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 : There is a growing body of literature supporting the use of creative arts therapies ; however , the efficacy of creative arts therapies in the treatment of  posttraumatic stress disorder ( PTSD )  has not been systematic ally evaluated . The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy , art therapy , dance/movement therapy , and drama therapy , in the treatment of PTSD . Method : Ten data bases were search ed for peer- review ed literature published from inception to December 2016 . Studies were included in the review if they used a r and omized controlled trial ( RCT ) , a pseudo RCT , or a controlled study design ; tested the efficacy of one of the creative arts therapies described above ; and reported changes to PTSD diagnosis or symptomatology . Results : From an initial yield of 1,918 records , 1,653 records were screened on title and abstract and 125 were screened at full-text . Seven studies met the inclusion criteria for review , with four studies investigating art therapy , two studies investigating music therapy , and a final study investigating drama therapy . Individual studies were initially rated on a st and ardized quality and bias checklist , and then GRADE was used to rate the overall evidence for each intervention . The evidence for music therapy , art therapy , and drama therapy  was ranked as low to very low , with no studies found for dance/movement therapy . Generally , the quality of the trials was very poor . Future directions for this field of research are to improve the scientific quality of the research trials in this area Background The Beck Depression Inventory , 2nd edition ( BDI-II ) is widely used in research on depression . However , the minimal clinical ly important difference ( MCID ) is unknown . MCID can be estimated in several ways . Here we take a patient-centred approach , anchoring the change on the BDI-II to the patient 's global report of improvement . Method We used data collected ( n = 1039 ) from three r and omized controlled trials for the management of depression .  Improvement on a ‘ global rating of change ’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency , assessing whether MCID is best measured in absolute terms ( i.e. difference ) or as percent reduction in scores from baseline ( i.e. ratio ) , and receiver operator characteristics ( ROC ) to estimate MCID according to the optimal threshold above which individuals report feeling ‘ better ’ . Results Improvement in BDI-II scores associated with reporting feeling ‘ better ’ depended on initial depression severity , and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score . We estimated a MCID of a 17.5 % reduction in scores from baseline from ROC analyses . The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32 % . Conclusions MCID on the BDI-II is dependent on baseline severity , is best measured on a ratio scale , and the MCID for treatment-resistant depression is larger than that for more typical depression . This has important implication s for clinical trials and practice OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes Background Only a few workplace initiatives among cleaners have been reported , even though they constitute a job group in great need of health promotion . The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain , work ability and sickness absence among cleaners . Methods A cluster-r and omised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training ( PCT ) , cognitive behavioural training ( CBTr ) or a reference group ( REF ) .  Question naires about musculoskeletal pain and work ability were completed at baseline and after one year 's intervention . Sickness absence data were obtained from the managers ' records . Analyses were performed according to the intention-to-treat-principle ( ITT ) . Results No overall reduction in musculoskeletal pain , work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses . However , explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT . People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF ( p = 0.05 ) . Conclusions The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners . It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence . Trial registration IS RCT N : IS RCT Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Background Exergames are a new form of rehabilitation that combine the characteristics of physical exercise and the benefits of non-immersive virtual reality ( VR ) . Effects of this novel therapy in women fibromyalgia are still unknown . The objective was to evaluate the effects of exergame-based intervention on mobility skills , balance and fear of falling in women with fibromyalgia . Methods This study was a r and omized controlled trial with concealed allocation . Seventy-six women with fibromyalgia were divided into two groups : the exercise group received an eight week intervention based on exergames , while the control group continued their usual activities . Mobility skills  were evaluated using the timed up and go test , while balance was assessed using the functional reach test , and the CTSIB protocol .  Fear of falling was evaluated on a scale of 0–100 ( 0 , no fear ; 100 , extreme fear ) . Measurements were performed before and after the intervention . A repeated- measures linear mixed model was used to compare the effects of the intervention between the two groups . Results The exercise group was significantly quicker than the control group in the timed up and go test ( MD , −0.71 ; 95 % CI [ −1.09–0.32 ] ; p < 0.001 ) . There were also significant improvements in functional reach and a reduced fear of falling ( MD , 4.34 ; 95 % CI [ 1.39–7.30 ] ; p = 0.005 and MD , −9.85 ; 95 % CI [ −0.19–−0.08 ] ; p = 0.048 , respectively ) . Discussion The improved TUG observed herein was better than the smallest real difference . Based on the results on mobility skills , balance and fear of falling , exergames may be an effective tool as a therapy for women with fibromyalgia Introduction Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia , but its efficiency remains largely unknown . Should patients or health care managers invest in this therapy ? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia . Methods Costs to the health care system and to society were considered in this study that included 33 participants , r and omly assigned to the experimental group ( n = 17 ) or a control group ( n = 16 ) . The intervention in the experimental group consisted of a 1-h , supervised , water-based exercise sessions , three times per week for 8 months . The main outcome measures were the health care costs and the number of quality -adjusted life-years ( QALYs ) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument . Sensitivity analyses were performed for variations in staff salary , number of women attending sessions and time spent going to the pool . The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique . Results The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs . The mean incremental QALY associated with the intervention was 0.131 ( 95 % CI : 0.011 to 0.290 ) . Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY ( 95 % CI : 1,782 to 47,000 ) for a health care perspective and € 7,878/QALY ( 3,559 to 93,818 ) from a societal perspective . The curves showed a 95 % probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective . Conclusion The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women  is cost effective in terms of both health care costs and societal costs . However , the characteristics of facilities ( distance from the patients ' homes and number of patients that can be accommo date d per session ) are major determinants to consider before investing in such a programme . Trial registration Current controlled trials IS RCT N53367487 OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice OBJECTIVE To evaluate the effects of an exergame-based intervention on a population sample of women with fibromyalgia . DESIGN Single-blinded , r and omized controlled trial with 8-week intervention . SETTING Fibromyalgia center . PARTICIPANTS Participants ( all women ) ( N=83 ) were divided into 2 groups : an  exercise group  ( n=42 ; mean age ± SD 
    Output:
    
agent
In addition , significant improvements were observed in quality of life , depression , impact of the disease , anxiety , and physical function .
Conclusion Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia , leading to a significant reduction of the level of pain with an effect size that can be considered as large .
***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 : There is a growing body of literature supporting the use of creative arts therapies ; however , the efficacy of creative arts therapies in the treatment of  posttraumatic stress disorder ( PTSD )  has not been systematic ally evaluated . The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy , art therapy , dance/movement therapy , and drama therapy , in the treatment of PTSD . Method : Ten data bases were search ed for peer- review ed literature published from inception to December 2016 . Studies were included in the review if they used a r and omized controlled trial ( RCT ) , a pseudo RCT , or a controlled study design ; tested the efficacy of one of the creative arts therapies described above ; and reported changes to PTSD diagnosis or symptomatology . Results : From an initial yield of 1,918 records , 1,653 records were screened on title and abstract and 125 were screened at full-text . Seven studies met the inclusion criteria for review , with four studies investigating art therapy , two studies investigating music therapy , and a final study investigating drama therapy . Individual studies were initially rated on a st and ardized quality and bias checklist , and then GRADE was used to rate the overall evidence for each intervention . The evidence for music therapy , art therapy , and drama therapy  was ranked as low to very low , with no studies found for dance/movement therapy . Generally , the quality of the trials was very poor . Future directions for this field of research are to improve the scientific quality of the research trials in this area Background The Beck Depression Inventory , 2nd edition ( BDI-II ) is widely used in research on depression . However , the minimal clinical ly important difference ( MCID ) is unknown . MCID can be estimated in several ways . Here we take a patient-centred approach , anchoring the change on the BDI-II to the patient 's global report of improvement . Method We used data collected ( n = 1039 ) from three r and omized controlled trials for the management of depression .  Improvement on a ‘ global rating of change ’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency , assessing whether MCID is best measured in absolute terms ( i.e. difference ) or as percent reduction in scores from baseline ( i.e. ratio ) , and receiver operator characteristics ( ROC ) to estimate MCID according to the optimal threshold above which individuals report feeling ‘ better ’ . Results Improvement in BDI-II scores associated with reporting feeling ‘ better ’ depended on initial depression severity , and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score . We estimated a MCID of a 17.5 % reduction in scores from baseline from ROC analyses . The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32 % . Conclusions MCID on the BDI-II is dependent on baseline severity , is best measured on a ratio scale , and the MCID for treatment-resistant depression is larger than that for more typical depression . This has important implication s for clinical trials and practice OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes Background Only a few workplace initiatives among cleaners have been reported , even though they constitute a job group in great need of health promotion . The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain , work ability and sickness absence among cleaners . Methods A cluster-r and omised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training ( PCT ) , cognitive behavioural training ( CBTr ) or a reference group ( REF ) .  Question naires about musculoskeletal pain and work ability were completed at baseline and after one year 's intervention . Sickness absence data were obtained from the managers ' records . Analyses were performed according to the intention-to-treat-principle ( ITT ) . Results No overall reduction in musculoskeletal pain , work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses . However , explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT . People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF ( p = 0.05 ) . Conclusions The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners . It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence . Trial registration IS RCT N : IS RCT Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Background Exergames are a new form of rehabilitation that combine the characteristics of physical exercise and the benefits of non-immersive virtual reality ( VR ) . Effects of this novel therapy in women fibromyalgia are still unknown . The objective was to evaluate the effects of exergame-based intervention on mobility skills , balance and fear of falling in women with fibromyalgia . Methods This study was a r and omized controlled trial with concealed allocation . Seventy-six women with fibromyalgia were divided into two groups : the exercise group received an eight week intervention based on exergames , while the control group continued their usual activities . Mobility skills  were evaluated using the timed up and go test , while balance was assessed using the functional reach test , and the CTSIB protocol .  Fear of falling was evaluated on a scale of 0–100 ( 0 , no fear ; 100 , extreme fear ) . Measurements were performed before and after the intervention . A repeated- measures linear mixed model was used to compare the effects of the intervention between the two groups . Results The exercise group was significantly quicker than the control group in the timed up and go test ( MD , −0.71 ; 95 % CI [ −1.09–0.32 ] ; p < 0.001 ) . There were also significant improvements in functional reach and a reduced fear of falling ( MD , 4.34 ; 95 % CI [ 1.39–7.30 ] ; p = 0.005 and MD , −9.85 ; 95 % CI [ −0.19–−0.08 ] ; p = 0.048 , respectively ) . Discussion The improved TUG observed herein was better than the smallest real difference . Based on the results on mobility skills , balance and fear of falling , exergames may be an effective tool as a therapy for women with fibromyalgia Introduction Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia , but its efficiency remains largely unknown . Should patients or health care managers invest in this therapy ? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia . Methods Costs to the health care system and to society were considered in this study that included 33 participants , r and omly assigned to the experimental group ( n = 17 ) or a control group ( n = 16 ) . The intervention in the experimental group consisted of a 1-h , supervised , water-based exercise sessions , three times per week for 8 months . The main outcome measures were the health care costs and the number of quality -adjusted life-years ( QALYs ) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument . Sensitivity analyses were performed for variations in staff salary , number of women attending sessions and time spent going to the pool . The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique . Results The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs . The mean incremental QALY associated with the intervention was 0.131 ( 95 % CI : 0.011 to 0.290 ) . Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY ( 95 % CI : 1,782 to 47,000 ) for a health care perspective and € 7,878/QALY ( 3,559 to 93,818 ) from a societal perspective . The curves showed a 95 % probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective . Conclusion The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women  is cost effective in terms of both health care costs and societal costs . However , the characteristics of facilities ( distance from the patients ' homes and number of patients that can be accommo date d per session ) are major determinants to consider before investing in such a programme . Trial registration Current controlled trials IS RCT N53367487 OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice OBJECTIVE To evaluate the effects of an exergame-based intervention on a population sample of women with fibromyalgia . DESIGN Single-blinded , r and omized controlled trial with 8-week intervention . SETTING Fibromyalgia center . PARTICIPANTS Participants ( all women ) ( N=83 ) were divided into 2 groups : an  exercise group  ( n=42 ; mean age ± SD 
    Output:
    