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: OBJECTIVES To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis . PATIENTS AND METHODS Fifty patients with knee osteoarthritis were r and omly recruited . They underwent a comprehensive spa therapy program for 21 days . Forty-six patients completed the study . The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 ( SF-36 ) and Arthritis Impact Measurement Scale 2 ( AIMS 2 ) . RESULTS Statistically significant improvement was observed in all subscales of SF-36 . All subscales of AIMS 2 improved too , but only half of them were significant . Correlation between matching subscales of each test was also significant , except physical activity . CONCLUSION Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term BACKGROUND Balneotherapy , traditionally administered during a continuous stay at the Dead Sea area , has been shown to be effective for patients suffering from knee osteoarthritis . OBJECTIVES To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis . METHODS Forty-four patients with knee osteoarthritis were included in a prospect i ve r and omized single-blind controlled study . The patients were divided into two groups : a treatment group ( n=24 ) , which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35 - 36 degrees C , and a control group ( n=20 ) treated in a Jacuzzi filled with tap water heated to 35 - 36 degrees C. Participants were assessed by the Lequesne index of osteoarthritis severity , the WOMAC index , the SF-36 quality of health question naire , VAS scales for pain ( completed by patients and physicians ) , and physical examination . RESULTS A statistically significant improvement , lasting up to 6 months , was observed in the treatment group for most of the clinical parameters . In the control group the only improvements were in the SF-36 bodily pain scale at 6 months , the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period . Although the patients in the control group had milder disease , the difference between the two groups was not statistically significant . CONCLUSIONS Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms , although little is known about their role in different circumstances . In this study , we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure . We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone ( GH ) and cortisol did not have any effect on the secretion of these hormones . However , if a preconditioning was performed with sumatriptan , a 5-HT1B/1D agonist that stimulates GH and inhibits cortisol secretion , a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration , although opposite verbal suggestions were given . These findings indicate that verbally induced expectations have no effect on hormonal secretion , whereas they affect pain and motor performance . This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved , whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play , even though a conditioning procedure is performed The objective of this prospect i ve parallel r and omized single-blind study was to assess that a cycle of mud-bath therapy ( MBT ) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis ( OA ) . Patients with symptomatic primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : one group received a cycle of MBT at spa center of Chianciano Terme ( Italy )  in addition to the usual treatment , and one group continued their regular care routine alone .  Clinical assessment s were performed 7 days before enrollment ( screening visit ) , at the time of enrollment ( basal time ) , after 2 weeks , and after 3 , 6 , 9 , and 12 months after the beginning of the study . All assessment s were conducted by two research ers blinded to treatment allocation . The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) subscore for physical function ( W-TPFS ) .  Of the 235 patients screened , 103 met the inclusion criteria : 53 patients were included in the MBT group and 50 in the control group . In the group of patients treated with MBT , we observed a statistically significant ( p < 0.001 ) reduction of VAS and W-TPFS score at the end of the treatment ; this improvement was significant ( p < 0.05 ) also at 3 months of follow-up . The control group did not show significant differences between baseline time and all other times . The differences between one group were significant for both primary parameters already from the 15th day and persisted up to the 9th month . This beneficial effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of MBT seemed to be good , with light and transitory side effects . Our results confirm that a cycle of MBT added to usual treatment provides a beneficial effect on the painful symptoms and functional capacities in patients with knee OA that lasts over time . Mud-bath therapy can represent a useful backup to pharmacologic treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 BACKGROUND Osteoarthritis is a degenerative disease associated with pain , reduced range of motion , and impaired function . Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases . AIM To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of  knee osteoarthritis  . DESIGN A r and omized , assessor-blind , controlled trial . SETTING A spa resort . POPULATION One hundred and forty patients of both genders , mean age of 64.8±8.9 years , with knee osteoarthritis and chronic knee pain . METHODS Patients were r and omized into three groups : the sulfurous water ( SW ) group ( N.=47 ) , non-sulfurous water ( NSW ) group ( N.=50 ) , or control group ( N.=43 ) who received no treatment . Patients were not blinded to treatment allocation . Treatment groups received 30 individual thermal baths ( three 20-minute baths a week for 10 weeks ) at 37 - 39 ° C . The outcome measures were pain ( visual analog scale , VAS ) , physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC ; Lequesne Algofunctional Index , LAFI ; Stanford Health Assessment Question naire , HAQ ) , and use of pain medication . Patients were assessed before treatment ( T1 ) , at treatment endpoint ( T2 ) , and two months post-intervention ( T3 ) . Intra- and intergroup comparisons were performed at a significance level of 0.05 ( P<0.05 ) . RESULTS A significant decrease in VAS pain scores ( pain during movement , at rest , and at night ) and use of pain medication , and improvement in WOMAC , LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups ( P<0.001 ) , and between controls and both treatment groups at T2 and T3 ( P<0.001 ) . No significant differences in these variables were observed between treatment groups at T2 , but patients in the SW group reported less pain and better functional status than those in the NSW group at T3 , showing a lasting effect of sulfurous water baths . CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis ; however , sulfurous baths yielded longer-lasting effects than non-sulfurous water baths . CLINICAL REHABILITATION IMPACT Baths in thermal waters , especially those in sulfurous waters , are effective in reducing pain and improving physical function in patients with knee osteoarthritis The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis . This is a r and omized , controlled , single-blind clinical trial . Fifty patients diagnosed with knee osteoarthrit 
    Output:
    
agent
In conclusion , even though limitations must be considered , evidence shows that BT and spa therapy can significantly improve QoL of patients with knee OA .
Moreover , reduction of drug consumption and improvement of algofunctional indexes may be other beneficial effects .
***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: OBJECTIVES To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis . PATIENTS AND METHODS Fifty patients with knee osteoarthritis were r and omly recruited . They underwent a comprehensive spa therapy program for 21 days . Forty-six patients completed the study . The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 ( SF-36 ) and Arthritis Impact Measurement Scale 2 ( AIMS 2 ) . RESULTS Statistically significant improvement was observed in all subscales of SF-36 . All subscales of AIMS 2 improved too , but only half of them were significant . Correlation between matching subscales of each test was also significant , except physical activity . CONCLUSION Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term BACKGROUND Balneotherapy , traditionally administered during a continuous stay at the Dead Sea area , has been shown to be effective for patients suffering from knee osteoarthritis . OBJECTIVES To evaluate the effectiveness of an intermittent regimen of balneotherapy at the Dead Sea for patients with knee osteoarthritis . METHODS Forty-four patients with knee osteoarthritis were included in a prospect i ve r and omized single-blind controlled study . The patients were divided into two groups : a treatment group ( n=24 ) , which were treated twice weekly for 6 consecutive weeks in a sulfur pool heated to 35 - 36 degrees C , and a control group ( n=20 ) treated in a Jacuzzi filled with tap water heated to 35 - 36 degrees C. Participants were assessed by the Lequesne index of osteoarthritis severity , the WOMAC index , the SF-36 quality of health question naire , VAS scales for pain ( completed by patients and physicians ) , and physical examination . RESULTS A statistically significant improvement , lasting up to 6 months , was observed in the treatment group for most of the clinical parameters . In the control group the only improvements were in the SF-36 bodily pain scale at 6 months , the Lequesne index at 1 month and the WOMAC pain score at the end of the treatment period . Although the patients in the control group had milder disease , the difference between the two groups was not statistically significant . CONCLUSIONS Intermittent balneotherapy appears to be effective for patients with knee osteoarthritis The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms , although little is known about their role in different circumstances . In this study , we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure . We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone ( GH ) and cortisol did not have any effect on the secretion of these hormones . However , if a preconditioning was performed with sumatriptan , a 5-HT1B/1D agonist that stimulates GH and inhibits cortisol secretion , a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration , although opposite verbal suggestions were given . These findings indicate that verbally induced expectations have no effect on hormonal secretion , whereas they affect pain and motor performance . This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved , whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play , even though a conditioning procedure is performed The objective of this prospect i ve parallel r and omized single-blind study was to assess that a cycle of mud-bath therapy ( MBT ) provides any benefits over usual treatment in patients with bilateral knee osteoarthritis ( OA ) . Patients with symptomatic primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : one group received a cycle of MBT at spa center of Chianciano Terme ( Italy )  in addition to the usual treatment , and one group continued their regular care routine alone .  Clinical assessment s were performed 7 days before enrollment ( screening visit ) , at the time of enrollment ( basal time ) , after 2 weeks , and after 3 , 6 , 9 , and 12 months after the beginning of the study . All assessment s were conducted by two research ers blinded to treatment allocation . The primary efficacy outcomes were the global pain score evaluated by Visual Analog Scale ( VAS ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) subscore for physical function ( W-TPFS ) .  Of the 235 patients screened , 103 met the inclusion criteria : 53 patients were included in the MBT group and 50 in the control group . In the group of patients treated with MBT , we observed a statistically significant ( p < 0.001 ) reduction of VAS and W-TPFS score at the end of the treatment ; this improvement was significant ( p < 0.05 ) also at 3 months of follow-up . The control group did not show significant differences between baseline time and all other times . The differences between one group were significant for both primary parameters already from the 15th day and persisted up to the 9th month . This beneficial effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of MBT seemed to be good , with light and transitory side effects . Our results confirm that a cycle of MBT added to usual treatment provides a beneficial effect on the painful symptoms and functional capacities in patients with knee OA that lasts over time . Mud-bath therapy can represent a useful backup to pharmacologic treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 BACKGROUND Osteoarthritis is a degenerative disease associated with pain , reduced range of motion , and impaired function . Balneotherapy or bathing in thermal or mineral waters is used as a non-invasive treatment for various rheumatic diseases . AIM To evaluate the effectiveness of hot sulfurous and non-sulfurous waters in the treatment of  knee osteoarthritis  . DESIGN A r and omized , assessor-blind , controlled trial . SETTING A spa resort . POPULATION One hundred and forty patients of both genders , mean age of 64.8±8.9 years , with knee osteoarthritis and chronic knee pain . METHODS Patients were r and omized into three groups : the sulfurous water ( SW ) group ( N.=47 ) , non-sulfurous water ( NSW ) group ( N.=50 ) , or control group ( N.=43 ) who received no treatment . Patients were not blinded to treatment allocation . Treatment groups received 30 individual thermal baths ( three 20-minute baths a week for 10 weeks ) at 37 - 39 ° C . The outcome measures were pain ( visual analog scale , VAS ) , physical function ( Western Ontario and McMaster Universities Osteoarthritis Index , WOMAC ; Lequesne Algofunctional Index , LAFI ; Stanford Health Assessment Question naire , HAQ ) , and use of pain medication . Patients were assessed before treatment ( T1 ) , at treatment endpoint ( T2 ) , and two months post-intervention ( T3 ) . Intra- and intergroup comparisons were performed at a significance level of 0.05 ( P<0.05 ) . RESULTS A significant decrease in VAS pain scores ( pain during movement , at rest , and at night ) and use of pain medication , and improvement in WOMAC , LAFI and HAQ scores were observed from baseline to T2 and T3 within treatment groups ( P<0.001 ) , and between controls and both treatment groups at T2 and T3 ( P<0.001 ) . No significant differences in these variables were observed between treatment groups at T2 , but patients in the SW group reported less pain and better functional status than those in the NSW group at T3 , showing a lasting effect of sulfurous water baths . CONCLUSIONS Both therapeutic methods were effective in the treatment of knee osteoarthritis ; however , sulfurous baths yielded longer-lasting effects than non-sulfurous water baths . CLINICAL REHABILITATION IMPACT Baths in thermal waters , especially those in sulfurous waters , are effective in reducing pain and improving physical function in patients with knee osteoarthritis The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis . In this double-blind , r and omized , follow-up study on 53 patients with knee osteoarthritis , one group received hot mud-pack therapy , whereas the other ( control ) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks . Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , EuroQoL-5D quality -of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment , at the end of treatment ( at Week 2 ) , and at Weeks 6 and 12 . The WOMAC and the EQ5D quality -of-life scores improved from the baseline to the end of treatment in both groups , and further improvement was observed during the follow-up period ( p < 0.001 , respectively , in both groups ) . The need for medications for knee joint pain improved in both groups , and these changes were significant only in the mud-treated group ( p < 0.001 ) , but not in the control group ( p = 0.106 ) compared to baseline . The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group , and these changes became significant by Visit 4 compared to baseline ( p = 0.016 ) . The control group showed only temporary and not significant decrease . The difference was not significant between the groups in any of the outcome parameters at any visits . The Neydharting mud pack has a favorable effect on the clinical parameters , quality of life , and need for medications in patients with knee osteoarthritis . To evaluate the chemical effect , the number of patients should be increased BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis . This is a r and omized , controlled , single-blind clinical trial . Fifty patients diagnosed with knee osteoarthrit 
    Output:
    