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 study the effect of a combination of thalassotherapy , exercise and patient education in people with fibromyalgia . METHODS Patients with fibromyalgia , selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association , were pre-r and omized to receive either 2(1/2 ) weeks of treatment in a Tunisian spa resort , including thalassotherapy , supervised exercise and group education ( active treatment ) or treatment as usual ( control treatment ) . Primary outcome measure was health-related quality of life , measured with the R AND -36 question naire . Secondary measures included the Fibromyalgia Impact Question naire , the McGill Pain Question naire , the Beck Depression Inventory , tender point score and a 6-min treadmill walk test . RESULTS Fifty-eight participants receiving the active treatment reported significant improvement on R AND -36 physical and mental component summary scales . For physical health , differences from the 76 controls were statistically significant after 3 months , but not after 6 and 12 months . A similar pattern of temporary improvement was seen in the self-reported secondary measures . Tender point scores and treadmill walk tests improved more after active treatment , but did not reach significant between-group differences , except for walk tests after 12 months . CONCLUSIONS A combination of thalassotherapy , exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life OBJECTIVES To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome ( FM ) . METHODS 134 patients with FM , selected from a rheumatology outpatient department and from members of the Dutch FM patient association were r and omly assigned to a 2(1/2 ) week spa treatment course in Tunisia or to usual care only . Results are expressed as quality -adjusted life years ( QALYs ) for a 6-month as well as a 12-month time horizon . Utilities were derived form the Short Form 6D ( SF-6D ) scores and the visual analogue scale ( VAS ) rating general health . Costs were reported from societal perspective . Mean incremental cost per patient and the incremental cost utility ratio ( ICER ) were calculated ; 95 % confidence intervals ( CIs ) were estimated using double-sided bootstrapping . RESULTS The data of 128 ( 55 spa and 73 controls ) of the 134 patients ( 96 % ) could be used for analysis . Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D ( AUC 0.32 vs 0.30 , P < 0.05 ) and the VAS ( AUC 0.23 vs 0.19 , P < 0.01 ) . After 1yr no significant between-group differences were found . Mean incremental cost of spa treatment was 1311 Euro per patient ( 95 % CI 369 - 2439 ) , equalling the cost of the intervention ( thalassotherapy including airfare and lodging ) , or 885 Euro per patient based on a more realistic cost estimate . CONCLUSIONS The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient Perspectives of patients with fibromyalgia influence their likelihood of participating in r and omized placebo-controlled trials and potentially clash with current , well-established methodology of r and omized controlled trial design . M and ates to use only acetaminophen for breakthrough pain and that require discontinuation of concomitant medications , especially in studies lacking an active comparator arm , could bias a trial cohort to thereby reduce the generalizability of study findings and conclusions . This study evaluates factors affecting willingness to participate in such clinical trials , including the impact of altruism , payment , study duration , forced discontinuation of specific medications , and subject demographics for patients seen by rheumatologists proficient and avidly interested in treating fibromyalgia We aim ed to evaluate the effectiveness of balneotherapy in  fibromyalgia management .  Fifty women with fibromyalgia under pharmacological treatment were r and omly assigned to either the balneotherapy ( 25 ) or the control ( 25 ) group . Four patients from the balneotherapy group and one patient from the control group left the study after r and omization . The patients in the balneotherapy group ( 21 ) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center . The patients in the control group ( 24 ) continued to have their medical treatment and routine daily life . An investigator who was blinded to the study arms assessed the patients . All patients were assessed four times ; at the beginning of the study , at the end of the 2nd week , the 1st month , and the 3rd month after balneotherapy . Outcome measures of the study were pain intensity , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , patient ’s global assessment , investigator ’s global assessment , SF-36 scores , and tender point count .  Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity , FIQ , Beck Depression Inventory , patient ’s global assessment , investigator ’s global assessment scores , and tender point count as compared to the control group . The superiority of balneotherapy lasted up to the end of the 3rd month , except for the Beck Depression Inventory score and the investigator ’s global assessment score . Significant improvements were observed in PF , GH , and MH subscales of SF-36 during the study period in the balneotherapy group ; however , no such improvement was observed in the control group . Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls . It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes OBJECTIVE To evaluate the effects of pool exercise in patients with fibromyalgia and chronic widespread pain and to determine characteristics influencing the effects of treatment . METHODS A total of 134 women with fibromyalgia and 32 with chronic widespread pain were r and omized to a 20-session pool exercise and a 6-session education programme or to a control group undertaking the same education programme . The primary outcomes were the Fibromyalgia Impact Question naire ( FIQ ) total score and the 6-minute walk test ( 6MWT ) . FIQ Pain and other health variables were included . RESULTS The FIQ total ( p = 0.04 ) improved in the intervention group , with an effect size of 0.32 . Patients who had participated in at least 60 % of the exercise sessions improved in the FIQ total ( effect size 0.44 ) , the 6MWT ( effect size 0.43 ) and FIQ Pain ( effect size 0.69 ) compared with controls ( p < 0.05 ) . Long-term follow-up revealed lasting , but small , improvement ( effect size < 0.29 ) in the 6MWT among the active participants ( p < 0.05 ) . Analyses within the subgroups showed that patients with milder stress , pain or depression improved most by treatment on the FIQ total ( effect size > 0.50 , p < 0.05 ) compared with controls . CONCLUSION The exercise-education programme showed significant , but small , improvement in health status in patients with fibromyalgia and chronic widespread pain , compared with education only . Patients with milder symptoms improved most with this treatment BACKGROUND A one-week booster group treatment in rheumatic diseases ( rheumatoid arthritis , spondylarthropathies , fibromyalgia ) was developed in order to stabilize rehabilitation effects after medical rehabilitation . The program took place in an inpatient setting 3 - 5 months after rehabilitation , aim ed at refreshing and deepening already learnt contents as well as teaching new subjects ( e. g. about dietetics ) . Training and educational elements are given priority in this concept . METHOD A total of 140 patients participated in 19 booster weeks  . At the end of each booster week the acceptance was assessed by question naire and in a round-table discussion . RESULTS Comprehensibility and group atmosphere were judged very positively . The course was also considered very helpful , helpfulness being rated with marks about 2 ( 1 = very helpful , 6 = not at all helpful ) . Participants especially appreciated the course 's framework as a group setting emphasising the exchange of experience with co- patients . At the same time , however , participants wished more individualized treatment such as physiotherapy or massage . With regard to the quantity of the various therapy elements , participants would have preferred more traditional spa therapy , more medical treatment by a physician , more group physiotherapy and sports . They would also have liked more breaks . In general fewer psychological elements , less discussion and reflection but more physical activity was wished for . Little difference was found between the various diagnoses , but the program was rated slightly more positively by the patients with spondylarthropathies . CONCLUSION Overall , the great number of people participating in the program and their acceptance of the booster week are positive . Patients appreciated the group setting and the possibilities of exchanging experience on a high level . But it was difficult to change patients ' traditional expectations concerning medical rehabilitation to a behaviour-orientated course like ours . It is worth thinking about whether this concept should play a greater role in traditional medical inpatient rehabilitation programming Evidence -based recommendations support the use of multimodal therapy and hydrotherapy for fibromyalgia syndrome ; however , there is little st and ardisation of such programmes . The aim of the study was to assess the effectiveness of a pool-based exercise using deep water running ( DWR ) as part of a multimodal physiotherapy programme for patients with fibromyalgia syndrome . For a non-r and omised clinical study , 44 patients diagnosed with fibromyalgia were recruited from primary care . Patients in the experimental group received a multimodal programme incorporating pool-based exercise using DWR three times a week for an 8-week period . The control group received a leaflet containing advice and continued with normal activities . Patients were evaluated for physical function ( Fibromyalgia Impact Question naire , FIQ ) , pain , general health ( Short Form-12 Health Survey ) and quality of life ( European Quality of Life Scale-5D ) pre- and post intervention . Statistically significant results were found for the experimental group for FIQ total score , incorporating physical function , pain , fatigue , stiffness and psychological variables ( p < 0.05 ) . Statistically significant differences between the experimental group and control were also found for general health ( p < 0.05 ) and quality of life ( p < 0.05 ) . The results of this pilot study and the high level of compliance and adherence and low level of attrition suggest that this multimodal programme incorporating DWR is a safe and effective intervention for fibromyalgia syndrome that is acceptable to patients Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the 
    Output:
    
agent
A significant effect on depressive symptoms was not found .
The improvements for pain could be maintained at follow-up with smaller effects .
***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 study the effect of a combination of thalassotherapy , exercise and patient education in people with fibromyalgia . METHODS Patients with fibromyalgia , selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association , were pre-r and omized to receive either 2(1/2 ) weeks of treatment in a Tunisian spa resort , including thalassotherapy , supervised exercise and group education ( active treatment ) or treatment as usual ( control treatment ) . Primary outcome measure was health-related quality of life , measured with the R AND -36 question naire . Secondary measures included the Fibromyalgia Impact Question naire , the McGill Pain Question naire , the Beck Depression Inventory , tender point score and a 6-min treadmill walk test . RESULTS Fifty-eight participants receiving the active treatment reported significant improvement on R AND -36 physical and mental component summary scales . For physical health , differences from the 76 controls were statistically significant after 3 months , but not after 6 and 12 months . A similar pattern of temporary improvement was seen in the self-reported secondary measures . Tender point scores and treadmill walk tests improved more after active treatment , but did not reach significant between-group differences , except for walk tests after 12 months . CONCLUSIONS A combination of thalassotherapy , exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life OBJECTIVES To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome ( FM ) . METHODS 134 patients with FM , selected from a rheumatology outpatient department and from members of the Dutch FM patient association were r and omly assigned to a 2(1/2 ) week spa treatment course in Tunisia or to usual care only . Results are expressed as quality -adjusted life years ( QALYs ) for a 6-month as well as a 12-month time horizon . Utilities were derived form the Short Form 6D ( SF-6D ) scores and the visual analogue scale ( VAS ) rating general health . Costs were reported from societal perspective . Mean incremental cost per patient and the incremental cost utility ratio ( ICER ) were calculated ; 95 % confidence intervals ( CIs ) were estimated using double-sided bootstrapping . RESULTS The data of 128 ( 55 spa and 73 controls ) of the 134 patients ( 96 % ) could be used for analysis . Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D ( AUC 0.32 vs 0.30 , P < 0.05 ) and the VAS ( AUC 0.23 vs 0.19 , P < 0.01 ) . After 1yr no significant between-group differences were found . Mean incremental cost of spa treatment was 1311 Euro per patient ( 95 % CI 369 - 2439 ) , equalling the cost of the intervention ( thalassotherapy including airfare and lodging ) , or 885 Euro per patient based on a more realistic cost estimate . CONCLUSIONS The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient Perspectives of patients with fibromyalgia influence their likelihood of participating in r and omized placebo-controlled trials and potentially clash with current , well-established methodology of r and omized controlled trial design . M and ates to use only acetaminophen for breakthrough pain and that require discontinuation of concomitant medications , especially in studies lacking an active comparator arm , could bias a trial cohort to thereby reduce the generalizability of study findings and conclusions . This study evaluates factors affecting willingness to participate in such clinical trials , including the impact of altruism , payment , study duration , forced discontinuation of specific medications , and subject demographics for patients seen by rheumatologists proficient and avidly interested in treating fibromyalgia We aim ed to evaluate the effectiveness of balneotherapy in  fibromyalgia management .  Fifty women with fibromyalgia under pharmacological treatment were r and omly assigned to either the balneotherapy ( 25 ) or the control ( 25 ) group . Four patients from the balneotherapy group and one patient from the control group left the study after r and omization . The patients in the balneotherapy group ( 21 ) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center . The patients in the control group ( 24 ) continued to have their medical treatment and routine daily life . An investigator who was blinded to the study arms assessed the patients . All patients were assessed four times ; at the beginning of the study , at the end of the 2nd week , the 1st month , and the 3rd month after balneotherapy . Outcome measures of the study were pain intensity , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , patient ’s global assessment , investigator ’s global assessment , SF-36 scores , and tender point count .  Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity , FIQ , Beck Depression Inventory , patient ’s global assessment , investigator ’s global assessment scores , and tender point count as compared to the control group . The superiority of balneotherapy lasted up to the end of the 3rd month , except for the Beck Depression Inventory score and the investigator ’s global assessment score . Significant improvements were observed in PF , GH , and MH subscales of SF-36 during the study period in the balneotherapy group ; however , no such improvement was observed in the control group . Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls . It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes OBJECTIVE To evaluate the effects of pool exercise in patients with fibromyalgia and chronic widespread pain and to determine characteristics influencing the effects of treatment . METHODS A total of 134 women with fibromyalgia and 32 with chronic widespread pain were r and omized to a 20-session pool exercise and a 6-session education programme or to a control group undertaking the same education programme . The primary outcomes were the Fibromyalgia Impact Question naire ( FIQ ) total score and the 6-minute walk test ( 6MWT ) . FIQ Pain and other health variables were included . RESULTS The FIQ total ( p = 0.04 ) improved in the intervention group , with an effect size of 0.32 . Patients who had participated in at least 60 % of the exercise sessions improved in the FIQ total ( effect size 0.44 ) , the 6MWT ( effect size 0.43 ) and FIQ Pain ( effect size 0.69 ) compared with controls ( p < 0.05 ) . Long-term follow-up revealed lasting , but small , improvement ( effect size < 0.29 ) in the 6MWT among the active participants ( p < 0.05 ) . Analyses within the subgroups showed that patients with milder stress , pain or depression improved most by treatment on the FIQ total ( effect size > 0.50 , p < 0.05 ) compared with controls . CONCLUSION The exercise-education programme showed significant , but small , improvement in health status in patients with fibromyalgia and chronic widespread pain , compared with education only . Patients with milder symptoms improved most with this treatment BACKGROUND A one-week booster group treatment in rheumatic diseases ( rheumatoid arthritis , spondylarthropathies , fibromyalgia ) was developed in order to stabilize rehabilitation effects after medical rehabilitation . The program took place in an inpatient setting 3 - 5 months after rehabilitation , aim ed at refreshing and deepening already learnt contents as well as teaching new subjects ( e. g. about dietetics ) . Training and educational elements are given priority in this concept . METHOD A total of 140 patients participated in 19 booster weeks  . At the end of each booster week the acceptance was assessed by question naire and in a round-table discussion . RESULTS Comprehensibility and group atmosphere were judged very positively . The course was also considered very helpful , helpfulness being rated with marks about 2 ( 1 = very helpful , 6 = not at all helpful ) . Participants especially appreciated the course 's framework as a group setting emphasising the exchange of experience with co- patients . At the same time , however , participants wished more individualized treatment such as physiotherapy or massage . With regard to the quantity of the various therapy elements , participants would have preferred more traditional spa therapy , more medical treatment by a physician , more group physiotherapy and sports . They would also have liked more breaks . In general fewer psychological elements , less discussion and reflection but more physical activity was wished for . Little difference was found between the various diagnoses , but the program was rated slightly more positively by the patients with spondylarthropathies . CONCLUSION Overall , the great number of people participating in the program and their acceptance of the booster week are positive . Patients appreciated the group setting and the possibilities of exchanging experience on a high level . But it was difficult to change patients ' traditional expectations concerning medical rehabilitation to a behaviour-orientated course like ours . It is worth thinking about whether this concept should play a greater role in traditional medical inpatient rehabilitation programming Evidence -based recommendations support the use of multimodal therapy and hydrotherapy for fibromyalgia syndrome ; however , there is little st and ardisation of such programmes . The aim of the study was to assess the effectiveness of a pool-based exercise using deep water running ( DWR ) as part of a multimodal physiotherapy programme for patients with fibromyalgia syndrome . For a non-r and omised clinical study , 44 patients diagnosed with fibromyalgia were recruited from primary care . Patients in the experimental group received a multimodal programme incorporating pool-based exercise using DWR three times a week for an 8-week period . The control group received a leaflet containing advice and continued with normal activities . Patients were evaluated for physical function ( Fibromyalgia Impact Question naire , FIQ ) , pain , general health ( Short Form-12 Health Survey ) and quality of life ( European Quality of Life Scale-5D ) pre- and post intervention . Statistically significant results were found for the experimental group for FIQ total score , incorporating physical function , pain , fatigue , stiffness and psychological variables ( p < 0.05 ) . Statistically significant differences between the experimental group and control were also found for general health ( p < 0.05 ) and quality of life ( p < 0.05 ) . The results of this pilot study and the high level of compliance and adherence and low level of attrition suggest that this multimodal programme incorporating DWR is a safe and effective intervention for fibromyalgia syndrome that is acceptable to patients Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the 
    Output:
    