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: OBJECTIVES : To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables -- a set of objective criteria for technical performance and continuity of care -- led to a better outcome in clinical and return to work variables . METHODS : The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain . Univariate analyses as well as multiple logistic regression and Cox 's regression analyses were performed to assess the relation between quality of care and outcome . RESULTS : Process indicators for technical competence , continuity of care , and total performance were all significantly related to satisfaction of employees . Continuity of care and total performance were significantly related to working status at 3 months , and time to return to work . None of the process indicators was related to pain or disability after 3 months follow up . Satisfaction was not related to any of the other outcome variables . This indicates that if guidelines for occupational rehabilitation are met , outcome is better . CONCLUSION : Quality of the process of care was related to outcome . Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians . The effectiveness of an improved intervention should be studied in a subsequent r and omised clinical trial This paper describes a participatory ergonomics program aim ed at early return to regular work of workers suffering from subacute occupational back pain and assesses the perceptions of the participants on the implementation of ergonomic solutions  in the workplace . The participatory ergonomics program was used in the rehabilitation of workers suffering from subacute back pain for more than 6 weeks , a program that was associated with an increased rate of return to work . The perceptions of the participatory ergonomics participants were assessed 6 months after completion of the ergonomic intervention through a question naire sent to employer representatives , union representatives and injured workers of participating workplaces . About half of the ergonomic solutions were implemented according to the perception of the participants , with a substantial agreement between respondents 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 OBJECTIVE To assess the efficacy of a back school program for patients with a first episode of acute work-related low back pain requiring compensation . DESIGN A r and omized single-blind controlled trial . SETTING A private physiatrics outpatient clinic . PATIENTS The mean duration of low back pain was 15 days . INTERVENTION Eligible patients were r and omized to a st and ard treatment program that included daily physiotherapy ( n = 86 ) or the same program with the addition of back school ( n = 82 ) . The back school program consisted of three 90-minute sessions given by a single trained instructor at 0 , 1 , and 8 weeks . MAIN OUTCOME MEASURES The primary outcomes were the time off work for the presenting episode of back pain and the number and duration of recurrences in the year following the study onset . Secondary outcomes included the level of pain , spinal mobility , active straight-leg raising , and functional disability assessed by the Oswestry and Rol and -Morris scales . RESULTS Those r and omized to the back school group gained significantly more knowledge , based on the multiple choice examination ( p = .0001 ) and performed the exercise program significantly better ( p = .0001 ) than the st and ard care group . There were no differences between the two treatment groups for either of the primary outcomes . The median time to return to work from r and omization was 33 days for both the back school and the st and ard care groups ( p = .48 ) . The number of compensated recurrences of low back pain over 1 year was similar ( back school = 14 , st and ard care = 10 , p = .16 ) , as was the median duration of these episodes ( back school = 25 days , st and ard care = 70 days , p = .21 ) . There were no significant differences favoring the back school group for any of the secondary outcomes at the posttreatment , 6-month , or 12-month assessment s. CONCLUSION A back school intervention in addition to st and ard care result ed in no reduction in the time to return to work or the number or duration of recurrences of low back pain requiring compensation over a period of one year Study Design An inception cohort design was used in which 421 patients were evaluated systematic ally with a st and ard battery of psychosocial assessment tests ( Structured Interview for DSM-III-R Diagnosis , Minnesota Multiphasic Personality Inventory , and Million Visual Pain Analog Scale ) within 6 weeks of acute back pain onset . Objectives The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems  ( as measured by job-work status at 1-year follow-up evaluation ) . Summary of Background Data There has been a relative paucity of prospect i ve research in the United States comprehensively evaluating potential psychoscial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability . Such research has been quite limited because of the time and cost involved in conducting prospect i ve studies . Methods All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks , These acute patients were tracked every 3 months , culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status . Results Logistic regression analyses , conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury , revealed the importance of three psychosocial measures : self-reported pain and disability , scores on Scale 3 of the Minnesota Multiphasic Personality Inventory , and workers ' compensation and personal injury insurance status . The model generated correctly classified 90.7 % of the cases . Results revealed that major psychopathology , such as depression and substance abuse , did not precede or cause the development of chronic pain disability . Conclusions These results show the presence of a robust “ psychosocial disability factor ” that is associated with those injured workers who are likely to develop chronic low back pain disability problems .  Based on these data , a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability . The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability , although high rates of psychopathology have been shown in chronic low back pain . Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity Objectives Given the individual and economic burden of chronic work disability in low back pain patients , there is a need for effective preventive interventions . The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral grade d activity , regarding days of sick leave and work status . Design R and omized controlled trial . Patients and Setting Employees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner , occupational physician , or rehabilitation physician . Forty-five employees had been r and omly assigned to the experimental treatment condition that included behavioral grade d activity and problem-solving therapy ( GAPS ) , and 39 employees had been r and omly assigned to behavioral grade d activity and group education ( GAGE ) . Outcome Measures Days of sick leave and work status . Data were retrieved from occupational health services . Results Data analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention . Moreover , work status was more favorable for employees in this condition , in that more employees had a 100 % return-to-work and fewer patients ended up receiving disability pensions one year after the intervention . Sensitivity analyses confirmed these results . Conclusions The addition of problem-solving therapy to behavioral grade d activity had supplemental value in employees with nonspecific low back pain Abstract Objectives : To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain . Design : Prospect i ve cohort study . Setting : Two general practice s in the south Manchester area . Participants : 180 patients , who previously participated in a cross sectional population survey , who consulted because of low back pain during the study period . They were followed at 1 week and 3 and 12 months after consultation . Main outcome measure : Persistent disabling low back pain in the 12 months after the consultation . Results : Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age , among those with a history of low back pain , and in women .  Persistence of symptoms was associated with “ premorbid ” factors ( high levels of psychological distress ( odds ratio 3.3 ; 95 % confidence interval 1.5 to 7.2 ) , poor self rated health ( 3.6 ; 1.9 to 6.8 ) , low levels of physical activity ( 2.8 ; 1.4 to 5.6 ) , smoking ( 2.1 ; 1.0 to 4.3 ) , dissatisfaction with employment ( 2.4 ; 1.3 to 4.5 ) ) and factors related to the episode of low back pain ( duration of symptoms , pain radiating to the leg ( 2.6 ; 1.3 to 5.1 ) , widespread pain ( 6.4 ; 2.7 to 15 ) , and restriction in spinal mobility ) . A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6 % to 70 % . Conclusions : The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid BACKGROUND AND METHODS Bed rest is widely advocated for sciatica , but its effectiveness has not been established . To study the effectiveness of bed rest in patients with a lumbosacral radicular syndrome of sufficient severity to justify treatment with bed rest for two weeks , we r and omly assigned 183 subjects to either bed rest or watchful waiting for this period . The primary outcome measures were the investigator 's and patient 's global assessment s of improvement after 2 and 12 weeks , and the secondary outcome measures were changes in functional status and in pain scores ( after 2 , 3 , and 12 weeks ) , absenteeism from work , and the need for surgical intervention . Neither the investigators who assessed the outcomes nor those involved in data entry and analysis were aware of the patients ' treatment assignments . RESULTS After two weeks , 64 of the 92 patients in the bed-rest group ( 70 percent ) reported improvement , as compared with 59 of the 91 patients in the control ( watchful-waiting ) group ( 65 percent ) ( adjusted odds ratio for improvement in the bed-rest group , 1.2 ; 95 percent confidence interval , 0.6 to 2.3 ) . After 12 weeks , 87 percent of the patients in both groups reported improvement . The results of assessment s of the intensity of pain , the bothersomeness of symptoms , and functional status revealed no significant differences between the two groups . The extent of absenteeism from work and rates of surgical intervention were similar in the two groups . CONCLUSIONS Among patients with symptoms and signs of a lumbosacral radicular syndrome , bed rest is not a more effective therapy than watchful waiting In an attempt to prevent acute low-back pain from becoming a chronic disability problem , an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity . The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up . Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status . On the basis of this screening , high-risk patients were then r and omly assigned to one of two groups : a functional restoration early intervention group ( n = 22 ) , or a nonintervention group ( n = 48 ) . A group of low-risk subjects ( n = 54 ) who did not receive any early intervention  was also evaluated . All these subjects were prospect ively tracked at 3-month intervals starting from the date of their initial evaluation , culminating in a 12-month follow-up . During these follow-up evaluations , pain disability and socioeconomic outcomes ( such as return-to-work and healthcare utilization ) were assessed . Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chron 
    Output:
    
agent
Specific LBP , higher disability levels , older age , female gender , more social dysfunction and more social isolation , heavier work , and receiving higher compensation were identified as predictors for a longer duration of sick leave .
A history of LBP , job satisfaction , educational level , marital status , number of dependants , smoking , working more than 8 hour shifts , occupation , and size of industry or company do not influence duration of sick leave due to LBP .
Many different constructs were measured to identify psychosocial predictors of long term sick leave , which made it impossible to determine the role of these factors
***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: OBJECTIVES : To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables -- a set of objective criteria for technical performance and continuity of care -- led to a better outcome in clinical and return to work variables . METHODS : The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain . Univariate analyses as well as multiple logistic regression and Cox 's regression analyses were performed to assess the relation between quality of care and outcome . RESULTS : Process indicators for technical competence , continuity of care , and total performance were all significantly related to satisfaction of employees . Continuity of care and total performance were significantly related to working status at 3 months , and time to return to work . None of the process indicators was related to pain or disability after 3 months follow up . Satisfaction was not related to any of the other outcome variables . This indicates that if guidelines for occupational rehabilitation are met , outcome is better . CONCLUSION : Quality of the process of care was related to outcome . Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians . The effectiveness of an improved intervention should be studied in a subsequent r and omised clinical trial This paper describes a participatory ergonomics program aim ed at early return to regular work of workers suffering from subacute occupational back pain and assesses the perceptions of the participants on the implementation of ergonomic solutions  in the workplace . The participatory ergonomics program was used in the rehabilitation of workers suffering from subacute back pain for more than 6 weeks , a program that was associated with an increased rate of return to work . The perceptions of the participatory ergonomics participants were assessed 6 months after completion of the ergonomic intervention through a question naire sent to employer representatives , union representatives and injured workers of participating workplaces . About half of the ergonomic solutions were implemented according to the perception of the participants , with a substantial agreement between respondents 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 OBJECTIVE To assess the efficacy of a back school program for patients with a first episode of acute work-related low back pain requiring compensation . DESIGN A r and omized single-blind controlled trial . SETTING A private physiatrics outpatient clinic . PATIENTS The mean duration of low back pain was 15 days . INTERVENTION Eligible patients were r and omized to a st and ard treatment program that included daily physiotherapy ( n = 86 ) or the same program with the addition of back school ( n = 82 ) . The back school program consisted of three 90-minute sessions given by a single trained instructor at 0 , 1 , and 8 weeks . MAIN OUTCOME MEASURES The primary outcomes were the time off work for the presenting episode of back pain and the number and duration of recurrences in the year following the study onset . Secondary outcomes included the level of pain , spinal mobility , active straight-leg raising , and functional disability assessed by the Oswestry and Rol and -Morris scales . RESULTS Those r and omized to the back school group gained significantly more knowledge , based on the multiple choice examination ( p = .0001 ) and performed the exercise program significantly better ( p = .0001 ) than the st and ard care group . There were no differences between the two treatment groups for either of the primary outcomes . The median time to return to work from r and omization was 33 days for both the back school and the st and ard care groups ( p = .48 ) . The number of compensated recurrences of low back pain over 1 year was similar ( back school = 14 , st and ard care = 10 , p = .16 ) , as was the median duration of these episodes ( back school = 25 days , st and ard care = 70 days , p = .21 ) . There were no significant differences favoring the back school group for any of the secondary outcomes at the posttreatment , 6-month , or 12-month assessment s. CONCLUSION A back school intervention in addition to st and ard care result ed in no reduction in the time to return to work or the number or duration of recurrences of low back pain requiring compensation over a period of one year Study Design An inception cohort design was used in which 421 patients were evaluated systematic ally with a st and ard battery of psychosocial assessment tests ( Structured Interview for DSM-III-R Diagnosis , Minnesota Multiphasic Personality Inventory , and Million Visual Pain Analog Scale ) within 6 weeks of acute back pain onset . Objectives The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems  ( as measured by job-work status at 1-year follow-up evaluation ) . Summary of Background Data There has been a relative paucity of prospect i ve research in the United States comprehensively evaluating potential psychoscial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability . Such research has been quite limited because of the time and cost involved in conducting prospect i ve studies . Methods All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks , These acute patients were tracked every 3 months , culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status . Results Logistic regression analyses , conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury , revealed the importance of three psychosocial measures : self-reported pain and disability , scores on Scale 3 of the Minnesota Multiphasic Personality Inventory , and workers ' compensation and personal injury insurance status . The model generated correctly classified 90.7 % of the cases . Results revealed that major psychopathology , such as depression and substance abuse , did not precede or cause the development of chronic pain disability . Conclusions These results show the presence of a robust “ psychosocial disability factor ” that is associated with those injured workers who are likely to develop chronic low back pain disability problems .  Based on these data , a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability . The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability , although high rates of psychopathology have been shown in chronic low back pain . Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity Objectives Given the individual and economic burden of chronic work disability in low back pain patients , there is a need for effective preventive interventions . The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral grade d activity , regarding days of sick leave and work status . Design R and omized controlled trial . Patients and Setting Employees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner , occupational physician , or rehabilitation physician . Forty-five employees had been r and omly assigned to the experimental treatment condition that included behavioral grade d activity and problem-solving therapy ( GAPS ) , and 39 employees had been r and omly assigned to behavioral grade d activity and group education ( GAGE ) . Outcome Measures Days of sick leave and work status . Data were retrieved from occupational health services . Results Data analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention . Moreover , work status was more favorable for employees in this condition , in that more employees had a 100 % return-to-work and fewer patients ended up receiving disability pensions one year after the intervention . Sensitivity analyses confirmed these results . Conclusions The addition of problem-solving therapy to behavioral grade d activity had supplemental value in employees with nonspecific low back pain Abstract Objectives : To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain . Design : Prospect i ve cohort study . Setting : Two general practice s in the south Manchester area . Participants : 180 patients , who previously participated in a cross sectional population survey , who consulted because of low back pain during the study period . They were followed at 1 week and 3 and 12 months after consultation . Main outcome measure : Persistent disabling low back pain in the 12 months after the consultation . Results : Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age , among those with a history of low back pain , and in women .  Persistence of symptoms was associated with “ premorbid ” factors ( high levels of psychological distress ( odds ratio 3.3 ; 95 % confidence interval 1.5 to 7.2 ) , poor self rated health ( 3.6 ; 1.9 to 6.8 ) , low levels of physical activity ( 2.8 ; 1.4 to 5.6 ) , smoking ( 2.1 ; 1.0 to 4.3 ) , dissatisfaction with employment ( 2.4 ; 1.3 to 4.5 ) ) and factors related to the episode of low back pain ( duration of symptoms , pain radiating to the leg ( 2.6 ; 1.3 to 5.1 ) , widespread pain ( 6.4 ; 2.7 to 15 ) , and restriction in spinal mobility ) . A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6 % to 70 % . Conclusions : The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid BACKGROUND AND METHODS Bed rest is widely advocated for sciatica , but its effectiveness has not been established . To study the effectiveness of bed rest in patients with a lumbosacral radicular syndrome of sufficient severity to justify treatment with bed rest for two weeks , we r and omly assigned 183 subjects to either bed rest or watchful waiting for this period . The primary outcome measures were the investigator 's and patient 's global assessment s of improvement after 2 and 12 weeks , and the secondary outcome measures were changes in functional status and in pain scores ( after 2 , 3 , and 12 weeks ) , absenteeism from work , and the need for surgical intervention . Neither the investigators who assessed the outcomes nor those involved in data entry and analysis were aware of the patients ' treatment assignments . RESULTS After two weeks , 64 of the 92 patients in the bed-rest group ( 70 percent ) reported improvement , as compared with 59 of the 91 patients in the control ( watchful-waiting ) group ( 65 percent ) ( adjusted odds ratio for improvement in the bed-rest group , 1.2 ; 95 percent confidence interval , 0.6 to 2.3 ) . After 12 weeks , 87 percent of the patients in both groups reported improvement . The results of assessment s of the intensity of pain , the bothersomeness of symptoms , and functional status revealed no significant differences between the two groups . The extent of absenteeism from work and rates of surgical intervention were similar in the two groups . CONCLUSIONS Among patients with symptoms and signs of a lumbosacral radicular syndrome , bed rest is not a more effective therapy than watchful waiting In an attempt to prevent acute low-back pain from becoming a chronic disability problem , an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity . The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up . Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status . On the basis of this screening , high-risk patients were then r and omly assigned to one of two groups : a functional restoration early intervention group ( n = 22 ) , or a nonintervention group ( n = 48 ) . A group of low-risk subjects ( n = 54 ) who did not receive any early intervention  was also evaluated . All these subjects were prospect ively tracked at 3-month intervals starting from the date of their initial evaluation , culminating in a 12-month follow-up . During these follow-up evaluations , pain disability and socioeconomic outcomes ( such as return-to-work and healthcare utilization ) were assessed . Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chron 
    Output:
    