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 AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved Study Design . A baseline study of the general population and the health care providers in 3 Norwegian counties . Objective . To investigate if beliefs about low back pain ( LBP ) are related to personal experiences and profession sought for care . Summary of Background Data . Myths about LBP that are ab and oned by health professionals are still alive in the public . Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP . Methods . A sample of 1502 r and omly selected people was interviewed  by telephone , and all the 1105 physicians , physiotherapists , and chiropractors in the area were sent a question naire in April 2002 . All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP . Results . Personal back pain experiences were important for beliefs about LBP . People with a history of previous back pain had more faith in the 2 statements “ Back pain recovers best by itself ” ( 52.2 % ) and “ In most cases back pain recovers by itself in a couple of weeks ” ( 32.5 % ) than those with current pain ( 36.9 % and 20.9 % , respectively , P < 0.000 ) . There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements , and these differences were also reflected in the beliefs of patients treated by the different professional groups . Conclusions . Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain . Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider . These differences may frustrate the public and patients who visit more than one provider , and hinder collaboration among professional groups The primary purpose of this study was to examine the extent to which specific patient attitudes and beliefs about medical care and  self-care for back pain predict future healthcare use . An automated data base allowed examination of the predictive relationships in two primary care patient sample s. In general , beliefs that physicians should find a definitive cause and permanent cure for back pain predicted neither physician visits nor prescription medication fills . Patient attitudes endorsing the benefits of medical treatment for back pain ( as opposed to a permanent cure ) predicted the use of these specific healthcare services . In a third sample of primary care back pain patients , we assessed whether a four-session self-care intervention modified those attitudes and beliefs shown to predict future healthcare use . The group intervention was associated with changes in attitudes about use of physician services but not medication use . A secondary purpose was to examine initial psychometric properties of a proposed back pain Self-Care Orientation Scale made up of the original 11 items . Factor analyses of the item set yielded three factors , but inconclusive results ; the internal consistency of the identified sub-scales was only moderate . However , findings that a subset of items predicted physician visits and prescriptions medication fills , and was sensitive to change following a self-care intervention , suggest avenues for improving measurement of self-care orientation . These findings help clarify specific patient attitudes and beliefs that are related to healthcare utilization and suggest that a subset of these beliefs can be modified through a brief educational intervention We r and omly surveyed 100 specialists in rehabilitation medicine and 100 rheumatologists concerning their perceptions of the value of 11 different physical modalities -- cold , active and passive exercise , interferential current , laser , magnetotherapy , microwave , shortwave diathermy , traction , ultrasound and transcutaneous nerve stimulation in the treatment of seven different musculoskeletal conditions -- acute arthritis , joint contracture , neck pain , back pain , tendinitis , reflex sympathetic dystrophy and frozen shoulder . There were significant differences in the perceived benefits of modalities which varied by modality and condition . Overall , rehabilitation medicine specialists regarded modalities to be helpful more often than rheumatologists ( P < 0.001 ) & NA ; Psychosocial factors have been shown to play an important role in the development of chronic low back pain ( LBP ) . In our recently completed cluster‐r and omized trial we found , however , no evidence of an effect of our minimal intervention strategy ( MIS ) aim ed at psychosocial factors , over usual care ( UC ) in patients with (sub)acute LBP . To explore the reasons why , this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS . General practitioner ( GP ) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions . GP behaviour was evaluated by analysing treatment registration forms and patients ' responses to items regarding treatment content . Patients also scored items on satisfaction and compliance . Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Question naire , the Coping Strategies Question naire and the 4‐Dimensional Symptom Question naire . A total of 60 GPs and 314 patients participated in the study . GPs in the MIS‐group adopted a less biomedical orientated attitude than in the UC‐group , but were only moderately successful in identification of psychosocial factors . Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups . Changes on psychosocial measures , however , did not differ between groups . The suboptimal identification of psychosocial factors in the MIS‐group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC There are no national low back pain ( LBP ) clinical guidelines in Irel and , and neither the level of adherence of General Practitioners ( GPs ) to the European guidelines , nor the cost of LBP to the patient and the state , have been investigated . A prospect i ve pilot study was conducted on 54 consenting patients ( 18 M , 36F : mean age ( SD ) : 40.5 ( 14.3 ) years ) with a new episode of acute LBP ( <3 months ) attending one of nine participating GPs . Baseline demographic , LBP classification [ i.e. simple back ache ( SBA ) , nerve root pain ( NRP ) , serious spinal pathology ( SSP ) ] and primary care management data were recorded over a three month period . Adherence and costs were estimated based on : medication prescription , referral for investigations , treatment or consultations , and wage replacement costs ( time signed off work ) . For both SBA and NRP , medication prescriptions were consistent with European guideline recommendations , but not for referral for further treatment ( 39 % of SBA patients were referred on first visit ) , secondary care ( 54 % of NRP patients were referred on first visit ) , or discontinuation of work ( 50 % NRP patients on first GP visit ) . The average total cost ( direct and wage replacement ) for a single episode of LBP over 12 weeks was 20,531 Euros ( 20,300 - 20,762 ) . Direct costs accounted for 43 % [ 8874.36 Euros , ( 8643.37 - 9105.37 Euros ) ] and wage replacement costs 57 % ( 11,657 Euros ) . In conclusion , management of acute LBP in a cohort of GPs in Irel and was not consistent with European clinical guideline recommendations , and warrants higher levels of postgraduate education among GPs , as well as restructuring of primary care services , which should improve patient outcome and reduce costs Concepts of disease , illness ( being ill ) , and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories . Question naires were filled in by 898 individuals ; 194 General Practitioners , 76 medical consultants working for the National Insurance Administration , 307 insurance clerks , and a representative sample ( N = 321 ) of the general public . The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems . Discrepancies between the medical profession representatives and the general public were , in general , attributable to differences in information and knowledge about these somatic conditions . However , for musculoskeletal pain all groups had conceptual problems . In particular , there was a lack of consensus for issuing sickness certificates . For musculoskeletal pain conditions the doctors , as a group , seemed to score at r and om or 50 - 50 level for sickness certification . All groups , including medical doctors , were reluctant to accept depression and social problems as diseases , or to accept social problems as reasons for sickness certification . The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints 
    Output:
    
agent
Themes that emerged included doctors ' attitudes and beliefs , and four factors that influenced attitudes and beliefs : doctors ' specialty , demographic factors , personal beliefs and education .
There was consistent evidence that doctors ' specialty impacted their attitudes and beliefs : lack of consensus regarding the natural history of LBP , around treatment options , and issues regarding work .
There was inconsistent evidence that demographic factors ( age ) and level of education impacted doctors ' attitudes and beliefs .
Long term , these changes in these areas have the potential to maximise patient-care , and reduce costs to health services
***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 AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved Study Design . A baseline study of the general population and the health care providers in 3 Norwegian counties . Objective . To investigate if beliefs about low back pain ( LBP ) are related to personal experiences and profession sought for care . Summary of Background Data . Myths about LBP that are ab and oned by health professionals are still alive in the public . Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP . Methods . A sample of 1502 r and omly selected people was interviewed  by telephone , and all the 1105 physicians , physiotherapists , and chiropractors in the area were sent a question naire in April 2002 . All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP . Results . Personal back pain experiences were important for beliefs about LBP . People with a history of previous back pain had more faith in the 2 statements “ Back pain recovers best by itself ” ( 52.2 % ) and “ In most cases back pain recovers by itself in a couple of weeks ” ( 32.5 % ) than those with current pain ( 36.9 % and 20.9 % , respectively , P < 0.000 ) . There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements , and these differences were also reflected in the beliefs of patients treated by the different professional groups . Conclusions . Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain . Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider . These differences may frustrate the public and patients who visit more than one provider , and hinder collaboration among professional groups The primary purpose of this study was to examine the extent to which specific patient attitudes and beliefs about medical care and  self-care for back pain predict future healthcare use . An automated data base allowed examination of the predictive relationships in two primary care patient sample s. In general , beliefs that physicians should find a definitive cause and permanent cure for back pain predicted neither physician visits nor prescription medication fills . Patient attitudes endorsing the benefits of medical treatment for back pain ( as opposed to a permanent cure ) predicted the use of these specific healthcare services . In a third sample of primary care back pain patients , we assessed whether a four-session self-care intervention modified those attitudes and beliefs shown to predict future healthcare use . The group intervention was associated with changes in attitudes about use of physician services but not medication use . A secondary purpose was to examine initial psychometric properties of a proposed back pain Self-Care Orientation Scale made up of the original 11 items . Factor analyses of the item set yielded three factors , but inconclusive results ; the internal consistency of the identified sub-scales was only moderate . However , findings that a subset of items predicted physician visits and prescriptions medication fills , and was sensitive to change following a self-care intervention , suggest avenues for improving measurement of self-care orientation . These findings help clarify specific patient attitudes and beliefs that are related to healthcare utilization and suggest that a subset of these beliefs can be modified through a brief educational intervention We r and omly surveyed 100 specialists in rehabilitation medicine and 100 rheumatologists concerning their perceptions of the value of 11 different physical modalities -- cold , active and passive exercise , interferential current , laser , magnetotherapy , microwave , shortwave diathermy , traction , ultrasound and transcutaneous nerve stimulation in the treatment of seven different musculoskeletal conditions -- acute arthritis , joint contracture , neck pain , back pain , tendinitis , reflex sympathetic dystrophy and frozen shoulder . There were significant differences in the perceived benefits of modalities which varied by modality and condition . Overall , rehabilitation medicine specialists regarded modalities to be helpful more often than rheumatologists ( P < 0.001 ) & NA ; Psychosocial factors have been shown to play an important role in the development of chronic low back pain ( LBP ) . In our recently completed cluster‐r and omized trial we found , however , no evidence of an effect of our minimal intervention strategy ( MIS ) aim ed at psychosocial factors , over usual care ( UC ) in patients with (sub)acute LBP . To explore the reasons why , this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS . General practitioner ( GP ) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions . GP behaviour was evaluated by analysing treatment registration forms and patients ' responses to items regarding treatment content . Patients also scored items on satisfaction and compliance . Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Question naire , the Coping Strategies Question naire and the 4‐Dimensional Symptom Question naire . A total of 60 GPs and 314 patients participated in the study . GPs in the MIS‐group adopted a less biomedical orientated attitude than in the UC‐group , but were only moderately successful in identification of psychosocial factors . Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups . Changes on psychosocial measures , however , did not differ between groups . The suboptimal identification of psychosocial factors in the MIS‐group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC There are no national low back pain ( LBP ) clinical guidelines in Irel and , and neither the level of adherence of General Practitioners ( GPs ) to the European guidelines , nor the cost of LBP to the patient and the state , have been investigated . A prospect i ve pilot study was conducted on 54 consenting patients ( 18 M , 36F : mean age ( SD ) : 40.5 ( 14.3 ) years ) with a new episode of acute LBP ( <3 months ) attending one of nine participating GPs . Baseline demographic , LBP classification [ i.e. simple back ache ( SBA ) , nerve root pain ( NRP ) , serious spinal pathology ( SSP ) ] and primary care management data were recorded over a three month period . Adherence and costs were estimated based on : medication prescription , referral for investigations , treatment or consultations , and wage replacement costs ( time signed off work ) . For both SBA and NRP , medication prescriptions were consistent with European guideline recommendations , but not for referral for further treatment ( 39 % of SBA patients were referred on first visit ) , secondary care ( 54 % of NRP patients were referred on first visit ) , or discontinuation of work ( 50 % NRP patients on first GP visit ) . The average total cost ( direct and wage replacement ) for a single episode of LBP over 12 weeks was 20,531 Euros ( 20,300 - 20,762 ) . Direct costs accounted for 43 % [ 8874.36 Euros , ( 8643.37 - 9105.37 Euros ) ] and wage replacement costs 57 % ( 11,657 Euros ) . In conclusion , management of acute LBP in a cohort of GPs in Irel and was not consistent with European clinical guideline recommendations , and warrants higher levels of postgraduate education among GPs , as well as restructuring of primary care services , which should improve patient outcome and reduce costs Concepts of disease , illness ( being ill ) , and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories . Question naires were filled in by 898 individuals ; 194 General Practitioners , 76 medical consultants working for the National Insurance Administration , 307 insurance clerks , and a representative sample ( N = 321 ) of the general public . The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems . Discrepancies between the medical profession representatives and the general public were , in general , attributable to differences in information and knowledge about these somatic conditions . However , for musculoskeletal pain all groups had conceptual problems . In particular , there was a lack of consensus for issuing sickness certificates . For musculoskeletal pain conditions the doctors , as a group , seemed to score at r and om or 50 - 50 level for sickness certification . All groups , including medical doctors , were reluctant to accept depression and social problems as diseases , or to accept social problems as reasons for sickness certification . The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints 
    Output:
    