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: STUDY DESIGN R and omized clinical trial . OBJECTIVE The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome . METHOD Fifty-five patients suffering from carpal tunnel syndrome were r and omized to two groups . Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder , the length of the biceps muscle , at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow . Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle , supraspinatus muscle and infraspinatus muscle . Of the 18 patients forming the control group , 13 agreed to receive the experimental treatments after the 15 control treatments . Outcome measures included a vali date d 18- question question naire to assess the severity of symptoms and functional status in carpal tunnel syndrome , and a quantification of the patients ' perceived improvement , using a scale from 0 % to 100 % . Outcome measures evaluations were completed at baseline , after 15 treatments , 30 days following the last treatment , and 6 months later . RESULTS For the disability question naire , a significant reduction of symptoms was noted only in the experimental group . In the experimental group the outcome at baseline was 33.5 ( SD , 10.3 ) ; after 15 treatments it was 18.6 ( SD , 7.0 ) . The control group outcome at baseline was 36.3 ( SD , 15.2 ) ; after 15 treatments it was 26.4 ( SD , 9.9 ) and after the crossover ( 15 control treatments plus 15 experimental treatments ) 20.2 ( SD , 12.2 ) . A significant between group difference ( P < 0.021 ) was noted in the patients ' perceived improvement after 15 treatments : 67 ( SD , 26 ) percent and 50 ( SD , 25 ) percent respectively for the experimental and control groups . CONCLUSION This practice -based clinical trial suggests that myofascial therapy using ischemic compression the length of the biceps , at the bicipital aponeurosis , at the pronator teres and at the subscapularis muscles could be a useful approach to reduce symptoms associated with the carpal tunnel syndrome . Patients ' perceived improvement in functional capacities persisted over a 6-month period OBJECTIVE Capener splinting is a common treatment for extension deficit of the proximal interphalangeal ( PIP ) joint . This study compared the effect of daily splint total end range time ( TERT ) of 6 - 12 hr versus 12 - 16 hr . METHOD Twenty-two participants with extension deficits of the PIP joint were r and omly allocated to a daily TERT of 6 - 12 hr or 12 - 16 hr . Progress after 8 wk of splinting was evaluated . RESULTS No significant difference was found in change in extension range of motion ( ROM ) between groups ( active ROM , F[4 , 17 ] = 2.19 , p = .13 ; passive ROM , F[4 , 17 ] = 0.95 , p = .46 ; torque ROM , F[4 , 17 ] = 1.49 , p = .26 ) . Considerable crossover between groups result ed in a similar average daily TERT ( 9.5 hr for the 6 - 12 hr group vs. 11.5 hr for the 12 - 16 hr group ) . CONCLUSION Further research with a larger sample is needed to determine whether longer daily TERT is beneficial . Our results suggest , however , that most patients find it difficult to wear splints > 12 hr/day STUDY DESIGN R and omized clinical trial . INTRODUCTION Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries , it is unclear whether orthosis self-removal has an impact on the final outcome . PURPOSE To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast ( ® ) ( QC ) compared to a removable , lever-type thermoplastic orthosis ( LTTP ) . METHODS 57 subjects were r and omized in 2 groups . DIPj extensor lag and the Gaberman success scale were used as primary outcomes . RESULTS LTTP subjects result ed in greater extensor lag than QC subjects ( x = 5 ° ; p = 0.05 ) at 12 weeks from baseline , and high edema and older age negatively affected DIPj extensor lag . No other differences were found between groups . CONCLUSION Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema . LEVEL OF EVIDENCE 1B OBJECTIVE This pilot study compared the effectiveness of 3 postoperative rehabilitation protocol s for patients with Zones V and VI extensor tendon lacerations . METHOD Twenty-seven patients were recruited from 3 sites and r and omly assigned to 1 of 3 established treatment protocol s : immobilization , early passive motion ( EPM ) , and early active motion ( EAM ) . Outcome measures were collected at 3 , 6 , and 12 wk after treatment and included total active motion ( TAM ) . RESULTS At the end of Week 12 , data on 24 injured digits of 18 patients were available for analysis . When data at Weeks 3 , 6 , and 12 were compared , patients in all groups showed steady improvement in TAM , but digits under the EAM treatment improved to a greater extent over time ( F[2 , 46 ] = 75.6 , p < .001 ) . CONCLUSION Patients with Zones V and VI extensor tendon injuries treated with the EAM protocol recovered range of motion more rapidly OBJECTIVE To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures :  treatment by a physical therapist with 12 sessions and an unassisted home exercise program . DESIGN R and omized controlled cohort study . SETTING Hospital-based care , primary center of orthopedic surgery . PARTICIPANTS Volunteers ( N=48 ) with fractures of the distal radius after internal fixation with locking plates . There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Evaluation of grip strength using a Jamar dynamometer , range of motion ( ROM ) , and Patient Related Wrist Evaluation ( PRWE ) . RESULTS After a 6-week period of postoperative treatment , the patients ( n=23 ) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist . Grip strength reached 54 % ( P=.003 ) , and ROM in extension and flexion 79 % ( P<.001 ) of the uninjured side . Ulnar and radial abduction was also higher in this group . In contrast , patients who were treated by a physical therapist achieved grip strength equal to 32 % , and ROM in extension and flexion of 52 % of the uninjured side . Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50 % lower value ( P<.001 ) in the PRWE score . CONCLUSIONS In the postoperative rehabilitation of wrist fractures , instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment PURPOSE To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture . METHODS We conducted a single-center , r and omized , controlled trial to investigate the effect of night extension orthoses on finger range of motion and h and function for 3 months following surgical release of Dupuytren contracture . We also wanted to determine how well finger extension was maintained in the total sample . We r and omized 56 patients to receive a night extension orthosis plus h and therapy  ( n = 26 ) or h and therapy alone ( n = 30 ) . The primary outcome was total active extension of the operated fingers ( ° ) . Secondary outcomes were total active flexion of the operated fingers ( ° ) , active distal palmar crease ( cm ) , grip strength ( kg ) , and self-reported h and function using the Disabilities of the Arm , Shoulder , and H and question naire ( 0 - 100 scale ) . RESULTS There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes . Between the first postoperative measure and 3 months after surgery , 62 % of little fingers had maintained or improved total active extension . CONCLUSIONS The use of a night extension orthosis in combination with st and ard h and therapy has no greater effect on maintaining finger extension than h and therapy alone in the 3 months following surgical release of Dupuytren contracture . Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery . Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients Background Dupuytren 's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired h and function . St and ard treatment involves surgical release or excision followed by post-operative h and therapy and splinting , however the evidence supporting night splinting is of low quality and equivocal . Methods A multi-centre , pragmatic , open , r and omised controlled trial was conducted to evaluate the effect of night splinting on self-reported function , finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy . 154 patients from 5 regional hospitals were r and omised after surgery to receive h and therapy only ( n = 77 ) or h and therapy with night-splinting ( n = 77 ) . Primary outcome was self-reported function using the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . Secondary outcomes were finger range of motion and patient satisfaction . Primary analysis was by intention to treat . Results 148 ( 96 % ) patients completed follow-up at 12 months . No statistically significant differences were observed on the DASH question naire ( 0 - 100 scale : adjusted mean diff . 0.66 , 95%CI - 2.79 to 4.11 , p = 0.703 ) , total extension deficit of operated digits ( degrees : adjusted mean diff 5.11 , 95%CI -2.33 to 12.55 , p = 0.172 ) or patient satisfaction ( 0 - 10 numerical rating scale : adjusted mean diff -0.35 , 95%CI -1.04 to 0.34 , p = 0.315 ) at 1 year post surgery . Similarly , in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes . Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving h and therapy and only splinted if and when contractures occurred . Given the added expense of therapists ' time , thermoplastic material s and the potential inconvenience to patients having to wear a device , the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur . Trial registration The trial was registered as an International St and ard R and omised Controlled Trial IS RCT OBJECTIVE To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the  rheumatoid h and . METHODS In a r and omized controlled trial , participants with rheumatoid arthritis ( RA ) recruited from a rheumatology department in Mid-Staffordshire , UK ( February 1999 to January 2001 ) were r and omized to three groups . All received joint protection ( JP ) information delivered by a therapist at baseline . Group 1 participants received a set of additional h and -strengthening and mobilizing home exercises , group 2 a different set of additional h and -stretching exercises and group 3 the JP information alone . The primary outcome was the Arthritis Impact Measurement Scales II ( AIMS II ) ( upper limb ; h and and finger function subscales ) . Outcomes were assessed at baseline and 1 , 3 and 6 months . Analysis was by intention to treat . RESULTS Sixty-seven participants ( mean age 59.6 yr ) were recruited : group 1 n = 21 , group 2 n = 24 and group 3 n = 22 . A 78 % follow-up was achieved at 6 months . There was a mean fall ( SD ) in AIMS II upper limb function 0 - 6 month change scores in group 1 of 1.00 ( 1.07 ) . In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 ( 1.54 ) and 0.30 ( 1.22 ) , respectively . The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant ( P = 0.007 ) and remained so after adjustment for multiple testing ( P = 0.012 ) . CONCLUSION Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening h and exercises in RA patients compared with simple stretches or advice alone OBJECTIVE To compare Stack , dorsal , and custom splinting techniques in people with acute type 1a or b mallet finger . DESIGN Multi-center r and omized controlled trial . SETTING Outpatient h and therapy clinics ( 2 public hospitals and 1 private clinic ) . PARTICIPANTS Patients ( N=64 ) with acute type 1a or 
    Output:
    
agent
The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions .
Very few studies have examined occupation-based interventions .
***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: STUDY DESIGN R and omized clinical trial . OBJECTIVE The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome . METHOD Fifty-five patients suffering from carpal tunnel syndrome were r and omized to two groups . Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder , the length of the biceps muscle , at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow . Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle , supraspinatus muscle and infraspinatus muscle . Of the 18 patients forming the control group , 13 agreed to receive the experimental treatments after the 15 control treatments . Outcome measures included a vali date d 18- question question naire to assess the severity of symptoms and functional status in carpal tunnel syndrome , and a quantification of the patients ' perceived improvement , using a scale from 0 % to 100 % . Outcome measures evaluations were completed at baseline , after 15 treatments , 30 days following the last treatment , and 6 months later . RESULTS For the disability question naire , a significant reduction of symptoms was noted only in the experimental group . In the experimental group the outcome at baseline was 33.5 ( SD , 10.3 ) ; after 15 treatments it was 18.6 ( SD , 7.0 ) . The control group outcome at baseline was 36.3 ( SD , 15.2 ) ; after 15 treatments it was 26.4 ( SD , 9.9 ) and after the crossover ( 15 control treatments plus 15 experimental treatments ) 20.2 ( SD , 12.2 ) . A significant between group difference ( P < 0.021 ) was noted in the patients ' perceived improvement after 15 treatments : 67 ( SD , 26 ) percent and 50 ( SD , 25 ) percent respectively for the experimental and control groups . CONCLUSION This practice -based clinical trial suggests that myofascial therapy using ischemic compression the length of the biceps , at the bicipital aponeurosis , at the pronator teres and at the subscapularis muscles could be a useful approach to reduce symptoms associated with the carpal tunnel syndrome . Patients ' perceived improvement in functional capacities persisted over a 6-month period OBJECTIVE Capener splinting is a common treatment for extension deficit of the proximal interphalangeal ( PIP ) joint . This study compared the effect of daily splint total end range time ( TERT ) of 6 - 12 hr versus 12 - 16 hr . METHOD Twenty-two participants with extension deficits of the PIP joint were r and omly allocated to a daily TERT of 6 - 12 hr or 12 - 16 hr . Progress after 8 wk of splinting was evaluated . RESULTS No significant difference was found in change in extension range of motion ( ROM ) between groups ( active ROM , F[4 , 17 ] = 2.19 , p = .13 ; passive ROM , F[4 , 17 ] = 0.95 , p = .46 ; torque ROM , F[4 , 17 ] = 1.49 , p = .26 ) . Considerable crossover between groups result ed in a similar average daily TERT ( 9.5 hr for the 6 - 12 hr group vs. 11.5 hr for the 12 - 16 hr group ) . CONCLUSION Further research with a larger sample is needed to determine whether longer daily TERT is beneficial . Our results suggest , however , that most patients find it difficult to wear splints > 12 hr/day STUDY DESIGN R and omized clinical trial . INTRODUCTION Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries , it is unclear whether orthosis self-removal has an impact on the final outcome . PURPOSE To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast ( ® ) ( QC ) compared to a removable , lever-type thermoplastic orthosis ( LTTP ) . METHODS 57 subjects were r and omized in 2 groups . DIPj extensor lag and the Gaberman success scale were used as primary outcomes . RESULTS LTTP subjects result ed in greater extensor lag than QC subjects ( x = 5 ° ; p = 0.05 ) at 12 weeks from baseline , and high edema and older age negatively affected DIPj extensor lag . No other differences were found between groups . CONCLUSION Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema . LEVEL OF EVIDENCE 1B OBJECTIVE This pilot study compared the effectiveness of 3 postoperative rehabilitation protocol s for patients with Zones V and VI extensor tendon lacerations . METHOD Twenty-seven patients were recruited from 3 sites and r and omly assigned to 1 of 3 established treatment protocol s : immobilization , early passive motion ( EPM ) , and early active motion ( EAM ) . Outcome measures were collected at 3 , 6 , and 12 wk after treatment and included total active motion ( TAM ) . RESULTS At the end of Week 12 , data on 24 injured digits of 18 patients were available for analysis . When data at Weeks 3 , 6 , and 12 were compared , patients in all groups showed steady improvement in TAM , but digits under the EAM treatment improved to a greater extent over time ( F[2 , 46 ] = 75.6 , p < .001 ) . CONCLUSION Patients with Zones V and VI extensor tendon injuries treated with the EAM protocol recovered range of motion more rapidly OBJECTIVE To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures :  treatment by a physical therapist with 12 sessions and an unassisted home exercise program . DESIGN R and omized controlled cohort study . SETTING Hospital-based care , primary center of orthopedic surgery . PARTICIPANTS Volunteers ( N=48 ) with fractures of the distal radius after internal fixation with locking plates . There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Evaluation of grip strength using a Jamar dynamometer , range of motion ( ROM ) , and Patient Related Wrist Evaluation ( PRWE ) . RESULTS After a 6-week period of postoperative treatment , the patients ( n=23 ) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist . Grip strength reached 54 % ( P=.003 ) , and ROM in extension and flexion 79 % ( P<.001 ) of the uninjured side . Ulnar and radial abduction was also higher in this group . In contrast , patients who were treated by a physical therapist achieved grip strength equal to 32 % , and ROM in extension and flexion of 52 % of the uninjured side . Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50 % lower value ( P<.001 ) in the PRWE score . CONCLUSIONS In the postoperative rehabilitation of wrist fractures , instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment PURPOSE To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture . METHODS We conducted a single-center , r and omized , controlled trial to investigate the effect of night extension orthoses on finger range of motion and h and function for 3 months following surgical release of Dupuytren contracture . We also wanted to determine how well finger extension was maintained in the total sample . We r and omized 56 patients to receive a night extension orthosis plus h and therapy  ( n = 26 ) or h and therapy alone ( n = 30 ) . The primary outcome was total active extension of the operated fingers ( ° ) . Secondary outcomes were total active flexion of the operated fingers ( ° ) , active distal palmar crease ( cm ) , grip strength ( kg ) , and self-reported h and function using the Disabilities of the Arm , Shoulder , and H and question naire ( 0 - 100 scale ) . RESULTS There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes . Between the first postoperative measure and 3 months after surgery , 62 % of little fingers had maintained or improved total active extension . CONCLUSIONS The use of a night extension orthosis in combination with st and ard h and therapy has no greater effect on maintaining finger extension than h and therapy alone in the 3 months following surgical release of Dupuytren contracture . Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery . Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients Background Dupuytren 's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired h and function . St and ard treatment involves surgical release or excision followed by post-operative h and therapy and splinting , however the evidence supporting night splinting is of low quality and equivocal . Methods A multi-centre , pragmatic , open , r and omised controlled trial was conducted to evaluate the effect of night splinting on self-reported function , finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy . 154 patients from 5 regional hospitals were r and omised after surgery to receive h and therapy only ( n = 77 ) or h and therapy with night-splinting ( n = 77 ) . Primary outcome was self-reported function using the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . Secondary outcomes were finger range of motion and patient satisfaction . Primary analysis was by intention to treat . Results 148 ( 96 % ) patients completed follow-up at 12 months . No statistically significant differences were observed on the DASH question naire ( 0 - 100 scale : adjusted mean diff . 0.66 , 95%CI - 2.79 to 4.11 , p = 0.703 ) , total extension deficit of operated digits ( degrees : adjusted mean diff 5.11 , 95%CI -2.33 to 12.55 , p = 0.172 ) or patient satisfaction ( 0 - 10 numerical rating scale : adjusted mean diff -0.35 , 95%CI -1.04 to 0.34 , p = 0.315 ) at 1 year post surgery . Similarly , in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes . Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving h and therapy and only splinted if and when contractures occurred . Given the added expense of therapists ' time , thermoplastic material s and the potential inconvenience to patients having to wear a device , the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur . Trial registration The trial was registered as an International St and ard R and omised Controlled Trial IS RCT OBJECTIVE To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the  rheumatoid h and . METHODS In a r and omized controlled trial , participants with rheumatoid arthritis ( RA ) recruited from a rheumatology department in Mid-Staffordshire , UK ( February 1999 to January 2001 ) were r and omized to three groups . All received joint protection ( JP ) information delivered by a therapist at baseline . Group 1 participants received a set of additional h and -strengthening and mobilizing home exercises , group 2 a different set of additional h and -stretching exercises and group 3 the JP information alone . The primary outcome was the Arthritis Impact Measurement Scales II ( AIMS II ) ( upper limb ; h and and finger function subscales ) . Outcomes were assessed at baseline and 1 , 3 and 6 months . Analysis was by intention to treat . RESULTS Sixty-seven participants ( mean age 59.6 yr ) were recruited : group 1 n = 21 , group 2 n = 24 and group 3 n = 22 . A 78 % follow-up was achieved at 6 months . There was a mean fall ( SD ) in AIMS II upper limb function 0 - 6 month change scores in group 1 of 1.00 ( 1.07 ) . In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 ( 1.54 ) and 0.30 ( 1.22 ) , respectively . The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant ( P = 0.007 ) and remained so after adjustment for multiple testing ( P = 0.012 ) . CONCLUSION Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening h and exercises in RA patients compared with simple stretches or advice alone OBJECTIVE To compare Stack , dorsal , and custom splinting techniques in people with acute type 1a or b mallet finger . DESIGN Multi-center r and omized controlled trial . SETTING Outpatient h and therapy clinics ( 2 public hospitals and 1 private clinic ) . PARTICIPANTS Patients ( N=64 ) with acute type 1a or 
    Output:
    