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: Study Design . A prospect i ve cohort study including patients with nonspecific spinal pain was performed . Objectives . To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment . Summary of Background Data . A wide range of instruments and techniques are used to assess and treat patients with spinal pain . Many instruments are used without being clinimetrically tested . Methods . A question naire concerning the patients ’ need of treatment and their potential to assimilate it was sent to experts in the health care arena : physicians , physical therapists , social insurance officers . The experts included were those connected with patients participating in a larger outcome study . Two cohorts of patients ( sample 1 , n = 217 ; sample 2 , n = 257 ) were followed for 6 and 12 months , during which time the patients ’ health and work status were mapped . Results . No acceptable agreement was found between any of the experts ’ ratings of patients ’ needs and potential for rehabilitation . Logistic regression showed that the experts ’ judgments were based almost solely on the age of the patient . The prediction analyses showed that the most consistent predictor of the patients ’ status at the 6-month follow-up assessment was the patients ’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition . Conclusions . Expert judgment as exercised in routine practice can not be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient ’s ability to benefit from treatment Study Design . A prospect i ve cross-sectional study was conducted . Objective . To determine the relation between degeneration of all the joints in the cervical spine , and to identify the effects of litigation on pain and disability levels in trauma and nontrauma patients . Summary of Background Data . The link between spinal degeneration and patient symptoms remains controversial . Two recent similar studies present conflicting results concerning the association between spinal degeneration and symptomatology . These two studies , performed in different countries , did not consider the impact of impending litigation on self-reported pain and disability levels . The role of the uncovertebral and facet articulations has hitherto not been investigated . Methods . Radiographic and question naire data from 180 consecutive patients with neck pain were collected .  Neck pain severity was measured using two time-dependent scales . All patients completed the Neck Disability Index ( NDI ) and questions about chronicity , etiology , and associated litigation . The radiographs were evaluated for the number of levels of degeneration and the severity of degeneration in the discs as well as the uncovertebral and facet articulations . Results . In this study , 71 patients ( 40.57 % ) reported neck pain  as a result of injury . However , only 5.1 % had associated litigation . There was no statistically significant difference in pain severity or disability levels between the patients with and those without cervical degeneration . According to the findings , the number of levels of cervical degeneration and the severity of degeneration in the discs , facets , and uncovertebral joints are not related to the levels of pain and disability . Patients reporting neck pain caused by injury had a tendency ( P = 0.055 ) to more pain during the preceding week and significantly more disability ( P < 0.001 ) . Significant differences included pain intensity ( P < 0.025 ) , reading ( P < 0.001 ) , headaches ( P < 0.025 ) , ability to drive ( P < 0.01 ) , and concentration ( P < 0.01 ) . Women reported significantly more pain ( P < 0.01 ) and disability ( P < 0.001 ) than men , but did not have more degeneration in any of the joints . Conclusions . In patients with neck pain , there is no difference in reported pain and disability levels between those with and those without evidence of cervical spine degeneration . Patients whose neck pain is the result of trauma report significantly more pain and disability than nontrauma patients . This is not because of more spinal degeneration or overriding litigation issues The authors prospect ively evaluated 3020 volunteers of the Boeing-Everett plant to assess risk factors that predispose workers to file industrial back injury cl aims . During four years of follow-up observation , more than 279 subjects reported acute back problems .  The effect of the only predictive physical variable was explainable by a history of medical treatment . The most predictive individual factors were ( 1 ) job task dissatisfaction and ( 2 ) distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory ( MMPI ) . This data perhaps explains why the focus on purely physical and injury-related factors has met with little success in dealing with what has become the most expensive orthopedic problem . Clinical ly , nonphysical factors that significantly impact the reporting of back injuries may also affect patients ' responses to medical treatment Study Design . R and omized controlled trial . Objectives . To investigate the effectiveness and costs of a mini-intervention , provided in addition to the usual care , and the incremental effect of a work site visit for patients with subacute disabling low back pain . Summary of Background Data . There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain . Methods . A total of 164 patients with subacute low back pain were r and omized to a  mini-intervention group ( A ) , a work site visit group ( B ) , or a usual care group ( C ) . Groups A ( n = 56 ) and B ( n = 51 ) underwent one assessment by a physician plus a physiotherapist . Group B received a work site visit in addition . Group C served as controls ( n = 57 ) and was treated in municipal primary health care . All patients received a leaflet on back pain . Pain , disability , specific and generic health-related quality of life , satisfaction with care , days on sick leave , and use and costs of health care consumption were measured at 3- , 6- , and 12-month follow-ups . Results . During follow-up , fewer subjects had daily pain in Groups A and B than in Group C ( Group A vs. Group C , P = 0.002 ; Group B vs. Group C , P = 0.030 ) . In Group A , pain was less bothersome ( Group A vs. Group C , P = 0.032 ) and interfered less with daily life ( Group A vs. Group C , P = 0.040 ) than among controls . Average days on sick leave were 19 in Group A , 28 in Group B , and 41 in Group C ( Group A vs. Group C , P = 0.019 ) . Treatment satisfaction was better in the intervention groups than among the controls , and costs were lowest in the mini-intervention group . Conclusions . Mini-intervention reduced daily back pain symptoms and sickness absence , improved adaptation to pain and patient satisfaction among patients with subacute low back pain , without increasing health care costs . A work site visit did not increase effectiveness Objective : To determine whether physical and psychosocial load at work influence sickness absence due to low back pain . Methods : The research was a part of the study on musculoskeletal disorders , absenteeism , stress , and health ( SMASH ) , a 3 year prospect i ve cohort study on risk factors for musculoskeletal disorders . Workers from 21 companies located throughout The Netherl and s participated in the part of this study on sickness absence due to low back pain . The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period . The mean ( range ) period of follow up in this group was 37 ( 7–44 ) months . Physical load at work was assessed by analyses of video recordings . Baseline information on psychosocial work characteristics was obtained by a question naire . Data on sickness absence were collected from company records . The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period . Results : After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants , significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion , trunk rotation , lifting , and low job satisfaction . A dose-response relation was found for trunk flexion , but not for trunk rotation or lifting . Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support . Quantitative job dem and s , conflicting dem and s , decision authority , and skill discretion showed no relation with sickness absence due to low back pain . Conclusions : Flexion and rotation of the trunk , lifting , and low job satisfaction are risk factors for sickness absence due to low back pain . Some indications of a relation between low social support , either from supervisors or coworkers , and sickness absence due to low back pain are also present Study Design . Population ‐based r and omized clinical trial . Objectives . To develop and test a model of management of subacute back pain , to prevent prolonged disability . Summary of Background Data . The present management of back pain seems inadequate , and development of innovative models has been urged . Methods . A model for the treatment of subacute work‐related back pain has been developed and evaluated in a population ‐based r and omized clinical trial . Workers ( n = 130 ) from eligible workplaces in the Sherbrooke area ( N = 31 ) , who had been absent from work for more than 4 weeks for back pain , were r and omized , based on their workplace , in one of four treatment groups : usual care , clinical intervention , occupational intervention , and full intervention ( a combination of the last two ) . The duration of absence from regular work and from any work was evaluated using survival analysis . Functional status and pain were compared at study entry and after 1 year of follow‐up . Results . The full intervention group returned to regular work 2.41 times faster than the usual care intervention group ( 95 % confidence interval 1.19‐4.89 ; P = 0.01 ) . The specific effect of the occupational intervention accounted for the most important part of this result , with a rate ratio of return to regular work of 1.91 ( 95 % confidence interval = 1.18‐3.10 ; P < 0.01 ) . Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups , compared with the trend in the usual care intervention group . Conclusions . Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases 
    Output:
    
agent
The following factors were found to have consistent , but limited , support as regards their influence on the risk for sick leave due to back and neck disorders : ( a ) heavy physical workload , bent or twisted working position , and low work satisfaction increases the risk for short-term and long-term sick leave ; ( b ) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave ; ( c ) female gender , smoking , exposure to vibration , and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave ; ( d ) self-reported pain and functional impairments were associated with a high risk for long-term sick leave ; ( e ) longer employment periods reduced the risk for short-term sick leave ; ( f ) perceived dem and s at work did not influence short-term sick leave ; ( g ) female gender and higher age increases the risk for disability pension
***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: Study Design . A prospect i ve cohort study including patients with nonspecific spinal pain was performed . Objectives . To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment . Summary of Background Data . A wide range of instruments and techniques are used to assess and treat patients with spinal pain . Many instruments are used without being clinimetrically tested . Methods . A question naire concerning the patients ’ need of treatment and their potential to assimilate it was sent to experts in the health care arena : physicians , physical therapists , social insurance officers . The experts included were those connected with patients participating in a larger outcome study . Two cohorts of patients ( sample 1 , n = 217 ; sample 2 , n = 257 ) were followed for 6 and 12 months , during which time the patients ’ health and work status were mapped . Results . No acceptable agreement was found between any of the experts ’ ratings of patients ’ needs and potential for rehabilitation . Logistic regression showed that the experts ’ judgments were based almost solely on the age of the patient . The prediction analyses showed that the most consistent predictor of the patients ’ status at the 6-month follow-up assessment was the patients ’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition . Conclusions . Expert judgment as exercised in routine practice can not be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient ’s ability to benefit from treatment Study Design . A prospect i ve cross-sectional study was conducted . Objective . To determine the relation between degeneration of all the joints in the cervical spine , and to identify the effects of litigation on pain and disability levels in trauma and nontrauma patients . Summary of Background Data . The link between spinal degeneration and patient symptoms remains controversial . Two recent similar studies present conflicting results concerning the association between spinal degeneration and symptomatology . These two studies , performed in different countries , did not consider the impact of impending litigation on self-reported pain and disability levels . The role of the uncovertebral and facet articulations has hitherto not been investigated . Methods . Radiographic and question naire data from 180 consecutive patients with neck pain were collected .  Neck pain severity was measured using two time-dependent scales . All patients completed the Neck Disability Index ( NDI ) and questions about chronicity , etiology , and associated litigation . The radiographs were evaluated for the number of levels of degeneration and the severity of degeneration in the discs as well as the uncovertebral and facet articulations . Results . In this study , 71 patients ( 40.57 % ) reported neck pain  as a result of injury . However , only 5.1 % had associated litigation . There was no statistically significant difference in pain severity or disability levels between the patients with and those without cervical degeneration . According to the findings , the number of levels of cervical degeneration and the severity of degeneration in the discs , facets , and uncovertebral joints are not related to the levels of pain and disability . Patients reporting neck pain caused by injury had a tendency ( P = 0.055 ) to more pain during the preceding week and significantly more disability ( P < 0.001 ) . Significant differences included pain intensity ( P < 0.025 ) , reading ( P < 0.001 ) , headaches ( P < 0.025 ) , ability to drive ( P < 0.01 ) , and concentration ( P < 0.01 ) . Women reported significantly more pain ( P < 0.01 ) and disability ( P < 0.001 ) than men , but did not have more degeneration in any of the joints . Conclusions . In patients with neck pain , there is no difference in reported pain and disability levels between those with and those without evidence of cervical spine degeneration . Patients whose neck pain is the result of trauma report significantly more pain and disability than nontrauma patients . This is not because of more spinal degeneration or overriding litigation issues The authors prospect ively evaluated 3020 volunteers of the Boeing-Everett plant to assess risk factors that predispose workers to file industrial back injury cl aims . During four years of follow-up observation , more than 279 subjects reported acute back problems .  The effect of the only predictive physical variable was explainable by a history of medical treatment . The most predictive individual factors were ( 1 ) job task dissatisfaction and ( 2 ) distress as reported on Scale 3 of the Minnesota Multiphasic Personality Inventory ( MMPI ) . This data perhaps explains why the focus on purely physical and injury-related factors has met with little success in dealing with what has become the most expensive orthopedic problem . Clinical ly , nonphysical factors that significantly impact the reporting of back injuries may also affect patients ' responses to medical treatment Study Design . R and omized controlled trial . Objectives . To investigate the effectiveness and costs of a mini-intervention , provided in addition to the usual care , and the incremental effect of a work site visit for patients with subacute disabling low back pain . Summary of Background Data . There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain . Methods . A total of 164 patients with subacute low back pain were r and omized to a  mini-intervention group ( A ) , a work site visit group ( B ) , or a usual care group ( C ) . Groups A ( n = 56 ) and B ( n = 51 ) underwent one assessment by a physician plus a physiotherapist . Group B received a work site visit in addition . Group C served as controls ( n = 57 ) and was treated in municipal primary health care . All patients received a leaflet on back pain . Pain , disability , specific and generic health-related quality of life , satisfaction with care , days on sick leave , and use and costs of health care consumption were measured at 3- , 6- , and 12-month follow-ups . Results . During follow-up , fewer subjects had daily pain in Groups A and B than in Group C ( Group A vs. Group C , P = 0.002 ; Group B vs. Group C , P = 0.030 ) . In Group A , pain was less bothersome ( Group A vs. Group C , P = 0.032 ) and interfered less with daily life ( Group A vs. Group C , P = 0.040 ) than among controls . Average days on sick leave were 19 in Group A , 28 in Group B , and 41 in Group C ( Group A vs. Group C , P = 0.019 ) . Treatment satisfaction was better in the intervention groups than among the controls , and costs were lowest in the mini-intervention group . Conclusions . Mini-intervention reduced daily back pain symptoms and sickness absence , improved adaptation to pain and patient satisfaction among patients with subacute low back pain , without increasing health care costs . A work site visit did not increase effectiveness Objective : To determine whether physical and psychosocial load at work influence sickness absence due to low back pain . Methods : The research was a part of the study on musculoskeletal disorders , absenteeism , stress , and health ( SMASH ) , a 3 year prospect i ve cohort study on risk factors for musculoskeletal disorders . Workers from 21 companies located throughout The Netherl and s participated in the part of this study on sickness absence due to low back pain . The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period . The mean ( range ) period of follow up in this group was 37 ( 7–44 ) months . Physical load at work was assessed by analyses of video recordings . Baseline information on psychosocial work characteristics was obtained by a question naire . Data on sickness absence were collected from company records . The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period . Results : After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants , significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion , trunk rotation , lifting , and low job satisfaction . A dose-response relation was found for trunk flexion , but not for trunk rotation or lifting . Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support . Quantitative job dem and s , conflicting dem and s , decision authority , and skill discretion showed no relation with sickness absence due to low back pain . Conclusions : Flexion and rotation of the trunk , lifting , and low job satisfaction are risk factors for sickness absence due to low back pain . Some indications of a relation between low social support , either from supervisors or coworkers , and sickness absence due to low back pain are also present Study Design . Population ‐based r and omized clinical trial . Objectives . To develop and test a model of management of subacute back pain , to prevent prolonged disability . Summary of Background Data . The present management of back pain seems inadequate , and development of innovative models has been urged . Methods . A model for the treatment of subacute work‐related back pain has been developed and evaluated in a population ‐based r and omized clinical trial . Workers ( n = 130 ) from eligible workplaces in the Sherbrooke area ( N = 31 ) , who had been absent from work for more than 4 weeks for back pain , were r and omized , based on their workplace , in one of four treatment groups : usual care , clinical intervention , occupational intervention , and full intervention ( a combination of the last two ) . The duration of absence from regular work and from any work was evaluated using survival analysis . Functional status and pain were compared at study entry and after 1 year of follow‐up . Results . The full intervention group returned to regular work 2.41 times faster than the usual care intervention group ( 95 % confidence interval 1.19‐4.89 ; P = 0.01 ) . The specific effect of the occupational intervention accounted for the most important part of this result , with a rate ratio of return to regular work of 1.91 ( 95 % confidence interval = 1.18‐3.10 ; P < 0.01 ) . Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups , compared with the trend in the usual care intervention group . Conclusions . Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases 
    Output:
    