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: Objective : To investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture Background : Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture . Purpose : The purpose of this study was to test the impact of a self-efficacy based intervention , the Exercise Plus Program , and the different components of the intervention , on self-efficacy , outcome expectations , and exercise behavior among older women post-hip fracture . Methods : Participants were r and omized to one of four groups : exercise plus , exercise only , plus only ( i.e. , motivation ) , or routine care . Data collection was done at baseline ( within 22 days of fracture ) , 2 , 6 , and 12 months post-hip fracture . Results : A total of 209 women were recruited with an average age of 81.0 years ( SD=6.9 ) . The majority was White ( 97.1 % ) , was widowed ( 57.2 % ) , and had a high school education ( 66.7 % ) . Generalized Estimating Equations were used to perform repeated measures analyses . No differences in trajectories of recovery were observed for self-efficacy or outcome expectations . A statistically significant difference in the overall trajectory of time in exercise was seen ( p<.001 ) , with more time spent exercising in all three treatment groups . Conclusions : The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only , exercise only , and the exercise plus groups all increased exercise Background This study is part of the Trondheim Hip Fracture Trial , where we compared free-living physical behavior in daily life 4 and 12 months following  hip surgery  for patients managed with comprehensive geriatric care ( CGC ) in a geriatric ward with those managed with orthopedic care ( OC )  in an orthopedic ward . Methods This is a single centre , prospect i ve , r and omized controlled trial . 397 hip fracture patients were r and omized to CGC ( n = 199 ) or OC ( n = 198 ) in the Emergency Department with follow-up assessment s performed four and 12 months post-surgery . Outcomes were mean upright time , number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor . Missing data were h and led by multiple imputation and group differences assessed by linear regression with adjustments for gender , age and fracture type . Results There were no group differences in participants ’ pre-fracture characteristics . Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min ( 17.4 % , CI 9.6 to 59.6 , p = .007 ) and at 12 months , 27.7 min ( 13.9 % , CI 3.5 to 51.8 , p = .025 ) . Average and maximum length of upright events was longer in the CGC ( p ’s < .042 ) . No group difference was found for number of upright events ( p ’s > .452 ) . Conclusion Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery , with more time and longer periods spent in upright . Results support findings from the same study for functional outcomes , and demonstrate that CGC impacts daily life as long as one year after surgery . Trials registration Clinical Trials.gov , NCT00667914 , April 18 , INTRODUCTION Consumer-based physical activity monitors ( PAMs ) are becoming increasingly popular , with multiple global organisations recommending physical activity levels that equate to 10,000 steps per day for optimal health . We therefore aim ed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds , along with the optimal anatomical placement site . METHODS Participants completed 3min on a treadmill for five speeds ( 5.0 km/h , 6.5 km/h , 8.0 km/h , 10 km/h , 12 km/h ) . An Actigraph wGT3XBT-BT was placed on the waist and wrist , a FitBit One on the waist , and a Fitbit Flex , Fitbit Charge HR and Jawbone UP24 on both wrists . A video of participant 's lower limbs was recorded for visual count . Analyses of variance ( ANOVAs ) were conducted to examine the effects of gait speed and device placement site on step count accuracy . RESULTS Thirty-one participants ( mean age 24.3±5.2yrs ) took part . Step count error ranged from 41.3±13.8 % for the wrist-worn Actigraph to only 0.04±4.3 % and -0.3±4.0 % for the waist-worn Fitbit One and Actigraph , respectively . Across all gait speeds , waist-worn devices achieved better accuracy than those on the wrist ( p<0.001 ) . The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds ( p=0.026 ) , with the Fitbit Flex , and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds . CONCLUSION The accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed . The Fitbit One and Actigraph on the waist were the strongest performers across all speeds BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND There is little consensus on how many hours of accelerometer wear time is needed to reflect a usual day . This study identifies the bias in daily physical activity ( PA ) estimates caused by accelerometer wear time . METHODS 124 adults ( age = 41 ± 11 years ; BMI = 27 ± 7 kg·m⁻² ) contributed approximately 1,200 days accelerometer wear time .  Five 40 day sample s were r and omly selected with 10 , 11 , 12 , 13 , and 14 h·d⁻¹ of wear time . Four semisimulation data sets ( 10 , 11 , 12 , 13 h·d⁻¹ ) were created from the reference 14 h·d⁻¹ data set to assess Absolute Percent Error ( APE ) . Repeated- measures ANOVAs compared min·d⁻¹ between 10 , 11 , 12 , 13 h·d⁻¹ and the reference 14 h·d⁻¹ for inactivity ( < 100 cts·min⁻¹ ) , light ( 100 - 1951 cts·min⁻¹ ) , moderate ( 1952 - 5724 cts·min⁻¹ ) , and vigorous ( ≥5725 cts·min⁻¹ ) PA . RESULTS APE ranged from 5.6%-41.6 % ( 10 h·d⁻¹ = 28.2%-41.6 % ; 11 h·d⁻¹ = 20.3%-36.0 % ; 12 h·d⁻¹ = 13.5%-14.3 % ; 13 h·d⁻¹ = 5.6%-7.8 % ) . Min·d⁻¹ differences were observed for inactivity , light , and moderate PA between 10 , 11 , 12 , and 13 h·d⁻¹ and the reference ( P < .05 ) . CONCLUSIONS This suggests a minimum accelerometer wear time of 13 h·d⁻¹ is needed to provide a valid measure of daily PA when 14 h·d⁻¹ is used as a reference Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility . The aim was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility . Older persons ( n = 245 ) , ≥70 years , one year after hip fracture , participated .  Six objective measures of physical behaviour collected by an activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale . All measures of time and length in upright periods were significantly lower in participants who reported not walking outdoors ( p < 0.001 ) . A set of cut-off points for the different physical behaviour variables was generated . Maximum length of upright events discriminated best between groups , with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors ( sensitivity : 0.805 , specificity : 0.704 , and AUC : 0.871 ) or 41 minutes or more to determine if a person is more likely to report outdoor walking on their own ( AUC : 0.891 ) . Physical behaviour  variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance BACKGROUND This study is a part of the r and omized controlled trial , the Trondheim Hip Fracture Trial , and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care ( CGC ) with those managed with orthopedic care ( OC ) .  METHODS Treatment comprised CGC with particular focus on mobilization , or OC .  A total of 397 hip fracture patients , age 70 years or older , home dwelling , and able to walk 10 m before the fracture , were included . Primary outcome was measurement of upright time ( st and ing and walking ) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor . Secondary outcomes were number of upright events on Day 4 , need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1 - 3 , and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery . RESULTS A total of 317 ( CGC n = 175 , OC n = 142 ) participants wore the activity monitor for a 24-hour period . CGC participants had significantly more upright time ( mean 57.6 vs 45.1 min , p = .016 ) , higher number of upright events ( p = .005 ) and better Short Physical Performance Battery scores ( p = .002 ) , than the 
    Output:
    
agent
Conclusion : Based on available evidence , older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery
***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 investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture Background : Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture . Purpose : The purpose of this study was to test the impact of a self-efficacy based intervention , the Exercise Plus Program , and the different components of the intervention , on self-efficacy , outcome expectations , and exercise behavior among older women post-hip fracture . Methods : Participants were r and omized to one of four groups : exercise plus , exercise only , plus only ( i.e. , motivation ) , or routine care . Data collection was done at baseline ( within 22 days of fracture ) , 2 , 6 , and 12 months post-hip fracture . Results : A total of 209 women were recruited with an average age of 81.0 years ( SD=6.9 ) . The majority was White ( 97.1 % ) , was widowed ( 57.2 % ) , and had a high school education ( 66.7 % ) . Generalized Estimating Equations were used to perform repeated measures analyses . No differences in trajectories of recovery were observed for self-efficacy or outcome expectations . A statistically significant difference in the overall trajectory of time in exercise was seen ( p<.001 ) , with more time spent exercising in all three treatment groups . Conclusions : The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only , exercise only , and the exercise plus groups all increased exercise Background This study is part of the Trondheim Hip Fracture Trial , where we compared free-living physical behavior in daily life 4 and 12 months following  hip surgery  for patients managed with comprehensive geriatric care ( CGC ) in a geriatric ward with those managed with orthopedic care ( OC )  in an orthopedic ward . Methods This is a single centre , prospect i ve , r and omized controlled trial . 397 hip fracture patients were r and omized to CGC ( n = 199 ) or OC ( n = 198 ) in the Emergency Department with follow-up assessment s performed four and 12 months post-surgery . Outcomes were mean upright time , number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor . Missing data were h and led by multiple imputation and group differences assessed by linear regression with adjustments for gender , age and fracture type . Results There were no group differences in participants ’ pre-fracture characteristics . Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min ( 17.4 % , CI 9.6 to 59.6 , p = .007 ) and at 12 months , 27.7 min ( 13.9 % , CI 3.5 to 51.8 , p = .025 ) . Average and maximum length of upright events was longer in the CGC ( p ’s < .042 ) . No group difference was found for number of upright events ( p ’s > .452 ) . Conclusion Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery , with more time and longer periods spent in upright . Results support findings from the same study for functional outcomes , and demonstrate that CGC impacts daily life as long as one year after surgery . Trials registration Clinical Trials.gov , NCT00667914 , April 18 , INTRODUCTION Consumer-based physical activity monitors ( PAMs ) are becoming increasingly popular , with multiple global organisations recommending physical activity levels that equate to 10,000 steps per day for optimal health . We therefore aim ed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds , along with the optimal anatomical placement site . METHODS Participants completed 3min on a treadmill for five speeds ( 5.0 km/h , 6.5 km/h , 8.0 km/h , 10 km/h , 12 km/h ) . An Actigraph wGT3XBT-BT was placed on the waist and wrist , a FitBit One on the waist , and a Fitbit Flex , Fitbit Charge HR and Jawbone UP24 on both wrists . A video of participant 's lower limbs was recorded for visual count . Analyses of variance ( ANOVAs ) were conducted to examine the effects of gait speed and device placement site on step count accuracy . RESULTS Thirty-one participants ( mean age 24.3±5.2yrs ) took part . Step count error ranged from 41.3±13.8 % for the wrist-worn Actigraph to only 0.04±4.3 % and -0.3±4.0 % for the waist-worn Fitbit One and Actigraph , respectively . Across all gait speeds , waist-worn devices achieved better accuracy than those on the wrist ( p<0.001 ) . The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds ( p=0.026 ) , with the Fitbit Flex , and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds . CONCLUSION The accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed . The Fitbit One and Actigraph on the waist were the strongest performers across all speeds BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND There is little consensus on how many hours of accelerometer wear time is needed to reflect a usual day . This study identifies the bias in daily physical activity ( PA ) estimates caused by accelerometer wear time . METHODS 124 adults ( age = 41 ± 11 years ; BMI = 27 ± 7 kg·m⁻² ) contributed approximately 1,200 days accelerometer wear time .  Five 40 day sample s were r and omly selected with 10 , 11 , 12 , 13 , and 14 h·d⁻¹ of wear time . Four semisimulation data sets ( 10 , 11 , 12 , 13 h·d⁻¹ ) were created from the reference 14 h·d⁻¹ data set to assess Absolute Percent Error ( APE ) . Repeated- measures ANOVAs compared min·d⁻¹ between 10 , 11 , 12 , 13 h·d⁻¹ and the reference 14 h·d⁻¹ for inactivity ( < 100 cts·min⁻¹ ) , light ( 100 - 1951 cts·min⁻¹ ) , moderate ( 1952 - 5724 cts·min⁻¹ ) , and vigorous ( ≥5725 cts·min⁻¹ ) PA . RESULTS APE ranged from 5.6%-41.6 % ( 10 h·d⁻¹ = 28.2%-41.6 % ; 11 h·d⁻¹ = 20.3%-36.0 % ; 12 h·d⁻¹ = 13.5%-14.3 % ; 13 h·d⁻¹ = 5.6%-7.8 % ) . Min·d⁻¹ differences were observed for inactivity , light , and moderate PA between 10 , 11 , 12 , and 13 h·d⁻¹ and the reference ( P < .05 ) . CONCLUSIONS This suggests a minimum accelerometer wear time of 13 h·d⁻¹ is needed to provide a valid measure of daily PA when 14 h·d⁻¹ is used as a reference Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility . The aim was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility . Older persons ( n = 245 ) , ≥70 years , one year after hip fracture , participated .  Six objective measures of physical behaviour collected by an activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale . All measures of time and length in upright periods were significantly lower in participants who reported not walking outdoors ( p < 0.001 ) . A set of cut-off points for the different physical behaviour variables was generated . Maximum length of upright events discriminated best between groups , with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors ( sensitivity : 0.805 , specificity : 0.704 , and AUC : 0.871 ) or 41 minutes or more to determine if a person is more likely to report outdoor walking on their own ( AUC : 0.891 ) . Physical behaviour  variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance BACKGROUND This study is a part of the r and omized controlled trial , the Trondheim Hip Fracture Trial , and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care ( CGC ) with those managed with orthopedic care ( OC ) .  METHODS Treatment comprised CGC with particular focus on mobilization , or OC .  A total of 397 hip fracture patients , age 70 years or older , home dwelling , and able to walk 10 m before the fracture , were included . Primary outcome was measurement of upright time ( st and ing and walking ) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor . Secondary outcomes were number of upright events on Day 4 , need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1 - 3 , and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery . RESULTS A total of 317 ( CGC n = 175 , OC n = 142 ) participants wore the activity monitor for a 24-hour period . CGC participants had significantly more upright time ( mean 57.6 vs 45.1 min , p = .016 ) , higher number of upright events ( p = .005 ) and better Short Physical Performance Battery scores ( p = .002 ) , than the 
    Output:
    