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: OBJECTIVE To conduct a preliminary investigation of the effects on floatation spa therapy on quality of life in patients with osteoarthritis to see if controlled trials are warranted . DESIGN Uncontrolled clinical trial . SETTING Private floatation spa therapy centre . PATIENTS Fourteen patients with chronic osteoarthritis of the weight-bearing joints , of whom four dropped out . INTERVENTION Six weekly sessions of floatation spa therapy . OUTCOME MEASURES SF36 , AIMS 2 and MYMOP quality -of-life question naires . MAIN RESULTS All patients improved . Differences between baseline and discharge scores showed statistically significant improvement for MYMOP , but not AIMS 2 or SF-36 . CONCLUSIONS Controlled trials of floatation spa therapy for patients with osteoarthritis are warranted Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel . The patients were divided into four groups of 10 . Group I was treated with daily mud packs , group II with daily hot sulphur baths , group III with a combination of mud packs and hot sulphur baths , and group IV served as a control group . The patients were assessed by a rheumatologist who was blinded to the treatment modalities . Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices . Improvement in the control group was minor in comparison and not statistically significant . No significant improvement was observed in any of the laboratory variables measured . Except for three mild cases of thermal reaction there were no side effects Thirty patients with classical or definite rheumatoid arthritis were r and omly divided into two groups of fifteen patients each of similar age , sex , duration and severity of disease , and medical treatment . All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes . Group I received Dead Sea bath salts and Group II , the control group , received sodium chloride ( NaCl ) . The study was double-blind and of two weeks ' duration . All patients were evaluated by one rheumatologist both before treatment , and two weeks later at the end of the treatment period . Follow-up evaluations were made one and three months after conclusion of the treatments . The clinical parameters evaluated included duration of morning stiffness , fifteen meter walk time , h and -grip strength , activities of daily living , circumference of proximal interphalangeal joints , number of active joints , Ritchie index and the patient 's own assessment of disease activity . The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A , rheumatoid factor , sodium , potassium , calcium and magnesium . A statistically significant improvement ( p less than 0.01 or p less than 0.05 ) was observed in Group I only , in most of the clinical parameters assessed . Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month Abstract The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis ( PsA ) . A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks . Patients were r and omly allocated into two groups : group 1 ( 23 patients ) and group 2 ( 19 patients ) . Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea . Group 1 was also treated with mud packs and sulfur baths . Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival , at the end of treatment , and at weeks 8 , 16 , and 28 from the start of treatment . The clinical indices assessed were morning stiffness , right and left h and grip , number of tender joints , number of swollen joints , Schober test , distance from finger to floor when bending forward , patient 's self- assessment of disease severity , inflammatory neck and back pain and psoriasis area and severity index ( PASI ) score . Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI , morning stiffness , patient self- assessment , right and left grip , Schober test and distance from finger to floor when bending forward . For variables such as tender and swollen joints , and inflammatory neck and back pain , improvement over time was statistically significant in group 1 . Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain In chronic rheumatic diseases , recent treatment regimens comprise multimodal concepts including pharmacologic , physical/exercise , occupational and psychological therapies . Rehabilitation programmes are used for long-term management of disease . Spa therapy is often integrated in various middle and south European and Asian countries . Here , we investigated radon spa therapy as applied in health resorts compared to a control intervention in rheumatic out- patients . R and omised , blinded trial enroling 681 patients [ mean age 58.3 ( st and ard deviation 11.1 ) ; female 59.7 % ] in 7 health resorts in Germany and Austria with chronic back pain ( n1 = 437 ) , osteoarthritis ( OA ) ( n2 = 230 ) , rheumatoid arthritis ( n3 = 98 ) , and /or ankylosing spondylitis ( n4 = 39 ) ; multiple nominations in 146 cases ) . Outcomes were pain ( primary ) , quality of life , functional capacity , and medication measured before start , after end of treatment , and 3 times thereafter in 3 monthly intervals . Adverse events were documented . To analyse between-group differences , repeated- measures analysis of covariance was performed in metric endpoints and Fisher ’s exact test in rates . Two-sided significance level of 5 % was chosen . Until end of follow-up , superiority of radon therapy was found regarding pain relief ( p = 0.032 ) and analgesic drug consumption ( p = 0.007 ) , but not regarding quality of life . Functional capacity was assessed specific to the underlying indication . Significant benefits were found in radon-treated OA patients until 6-month follow-up ( p = 0.05 ) , but not until end of study ( p = 0.096 ) . Neither the back pain sub- population nor the two smaller patient population s with inflammatory indications benefited significantly in functional capacity . Results suggest beneficial analgesic effects of radon spa therapy in rheumatic diseases until 9 months post-intervention BACKGROUND A beneficial effect was observed in patients with psoriasis vulgaris following balneotherapy with Dead Sea bath salt . OBJECTIVES To evaluate the possible role of trace elements in the effectiveness of balneotherapy . METHODS Serum levels of 11 trace elements were analyzed in 23 patients with psoriasis vulgaris who participated in a double-blind controlled study of balneotherapy with either Dead Sea bath salt ( 12 patients ) or common salt ( 11 patients ) . Thirteen healthy volunteers served as controls . RESULTS The mean pre-treatment serum levels of boron , cadmium , lithium and rubidium were significantly lower in patients compared to controls , whereas the mean pre-treatment serum level of manganese was significantly higher in patients compared to controls . Balneotherapy with Dead Sea bath salt result ed in a significant decrease ( P = 0.0051 ) in the mean serum level of manganese from 0.10 + /- 0.05 mol/L to 0.05 + /- 0.02 mumol/L. The mean reduction in the serum level of manganese differed significantly ( P = 0.002 ) between responders ( % Psoriasis Area and Severity Index score reduction > or = 25 ) and non-responders ( % PASI score reduction < 25 ) . Following balneotherapy with Dead Sea bath salt the mean serum level of lithium  decreased in responders by 0.01 + /- 0.02 mumol/L , whereas its level in non-responders increased by 0.03 + /- 0.03 mumol/L. ( P = 0.015 ) . CONCLUSIONS Manganese and lithium may play a role in the effectiveness of balneotherapy with Dead Sea bath salt for psoriasis Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To determine the efficacy of combined spa-exercise therapy in addition to st and ard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis ( AS ) . METHODS A total of 120 Dutch out patients with AS were r and omly allocated into 3 groups of 40 patients each . Group 1 ( mean age 48 + /- 10 years ; male : female ratio 25:15 ) was treated in a spa resort in Bad Hofgastein , Austria ; group 2 ( mean age 49 + /- 9 years ; male : female ratio 28:12 ) in a spa resort in Arcen , The Netherl and s. The control group ( mean age 48 + /- 10 years ; male : female ratio 34:6 ) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks . St and ardized spa-exercise therapy of 3 weeks duration consisted of group physical exercises , walking , correction therapy ( lying supine on a bed ) , hydrotherapy , sports , and visits to either the Gasteiner Heilstollen ( Austria ) or sauna ( Netherl and s ) . After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks . Primary outcomes were functional ability , patient 's global well-being , pain , and duration of morning stiffness , aggregated in a pooled index of change ( PIC ) . RESULTS Analysis of variance showed a statistically significant time-effect ( P < 0.001 ) and time-by-treatment interaction ( P = 0.004 ) , indicating that the 3 groups differed over time with respect to the course of the PIC . Four weeks after start of spa-exercise therapy , the mean difference in PIC between group 1 and controls was 0.49 ( 95 % confidence interval [ CI ] 0.16 - 0.82 , P = 0.004 ) and between group 2 and controls was 0.46 ( 95 % CI 0.15 - 0.78 , P = 0.005 ) . At 16 weeks , the difference between group 1 and controls was 0.63 ( 95 % CI 0.23 - 1.02 , P = 0.002 ) and between group 2 and controls was 0.34 ( 95 % CI--0.05 - 0.73 ; P = 0.086 ) . At 28 and 40 weeks , more improvement was found for group 1 compared with controls ( P = 0.012 and P = 0.062 , respectively ) but not for group 2 compared with controls . CONCLUSION In patients with AS , a 3-week course of combined spa-exercise therapy , in addition to drug treatment and weekly group physical therapy alone , provides beneficial effects . These beneficial effects may last for at least 40 weeks The objective of this study was to evaluate the effect of spa therapy on clinical parameters of patients with gonarthrosis . Patients with gonarthrosis ( n=33 ) underwent a 2-week spa therapy using three treatment regimes and a 20-week follow-up as follows : group I ( n=11 ) had mineral water baths and hot native mineral mud packs , group II ( n=12 ) had mineral water baths and rinsed mineral-free mud packs and group III ( n=10 ) had tap water baths and mineral-free mud packs . The patients and the assessing rheumatologist were blinded to the difference in the treatment protocol s. A significant improvement in the index of severity of the knee ( ISK ) , as well as night pain scores , was achieved in group I. Improvement in physical findings and a reduction in pain ratings on a visual analogue scale ( VAS ) did not reach statistical significance . Analgesic consumption was significantly decreased in both groups I and III for up to 12 weeks . Global improvement assessed by patients and physician was observed in all three groups up to 16 weeks but persisted to the end of the follow-up period in group I only . Patients with gonarthrosis seemed to benefit from spa therapy under all three regimes . However , for two parameters ( night pain and ISK ) the combination of mineral water baths and mud packs ( group I ) appeared to be superior The effect of " Kangal Hot Spring with Fish " in the treatment of psoriasis is investigated . The study was carried out on 87 patients with psoriasis vulgaris and the patients were evaluated by a dermatologist for 21 days . The evaluation of the disease was performed using PASI ( Psoriasis Area and Severity Index ) scores . Recurrences were investigated in the patient population , who had been previously treated in the same hot spring . The first examination scores were significantly higher than the scores of the 3 , 6 , 9 , 12 , 15 and 21 days after treatment ( p < 0.01 ) . Longer remission periods , when compared to the topical corticosteroid treatment , expressed by the 35 patients previously treated in hot spring ( p < 0.01 ) . Spa therapy under observation of a dermatologist may be effective and useful for psoriasis vulgaris patients This study investigates the effects of radon ( plus CO2 ) baths on RA in contrast to artificial CO2 baths in RA rehabilitation using a double-blinded trial enrolling 134 r and omised patients of an in-patient rehabilitative programme ( further 7 
    Output:
    
agent
We found no statistically significant differences in pain on the McGill Question naire or in physical disability ( very low level of evidence ) between balneotherapy and the other interventions .
Overall evidence is insufficient to show that balneotherapy is more effective than no treatment , that one type of bath is more effective than another or that one type of bath is more effective than mudpacks , exercise or relaxation therapy
***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: OBJECTIVE To conduct a preliminary investigation of the effects on floatation spa therapy on quality of life in patients with osteoarthritis to see if controlled trials are warranted . DESIGN Uncontrolled clinical trial . SETTING Private floatation spa therapy centre . PATIENTS Fourteen patients with chronic osteoarthritis of the weight-bearing joints , of whom four dropped out . INTERVENTION Six weekly sessions of floatation spa therapy . OUTCOME MEASURES SF36 , AIMS 2 and MYMOP quality -of-life question naires . MAIN RESULTS All patients improved . Differences between baseline and discharge scores showed statistically significant improvement for MYMOP , but not AIMS 2 or SF-36 . CONCLUSIONS Controlled trials of floatation spa therapy for patients with osteoarthritis are warranted Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel . The patients were divided into four groups of 10 . Group I was treated with daily mud packs , group II with daily hot sulphur baths , group III with a combination of mud packs and hot sulphur baths , and group IV served as a control group . The patients were assessed by a rheumatologist who was blinded to the treatment modalities . Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices . Improvement in the control group was minor in comparison and not statistically significant . No significant improvement was observed in any of the laboratory variables measured . Except for three mild cases of thermal reaction there were no side effects Thirty patients with classical or definite rheumatoid arthritis were r and omly divided into two groups of fifteen patients each of similar age , sex , duration and severity of disease , and medical treatment . All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes . Group I received Dead Sea bath salts and Group II , the control group , received sodium chloride ( NaCl ) . The study was double-blind and of two weeks ' duration . All patients were evaluated by one rheumatologist both before treatment , and two weeks later at the end of the treatment period . Follow-up evaluations were made one and three months after conclusion of the treatments . The clinical parameters evaluated included duration of morning stiffness , fifteen meter walk time , h and -grip strength , activities of daily living , circumference of proximal interphalangeal joints , number of active joints , Ritchie index and the patient 's own assessment of disease activity . The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A , rheumatoid factor , sodium , potassium , calcium and magnesium . A statistically significant improvement ( p less than 0.01 or p less than 0.05 ) was observed in Group I only , in most of the clinical parameters assessed . Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month Abstract The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis ( PsA ) . A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks . Patients were r and omly allocated into two groups : group 1 ( 23 patients ) and group 2 ( 19 patients ) . Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea . Group 1 was also treated with mud packs and sulfur baths . Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival , at the end of treatment , and at weeks 8 , 16 , and 28 from the start of treatment . The clinical indices assessed were morning stiffness , right and left h and grip , number of tender joints , number of swollen joints , Schober test , distance from finger to floor when bending forward , patient 's self- assessment of disease severity , inflammatory neck and back pain and psoriasis area and severity index ( PASI ) score . Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI , morning stiffness , patient self- assessment , right and left grip , Schober test and distance from finger to floor when bending forward . For variables such as tender and swollen joints , and inflammatory neck and back pain , improvement over time was statistically significant in group 1 . Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain In chronic rheumatic diseases , recent treatment regimens comprise multimodal concepts including pharmacologic , physical/exercise , occupational and psychological therapies . Rehabilitation programmes are used for long-term management of disease . Spa therapy is often integrated in various middle and south European and Asian countries . Here , we investigated radon spa therapy as applied in health resorts compared to a control intervention in rheumatic out- patients . R and omised , blinded trial enroling 681 patients [ mean age 58.3 ( st and ard deviation 11.1 ) ; female 59.7 % ] in 7 health resorts in Germany and Austria with chronic back pain ( n1 = 437 ) , osteoarthritis ( OA ) ( n2 = 230 ) , rheumatoid arthritis ( n3 = 98 ) , and /or ankylosing spondylitis ( n4 = 39 ) ; multiple nominations in 146 cases ) . Outcomes were pain ( primary ) , quality of life , functional capacity , and medication measured before start , after end of treatment , and 3 times thereafter in 3 monthly intervals . Adverse events were documented . To analyse between-group differences , repeated- measures analysis of covariance was performed in metric endpoints and Fisher ’s exact test in rates . Two-sided significance level of 5 % was chosen . Until end of follow-up , superiority of radon therapy was found regarding pain relief ( p = 0.032 ) and analgesic drug consumption ( p = 0.007 ) , but not regarding quality of life . Functional capacity was assessed specific to the underlying indication . Significant benefits were found in radon-treated OA patients until 6-month follow-up ( p = 0.05 ) , but not until end of study ( p = 0.096 ) . Neither the back pain sub- population nor the two smaller patient population s with inflammatory indications benefited significantly in functional capacity . Results suggest beneficial analgesic effects of radon spa therapy in rheumatic diseases until 9 months post-intervention BACKGROUND A beneficial effect was observed in patients with psoriasis vulgaris following balneotherapy with Dead Sea bath salt . OBJECTIVES To evaluate the possible role of trace elements in the effectiveness of balneotherapy . METHODS Serum levels of 11 trace elements were analyzed in 23 patients with psoriasis vulgaris who participated in a double-blind controlled study of balneotherapy with either Dead Sea bath salt ( 12 patients ) or common salt ( 11 patients ) . Thirteen healthy volunteers served as controls . RESULTS The mean pre-treatment serum levels of boron , cadmium , lithium and rubidium were significantly lower in patients compared to controls , whereas the mean pre-treatment serum level of manganese was significantly higher in patients compared to controls . Balneotherapy with Dead Sea bath salt result ed in a significant decrease ( P = 0.0051 ) in the mean serum level of manganese from 0.10 + /- 0.05 mol/L to 0.05 + /- 0.02 mumol/L. The mean reduction in the serum level of manganese differed significantly ( P = 0.002 ) between responders ( % Psoriasis Area and Severity Index score reduction > or = 25 ) and non-responders ( % PASI score reduction < 25 ) . Following balneotherapy with Dead Sea bath salt the mean serum level of lithium  decreased in responders by 0.01 + /- 0.02 mumol/L , whereas its level in non-responders increased by 0.03 + /- 0.03 mumol/L. ( P = 0.015 ) . CONCLUSIONS Manganese and lithium may play a role in the effectiveness of balneotherapy with Dead Sea bath salt for psoriasis Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To determine the efficacy of combined spa-exercise therapy in addition to st and ard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis ( AS ) . METHODS A total of 120 Dutch out patients with AS were r and omly allocated into 3 groups of 40 patients each . Group 1 ( mean age 48 + /- 10 years ; male : female ratio 25:15 ) was treated in a spa resort in Bad Hofgastein , Austria ; group 2 ( mean age 49 + /- 9 years ; male : female ratio 28:12 ) in a spa resort in Arcen , The Netherl and s. The control group ( mean age 48 + /- 10 years ; male : female ratio 34:6 ) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks . St and ardized spa-exercise therapy of 3 weeks duration consisted of group physical exercises , walking , correction therapy ( lying supine on a bed ) , hydrotherapy , sports , and visits to either the Gasteiner Heilstollen ( Austria ) or sauna ( Netherl and s ) . After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks . Primary outcomes were functional ability , patient 's global well-being , pain , and duration of morning stiffness , aggregated in a pooled index of change ( PIC ) . RESULTS Analysis of variance showed a statistically significant time-effect ( P < 0.001 ) and time-by-treatment interaction ( P = 0.004 ) , indicating that the 3 groups differed over time with respect to the course of the PIC . Four weeks after start of spa-exercise therapy , the mean difference in PIC between group 1 and controls was 0.49 ( 95 % confidence interval [ CI ] 0.16 - 0.82 , P = 0.004 ) and between group 2 and controls was 0.46 ( 95 % CI 0.15 - 0.78 , P = 0.005 ) . At 16 weeks , the difference between group 1 and controls was 0.63 ( 95 % CI 0.23 - 1.02 , P = 0.002 ) and between group 2 and controls was 0.34 ( 95 % CI--0.05 - 0.73 ; P = 0.086 ) . At 28 and 40 weeks , more improvement was found for group 1 compared with controls ( P = 0.012 and P = 0.062 , respectively ) but not for group 2 compared with controls . CONCLUSION In patients with AS , a 3-week course of combined spa-exercise therapy , in addition to drug treatment and weekly group physical therapy alone , provides beneficial effects . These beneficial effects may last for at least 40 weeks The objective of this study was to evaluate the effect of spa therapy on clinical parameters of patients with gonarthrosis . Patients with gonarthrosis ( n=33 ) underwent a 2-week spa therapy using three treatment regimes and a 20-week follow-up as follows : group I ( n=11 ) had mineral water baths and hot native mineral mud packs , group II ( n=12 ) had mineral water baths and rinsed mineral-free mud packs and group III ( n=10 ) had tap water baths and mineral-free mud packs . The patients and the assessing rheumatologist were blinded to the difference in the treatment protocol s. A significant improvement in the index of severity of the knee ( ISK ) , as well as night pain scores , was achieved in group I. Improvement in physical findings and a reduction in pain ratings on a visual analogue scale ( VAS ) did not reach statistical significance . Analgesic consumption was significantly decreased in both groups I and III for up to 12 weeks . Global improvement assessed by patients and physician was observed in all three groups up to 16 weeks but persisted to the end of the follow-up period in group I only . Patients with gonarthrosis seemed to benefit from spa therapy under all three regimes . However , for two parameters ( night pain and ISK ) the combination of mineral water baths and mud packs ( group I ) appeared to be superior The effect of " Kangal Hot Spring with Fish " in the treatment of psoriasis is investigated . The study was carried out on 87 patients with psoriasis vulgaris and the patients were evaluated by a dermatologist for 21 days . The evaluation of the disease was performed using PASI ( Psoriasis Area and Severity Index ) scores . Recurrences were investigated in the patient population , who had been previously treated in the same hot spring . The first examination scores were significantly higher than the scores of the 3 , 6 , 9 , 12 , 15 and 21 days after treatment ( p < 0.01 ) . Longer remission periods , when compared to the topical corticosteroid treatment , expressed by the 35 patients previously treated in hot spring ( p < 0.01 ) . Spa therapy under observation of a dermatologist may be effective and useful for psoriasis vulgaris patients This study investigates the effects of radon ( plus CO2 ) baths on RA in contrast to artificial CO2 baths in RA rehabilitation using a double-blinded trial enrolling 134 r and omised patients of an in-patient rehabilitative programme ( further 7 
    Output:
    