***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 compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis . METHODS : Thirty-five female patients with multiple sclerosis were r and omized into two groups : a treatment group ( n = 18 ) and a sham group ( n = 17 ) . The evaluation included use of the Overactive Bladder Question naire , Medical Outcomes Study Short Form 36 , International Consultation on Incontinence Question naire Short Form , and Qualiveen question naire . The intervention was performed twice per week for 12 weeks in both groups . The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home . The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required . Pre- and post-intervention data were recorded . RESULTS : The evaluation results of the two groups were similar at baseline . At the end of the treatment , the treatment group reported fewer storage and voiding symptoms than the sham group . Furthermore , the differences found between the groups were significant improvements in the following scores in the treatment group : Overactive Bladder Question naire , International Consultation on Incontinence Question naire Short Form , and the General Quality of Life , and Specific Impact of Urinary Problems domains of the Qualiveen question naire . CONCLUSIONS : The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training , as the disease-specific of quality of life question naires demonstrated . This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention Study design : R and omised controlled trial . Objectives : High- quality evidence for interventions in  bowel management ( BM )  after spinal cord injury ( SCI ) is lacking and BM programs are developed empirically . This r and omized , controlled trial compared usual care with a stepwise protocol based on earlier published work to examine whether systematic use of less invasive interventions could reduce the need for oral laxatives and invasive interventions such as manual evacuation , and improve BM outcomes in individuals with chronic SCI . Setting : United Kingdom . Methods : In all , 68 individuals were recruited ( 35 in intervention group ) , median age 47 years ( range 24–73 years ) , median duration of injury 16 years ( range 1–47 years ) . Bowel diaries were maintained for a maximum of 6 weeks while the intervention group followed a stepwise protocol design ed to test interventions singly and in combination . Measures of quality of life and preferences for different bowel care interventions were recorded . Results : The stepwise protocol did not improve BM outcomes ; fecal incontinence was more frequent ( P=0.04 ) ; the need for oral laxatives and invasive interventions was not reduced ( P=0.4 ) . Bowel care took consistently longer in the intervention group . Conclusions : The study findings support the need for manual evacuation in BM and provide evidence of acceptability of the technique to SCI individuals . For some individuals oral laxatives are an essential part of management . The results are in contrast with previous studies in younger sample s with shorter duration of injury Dietary fiber supplements are used to manage  fecal incontinence ( FI ) , but little is known about the fiber type to recommend or the level of effectiveness of such supplements , which appears related to the fermentability of the fiber . The aim of this single-blind , r and omized controlled trial was to compare the effects of three dietary fiber supplements ( carboxymethylcellulose [ CMC ] , gum arabic [ GA ] , or psyllium ) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces . The primary outcome was FI frequency ; secondary outcomes included FI amount and consistency , supplement intolerance , and quality of life ( QoL ) . Possible mechanisms underlying supplement effects were also examined . After a 14-day baseline , 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days . FI frequency significantly decreased after psyllium supplementation versus placebo , in both intent-to-treat and per- protocol mixed model analyses . CMC increased FI frequency . In intent-to-treat analysis , the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo , 2.5 for Psyllium , 4.3 for GA , and 6.2 for CMC . Only psyllium consumption result ed in a gel in feces . Supplement intolerance was low . QoL scores did not differ among groups . Patients with FI may experience a reduction in FI frequency after psyllium supplementation , and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI . Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI Objective : A stratified , r and omised , waitlist controlled study over 12 months assessed the effectiveness of rehabilitation in persons with multiple sclerosis ( MS ) in an Australian community cohort . Methods : Patients with definite MS ( n = 101 ) recruited from a tertiary hospital data base , r and omised to a treatment group ( n = 49 ) for individualised rehabilitation programme or a control waitlist group ( n = 52 ) . Functional Independence Measure ( FIM ) was used to assess “ activity ” while the Multiple Sclerosis Impact Scale ( MSIS-29 ) and General Health Question naire ( GHQ-28 ) assessed “ participation ” and quality of life ( QoL ) . Assessment s were at baseline and 12 months . Results : Analysis of data from 98 patients ( treatment n = 48 , control n = 50 ) showed reduced disability in the treatment group , with statistically significant differences in post-treatment FIM motor scores for the two groups ( p<0.001 ) . There was a clinical and statistically significant improvement in FIM ( motor ) total scores ( p<0.001 ) , and the FIM motor domains of : transfer ( p<0.001 ) , locomotion ( p<0.001 ) , self-care ( p<0.001 ) and the FIM cognitive subscale ( p<0.016 ) . In the treated group , 70.8 % improved compared with 13 % of controls . Significantly more patients in the control group deteriorated over the study period ( 58.7 % vs 16.7 % ; p<0.001 ) . There were no differences between the control and treatment group scores on the MSIS-physical ( p = 0.18 ) , MSIS-psychological ( p = 0.45 ) or GHQ subscales . Conclusion : An individualised rehabilitation programme reduces disability in persons with MS compared with no intervention . The impact of rehabilitation on QoL needs further evaluation . More information on the effectiveness of the various components of the multidisciplinary rehabilitation programmes are now needed . Australian clinical trials registry : Trials registration number : ACTRNO12605000676617 Background : Constipation affects many people with multiple sclerosis ( MS ) , negatively impacting on their quality of life . The use of abdominal massage has been reported in several population s and has been shown to increase the frequency of defaecation . Objective : The objective of this study was to determine the feasibility of undertaking abdominal massage in people with MS . Methods : Following ethical approval , 30 patients with MS and constipation were recruited . After providing informed written consent and completion of baseline outcome measures , participants were r and omly allocated to a massage group or a control group . The massage group participants were provided with advice on bowel management , and they or their carers were taught how to deliver abdominal massage and were recommended to perform it daily during the 4-week intervention period . The control group received bowel management advice only . Outcomes were measured pre ( Week 0 ) and post treatment ( Week 4 ) , and at Week 8 and included : the Constipation Scoring System ( CSS ) ( primary outcome ) , the Neurogenic Bowel Dysfunction Score , and a bowel diary . Results : Both groups demonstrated a decrease in CSS score from Week 0 to Week 4 , indicating an improvement in constipation symptoms ; however , the massage group improved significantly more than the control groups ( mean difference between groups in score change −5.0 ( SD 1.5 ) , 95 % CI −8.1 , −1.8 ; t = −3.28 , df = 28 , p = 0.003 ) . Conclusion : The results of this small study suggest a positive effect of the intervention on the symptoms of constipation , and support the feasibility of a substantive trial of abdominal massage for the alleviation of the symptoms of constipation in people with MS Ayaş Ş , Leblebici B , Sözay S , Bayramoğlu M , Niron EA : The effect of abdominal massage on bowel function in patients with spinal cord injury . Am J Phys Med Rehabil 2006;85:951–955 . Objectives : To investigate the effect of abdominal massage on clinical aspects of bowel dysfunction and colonic transit time in patients with spinal cord injury . Twenty-four patients were placed on a st and ard bowel program ( phase I ) , after which abdominal massage was added to the regimen ( phase II ) . Parameters of gastrointestinal system function and colonic transit times were evaluated . Design : Uncontrolled clinical study . Results : Eleven ( 45.8 % ) of the 24 patients had abdominal distention , and 10 ( 41.7 % ) had fecal incontinence in phase I ; corresponding results for phase II were three ( 12.5 % ) and four ( 16.7 % ) ( P = 0.008 and 0.031 , respectively ) . There were no significant differences between the proportions of patients with difficult intestinal evacuation or abdominal pain or in mean time required for bowel evacuation in phase I vs. phase II . The mean frequencies of defecation in phases I and II were 3.79 ± 2.15 ( 2.75–4.55 ) and 4.61 ± 2.17 ( 3.67–5.54 ) bowel movements per week , respectively ( P = 0.006 ) . Mean total colonic transit time decreased from 90.60 ± 32.67 ( 75.87–110.47 ) hrs in phase I to 72 ± 34.10 ( 58.49–94.40 ) hrs in phase II ( P = 0.035 ) . Conclusions : Abdominal massage has positive effects on some clinical aspects of neurogenic bowel dysfunction in patients with spinal cord injury Few instruments have been developed and vali date d for the evaluation of multi-dimensional GI symptoms . The Gastrointestinal Symptoms Severity Index ( GISSI ) , a multi-dimensional , self-report instrument , was design ed as a brief measure of the frequency , severity , and bothersomeness of individual GI and pelvic floor/urogynecologic symptoms . Aim To report the psychometric properties of the GISSI subscales , including factorial structure , validity , and internal consistency . Methods The GISSI included 32 items that assessed upper and lower GI symptoms and seven items related to pelvic floor/urogynecologic symptoms . A total of 934 patients presenting for upper and lower GI complaints completed the question naire between January 2013 and December 2013 . The sample was r and omly split into derivation ( n = 466 ) and validation data sets ( n = 468 ) . A non-patient sample of 200 was collected separately . Results Exploratory factor analysis supported a six-factor model for the derivation sample that accounted for 69.3 % of the total variance . The six GI symptom clusters were labeled as constipation/difficult defecation ( five items ) , abdominal pain/discomfort ( four items ) , dyspepsia ( four items ) , diarrhea/anal incontinence ( four items ) , GERD/chest symptoms ( four items ) , and nausea/vomiting ( two items ) . Inclusion of additional items related to female pelvic floor/urogynecologic symptoms result ed in a separate factor . Confirmatory factor analysis of the validation data set supported the a priori hypothesized six-factor measurement model ( Χ2(428 ) = 1462.98 ; P < 0.001 ; GFI = .88 ; RMSEA = .051 ) . Conclusion The GISSI demonstrated good to excellent psychometric properties and provided multi-dimensional scaling of prominent GI symptom clusters . Further validation may provide an efficient , valid , and reliable measure of patient-reported clinical outcomes OBJECTIVES To evaluate effects of a multicomponent intervention on fecal incontinence ( FI ) and urinary incontinence ( UI ) outcomes . DESIGN R and omized controlled trial . SETTING Six nursing homes ( NHs ) . PARTICIPANTS One hundred twelve NH residents . INTERVENTION Intervention subjects were offered toileting assistance , exercise , and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months . MEASUREMENTS Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff . Anorectal assessment s were completed on a subset of 29 residents . RESULTS The intervention significantly increased physical activity , frequency of toileting , and food and fluid intake . UI improved ( P=.049 ) , as did frequency of bowel movements ( P<.001 ) and percentage of bowel movements ( P<.001 ) in the toilet . The frequency of FI did not change . Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic 
    Output:
    
System-based continence recommendations are identified to include rehab-oriented electronic documentation systems , written continence policies and procedures , and ongoing nursing education emphasizing accountability to high performance st and ards .