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 The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old . Such investigations are often analysed inappropriately , notably by using correlation coefficients . The use of correlation is misleading . An alternative approach , based on graphical techniques and simple calculations , is described , together with the relation between this analysis and the assessment of repeatability OBJECTIVE This study compares the sensitivity to change of the Neck Disability Index ( NDI ) and the Neck Bournemouth Question naire ( NBQ ) in patients with chronic uncomplicated neck pain . METHODS This prospect i ve longitudinal study was completed in an outpatient physical therapy clinic . Subjects , with uncomplicated neck pain ( no concurrent shoulder pain or nerve root symptoms ) for more than a 3-month duration , participated in a 4-week course of therapy that included moist heat , neck exercises , and either mobilization or massage . Outcome measures included st and ardized response means ( sensitivity to change ) , Cronbach alpha ( internal consistency ) , and 2-way Spearman correlations between the 2 question naires and between a pain Visual Analog Scale and each question naire ( convergent validity ) . RESULTS Mean ( SD ) score change of the NDI was 6.22 ( 5.12 ) , and of the NBQ , 14.00 ( 11.99 ) . St and ardized response means were 1.21 and 1.17 , respectively . Both question naires were more sensitive to change than the pain Visual Analog Scale ( 0.68 ) . There was moderate correlation between the change scores of all 3 outcome tools ( Spearman 0.46 - 0.57 ) . The NBQ had higher internal consistency than the NDI . CONCLUSIONS The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain . Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain . Both had acceptable internal consistency and are appropriate for use as single- outcome scales OBJECTIVE Develop and test a short-form comprehensive outcome measure for back pain . DESIGN Prospect i ve longitudinal study of 3 consecutive cohorts of back pain patients . SETTING Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practice s. METHOD Domains judged important in the back pain model and responsive to clinical change were identified from the literature . Items were scored on an 11-point numerical rating scale . The instrument was psychometrically tested by use of those tests relevant to an evaluative measure . RESULTS Seven dimensions of the back pain model were included in the question naire . Having established face validity , the instrument was shown to demonstrate high internal consistency ( Cronbach 's alpha = 0.9 ) and good test-retest reliability ( ICC = 0.95 ) . All items were retained on the basis that they contributed to the overall score ( item-corrected total score correlations ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations ) . The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures . The effect size of the instrument was high ( 1.29 ) and comparable with established measures . CONCLUSION A reliable , valid , and responsive instrument has been developed for use in back pain patients . It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments PURPOSE Report the test-retest reliability , construct validity , minimum clinical ly important difference ( MCID ) , and minimal detectable change ( MDC ) for the Neck Disability Index ( NDI ) . STUDY DESIGN / SETTING Cohort study of patients presenting to outpatient physical therapy clinics . PATIENT SAMPLE Ninety-one subjects with a primary complaint of neck pain , with or without concomitant upper extremity ( UE ) symptoms , who were participants in a r and omized clinical trial . OUTCOME MEASURES NDI and the 15-point Global Rating of Change ( GRC ) self-report measures . METHODS All subjects completed the NDI at baseline and at a 3-week follow-up . Additionally , subjects completed the GRC scale  , which was used to dichotomize patients into improved or stable groups . Changes in the NDI were used to assess test-retest reliability , construct validity , MCID , and MDC . RESULTS Test-retest reliability was moderate for the NDI ( intraclass correlation coefficient , 0.64 ; 95 % confidence interval , 0.19 - 0.84 ) . For the NDI , the MCID was 7.5 points and the MDC was 10.2 points . CONCLUSIONS The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms . Because the MCID is within the bounds of measurement error , a 10-point change ( the MDC ) should be used as the MCID Study Design . Prospect i ve , single-cohort study . Objective . To determine the relative sensitivity of a range of outcome measures used in evaluating treatment interventions in patients with neck pain and the magnitude of change scores on the neck Bournemouth Question naire and the cutoff score on the Patients ’ Global Impression of Change scale associated with clinical ly significant improvement . Summary of Background Data . Traditionally , evaluation of treatment interventions using subjective outcome measures has been based on the statistical significance of the difference between group mean values . To be clinical ly meaningful , however , information is required from sensitive outcome measures on the proportion of patients undergoing a clinical ly important improvement and from this , the number needed to treat for a single patient to benefit . Methods . Patients with nonspecific neck pain from a number of treatment centers completed a battery of self-report question naires , including the Bournemouth Question naire , before and after chiropractic treatment . After treatment , patients also completed a retrospective analysis of their overall improvement since the start of treatment ( Patients ’ Global Impression of Change ) . The a priori definition of clinical ly significant improvement was defined as a Reliable Change Index on the Bournemouth Question naire of > 1.96 . Results . The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients ’ Global Impression of Change ( 11-point Numerical Rating Scale : 0 = much better , 5 = no change , and 10 = much worse ) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Question naire . For the total score of the Bournemouth Question naire , raw change scores of 13 or more points , percentage change scores of 36 % or more , and individual effect sizes of 1.0 or more were all associated with clinical ly significant improvement . The sensitivity of the Bournemouth Question naire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index . Conclusions . The present findings will assist in the choice of outcome measures in trials on neck pain . The study also illustrates a method ologic framework for interpreting change scores in terms of clinical improvement , facilitating the process of making sense of research data in the clinical setting Study Design . Patients enrolled in a r and omized controlled trial were asked to complete various question naires , which were then compared to establish validity for a new neck pain question naire . Objectives . To vali date a new and brief outcome measure for use with patients with mechanical neck pain . Summary of Background Data . Neck pain is a very common problem and one that clinicians will be required to treat with some regularity . In today ’s climate of evidence -based practice and the need to quantify and justify clinical intervention , a quick and easy method to evaluate progress is required . Such a measure has already been produced for those experiencing back pain , but as yet , there is no such measure for neck pain and this needs to be addressed . Methods . The  back pain measure  was adapted to enable its use with patients with neck pain .  Repeatability was assessed by using a 1-week test/retest on 104 patients who were enrolled in a neck pain trial .  Validity was assessed by comparing the new question naire against other already well vali date d measures ( i.e. , the Neck Disability Index and a Visual Analogue Scale for pain ) with 133 patients . Results . The test/retest showed excellent repeatability with high intraclass correlations and P < 0.001 for each question tested . The Core Neck Pain Question naire also showed good validity , giving close agreement to the other comparison measures . Conclusion . The short Core Neck Pain Question naire has been demonstrated to be repeatable and valid as a brief outcome measure for use with patients with mechanical neck pain OBJECTIVE To modify an existing outcome measure ( Bournemouth Question naire [ BQ ] ) for use in patients with nonspecific neck pain and test its psychometric properties . DESIGN Prospect i ve longitudinal study in which the question naire was administered on 3 occasions ( pretreatment , retest , and posttreatment ) . SETTING Anglo-European College of Chiropractic outpatient clinic and 8 field chiropractic practice s. METHOD Seven core items relating to the biopsychosocial model of pain were included in the original question naire ( back BQ ) . The wording of one of these items ( disability in activities of daily living ) was modified to include activities likely to be affected by neck pain . Testing of the neck BQ was carried out in 102 patients with nonspecific neck pain . RESULTS The instrument demonstrated high internal consistency on 3 administrations ( Cronbach 's alpha = 0.87 , 0.91 , 0.92 ) . All 7 items were retained on the basis that they each significantly contributed to the total score ( item-corrected total score correlations > 0.43 ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations > 0.42 ) . The instrument was reliable in test-retest administrations in stable subjects ( ICC = 0.65 ) . The instrument demonstrated acceptable construct validity and longitudinal construct validity with established external measures . The treatment effect size of the instrument was found to be high ( 1.67 ) . CONCLUSION The neck BQ covers the salient dimensions of the biopsychosocial model of pain , is quick and easy to complete , and has been shown to be reliable , valid , and responsive to clinical ly significant change in patients with nonspecific neck pain . Its use as an outcome measure in clinical trials and outcomes research is recommended Objectives To estimate the sensitivity to change and internal consistency of the Northwick Park Neck Pain Question naire ( NPQ ) and derive its minimal clinical ly important difference ( MCID ) . Methods Data on 311 participants in a r and omized controlled trial of physical therapy for neck pain were analyzed , between baseline and 6-month follow-up . Cronbach α was used to estimate internal consistency . Three methods of evaluating the NPQ 's sensitivity to change were used ; Cohen 's effect size , st and ardized response mean , and Guyatt 's responsiveness statistic . The smallest change on the NPQ that can be construed as clinical ly important ( the MCID ) was obtained by ( 1 ) comparing values derived from different methods that account for the measurement error of the question naire with improvements in other neck pain-specific measures , and then ( 2 ) examining the impact of the addition of an independent measure ( “ anchor ” ) relating to participants ' subjective rating of improvement . Results Cronbach α was 0.79 for the whole scale . Using all participants , Cohen 's d was 0.78 , st and ardized response mean was 0.71 , and Guyatt 's responsiveness statistic was 0.93 . Using only participants who stated they had improved , the estimates were 1.35 , 1.27 , 1.45 , respectively . The MCID for the NPQ was determined as a 25 % reduction in score from baseline together with a patient 's global rating of their neck pain of at least “ better . ” Conclusions These results show high internal consistency and sensitivity to change for the NPQ , and provide an MCID that allows participants with varying levels of severity to demonstrate improvement A method is described for evaluating the progress of patients with back pain .  Various symptoms were scored on analogue scales and spinal motion was measured by various techniques . These data were integrated to make subjective and objective indices respectively . Reasonable reproducibility of the measurements was obtained . This technique was used to eluci date the role of the lumbar support in surgical corsets in relief of back pain .  Sufferers from back pain were r and omly allocated to corsets with and without lumbar supports . There was significant improvement in those with a support compared with those without . On the other h and objective changes measured with the corset removed did not differ between the 2 groups . This study indicates that the spinal support 
    Output:
    
agent
The Neck Disability Index is the most frequently evaluated question naire and shows positive results for internal consistency , content validity , structural validity , hypothesis testing , and responsiveness , but a negative result for reliability .
The other question naires show positive results , but the evidence for each measurement property is mostly limited , and at least 50 % of the information on measurement properties per question naire is lacking .
***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 The COSMIN checklist is a tool for evaluating the method ological quality of studies on measurement properties of health-related patient-reported outcomes . The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist ( n = 114 ) . Methods 75 articles evaluating measurement properties were r and omly selected from the bibliographic data base compiled by the Patient-Reported Outcome Measurement Group , Oxford , UK . Raters were asked to assess the method ological quality of three articles , using the COSMIN checklist . In a one-way design , percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item . Results 88 raters participated . Of the 75 selected articles , 26 articles were rated by four to six participants , and 49 by two or three participants . Overall , percentage agreement was appropriate ( 68 % was above 80 % agreement ) , and the kappa coefficients for the COSMIN items were low ( 61 % was below 0.40 , 6 % was above 0.75 ) . Reasons for low inter-rater agreement were need for subjective judgement , and accustom to different st and ards , terminology and definitions . Conclusions Results indicated that raters often choose the same response option , but that it is difficult on item level to distinguish between articles . When using the COSMIN checklist in a systematic review , we recommend getting some training and experience , completing it by two independent raters , and reaching consensus on one final rating . Instructions for using the checklist are improved In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old . Such investigations are often analysed inappropriately , notably by using correlation coefficients . The use of correlation is misleading . An alternative approach , based on graphical techniques and simple calculations , is described , together with the relation between this analysis and the assessment of repeatability OBJECTIVE This study compares the sensitivity to change of the Neck Disability Index ( NDI ) and the Neck Bournemouth Question naire ( NBQ ) in patients with chronic uncomplicated neck pain . METHODS This prospect i ve longitudinal study was completed in an outpatient physical therapy clinic . Subjects , with uncomplicated neck pain ( no concurrent shoulder pain or nerve root symptoms ) for more than a 3-month duration , participated in a 4-week course of therapy that included moist heat , neck exercises , and either mobilization or massage . Outcome measures included st and ardized response means ( sensitivity to change ) , Cronbach alpha ( internal consistency ) , and 2-way Spearman correlations between the 2 question naires and between a pain Visual Analog Scale and each question naire ( convergent validity ) . RESULTS Mean ( SD ) score change of the NDI was 6.22 ( 5.12 ) , and of the NBQ , 14.00 ( 11.99 ) . St and ardized response means were 1.21 and 1.17 , respectively . Both question naires were more sensitive to change than the pain Visual Analog Scale ( 0.68 ) . There was moderate correlation between the change scores of all 3 outcome tools ( Spearman 0.46 - 0.57 ) . The NBQ had higher internal consistency than the NDI . CONCLUSIONS The NDI and the NBQ performed comparably in this group of patients with chronic uncomplicated neck pain . Both are sensitive to change and would be efficient outcome tools in studies of chronic neck pain . Both had acceptable internal consistency and are appropriate for use as single- outcome scales OBJECTIVE Develop and test a short-form comprehensive outcome measure for back pain . DESIGN Prospect i ve longitudinal study of 3 consecutive cohorts of back pain patients . SETTING Anglo-European College of Chiropractic outpatient clinic and several field chiropractic practice s. METHOD Domains judged important in the back pain model and responsive to clinical change were identified from the literature . Items were scored on an 11-point numerical rating scale . The instrument was psychometrically tested by use of those tests relevant to an evaluative measure . RESULTS Seven dimensions of the back pain model were included in the question naire . Having established face validity , the instrument was shown to demonstrate high internal consistency ( Cronbach 's alpha = 0.9 ) and good test-retest reliability ( ICC = 0.95 ) . All items were retained on the basis that they contributed to the overall score ( item-corrected total score correlations ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations ) . The instrument demonstrated acceptable construct and longitudinal construct validity with established external measures . The effect size of the instrument was high ( 1.29 ) and comparable with established measures . CONCLUSION A reliable , valid , and responsive instrument has been developed for use in back pain patients . It is practical for use in investigations of both the efficacy and effectiveness of back pain treatments PURPOSE Report the test-retest reliability , construct validity , minimum clinical ly important difference ( MCID ) , and minimal detectable change ( MDC ) for the Neck Disability Index ( NDI ) . STUDY DESIGN / SETTING Cohort study of patients presenting to outpatient physical therapy clinics . PATIENT SAMPLE Ninety-one subjects with a primary complaint of neck pain , with or without concomitant upper extremity ( UE ) symptoms , who were participants in a r and omized clinical trial . OUTCOME MEASURES NDI and the 15-point Global Rating of Change ( GRC ) self-report measures . METHODS All subjects completed the NDI at baseline and at a 3-week follow-up . Additionally , subjects completed the GRC scale  , which was used to dichotomize patients into improved or stable groups . Changes in the NDI were used to assess test-retest reliability , construct validity , MCID , and MDC . RESULTS Test-retest reliability was moderate for the NDI ( intraclass correlation coefficient , 0.64 ; 95 % confidence interval , 0.19 - 0.84 ) . For the NDI , the MCID was 7.5 points and the MDC was 10.2 points . CONCLUSIONS The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms . Because the MCID is within the bounds of measurement error , a 10-point change ( the MDC ) should be used as the MCID Study Design . Prospect i ve , single-cohort study . Objective . To determine the relative sensitivity of a range of outcome measures used in evaluating treatment interventions in patients with neck pain and the magnitude of change scores on the neck Bournemouth Question naire and the cutoff score on the Patients ’ Global Impression of Change scale associated with clinical ly significant improvement . Summary of Background Data . Traditionally , evaluation of treatment interventions using subjective outcome measures has been based on the statistical significance of the difference between group mean values . To be clinical ly meaningful , however , information is required from sensitive outcome measures on the proportion of patients undergoing a clinical ly important improvement and from this , the number needed to treat for a single patient to benefit . Methods . Patients with nonspecific neck pain from a number of treatment centers completed a battery of self-report question naires , including the Bournemouth Question naire , before and after chiropractic treatment . After treatment , patients also completed a retrospective analysis of their overall improvement since the start of treatment ( Patients ’ Global Impression of Change ) . The a priori definition of clinical ly significant improvement was defined as a Reliable Change Index on the Bournemouth Question naire of > 1.96 . Results . The best cutoffs with a balance between the highest sensitivity and highest specificity in detecting clinical improvement were a score of 2 or less on the Patients ’ Global Impression of Change ( 11-point Numerical Rating Scale : 0 = much better , 5 = no change , and 10 = much worse ) and a raw change score of three or more points on each of the seven 11-point Numerical Rating Scale subscales of the Bournemouth Question naire . For the total score of the Bournemouth Question naire , raw change scores of 13 or more points , percentage change scores of 36 % or more , and individual effect sizes of 1.0 or more were all associated with clinical ly significant improvement . The sensitivity of the Bournemouth Question naire in terms of its effect size was comparable with that of pain intensity scales and the Neck Disability Index . Conclusions . The present findings will assist in the choice of outcome measures in trials on neck pain . The study also illustrates a method ologic framework for interpreting change scores in terms of clinical improvement , facilitating the process of making sense of research data in the clinical setting Study Design . Patients enrolled in a r and omized controlled trial were asked to complete various question naires , which were then compared to establish validity for a new neck pain question naire . Objectives . To vali date a new and brief outcome measure for use with patients with mechanical neck pain . Summary of Background Data . Neck pain is a very common problem and one that clinicians will be required to treat with some regularity . In today ’s climate of evidence -based practice and the need to quantify and justify clinical intervention , a quick and easy method to evaluate progress is required . Such a measure has already been produced for those experiencing back pain , but as yet , there is no such measure for neck pain and this needs to be addressed . Methods . The  back pain measure  was adapted to enable its use with patients with neck pain .  Repeatability was assessed by using a 1-week test/retest on 104 patients who were enrolled in a neck pain trial .  Validity was assessed by comparing the new question naire against other already well vali date d measures ( i.e. , the Neck Disability Index and a Visual Analogue Scale for pain ) with 133 patients . Results . The test/retest showed excellent repeatability with high intraclass correlations and P < 0.001 for each question tested . The Core Neck Pain Question naire also showed good validity , giving close agreement to the other comparison measures . Conclusion . The short Core Neck Pain Question naire has been demonstrated to be repeatable and valid as a brief outcome measure for use with patients with mechanical neck pain OBJECTIVE To modify an existing outcome measure ( Bournemouth Question naire [ BQ ] ) for use in patients with nonspecific neck pain and test its psychometric properties . DESIGN Prospect i ve longitudinal study in which the question naire was administered on 3 occasions ( pretreatment , retest , and posttreatment ) . SETTING Anglo-European College of Chiropractic outpatient clinic and 8 field chiropractic practice s. METHOD Seven core items relating to the biopsychosocial model of pain were included in the original question naire ( back BQ ) . The wording of one of these items ( disability in activities of daily living ) was modified to include activities likely to be affected by neck pain . Testing of the neck BQ was carried out in 102 patients with nonspecific neck pain . RESULTS The instrument demonstrated high internal consistency on 3 administrations ( Cronbach 's alpha = 0.87 , 0.91 , 0.92 ) . All 7 items were retained on the basis that they each significantly contributed to the total score ( item-corrected total score correlations > 0.43 ) and to the instrument 's responsiveness to clinical change ( item change-corrected total change score correlations > 0.42 ) . The instrument was reliable in test-retest administrations in stable subjects ( ICC = 0.65 ) . The instrument demonstrated acceptable construct validity and longitudinal construct validity with established external measures . The treatment effect size of the instrument was found to be high ( 1.67 ) . CONCLUSION The neck BQ covers the salient dimensions of the biopsychosocial model of pain , is quick and easy to complete , and has been shown to be reliable , valid , and responsive to clinical ly significant change in patients with nonspecific neck pain . Its use as an outcome measure in clinical trials and outcomes research is recommended Objectives To estimate the sensitivity to change and internal consistency of the Northwick Park Neck Pain Question naire ( NPQ ) and derive its minimal clinical ly important difference ( MCID ) . Methods Data on 311 participants in a r and omized controlled trial of physical therapy for neck pain were analyzed , between baseline and 6-month follow-up . Cronbach α was used to estimate internal consistency . Three methods of evaluating the NPQ 's sensitivity to change were used ; Cohen 's effect size , st and ardized response mean , and Guyatt 's responsiveness statistic . The smallest change on the NPQ that can be construed as clinical ly important ( the MCID ) was obtained by ( 1 ) comparing values derived from different methods that account for the measurement error of the question naire with improvements in other neck pain-specific measures , and then ( 2 ) examining the impact of the addition of an independent measure ( “ anchor ” ) relating to participants ' subjective rating of improvement . Results Cronbach α was 0.79 for the whole scale . Using all participants , Cohen 's d was 0.78 , st and ardized response mean was 0.71 , and Guyatt 's responsiveness statistic was 0.93 . Using only participants who stated they had improved , the estimates were 1.35 , 1.27 , 1.45 , respectively . The MCID for the NPQ was determined as a 25 % reduction in score from baseline together with a patient 's global rating of their neck pain of at least “ better . ” Conclusions These results show high internal consistency and sensitivity to change for the NPQ , and provide an MCID that allows participants with varying levels of severity to demonstrate improvement A method is described for evaluating the progress of patients with back pain .  Various symptoms were scored on analogue scales and spinal motion was measured by various techniques . These data were integrated to make subjective and objective indices respectively . Reasonable reproducibility of the measurements was obtained . This technique was used to eluci date the role of the lumbar support in surgical corsets in relief of back pain .  Sufferers from back pain were r and omly allocated to corsets with and without lumbar supports . There was significant improvement in those with a support compared with those without . On the other h and objective changes measured with the corset removed did not differ between the 2 groups . This study indicates that the spinal support 
    Output:
    