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: This prospect i ve , r and omized study compares functional outcomes between a novel support device ( Secure Tracks ™ ) and a st and ard walker  following unilateral total knee replacement . Thirty patients were r and omized for the study ; 15 walker patients ( 70.7±6.4 yrs ) and 15 Secure Track patients ( 68.2±6.7 yrs ) ( p=0.31 ) . Total distance walked during all therapy sessions was nearly two times greater in the Secure Track ( 2,332 ft ) than with the walker ( 1,241 ft)(p=.053 ) . This trend began on the day of surgery ( 275 ft vs. 176 ft , p<.069 ) and was statistically significant by the following morning ( 287 ft vs. 151 ft , p=.019 ) . Patients in the Secure Track spent a greater amount of time up and ambulating with the therapists in all sessions ( .006.30 ) . At the first clinical follow-up , patients that had walked in the Secure Track completed the timed up and go test ( TUG ) , a predictor of fall risk , 3 seconds faster than the st and ard rehabilitation group ( 9.6 vs. 12.9 seconds , p<.091 ) . The novel therapy patients demonstrated significantly greater pain relief following the TUG test ( p=.005 ) . This study demonstrates that the choice of support device can increase patient ambulation following surgery , which will in turn improve functional outcomes and pain relief Benefits of a direct anterior approach ( DAA ) versus a posterior-lateral ( PA ) approach to THA were assessed in a single-surgeon , IRB-approved , prospect i ve , r and omized clinical study . Subjects ( 43 DAA and 44 PA ) were evaluated at 6 weeks , and 3 , 6 and 12 months . The primary end point was ability to climb stairs normally and walk unlimited at each time point . Secondary end points included assessment by several outcome instruments . DAA subjects performed better during the immediate post-operative period ; they had lower VAS pain scores on the first post-operative day , more subjects climbing stairs normally and walking unlimited at 6 weeks , and higher HOOS Symptoms scores at 3 months . There were no significant differences between groups at later time points . Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive Tian W , DeJong G , Munin MC , Smout R : Patterns of  rehabilitation after hip arthroplasty and the association with outcomes : An episode of care view . Objectives : To examine the patterns of rehabilitation  after elective and nonelective hip arthroplasty  and its association with outcomes over an episode of postacute care . Design : Data were obtained from a multisite prospect i ve observational cohort study and its companion follow-up study . Patterns of care were measured by the combination of setting s of care where  hip arthroplasty patients received rehabilitation therapy . Main outcome measure was motor portion of the functional independence measure . Results : Approximately 90 % of hip arthroplasty patients received rehabilitation care from more than one setting . Eight patterns of care were identified in the follow-up period . Patterns of subsequent care were driven more by initial setting than by etiology . Nonelective hip arthroplasty patients had lower motor functional independence measure scores and used more rehabilitation services than did elective hip arthroplasty patients . Patterns of care were modest factors ( accounted for only 7 % of variance ) in predicting patient motor functional independence measure over an episode of postacute care . Conclusions : Etiology of hip arthroplasty is associated with amounts of rehabilitation care used and outcomes . After the initial postacute rehabilitation setting , patients continued to receive considerable amounts of therapy in various setting s. It is important to look beyond a single setting of care to an entire episode of care when examining clinical outcomes The aim of this study was to investigate whether pre-operative , sensorimotor training results in improved physical function , quality of life , sensorimotor function and reduced disability in total hip replacement patients . 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this r and omised controlled trial . The intervention group participated in a pre-operative home exercise sensorimotor training programme ; the control group received no therapy . Primary outcome measure was physical function , secondary outcome measures were quality of life , disability and sensorimotor function . Outcomes were measured using generic and disease-specific question naires as well as objective ly assessed balance ability . Measurements were taken one day before surgery and 10 days , 4 and 12 months after surgery . The intervention showed improved quality of life and sensorimotor function before surgery . These effects were lost following surgery . The intervention group experienced more disability at 4 months than the control group . At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point . It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme . The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies , reduce unrealistic expectations and increase satisfaction We have developed a 12-item question naire for patients having a total knee replacement ( TKR ) . We made a prospect i ve study of 117 patients before operation and at follow-up six months later , asking them to complete the new question naire and the form SF36 . Some also filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon completed the American Knee Society ( AKS ) clinical score . The single score derived from the new question naire had high internal consistency , and its reproducibility , examined by test-retest reliability , was found to be satisfactory . Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . We also compared change in scores with the patients ' retrospective judgement of change in their condition . The effect size for the new question naire compared favourably with those for the relevant parts of the SF36 . The change scores for the new knee question naire were significantly greater ( p < 0.0001 ) for patients who reported the most improvement in their condition . The new question naire provides a measure of outcome for TKR that is short , practical , reliable , valid and sensitive to clinical ly important changes over time Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain , function , satisfaction , and quality of life .  Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and r and omly allocated before admission to receive either the st and ard pathway of care or the rehabilitation program and booklet . All patients showed increases in function and psychological variables with time . The preoperative class and booklet , however , seemed to have the greatest impact on length of hospital stay , reducing the hospital stay by 3 days , and therapy input required , significantly influencing the cost of the procedure ( the rehabilitation class led to a cost saving of 587 British pounds ; approximately 810 dollars , per patient ) . In addition , patients attending the class reported higher levels of satisfaction ( 99 % satisfied in the preoperative rehabilitation class compared with 80 % in the control group 3 months postoperatively ) and had more realistic expectations of surgery OBJECTIVE To characterize rehabilitation services for patients with knee and hip replacement in 3 types of postacute facilities in the U.S. DESIGN Multi-site prospect i ve observational cohort study . SETTING Eight freest and ing skilled nursing facilities ( SNFs ) , 1 hospital-based SNF , and 11 inpatient rehabilitation facilities ( IRFs ) . PARTICIPANTS Patients ( N=2158 ) with knee or hip replacement . INTERVENTIONS No new interventions . MAIN OUTCOME MEASURES Length of stay ( LOS ) , amount and intensity of physical therapy ( PT ) and occupational therapy ( OT ) , types of therapy activities . RESULTS Average LOS was about 15 days for freest and ing SNF patients , and 9 to 10 days for hospital-based SNF and IRF patients . Freest and ing SNFs and IRFs provide about the same number of hours of PT and OT ; the hospital-based SNF provided 27 % fewer hours . Freest and ing SNFs and the hospital-based SNF provided fewer hours a day than did IRFs . Joint replacement patients across all 3 types of facilities spent , on average , 70 % to 75 % of their PT time in just 2 activities -- exercise and gait and spent 56 % to 66 % of their OT time in 3 activities -- exercise , functional mobility , and dressing lower body . CONCLUSIONS Both freest and ing SNFs and IRFs provided similar amounts of PT with a similar emphasis on exercise and gait activities . IRFs , however , provided more OT than freest and ing SNFs . IRFs had shorter LOSs and more intensive therapy services than freest and ing SNFs . Study freest and ing SNFs exhibited greater variation in LOS and intensity of therapy than IRFs Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers 
    Output:
    
agent
AUTHORS ' CONCLUSIONS Very low quality evidence is available from single trials , thus we are uncertain if hip pre caution s with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA .
***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: This prospect i ve , r and omized study compares functional outcomes between a novel support device ( Secure Tracks ™ ) and a st and ard walker  following unilateral total knee replacement . Thirty patients were r and omized for the study ; 15 walker patients ( 70.7±6.4 yrs ) and 15 Secure Track patients ( 68.2±6.7 yrs ) ( p=0.31 ) . Total distance walked during all therapy sessions was nearly two times greater in the Secure Track ( 2,332 ft ) than with the walker ( 1,241 ft)(p=.053 ) . This trend began on the day of surgery ( 275 ft vs. 176 ft , p<.069 ) and was statistically significant by the following morning ( 287 ft vs. 151 ft , p=.019 ) . Patients in the Secure Track spent a greater amount of time up and ambulating with the therapists in all sessions ( .006.30 ) . At the first clinical follow-up , patients that had walked in the Secure Track completed the timed up and go test ( TUG ) , a predictor of fall risk , 3 seconds faster than the st and ard rehabilitation group ( 9.6 vs. 12.9 seconds , p<.091 ) . The novel therapy patients demonstrated significantly greater pain relief following the TUG test ( p=.005 ) . This study demonstrates that the choice of support device can increase patient ambulation following surgery , which will in turn improve functional outcomes and pain relief Benefits of a direct anterior approach ( DAA ) versus a posterior-lateral ( PA ) approach to THA were assessed in a single-surgeon , IRB-approved , prospect i ve , r and omized clinical study . Subjects ( 43 DAA and 44 PA ) were evaluated at 6 weeks , and 3 , 6 and 12 months . The primary end point was ability to climb stairs normally and walk unlimited at each time point . Secondary end points included assessment by several outcome instruments . DAA subjects performed better during the immediate post-operative period ; they had lower VAS pain scores on the first post-operative day , more subjects climbing stairs normally and walking unlimited at 6 weeks , and higher HOOS Symptoms scores at 3 months . There were no significant differences between groups at later time points . Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases Purpose : Total hip arthroplasty ( THA ) is a common and effective treatment of hip osteoarthritis . Activity restrictions known as hip pre caution s are widely practice d in rehabilitation post THA , aim ing to foster healing and prevent hip dislocation . The focused clinical question was : Does the application of hip pre caution s in patients post THA versus unrestricted activities significantly decrease the risk of prosthetic dislocation ? Methods : A comprehensive literature search was conducted for r and omized controlled trials or cohort studies with a comparative group and minimum 6 months follow-up , with dislocation as an end point . Retrieved titles were assessed independently by 2 review ers for inclusion and underwent st and ardized data extraction . Results : Title search produced 80 potentially relevant articles . Five articles were retrieved for data extraction of which 2 met a prior eligibility criteria . No eligible studies were found that concerned posterior approaches to hip arthroplasty , so the results of this review concern only anterolateral approaches . Neither included study showed any benefit of hip pre caution s in preventing dislocation . Conclusion : The rate of dislocation after anterolateral THA is low and is not improved by hip pre caution s. Hip pre caution s are associated with a slower return to activities , significant expense , and decreased patient satisfaction . Existing studies risk being compromised by a type II error , but a definitive study may be prohibitively large and expensive Tian W , DeJong G , Munin MC , Smout R : Patterns of  rehabilitation after hip arthroplasty and the association with outcomes : An episode of care view . Objectives : To examine the patterns of rehabilitation  after elective and nonelective hip arthroplasty  and its association with outcomes over an episode of postacute care . Design : Data were obtained from a multisite prospect i ve observational cohort study and its companion follow-up study . Patterns of care were measured by the combination of setting s of care where  hip arthroplasty patients received rehabilitation therapy . Main outcome measure was motor portion of the functional independence measure . Results : Approximately 90 % of hip arthroplasty patients received rehabilitation care from more than one setting . Eight patterns of care were identified in the follow-up period . Patterns of subsequent care were driven more by initial setting than by etiology . Nonelective hip arthroplasty patients had lower motor functional independence measure scores and used more rehabilitation services than did elective hip arthroplasty patients . Patterns of care were modest factors ( accounted for only 7 % of variance ) in predicting patient motor functional independence measure over an episode of postacute care . Conclusions : Etiology of hip arthroplasty is associated with amounts of rehabilitation care used and outcomes . After the initial postacute rehabilitation setting , patients continued to receive considerable amounts of therapy in various setting s. It is important to look beyond a single setting of care to an entire episode of care when examining clinical outcomes The aim of this study was to investigate whether pre-operative , sensorimotor training results in improved physical function , quality of life , sensorimotor function and reduced disability in total hip replacement patients . 80 subjects awaiting total hip replacement at a Swiss hospital were recruited for this r and omised controlled trial . The intervention group participated in a pre-operative home exercise sensorimotor training programme ; the control group received no therapy . Primary outcome measure was physical function , secondary outcome measures were quality of life , disability and sensorimotor function . Outcomes were measured using generic and disease-specific question naires as well as objective ly assessed balance ability . Measurements were taken one day before surgery and 10 days , 4 and 12 months after surgery . The intervention showed improved quality of life and sensorimotor function before surgery . These effects were lost following surgery . The intervention group experienced more disability at 4 months than the control group . At one year follow-up group-membership influenced quality of life scores depending on the measurement-time-point . It can be concluded that no useful effect was identified for a pre-operative sensory-motor training-programme . The psychological aspects following total hip replacement need to be considered in order to facilitate coping-strategies , reduce unrealistic expectations and increase satisfaction We have developed a 12-item question naire for patients having a total knee replacement ( TKR ) . We made a prospect i ve study of 117 patients before operation and at follow-up six months later , asking them to complete the new question naire and the form SF36 . Some also filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon completed the American Knee Society ( AKS ) clinical score . The single score derived from the new question naire had high internal consistency , and its reproducibility , examined by test-retest reliability , was found to be satisfactory . Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . We also compared change in scores with the patients ' retrospective judgement of change in their condition . The effect size for the new question naire compared favourably with those for the relevant parts of the SF36 . The change scores for the new knee question naire were significantly greater ( p < 0.0001 ) for patients who reported the most improvement in their condition . The new question naire provides a measure of outcome for TKR that is short , practical , reliable , valid and sensitive to clinical ly important changes over time Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain , function , satisfaction , and quality of life .  Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and r and omly allocated before admission to receive either the st and ard pathway of care or the rehabilitation program and booklet . All patients showed increases in function and psychological variables with time . The preoperative class and booklet , however , seemed to have the greatest impact on length of hospital stay , reducing the hospital stay by 3 days , and therapy input required , significantly influencing the cost of the procedure ( the rehabilitation class led to a cost saving of 587 British pounds ; approximately 810 dollars , per patient ) . In addition , patients attending the class reported higher levels of satisfaction ( 99 % satisfied in the preoperative rehabilitation class compared with 80 % in the control group 3 months postoperatively ) and had more realistic expectations of surgery OBJECTIVE To characterize rehabilitation services for patients with knee and hip replacement in 3 types of postacute facilities in the U.S. DESIGN Multi-site prospect i ve observational cohort study . SETTING Eight freest and ing skilled nursing facilities ( SNFs ) , 1 hospital-based SNF , and 11 inpatient rehabilitation facilities ( IRFs ) . PARTICIPANTS Patients ( N=2158 ) with knee or hip replacement . INTERVENTIONS No new interventions . MAIN OUTCOME MEASURES Length of stay ( LOS ) , amount and intensity of physical therapy ( PT ) and occupational therapy ( OT ) , types of therapy activities . RESULTS Average LOS was about 15 days for freest and ing SNF patients , and 9 to 10 days for hospital-based SNF and IRF patients . Freest and ing SNFs and IRFs provide about the same number of hours of PT and OT ; the hospital-based SNF provided 27 % fewer hours . Freest and ing SNFs and the hospital-based SNF provided fewer hours a day than did IRFs . Joint replacement patients across all 3 types of facilities spent , on average , 70 % to 75 % of their PT time in just 2 activities -- exercise and gait and spent 56 % to 66 % of their OT time in 3 activities -- exercise , functional mobility , and dressing lower body . CONCLUSIONS Both freest and ing SNFs and IRFs provided similar amounts of PT with a similar emphasis on exercise and gait activities . IRFs , however , provided more OT than freest and ing SNFs . IRFs had shorter LOSs and more intensive therapy services than freest and ing SNFs . Study freest and ing SNFs exhibited greater variation in LOS and intensity of therapy than IRFs Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers 
    Output:
    