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: BACKGROUND Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity . Little is known about the relationship between low back pain and physical activity , and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population . OBJECTIVES We aim ed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain , and the impact of those perceptions and behaviour on physical activity . METHODS Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who , because of their low back trouble , had been referred by their GPs to a community-based , single-blind , r and omized controlled trial ( RCT ) at the University of York , which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme . Fifty-four interviews were conducted with this subgroup of the RCT ; four informants were interviewed once , 19 twice and four of them three times . Interviews were transcribed and analysed using manual and computer-aided approaches . RESULTS Physical activity was perceived as ( i ) activities of daily living , ( ii ) activities causing breathlessness that they went out of the way to do and ( iii ) more competitive-type activity . The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants ' backs and changes in physical activity . These two factors hindered increases in physical activity , even though the majority of informants believed strongly that being physically active helped ease their low back pain . CONCLUSIONS When advocating that individuals with acute low back pain return to or increase physical activity , it is important that clinicians identify avoidance of physical activity and /or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately . If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity , they should explore issues of fear of pain , and avoidance of and confidence to do physical activities , in addition to other factors influencing physical activity OBJECTIVES To investigate the course of  low back pain ( LBP ) in a general population over 5 years . DESIGN Prospect i ve population -based survey by postal question naires in 1991 , 1992 , and 1996 . SETTING The municipal of Ebeltoft , Denmark . SUBJECTS Two thous and people aged 30 to 50 years , representative of the Danish population . Main outcome measure Number of days with low back pain during the past year . RESULTS One thous and three hundred seventy were recruited of whom 813 ( 59 % ) were followed to 5 years . The responders could be divided into 3 groups with regard to LBP : no pain , short-term pain , and long-lasting/recurring pain . More than one third of people who experienced LBP in the previous year did so for > 30 days . Forty percent of people with LBP > 30 days at baseline remained in that group 1 and 5 years later , and 9 % with LBP > 30 days in year 0 were pain free in year 5 . People with LBP in year 0 were 4 times more likely to have LBP in year 1 , and 2 times more likely to be affected in year 5 . CONCLUSIONS Low back pain should not be considered transient and therefore neglected , since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions . On the other h and , chronicity as defined solely by the duration of symptoms should not be considered chronic Background Non-specific chronic low back pain ( NSCLBP ) has become a significant problem due to high healthcare utilization , rising costs of care and perceived limitations of effectiveness of many current treatments . Systematic review s have repeatedly concluded that , on average across participants , exercise for NSCLBP appears effective in decreasing pain and improving function . Not all people with NSCLBP benefit from exercise programs and it would assist care-providers and care-seekers if factors that impact on program effectiveness and success were identified . Methods and design The study will be a r and omised controlled trial comparing an exercise rehabilitation program informed by a participant preferences question naire compared to a program without this guideline for patients with chronic low back pain . A sample of 150 patients will be recruited in Melbourne , Australia through community-based healthcare clinics that provide supervised exercise rehabilitation programs for people with non-specific chronic low back pain . Clinicians will be r and omly assigned to exercise preferences question naire or no question naire and participants will be allocated in a concealed manner . A qualitative focus group study of exercise instructor feedback about the exercise preferences instrument will be embedded in the research design . Two qualitative focus group studies will also be conducted for participants in the intervention and the control groups to obtain feedback about participants ' experiences of the two types of exercise programs . The primary outcomes will be functional ability , pain , fear avoidance , exercise adherence . Discussion This trial will evaluate the effectiveness of individualised exercise prescription compared to usual exercise prescription for NSCLP and , using feedback following the trial , refine the exercise preferences question naire OBJECTIVES To explore the views of participants in a r and omized controlled trial of physical treatments for low back pain  about the treatment packages they received in the trial . METHODS Within a r and omized controlled trial that found small to moderate benefits from adding a manipulation package or an exercise programme to general practice care , we elicited participants ' views on the treatment using an open question in participant question naires . These data were analysed using an adapted framework approach . RESULTS We received a total of 1259 comments from 1334 participants . Participants r and omized to usual general practice care reported dissatisfaction with receiving only ' usual care ' , which consisted of providing analgesic medication without providing an explanation for their pain . Those r and omized to a manipulation package felt the intervention was appropriate to their needs and commonly reported striking benefits . Participants assigned to the exercise programme developed a sense of self-reliance in managing back pain , although some failed to be sufficiently motivated to continue their exercise regimen outside the classes . CONCLUSIONS This qualitative analysis has found much clearer differences between the groups than the main quantitative analysis . This suggests that some of the added value from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement . Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value of such treatments to individual patients Study Design . Population -based , prospect i ve cohort . Objectives . To estimate incidence and course of severity- grade d low back pain ( LBP ) episodes in adults . Summary of Background Data . Past studies report variable estimates that do not differentiate LBP severity . Methods . An incidence cohort of 318 subjects free of LBP and a course cohort of 792 prevalent cases was formed from respondents to a mailed survey .  Incident , recurrent , persistent , aggravated , improved , and resolved episodes were defined by the Chronic Pain Question naire . The follow-up at 6 and 12 months was 74 % and 62 % , respectfully . Annual estimates were age and sex st and ardized . Results . The cumulative incidence was 18.6 % ( 95 % confidence interval [ CI ] , 14.2%–23.0 % ) . Most LBP episodes were mild . Only 1.0 % ( 95 % CI , 0.0%–2.2 % ) developed intense and 0.4 % ( 95 % CI , 0.0%–1.0 % ) developed disabling LBP . Resolution occurred in 26.8 % ( 95 % CI , 23.7%–30.0 % ) , and 40.2 % ( 95 % CI , 36.7%–43.8 % ) of episodes persisted . The severity of LBP increased for 14.2 % ( 95 % CI , 11.5%–16.8 % ) and improved for 36.1 % ( 95 % CI , 29.7%–42.2 % ) . Of those that recovered , 28.7 % ( 95 % CI , 21.2%–36.2%)had a recurrence within 6months , and 82.4 % of it was mild LBP . Younger subjects were less likely to have persistent LBP ( incidence rate ratio , 0.88 ; 95 % CI , 0.80–0.97 ) and more likely to have resolution ( incidence rate ratio , 1.26 ; 95 % CI , 1.02–1.56 ) . Conclusions . Most new and recurrent LBP episodes are mild . Less than one third of cases resolve annually , and more than 20 % recur within 6 months . LBP episodes are more recurrent and persistent in older adults Spinal stabilisation exercises are commonly used in the management of low back pain ( LBP ) . There is limited evidence relating to patients ' experiences of their involvement in such programmes . The aim of this study was to explore the experiences of a sample of individuals with chronic LBP who participated in a r and omised controlled trial ( RCT ) investigating the most efficacious dosage and frequency of spinal stabilisation exercises .  The qualitative study involved nine participants who took part in focus group discussion s. The data were analysed using thematic content analysis and provided insights into the experiences of the participants . Four themes emerged : Physical dimensions of the LBP experience , emotional and psychological dimensions of the LBP experience and perceived effects of the programme and lastly , the impact of the treatment programme on participants ' knowledge , underst and ing and adherence . In conclusion participants ' experiences were not limited to the positive effects of stabilisation exercises on pain , functional disability and quality of life , but also reflected increases in confidence , the formulation of self help strategies and the ability to exert better control over their LBP . The findings highlight the importance of well planned associated educational support packages in the treatment of LBP paving the way for future qualitative research & NA ; Using latent class analysis ( LCA ) , a previous study on patients attending primary care identified four courses of low back pain ( LBP ) over the subsequent 6 months . To date , no studies have used longitudinal pain recordings to examine the “ natural ” course of recurrent and chronic LBP in a population ‐based sample of individuals . This study examines the course of LBP in the general population and elaborates on the stability and criterion‐related validity of the clusters derived . A r and om sample of 400 individuals reporting LBP in a population ‐based study was asked to complete a comprehensive question naire at the start and end of the year 's survey , and 52 weekly pain diaries in between . The latter were analyzed using LCA . 305 individuals returned more than 50 % of the diaries . Four clusters were identified ( severe persistent , moderate persistent , mild persistent , and fluctuating ) . The clusters differed significantly with regards to pain and disability . Assessment of cluster stability showed that a considerable proportion of patients in the “ fluctuating ” group changed their classification over time . Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care . Due to the population ‐based design , this study achieves , for the first time , a close insight into the “ natural ” course of chronic and recurrent low back pain , including individuals that did not necessarily visit the general practitioner . The findings will help to underst and better the nature of this pain in the general population 
    Output:
    
agent
Participants believed that there were distinctions between general activity , real/fitness exercise , and medical exercise .
People participating in exercise classes and group work may be more comfortable when matched for abilities and experience .
When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement , people make a reasoned decision to discontinue .
DISCUSSION People are likely to prefer and participate in exercise or training programs and activities that are design ed with consideration of their preferences , circumstances , fitness levels , and exercise experiences
***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: BACKGROUND Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity . Little is known about the relationship between low back pain and physical activity , and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population . OBJECTIVES We aim ed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain , and the impact of those perceptions and behaviour on physical activity . METHODS Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who , because of their low back trouble , had been referred by their GPs to a community-based , single-blind , r and omized controlled trial ( RCT ) at the University of York , which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme . Fifty-four interviews were conducted with this subgroup of the RCT ; four informants were interviewed once , 19 twice and four of them three times . Interviews were transcribed and analysed using manual and computer-aided approaches . RESULTS Physical activity was perceived as ( i ) activities of daily living , ( ii ) activities causing breathlessness that they went out of the way to do and ( iii ) more competitive-type activity . The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants ' backs and changes in physical activity . These two factors hindered increases in physical activity , even though the majority of informants believed strongly that being physically active helped ease their low back pain . CONCLUSIONS When advocating that individuals with acute low back pain return to or increase physical activity , it is important that clinicians identify avoidance of physical activity and /or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately . If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity , they should explore issues of fear of pain , and avoidance of and confidence to do physical activities , in addition to other factors influencing physical activity OBJECTIVES To investigate the course of  low back pain ( LBP ) in a general population over 5 years . DESIGN Prospect i ve population -based survey by postal question naires in 1991 , 1992 , and 1996 . SETTING The municipal of Ebeltoft , Denmark . SUBJECTS Two thous and people aged 30 to 50 years , representative of the Danish population . Main outcome measure Number of days with low back pain during the past year . RESULTS One thous and three hundred seventy were recruited of whom 813 ( 59 % ) were followed to 5 years . The responders could be divided into 3 groups with regard to LBP : no pain , short-term pain , and long-lasting/recurring pain . More than one third of people who experienced LBP in the previous year did so for > 30 days . Forty percent of people with LBP > 30 days at baseline remained in that group 1 and 5 years later , and 9 % with LBP > 30 days in year 0 were pain free in year 5 . People with LBP in year 0 were 4 times more likely to have LBP in year 1 , and 2 times more likely to be affected in year 5 . CONCLUSIONS Low back pain should not be considered transient and therefore neglected , since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions . On the other h and , chronicity as defined solely by the duration of symptoms should not be considered chronic Background Non-specific chronic low back pain ( NSCLBP ) has become a significant problem due to high healthcare utilization , rising costs of care and perceived limitations of effectiveness of many current treatments . Systematic review s have repeatedly concluded that , on average across participants , exercise for NSCLBP appears effective in decreasing pain and improving function . Not all people with NSCLBP benefit from exercise programs and it would assist care-providers and care-seekers if factors that impact on program effectiveness and success were identified . Methods and design The study will be a r and omised controlled trial comparing an exercise rehabilitation program informed by a participant preferences question naire compared to a program without this guideline for patients with chronic low back pain . A sample of 150 patients will be recruited in Melbourne , Australia through community-based healthcare clinics that provide supervised exercise rehabilitation programs for people with non-specific chronic low back pain . Clinicians will be r and omly assigned to exercise preferences question naire or no question naire and participants will be allocated in a concealed manner . A qualitative focus group study of exercise instructor feedback about the exercise preferences instrument will be embedded in the research design . Two qualitative focus group studies will also be conducted for participants in the intervention and the control groups to obtain feedback about participants ' experiences of the two types of exercise programs . The primary outcomes will be functional ability , pain , fear avoidance , exercise adherence . Discussion This trial will evaluate the effectiveness of individualised exercise prescription compared to usual exercise prescription for NSCLP and , using feedback following the trial , refine the exercise preferences question naire OBJECTIVES To explore the views of participants in a r and omized controlled trial of physical treatments for low back pain  about the treatment packages they received in the trial . METHODS Within a r and omized controlled trial that found small to moderate benefits from adding a manipulation package or an exercise programme to general practice care , we elicited participants ' views on the treatment using an open question in participant question naires . These data were analysed using an adapted framework approach . RESULTS We received a total of 1259 comments from 1334 participants . Participants r and omized to usual general practice care reported dissatisfaction with receiving only ' usual care ' , which consisted of providing analgesic medication without providing an explanation for their pain . Those r and omized to a manipulation package felt the intervention was appropriate to their needs and commonly reported striking benefits . Participants assigned to the exercise programme developed a sense of self-reliance in managing back pain , although some failed to be sufficiently motivated to continue their exercise regimen outside the classes . CONCLUSIONS This qualitative analysis has found much clearer differences between the groups than the main quantitative analysis . This suggests that some of the added value from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement . Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value of such treatments to individual patients Study Design . Population -based , prospect i ve cohort . Objectives . To estimate incidence and course of severity- grade d low back pain ( LBP ) episodes in adults . Summary of Background Data . Past studies report variable estimates that do not differentiate LBP severity . Methods . An incidence cohort of 318 subjects free of LBP and a course cohort of 792 prevalent cases was formed from respondents to a mailed survey .  Incident , recurrent , persistent , aggravated , improved , and resolved episodes were defined by the Chronic Pain Question naire . The follow-up at 6 and 12 months was 74 % and 62 % , respectfully . Annual estimates were age and sex st and ardized . Results . The cumulative incidence was 18.6 % ( 95 % confidence interval [ CI ] , 14.2%–23.0 % ) . Most LBP episodes were mild . Only 1.0 % ( 95 % CI , 0.0%–2.2 % ) developed intense and 0.4 % ( 95 % CI , 0.0%–1.0 % ) developed disabling LBP . Resolution occurred in 26.8 % ( 95 % CI , 23.7%–30.0 % ) , and 40.2 % ( 95 % CI , 36.7%–43.8 % ) of episodes persisted . The severity of LBP increased for 14.2 % ( 95 % CI , 11.5%–16.8 % ) and improved for 36.1 % ( 95 % CI , 29.7%–42.2 % ) . Of those that recovered , 28.7 % ( 95 % CI , 21.2%–36.2%)had a recurrence within 6months , and 82.4 % of it was mild LBP . Younger subjects were less likely to have persistent LBP ( incidence rate ratio , 0.88 ; 95 % CI , 0.80–0.97 ) and more likely to have resolution ( incidence rate ratio , 1.26 ; 95 % CI , 1.02–1.56 ) . Conclusions . Most new and recurrent LBP episodes are mild . Less than one third of cases resolve annually , and more than 20 % recur within 6 months . LBP episodes are more recurrent and persistent in older adults Spinal stabilisation exercises are commonly used in the management of low back pain ( LBP ) . There is limited evidence relating to patients ' experiences of their involvement in such programmes . The aim of this study was to explore the experiences of a sample of individuals with chronic LBP who participated in a r and omised controlled trial ( RCT ) investigating the most efficacious dosage and frequency of spinal stabilisation exercises .  The qualitative study involved nine participants who took part in focus group discussion s. The data were analysed using thematic content analysis and provided insights into the experiences of the participants . Four themes emerged : Physical dimensions of the LBP experience , emotional and psychological dimensions of the LBP experience and perceived effects of the programme and lastly , the impact of the treatment programme on participants ' knowledge , underst and ing and adherence . In conclusion participants ' experiences were not limited to the positive effects of stabilisation exercises on pain , functional disability and quality of life , but also reflected increases in confidence , the formulation of self help strategies and the ability to exert better control over their LBP . The findings highlight the importance of well planned associated educational support packages in the treatment of LBP paving the way for future qualitative research & NA ; Using latent class analysis ( LCA ) , a previous study on patients attending primary care identified four courses of low back pain ( LBP ) over the subsequent 6 months . To date , no studies have used longitudinal pain recordings to examine the “ natural ” course of recurrent and chronic LBP in a population ‐based sample of individuals . This study examines the course of LBP in the general population and elaborates on the stability and criterion‐related validity of the clusters derived . A r and om sample of 400 individuals reporting LBP in a population ‐based study was asked to complete a comprehensive question naire at the start and end of the year 's survey , and 52 weekly pain diaries in between . The latter were analyzed using LCA . 305 individuals returned more than 50 % of the diaries . Four clusters were identified ( severe persistent , moderate persistent , mild persistent , and fluctuating ) . The clusters differed significantly with regards to pain and disability . Assessment of cluster stability showed that a considerable proportion of patients in the “ fluctuating ” group changed their classification over time . Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care . Due to the population ‐based design , this study achieves , for the first time , a close insight into the “ natural ” course of chronic and recurrent low back pain , including individuals that did not necessarily visit the general practitioner . The findings will help to underst and better the nature of this pain in the general population 
    Output:
    