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: In practice the secondary prevention of work-related upper extremity ( WRUE ) symptoms generally targets biomechanical risk factors . Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability . The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone . Seventy office workers with WRUE symptoms were r and omly assigned to an ergonomics intervention group ( assessment and modification of work station and stretching exercises ) or a combined ergonomic and job stress intervention group ( ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress ) . Baseline , 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks , job stress , pain , symptoms , functional limitation , and general physical and mental health were obtained from all participants . While both groups experienced significant decreases in pain , symptoms , and functional limitation from baseline to three months with improvements continuing to 12 months post baseline , no significant differences between groups were observed for any outcome measures . Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone This r and omized clinical trial evaluated the effects of keyboard keyswitch design on computer users with h and paresthesias . Twenty computer users were matched and r and omly assigned to keyboard A ( n = 10 ) or B ( n = 10 ) . The keyboards were of conventional layout and differed in keyswitch design . Various outcome measures were assessed during the 12 weeks of use . Subjects assigned keyboard A experienced a decrease in h and pain between weeks 6 and 12 when compared with keyboard B subjects ( P = 0.05 ) and demonstrated an improvement in the Phalen test time ( right h and , P = 0.006 ; left h and , P = 0.06 ) . Keyboard assignment had no significant effect on change in h and function or median nerve latency . We conclude that use of keyboard A for 12 weeks led to a reduction in h and pain and an improved physical examination finding when compared with keyboard B. There was no corresponding improvement in h and function or median nerve latency OBJECTIVES To determine whether minimal intervention by occupational specialists involving information about the disorder , encouragement to stay active and instruction in grade d self-performed exercises could enhance the prognosis of lateral epicondylitis compared with the treatment usually given in general practice , to quantify workplace factors associated with the prognosis , and to consider treatments given in general practice . METHODS A r and omized controlled trial was performed in a cohort of 266 consecutive new cases of lateral epicondylitis diagnosed in general practice . Workplace factors were assessed with question naires at the time of inclusion , and patients completed follow-ups at 3 , 6 and 12 months . Status at 1 yr was assessed as overall improvement and pain reduction compared with the time of diagnosis . General practitioners ( GPs ) registered the treatments given for both cases and controls during follow-up . Numbers of contacts with GPs and physiotherapists were obtained from the National Health Insurance registry . Prognostic factors were analysed by multiple logistic regression analysis . RESULTS After 1 yr , 83 % of cases showed improvement in the condition , but the intervention was found to have had no advantage . Poor overall improvement was associated with employment in manual jobs [ odds ratio ( OR ) 3.0 , 95 % confidence interval ( CI ) 1.0 - 8.7 ] , a high level of physical strain at work ( OR 8.5 , CI 1.0 - 74.7 ) and a high level of pain at baseline ( OR 2.3 , CI 1.0 - 5.3 ) . Pain reduction less than 50 % was associated with manual jobs ( OR 2.3 , CI 1.1 - 5.1 ) , high physical strain at work ( OR 3.6 , CI 1.0 - 12.9 ) , high baseline distress ( OR 1.9 , CI 1.0 - 4.0 ) and tennis elbow on the dominant side ( OR 3.1 , CI 1.4 - 6.8 ) . The intervention group received less treatment and fewer treatment modalities , but the intervention was not followed by a reduction in the number of visits to GPs and physiotherapist clinics during 12 months of follow-up . CONCLUSIONS Poor prognosis at 1 yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain , whilst no relation was found between the type of medical treatment given/chosen and prognosis . This may have implication s for the future management of lateral epicondylitis in terms of a greater focus on interaction with the workplace regarding job modification to reduce physical dem and s during recovery OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop , a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb . The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting . METHOD 43 consecutive referrals to a soft tissue rheumatism clinic ( group 1 ) and 45 subjects with one of a list of specific upper limb disorders ( including shoulder capsulitis , rotator cuff tendinitis , lateral epicondylitis and tenosynovitis ) ( group 2 ) , were recruited from hospital rheumatology and orthopaedic outpatient clinics . All 88 subjects were examined by a research nurse ( blinded to diagnosis ) , and everyone from group 1 was independently examined by a rheumatologist . Between observer agreement was assessed among subjects from group 1 by calculating Cohen 's κ for dichotomous physical signs , and mean differences with limits of agreement for measured ranges of joint movement . To assess the validity of the examination , a pre-defined algorithm was applied to the nurse 's examination findings in patients from both groups , and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic 's independent diagnosis as the reference st and ard . RESULTS The between observer repeatability of physical signs varied from good to excellent , with κ coefficients of 0.66 to 1.00 for most categorical observations , and mean absolute differences of 1.4 ° –11.9 ° for measurements of shoulder movement . The sensitivity of the schedule in comparison with the reference st and ard varied between diagnoses from 58%–100 % , while the specificities ranged from 84%–100 % . The nurse and the clinic physician generally agreed in their diagnoses , but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis , whereas the clinic physician did not . CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting . Examination can feasibly be delegated to a trained nurse , and the protocol has the benefit of face and construct validity as well as consensus backing . Its performance in the community , where disease is less clear cut , merits separate evaluation , and further refinement is needed to discriminate between discrete pathologies at the shoulder Abstract Objective : To determine the aetiology of forearm pain . In particular to determine the relative contribution of ( a ) psychological factors , features of somatisation , and health anxiety and behaviour , ( b ) work related mechanical factors , and ( c ) work related psychosocial factors in the onset of forearm pain . Design : 2 year prospect i ve population based cohort study , with retrospective assessment of exposures at work . Setting : Altrincham , Greater Manchester . Participants : 1953 individuals aged 18 - 65 years . Outcome measures : Forearm pain of new onset . Results : At follow up , 105 ( 8.3 % ) participants reported forearm pain of new onset lasting at least one day in the past month . Among these , 67 % also reported shoulder pain , 65 % back pain , and 45 % chronic widespread pain . Increased risks of onset were associated with high levels of psychological distress ( relative risk 2.4 , 95 % confidence interval 1.5 to 3.8 ) , reporting at least two other somatic symptoms ( 1.7 , 0.95 to 3.0 ) , and high scores on the illness behaviour subscale of the illness attitude scales . The two work related mechanical exposures associated with the highest risk of forearm pain in the future were repetitive movements of the arm ( 4.1 , 1.7 to 10 ) or wrists ( 3.4 , 1.3 to 8.7 ) , whereas the strongest work related psychosocial risk was dissatisfaction with support from colleagues or supervisors ( 4.7 , 2.2 to 10 ) . Conclusions : Psychological distress , aspects of illness behaviour , and other somatic symptoms are important predictors of onset of forearm pain in addition to work related psychosocial and mechanical factors . Misleading terms such as “ cumulative trauma disorder ” or “ repetitive strain injury , ” implying a single uniform aetiology , should be avoided OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care Objective : To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals 
    Output:
    
agent
There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms .
There was limited , but high quality , evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks .
In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms .
There was a lack of high quality evidence to inform workplace management of lateral epicondylitis .
***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: In practice the secondary prevention of work-related upper extremity ( WRUE ) symptoms generally targets biomechanical risk factors . Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability . The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone . Seventy office workers with WRUE symptoms were r and omly assigned to an ergonomics intervention group ( assessment and modification of work station and stretching exercises ) or a combined ergonomic and job stress intervention group ( ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress ) . Baseline , 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks , job stress , pain , symptoms , functional limitation , and general physical and mental health were obtained from all participants . While both groups experienced significant decreases in pain , symptoms , and functional limitation from baseline to three months with improvements continuing to 12 months post baseline , no significant differences between groups were observed for any outcome measures . Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone This r and omized clinical trial evaluated the effects of keyboard keyswitch design on computer users with h and paresthesias . Twenty computer users were matched and r and omly assigned to keyboard A ( n = 10 ) or B ( n = 10 ) . The keyboards were of conventional layout and differed in keyswitch design . Various outcome measures were assessed during the 12 weeks of use . Subjects assigned keyboard A experienced a decrease in h and pain between weeks 6 and 12 when compared with keyboard B subjects ( P = 0.05 ) and demonstrated an improvement in the Phalen test time ( right h and , P = 0.006 ; left h and , P = 0.06 ) . Keyboard assignment had no significant effect on change in h and function or median nerve latency . We conclude that use of keyboard A for 12 weeks led to a reduction in h and pain and an improved physical examination finding when compared with keyboard B. There was no corresponding improvement in h and function or median nerve latency OBJECTIVES To determine whether minimal intervention by occupational specialists involving information about the disorder , encouragement to stay active and instruction in grade d self-performed exercises could enhance the prognosis of lateral epicondylitis compared with the treatment usually given in general practice , to quantify workplace factors associated with the prognosis , and to consider treatments given in general practice . METHODS A r and omized controlled trial was performed in a cohort of 266 consecutive new cases of lateral epicondylitis diagnosed in general practice . Workplace factors were assessed with question naires at the time of inclusion , and patients completed follow-ups at 3 , 6 and 12 months . Status at 1 yr was assessed as overall improvement and pain reduction compared with the time of diagnosis . General practitioners ( GPs ) registered the treatments given for both cases and controls during follow-up . Numbers of contacts with GPs and physiotherapists were obtained from the National Health Insurance registry . Prognostic factors were analysed by multiple logistic regression analysis . RESULTS After 1 yr , 83 % of cases showed improvement in the condition , but the intervention was found to have had no advantage . Poor overall improvement was associated with employment in manual jobs [ odds ratio ( OR ) 3.0 , 95 % confidence interval ( CI ) 1.0 - 8.7 ] , a high level of physical strain at work ( OR 8.5 , CI 1.0 - 74.7 ) and a high level of pain at baseline ( OR 2.3 , CI 1.0 - 5.3 ) . Pain reduction less than 50 % was associated with manual jobs ( OR 2.3 , CI 1.1 - 5.1 ) , high physical strain at work ( OR 3.6 , CI 1.0 - 12.9 ) , high baseline distress ( OR 1.9 , CI 1.0 - 4.0 ) and tennis elbow on the dominant side ( OR 3.1 , CI 1.4 - 6.8 ) . The intervention group received less treatment and fewer treatment modalities , but the intervention was not followed by a reduction in the number of visits to GPs and physiotherapist clinics during 12 months of follow-up . CONCLUSIONS Poor prognosis at 1 yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain , whilst no relation was found between the type of medical treatment given/chosen and prognosis . This may have implication s for the future management of lateral epicondylitis in terms of a greater focus on interaction with the workplace regarding job modification to reduce physical dem and s during recovery OBJECTIVES Following a consensus statement from a multidisciplinary UK workshop , a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb . The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting . METHOD 43 consecutive referrals to a soft tissue rheumatism clinic ( group 1 ) and 45 subjects with one of a list of specific upper limb disorders ( including shoulder capsulitis , rotator cuff tendinitis , lateral epicondylitis and tenosynovitis ) ( group 2 ) , were recruited from hospital rheumatology and orthopaedic outpatient clinics . All 88 subjects were examined by a research nurse ( blinded to diagnosis ) , and everyone from group 1 was independently examined by a rheumatologist . Between observer agreement was assessed among subjects from group 1 by calculating Cohen 's κ for dichotomous physical signs , and mean differences with limits of agreement for measured ranges of joint movement . To assess the validity of the examination , a pre-defined algorithm was applied to the nurse 's examination findings in patients from both groups , and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic 's independent diagnosis as the reference st and ard . RESULTS The between observer repeatability of physical signs varied from good to excellent , with κ coefficients of 0.66 to 1.00 for most categorical observations , and mean absolute differences of 1.4 ° –11.9 ° for measurements of shoulder movement . The sensitivity of the schedule in comparison with the reference st and ard varied between diagnoses from 58%–100 % , while the specificities ranged from 84%–100 % . The nurse and the clinic physician generally agreed in their diagnoses , but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis , whereas the clinic physician did not . CONCLUSION The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting . Examination can feasibly be delegated to a trained nurse , and the protocol has the benefit of face and construct validity as well as consensus backing . Its performance in the community , where disease is less clear cut , merits separate evaluation , and further refinement is needed to discriminate between discrete pathologies at the shoulder Abstract Objective : To determine the aetiology of forearm pain . In particular to determine the relative contribution of ( a ) psychological factors , features of somatisation , and health anxiety and behaviour , ( b ) work related mechanical factors , and ( c ) work related psychosocial factors in the onset of forearm pain . Design : 2 year prospect i ve population based cohort study , with retrospective assessment of exposures at work . Setting : Altrincham , Greater Manchester . Participants : 1953 individuals aged 18 - 65 years . Outcome measures : Forearm pain of new onset . Results : At follow up , 105 ( 8.3 % ) participants reported forearm pain of new onset lasting at least one day in the past month . Among these , 67 % also reported shoulder pain , 65 % back pain , and 45 % chronic widespread pain . Increased risks of onset were associated with high levels of psychological distress ( relative risk 2.4 , 95 % confidence interval 1.5 to 3.8 ) , reporting at least two other somatic symptoms ( 1.7 , 0.95 to 3.0 ) , and high scores on the illness behaviour subscale of the illness attitude scales . The two work related mechanical exposures associated with the highest risk of forearm pain in the future were repetitive movements of the arm ( 4.1 , 1.7 to 10 ) or wrists ( 3.4 , 1.3 to 8.7 ) , whereas the strongest work related psychosocial risk was dissatisfaction with support from colleagues or supervisors ( 4.7 , 2.2 to 10 ) . Conclusions : Psychological distress , aspects of illness behaviour , and other somatic symptoms are important predictors of onset of forearm pain in addition to work related psychosocial and mechanical factors . Misleading terms such as “ cumulative trauma disorder ” or “ repetitive strain injury , ” implying a single uniform aetiology , should be avoided OBJECTIVES This study evaluated the effects on work-related neck and upper-limb disorders  among computer workers stimulated ( by a software program ) to take regular breaks and perform physical exercises . Possible effects on sick leave and productivity were studied as well . A r and omized controlled design was used with cluster r and omization . Altogether 268 computer workers with complaints in the neck or an upper limb from 22 office locations were r and omized into a control group , one intervention group stimulated to take extra breaks and one intervention group stimulated to perform exercises during the extra breaks during an 8-weekperiod . Question naires were administered before and after the intervention , and questions were generated by the software during the intervention period . Computer usage was recorded online . RESULTS The data on self-reported recovery suggested a favorable effect ; more subjects in the intervention groups than in the control group reported recovery ( 55 % versus 34 % ) from their complaints and fewer reported deterioration ( 4 % versus 20 % ) . However , a comparison between the reported pre- and postintervention scores on the severity and frequency of the complaints showed no significant differences in the change among the three groups . No effects on sick leave were observed . The subjects in the intervention groups showed higher productivity . CONCLUSIONS The use of a software program stimulating workers to take regular breaks contributes to perceived recovery from neck or upper-limb complaints . There seems to be no additional effects from performing physical exercises during these breaks OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care Objective : To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals 
    Output:
    