued . When pain at the index knee joint reached > or = 40 mm ( 0 - 100 mm VAS ) , patients were r and omized to tramadol ER or placebo . Tramadol ER was initiated at 100 mg QD and increased to 200 mg QD by the end of 1 week of treatment . After the first week , further increases to tramadol ER 300 mg or 400 mg QD were allowed . Outcome measures included Arthritis Pain Intensity Visual Analogue Scale ( VAS ) , Western Ontario and McMaster Universities Arthritis Scale ( WOMAC ) Pain , Stiffness , Physical Function VAS subscales , Patient and Physician Global Assessment of Therapy , Sleep , dropouts due to insufficient therapeutic effect , and adverse events .  Two hundred forty-six patients were r and omized ( tramadol ER 124 , placebo 122 ) . There were no baseline differences between the two treatments . The mean age was 61 years , mean duration of OA 12.9 years , and the mean tramadol ER dose was 276 mg QD . All efficacy outcome measures favored tramadol ER over placebo . On the primary outcome variable of average change from baseline in Arthritis Pain Intensity VAS over 12 weeks , tramadol ER was superior to placebo ( least squares mean change from baseline : 30.4 mm vs. 17.7 mm , P < 0.001 ) . Significant differences from placebo were evident at week 1 , the first post-treatment visit . Similarly , outcomes on the WOMAC Pain , Stiffness and Physical Function subscales , the WOMAC Composite Scale , dropouts due to insufficient therapeutic effect , Patient and Physician Global Assessment of Therapy , and Sleep were all significantly better with tramadol ER than placebo ( P < 0.001 to < 0.05 ) . Treatment with tramadol ER results in statistically significant and clinical ly important and sustained improvements in pain , stiffness , physical function , global status , and sleep in patients with chronic pain . A once-a-day formulation of tramadol has the potential to provide patients increased control over the management of their pain , fewer interruptions in sleep and improved compliance We studied the efficacy and tolerability of glycosaminoglycan polysulfuric acid ( GAGPS ) in 80 patients with osteoarthritis ( OA ) of the knee . Patients received two series of five intra-articular injections , at 1-week intervals , of 25 mg ( 0.5 ml ) GAGPS into the knee in a double-blind , parallel , r and omized , placebo-controlled trial . There was an immediate decrease in pain after the injections of 43 % with GAGPS and 33 % with place 
    Output:
    
Conclusions Work-related outcomes are rarely reported in journal publication on r and omized , double blind , placebo-controlled trials of h and , hip or knee OA .