human
***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 Berg Balance Scale ( BBS ) is a balance measure commonly used for people with multiple sclerosis ( MS ) . The Mini-BESTest is an alternative based on balance systems . Objective The study objective was to compare the BBS and the Mini-BESTest for sensitivity to change , likelihood ratios for walking aid use and falls , and associations with clinical variables in people who have MS and are ambulatory . Design This was a cohort study with measurements before and after exposure to 8 weeks of routine physical therapy intervention . Methods For 52 participants who had a primary diagnosis of MS and who were independently mobile , with or without an aid , demographic details and a history of falls and near falls were collected . Participants completed the  Mini-BESTest , Multiple Sclerosis Impact Scale-29 , Multiple Sclerosis Walking Scale-12 , BBS , Modified Fatigue Impact Scale  , and  Six-Minute Walk Test .  Results No participant started with a baseline  Mini-BESTest  maximum score of 28 , whereas 38.5 % ( n=20 ) started with a baseline BBS maximum score of 56 . Statistically significant changes in the  Mini-BESTest score ( X̅=5.31 , SD=3.5 ) and the BBS score ( X̅=1.4 , SD=1.9 ) were demonstrated . Effect sizes for the Mini-BESTest and the BBS were 0.70 and 0.37 , respectively ; st and ard response means for the Mini-BESTest and the BBS were 1.52 and 0.74 , respectively . Areas under the receiver operating characteristic curves for the Mini-BESTest and the BBS were 0.88 and 0.77 , respectively , for detecting mobility device use and 0.88 and 0.75 , respectively , for detecting self-reported near falls . The Mini-BESTest had a higher correlation for each secondary measure than did the BBS . Limitations This study involved a sample of convenience ; 61 % of the participants did not use a walking aid . The order of testing was not r and omized , and fall status was obtained through retrospective recall . Conclusions The Mini-BESTest had a lower ceiling effect and higher values on responsiveness tests . These findings suggest that the Mini-BESTest may be better at detecting changes in balance in people who have MS , are ambulatory , and have relatively little walking disability Background Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation . The Dynamic Gait Index ( DGI ) evaluates walking during different tasks , but the feasibility in identifying people at risk for falls needs to be further investigated . Objective The objective of this study was to investigate ( 1 ) the construct validity ( known groups , convergent , and discriminant ) of the DGI and ( 2 ) the accuracy of predicting falls and establishing a cutoff point to identify fallers . Design This trial was a multicenter , cross-sectional study . Methods A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m ( comparable to Exp and ed Disability Status Scale 1–6 ) . Mean age of the participants was 49 years ; 76 % were women . The  25-Foot Timed Walk Test , Timed “ Up & Go ” Test , Four Square Step Test , Timed Sit-to-St and Test , MS Walking Scale , Multiple Sclerosis Impact Scale , and self-reported falls during the previous  2 months were used for validation , to establish cutoff points for identifying fallers , and to investigate predictive values . Results Significantly lower DGI scores ( P≤.001 ) were found for participants reporting falls ( n=31 ) . High sensitivity ( 87 % ) in identifying fallers was found , with a cutoff score ≤19 . The positive predictive value was 50 % , and the negative predictive value was 87 % . The positive likelihood ratio was 1.77 , and the negative likelihood ratio was 0.26 . The convergent validity was moderate to strong ( ρ=0.58–0.80 ) , with the highest correlation coefficient found for the 25-Foot Timed Walk Test . Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale . Limitations The sample included ambulatory people participating in a r and omized controlled trial investigating balance training . Conclusions The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis . With the cutoff point of ≤19 , sensitivity was high in identifying people at risk of falls Abstract Purpose : People with Multiple Sclerosis ( PwMS ) have a high incidence of accidental falls that have a potentially detrimental effect on their daily life participation . The effect of balance specific rehabilitation on clinical balance measures and frequency of falls in PwMS was studied . Method : A bi-centre r and omised rater-blinded controlled trial . Participants in both groups received 20 treatment sessions . Participants in the intervention group received treatment aim ed at improving balance and mobility .  Participants in the control group received treatments to reduce limitations at activity and body function level .  Primary measures were frequency of fallers ( > 1 fall in two months ) and responders ( > 3 points improvement ) at the Berg Balance Scale ( BBS ) . Data was analysed according to an intention to treat approach . Results : One hundred and nineteen participants were r and omised . Following treatment frequency of fallers was 22 % in the intervention group and 23 % in the control group , odds ratio ( OR ) and ( confidence limits ) : 1.05 ( 0.41 to 2.77 ) . Responders on the BBS were 28 % in the intervention group and 33 % in the control group , OR = 0.75 ( 0.30 to 1.91 ) . At follow up ORs for fallers and responders at BBS were 0.98 ( 0.48 to 2.01 ) and 0.79 ( 0.26 to 2.42 ) , respectively . Conclusions : Twenty sessions 2–3 times/week of balance specific rehabilitation did not reduce fall frequency nor improve balance suggesting the need for more frequent and challenging interventions . Implication s for Rehabilitation Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear . Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS . The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness OBJECTIVES To investigate falls prevalence , factors associated with falling , and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis ( MS ) . DESIGN Baseline and posttreatment data from a r and omized controlled trial . SETTING Community . PARTICIPANTS People with MS ( N=111 ) who use bilateral support for gait .  INTERVENTIONS Group and one-on-one physiotherapy . MAIN OUTCOME MEASURES Falls prevalence was assessed using retrospective recall . Demographic information was collected , impairments of body function were assessed , and results from the Berg Balance Scale , 6-minute walk test ( 6MWT ) , Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores , and the Modified Fatigue Impact Scale ( MFIS ) were obtained . RESULTS The prevalence of falls in a 3-month period was 50.5 % among participants with MS , of whom 28 % had more than 1 fall . Fallers had a greater physical ( mean difference , -3.9 ; P=.048 ) and psychological ( median difference , -4.5 ; P=.001 ) impact of MS and a greater impact of fatigue ( mean difference , -9.4 ; P=.002 ) . A logistic regression analysis found that the MFIS score made a unique , significant contribution to the model ( odds ratio=1.04 ; 95 % confidence interval , 1.018 - 1.079 ) , correctly identifying 68 % of fallers . A 10-week group physiotherapy intervention significantly reduced both the number of fallers ( 58.3 % before to 22.9 % after intervention , P=.005 ) and the number of falls ( 63 before to 25 after intervention , P=.001 ) . CONCLUSIONS The prevalence of falls is high in this population of persons with MS , and the impact of MS and of fatigue is greater in fallers . Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required Objective : To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests . Design : A longitudinal , multi-centred cohort study with prospect ively collected falls . Procedures : Self-reported incidents during the three months following a st and ardized test procedure . Subjects : Seventy-six people with multiple sclerosis and an Exp and ed Disability Status Scale score between 3.5 and 6.0 . Main outcome measures : Berg Balance Scale , Timed Up and Go cognitive , Four Square Step Test ( FSST ) and 12-item Multiple Sclerosis Walking Scale . Results : Forty-eight people ( 63 % ) registered 270 falls . Most falls occurred indoors during activities of daily life . We found a correlation of rs=0.57 between near falls and falls , and of rs = 0.82 between registered and retrospectively recalled falls . Fallers and non-fallers differed significantly regarding Exp and ed Disability Status Score ( odds ratio ( OR ) 1.99 , 95 % confidence interval ( CI ) 1.22 ; 3.40 ) , spasticity ( OR 1.14 , CI 1.02 ; 1.31 ) , proprioception ( OR 2.50 , CI 1.36 ; 5.12 ) and use of walking aids ( OR 2.27 , CI 1.23 ; 4.37 ) . Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity . The odds of falling were doubled for each degree of increased Exp and ed Disability Status Score and more than doubled for each degree of increased spasticity . The Berg Balance Scale , use of walking aids and Timed Up and Go cognitive best identified fallers ( 73—94 % ) and proprioception , Exp and ed Disability Status Score , 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers ( 75—93 % ) . Conclusions : In clinical practice , looking at the use of walking aids , investigating proprioception and spasticity , rating Exp and ed Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers Background : Imbalance leading to falls is common in people with multiple sclerosis ( PwMS ) . Objective : To evaluate the effects of a balance group exercise programme ( CoDuSe ) on balance and walking in PwMS ( Exp and ed Disability Status Scale , 4.0–7.5 ) . Methods : A multi-centre , r and omized , controlled single-blinded pilot study with r and om allocation to early or late start of exercise , with the latter group serving as control group for the physical function measures . In total , 14 supervised 60-minute exercise sessions were delivered over 7 weeks . Pretest – posttest analyses were conducted for self-reported near falls and falls in the group starting late . Primary outcome was Berg Balance Scale ( BBS ) . A total of 51 participants were initially enrolled ; three were lost to follow-up . Results : Post-intervention , the exercise group showed statistically significant improvement ( p = 0.015 ) in BBS and borderline significant improvement in MS Walking Scale ( p = 0.051 ) , both with large effect sizes ( 3.66 ; −2.89 ) . No other significant differences were found between groups . In the group starting late , numbers of falls and near falls were statistically significantly reduced after exercise compared to before ( p < 0.001 ; p < 0.004 ) . Conclusion : This pilot study suggests that the CoDuSe exercise  improved balance and reduced perceived walking limitations , compared to no exercise . The intervention reduced falls and near falls frequency Background . Balance and walking impairments are frequent in people with multiple sclerosis ( MS ) . Objective . The aim was to investigate the effects of a group-based balance exercise program targeting core stability , dual tasking , and sensory strategies ( CoDuSe ) on balance , postural sway , walking , perceived walking limitations , and balance confidence . Design . A single-blinded r and omized multicenter trial . No intervention was given to controls . Participants . People with MS able to walk 100 meters but unable to maintain t and em stance ≥30 seconds . Eighty-seven participants were r and omized to intervention or control . Intervention . The 60-minute CoDuSe group program , twice weekly for seven weeks , supervised by physical therapists . Measurements . Primary outcome was dynamic balance ( Berg Balance Scale ( BBS ) ) . Secondary outcomes were postural sway , walking ( Timed-Up and Go test ; Functional Gait Assessment ( FGA ) ) , MS Walking Scale , and Activities-specific Balance Confidence ( ABC ) Scale . Assessment s were performed before and after ( week 8) the intervention . Results . 73 participants fulfilled the study . There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures : postural sway with eyes open , FGA , MS Walking Scale , and ABC scale in favor of the intervention . Conclusions . The seven-week CoDuSe program improved dynamic balance more than no intervention Background There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS ( PwMS ) . This investigation assessed the relation between demographic , clinical , mobility and balance metrics and falls history in persons with multiple sclerosis 
    Output:
    
agent
Meta- analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05 ) , but discriminative ability of the measures is commonly not reported .
Of those reported , the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value ( 0.92 ) , but without reporting corresponding measures of clinical utility .
Conclusion : Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis
***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 Berg Balance Scale ( BBS ) is a balance measure commonly used for people with multiple sclerosis ( MS ) . The Mini-BESTest is an alternative based on balance systems . Objective The study objective was to compare the BBS and the Mini-BESTest for sensitivity to change , likelihood ratios for walking aid use and falls , and associations with clinical variables in people who have MS and are ambulatory . Design This was a cohort study with measurements before and after exposure to 8 weeks of routine physical therapy intervention . Methods For 52 participants who had a primary diagnosis of MS and who were independently mobile , with or without an aid , demographic details and a history of falls and near falls were collected . Participants completed the  Mini-BESTest , Multiple Sclerosis Impact Scale-29 , Multiple Sclerosis Walking Scale-12 , BBS , Modified Fatigue Impact Scale  , and  Six-Minute Walk Test .  Results No participant started with a baseline  Mini-BESTest  maximum score of 28 , whereas 38.5 % ( n=20 ) started with a baseline BBS maximum score of 56 . Statistically significant changes in the  Mini-BESTest score ( X̅=5.31 , SD=3.5 ) and the BBS score ( X̅=1.4 , SD=1.9 ) were demonstrated . Effect sizes for the Mini-BESTest and the BBS were 0.70 and 0.37 , respectively ; st and ard response means for the Mini-BESTest and the BBS were 1.52 and 0.74 , respectively . Areas under the receiver operating characteristic curves for the Mini-BESTest and the BBS were 0.88 and 0.77 , respectively , for detecting mobility device use and 0.88 and 0.75 , respectively , for detecting self-reported near falls . The Mini-BESTest had a higher correlation for each secondary measure than did the BBS . Limitations This study involved a sample of convenience ; 61 % of the participants did not use a walking aid . The order of testing was not r and omized , and fall status was obtained through retrospective recall . Conclusions The Mini-BESTest had a lower ceiling effect and higher values on responsiveness tests . These findings suggest that the Mini-BESTest may be better at detecting changes in balance in people who have MS , are ambulatory , and have relatively little walking disability Background Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation . The Dynamic Gait Index ( DGI ) evaluates walking during different tasks , but the feasibility in identifying people at risk for falls needs to be further investigated . Objective The objective of this study was to investigate ( 1 ) the construct validity ( known groups , convergent , and discriminant ) of the DGI and ( 2 ) the accuracy of predicting falls and establishing a cutoff point to identify fallers . Design This trial was a multicenter , cross-sectional study . Methods A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m ( comparable to Exp and ed Disability Status Scale 1–6 ) . Mean age of the participants was 49 years ; 76 % were women . The  25-Foot Timed Walk Test , Timed “ Up & Go ” Test , Four Square Step Test , Timed Sit-to-St and Test , MS Walking Scale , Multiple Sclerosis Impact Scale , and self-reported falls during the previous  2 months were used for validation , to establish cutoff points for identifying fallers , and to investigate predictive values . Results Significantly lower DGI scores ( P≤.001 ) were found for participants reporting falls ( n=31 ) . High sensitivity ( 87 % ) in identifying fallers was found , with a cutoff score ≤19 . The positive predictive value was 50 % , and the negative predictive value was 87 % . The positive likelihood ratio was 1.77 , and the negative likelihood ratio was 0.26 . The convergent validity was moderate to strong ( ρ=0.58–0.80 ) , with the highest correlation coefficient found for the 25-Foot Timed Walk Test . Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale . Limitations The sample included ambulatory people participating in a r and omized controlled trial investigating balance training . Conclusions The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis . With the cutoff point of ≤19 , sensitivity was high in identifying people at risk of falls Abstract Purpose : People with Multiple Sclerosis ( PwMS ) have a high incidence of accidental falls that have a potentially detrimental effect on their daily life participation . The effect of balance specific rehabilitation on clinical balance measures and frequency of falls in PwMS was studied . Method : A bi-centre r and omised rater-blinded controlled trial . Participants in both groups received 20 treatment sessions . Participants in the intervention group received treatment aim ed at improving balance and mobility .  Participants in the control group received treatments to reduce limitations at activity and body function level .  Primary measures were frequency of fallers ( > 1 fall in two months ) and responders ( > 3 points improvement ) at the Berg Balance Scale ( BBS ) . Data was analysed according to an intention to treat approach . Results : One hundred and nineteen participants were r and omised . Following treatment frequency of fallers was 22 % in the intervention group and 23 % in the control group , odds ratio ( OR ) and ( confidence limits ) : 1.05 ( 0.41 to 2.77 ) . Responders on the BBS were 28 % in the intervention group and 33 % in the control group , OR = 0.75 ( 0.30 to 1.91 ) . At follow up ORs for fallers and responders at BBS were 0.98 ( 0.48 to 2.01 ) and 0.79 ( 0.26 to 2.42 ) , respectively . Conclusions : Twenty sessions 2–3 times/week of balance specific rehabilitation did not reduce fall frequency nor improve balance suggesting the need for more frequent and challenging interventions . Implication s for Rehabilitation Programs for balance rehabilitation can improve balance but their effects in fall prevention are unclear . Twenty treatments sessions 2/3 times per week did not reduced frequency of falls in MS . The comparison with similar studies suggests that higher intensity of practice of highly challenging balance activities appears to be critical to maximizing effectiveness OBJECTIVES To investigate falls prevalence , factors associated with falling , and the effects of balance and strengthening interventions on falls in persons with multiple sclerosis ( MS ) . DESIGN Baseline and posttreatment data from a r and omized controlled trial . SETTING Community . PARTICIPANTS People with MS ( N=111 ) who use bilateral support for gait .  INTERVENTIONS Group and one-on-one physiotherapy . MAIN OUTCOME MEASURES Falls prevalence was assessed using retrospective recall . Demographic information was collected , impairments of body function were assessed , and results from the Berg Balance Scale , 6-minute walk test ( 6MWT ) , Multiple Sclerosis Impact Scale-29 version 2 physical and psychological scores , and the Modified Fatigue Impact Scale ( MFIS ) were obtained . RESULTS The prevalence of falls in a 3-month period was 50.5 % among participants with MS , of whom 28 % had more than 1 fall . Fallers had a greater physical ( mean difference , -3.9 ; P=.048 ) and psychological ( median difference , -4.5 ; P=.001 ) impact of MS and a greater impact of fatigue ( mean difference , -9.4 ; P=.002 ) . A logistic regression analysis found that the MFIS score made a unique , significant contribution to the model ( odds ratio=1.04 ; 95 % confidence interval , 1.018 - 1.079 ) , correctly identifying 68 % of fallers . A 10-week group physiotherapy intervention significantly reduced both the number of fallers ( 58.3 % before to 22.9 % after intervention , P=.005 ) and the number of falls ( 63 before to 25 after intervention , P=.001 ) . CONCLUSIONS The prevalence of falls is high in this population of persons with MS , and the impact of MS and of fatigue is greater in fallers . Development and evaluation of interventions to reduce falls risk and the transition to faller or multiple faller status are required Objective : To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests . Design : A longitudinal , multi-centred cohort study with prospect ively collected falls . Procedures : Self-reported incidents during the three months following a st and ardized test procedure . Subjects : Seventy-six people with multiple sclerosis and an Exp and ed Disability Status Scale score between 3.5 and 6.0 . Main outcome measures : Berg Balance Scale , Timed Up and Go cognitive , Four Square Step Test ( FSST ) and 12-item Multiple Sclerosis Walking Scale . Results : Forty-eight people ( 63 % ) registered 270 falls . Most falls occurred indoors during activities of daily life . We found a correlation of rs=0.57 between near falls and falls , and of rs = 0.82 between registered and retrospectively recalled falls . Fallers and non-fallers differed significantly regarding Exp and ed Disability Status Score ( odds ratio ( OR ) 1.99 , 95 % confidence interval ( CI ) 1.22 ; 3.40 ) , spasticity ( OR 1.14 , CI 1.02 ; 1.31 ) , proprioception ( OR 2.50 , CI 1.36 ; 5.12 ) and use of walking aids ( OR 2.27 , CI 1.23 ; 4.37 ) . Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity . The odds of falling were doubled for each degree of increased Exp and ed Disability Status Score and more than doubled for each degree of increased spasticity . The Berg Balance Scale , use of walking aids and Timed Up and Go cognitive best identified fallers ( 73—94 % ) and proprioception , Exp and ed Disability Status Score , 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers ( 75—93 % ) . Conclusions : In clinical practice , looking at the use of walking aids , investigating proprioception and spasticity , rating Exp and ed Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers Background : Imbalance leading to falls is common in people with multiple sclerosis ( PwMS ) . Objective : To evaluate the effects of a balance group exercise programme ( CoDuSe ) on balance and walking in PwMS ( Exp and ed Disability Status Scale , 4.0–7.5 ) . Methods : A multi-centre , r and omized , controlled single-blinded pilot study with r and om allocation to early or late start of exercise , with the latter group serving as control group for the physical function measures . In total , 14 supervised 60-minute exercise sessions were delivered over 7 weeks . Pretest – posttest analyses were conducted for self-reported near falls and falls in the group starting late . Primary outcome was Berg Balance Scale ( BBS ) . A total of 51 participants were initially enrolled ; three were lost to follow-up . Results : Post-intervention , the exercise group showed statistically significant improvement ( p = 0.015 ) in BBS and borderline significant improvement in MS Walking Scale ( p = 0.051 ) , both with large effect sizes ( 3.66 ; −2.89 ) . No other significant differences were found between groups . In the group starting late , numbers of falls and near falls were statistically significantly reduced after exercise compared to before ( p < 0.001 ; p < 0.004 ) . Conclusion : This pilot study suggests that the CoDuSe exercise  improved balance and reduced perceived walking limitations , compared to no exercise . The intervention reduced falls and near falls frequency Background . Balance and walking impairments are frequent in people with multiple sclerosis ( MS ) . Objective . The aim was to investigate the effects of a group-based balance exercise program targeting core stability , dual tasking , and sensory strategies ( CoDuSe ) on balance , postural sway , walking , perceived walking limitations , and balance confidence . Design . A single-blinded r and omized multicenter trial . No intervention was given to controls . Participants . People with MS able to walk 100 meters but unable to maintain t and em stance ≥30 seconds . Eighty-seven participants were r and omized to intervention or control . Intervention . The 60-minute CoDuSe group program , twice weekly for seven weeks , supervised by physical therapists . Measurements . Primary outcome was dynamic balance ( Berg Balance Scale ( BBS ) ) . Secondary outcomes were postural sway , walking ( Timed-Up and Go test ; Functional Gait Assessment ( FGA ) ) , MS Walking Scale , and Activities-specific Balance Confidence ( ABC ) Scale . Assessment s were performed before and after ( week 8) the intervention . Results . 73 participants fulfilled the study . There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures : postural sway with eyes open , FGA , MS Walking Scale , and ABC scale in favor of the intervention . Conclusions . The seven-week CoDuSe program improved dynamic balance more than no intervention Background There is a lack of information concerning the relation between objective measures of gait and balance and fall history in persons with MS ( PwMS ) . This investigation assessed the relation between demographic , clinical , mobility and balance metrics and falls history in persons with multiple sclerosis 
    Output:
    