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 Multiple sclerosis ( MS ) is a multi-focal progressive disorder of the central nervous system often result ing in diverse clinical manifestations . Imbalance appears in most people with multiple sclerosis ( PwMS ) . A popular balance training tool is virtual reality ( VR ) with several advantages including increased compliance and user satisfaction . Therefore , the aim of this pilot RCT ( Trial registration number , date : IS RCT N14425615 , 21/01/2016 ) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment ( CAREN ) system ( Motek Medical BV , Amsterdam , Netherl and s ) on balance measures in PwMS . Results were compared with those of a conventional balance exercise group . Secondary aims included the impact of this program on the fear of falling . Methods Thirty-two PwMS were equally r and omized into the  VR intervention group  or  the control group . Each group received balance training sessions for 6 consecutive weeks , two sessions per week , 30 min sessions . Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination . Results Final analysis included 30 patients ( 19 females , 11 males ; mean age , ( S.D. ) = 45.2 ( 11.6 ) years ; mean EDSS ( S.D. ) = 4.1 ( 1.3 ) , mean disease duration ( S.D. ) = 11.0 ( 8.9 ) years ) . Both groups showed a main effect of time on the center of pressure ( CoP ) path length with eyes open ( F = 5.278 , P = .024 ) , sway rate with eyes open ( F = 5.852 , P = .035 ) , Functional Reach Test ( F = 20.841 , P = .001 ) , Four Square Step Test ( F = 9.011 , P = .031 ) and the Fear of Falls self-reported question naire ( F = 17.815 , P = .023 ) . In addition , significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test ( F = 10.173 , P = .009 ) and fear of falling ( F = 6.710 , P = .021 ) . Conclusions We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS Abstract Aim : In this single blind r and omized controlled trial , we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis . Methods : Twenty-five individuals with multiple sclerosis with mild to moderate disability were r and omly assigned to either the control group ( n = 11 ) or the experimental group ( n = 14 ) . The subjects in the control group received treadmill training . Subjects in the experimental group received virtual reality based treadmill training .  Clinical measures and gait parameters were evaluated . Result : Subjects in both the groups significantly improved the walking endurance and speed , cadence and stride length , lower limb joint ranges of motion and powers , during single and dual task gait . Moreover , subjects in the experimental group also improved balance , as indicated by the results of the clinical motor tests ( p < 0.05 ) . Between-group comparisons revealed that the experimental group improved significantly more than control group in hip range of motion and hip generated power at terminal stance at post-training . Conclusion : Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis . Implication of rehabilitation Gait deficits are common in multiple sclerosis ( 85 % ) and worsen during dual task activities . Intensive and progressive treadmill training , with and without virtual reality , is effective on dual task gait in persons with multiple sclerosis . Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip , consequently allowing longer stride length and , consequently , higher gait speed BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Background : The use of interactive video games is exp and ing within rehabilitation . The evidence base is , however , limited . Objective : Our aim was to evaluate the effects of a Nintendo Wii Fit ® balance exercise programme on balance function and walking ability in people with multiple sclerosis ( MS ) . Methods : A multi-centre , r and omised , controlled single-blinded trial with r and om allocation to exercise or no exercise . The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games , twice a week for 6–7 weeks . Primary outcome was the Timed Up and Go test ( TUG ) . In total , 84 participants were enrolled ; four were lost to follow-up . Results : After the intervention , there were no statistically significant differences between groups but effect sizes for the TUG , TUGcognitive and , the Dynamic Gait Index ( DGI ) were moderate and small for all other measures . Statistically significant improvements within the exercise group were present for all measures ( large to moderate effect sizes ) except in walking speed and balance confidence . The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI . Conclusion : In comparison with no intervention , a programme of supervised balance exercise using Nintendo Wii Fit ® did not render statistically significant differences , but presented moderate effect sizes for several measures of balance performance Objectives While the health and well-being benefits of physical activity are recognised , people with multiple sclerosis ( MS ) often face greater barriers than the general population . The Nintendo Wii potentially offers a fun , convenient way of overcoming some of these . The aim was to test the feasibility of conducting a definitive trial of the effectiveness and cost-effectiveness of Mii-vitaliSe ; a home-based , physiotherapist-supported Nintendo Wii intervention . Design A single-centre wait-list r and omised controlled study . Setting MS service in secondary care . Participants Ambulatory , relatively inactive people with clinical ly confirmed MS . Intervention Thirty participants were r and omised to receive Mii-vitaliSe either immediately ( for 12 months ) or after a 6-month wait ( for 6 months ) . Mii-vitaliSe consisted of two supervised Nintendo Wii familiarisation sessions in the hospital followed by home use ( Wii Sports , Sports Resort and Fit Plus software ) with physiotherapist support and personalised re sources . Outcomes Included self-reported physical activity levels , quality of life , mood , self-efficacy , fatigue and assessment s of balance , gait , mobility and h and dexterity at baseline , 6 and 12 months . Interviews ( n=25 ) explored participants ’ experiences and , at study end , the two Mii-vitaliSe facilitators ’ experiences of intervention delivery ( main qualitative findings reported separately ) . Results Mean ( SD ) age was 49.3 ( 8.7 ) years , 90 % female , with 47 % diagnosed with MS < 6 years ago and 60 % new to active gaming .  The recruitment rate  was 31 % ( 95 % CI 20 % to 44 % ) . Outcome data were available for 29 ( 97 % ) at 6 months and 28 ( 93 % ) at 12 months . No serious adverse events were reported during the study . Qualitative data indicated that Mii-vitaliSe was well-received . Mean Wii use across both groups over the initial 6-month intervention period was twice a week for 27 min/day . Mean cost of delivering Mii-vitaliSe was £ 684 per person . Discussion Mii-vitaliSe appears acceptable and a future trial feasible and warranted . These findings will inform its design . Trial registration IS RCT Background Exergaming is a promising new alternative to traditional modes of therapeutic exercise which may be preferable and more effective for people with Multiple Sclerosis ( MS ) . Impaired balance is reported as one of the most disabling aspects of MS . The purpose s of this study were to examine the effects of exergaming on : ( 1 ) postural sway , ( 2 ) gait , ( 3 ) technology acceptance and ( 4 ) flow experience in people with MS . Secondary outcomes were disability : 12‐item Multiple Sclerosis Walking Scale ( MSWS-12 ) and the World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0 ) question naire . Methods Fifty-six adults ( mean age = 52 years , SD = 5.8 ; 38 women ) with a clinical diagnosis of MS and able to walk 100 meters with or without use of a walking aid were included in this study and r and omized into 3 groups . Group 1 received balance training using the Nintendo Wii Fit ™ ( exergaming ) and Group 2 undertook traditional balance training ( non-exergaming ) . Group 3 acted as a control group , receiving no intervention . Exergaming and traditional balance training groups received four weeks of twice weekly balance-orientated exercise . Postural sway was measured using a Kistler ™ force platform . Spatiotemporal parameters of gait were measured using a GAITRite ™ computerised walkway . Technology acceptance and flow experience were measured using the Unified Theory of Acceptance and Use of Technology and the Flow State Scale question naires , respectively . Results There were significant improvements in bipedal postural sway in both intervention groups when compared to the control group ; and no effects of either intervention on gait . There were no significant differences between the interventions in technology acceptance but on several dimensions of flow experience the Wii Fit ™ was superior to traditional balance training . Both interventions showed improvements in disability compared to control . Conclusions In terms of the physical effects of exergaming , the Wii Fit ™ is comparable to traditional balance training . These findings would support the use of the Wii Fit ™ as an effective means of balance and gait training for people with MS , which is both accepted and intrinsically motivating to MS users . Trial registration Controlled Trials IS RCT N13924231 BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Objective . To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System ( WBBS ) in patients affected by multiple sclerosis ( MS ) . Methods . In this 24-week , r and omized , 2-period crossover pilot study , 36 patients having an objective balance disorder were r and omly assigned in a 1:1 ratio to 2 counter 
    Output:
    
agent
***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 Multiple sclerosis ( MS ) is a multi-focal progressive disorder of the central nervous system often result ing in diverse clinical manifestations . Imbalance appears in most people with multiple sclerosis ( PwMS ) . A popular balance training tool is virtual reality ( VR ) with several advantages including increased compliance and user satisfaction . Therefore , the aim of this pilot RCT ( Trial registration number , date : IS RCT N14425615 , 21/01/2016 ) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment ( CAREN ) system ( Motek Medical BV , Amsterdam , Netherl and s ) on balance measures in PwMS . Results were compared with those of a conventional balance exercise group . Secondary aims included the impact of this program on the fear of falling . Methods Thirty-two PwMS were equally r and omized into the  VR intervention group  or  the control group . Each group received balance training sessions for 6 consecutive weeks , two sessions per week , 30 min sessions . Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination . Results Final analysis included 30 patients ( 19 females , 11 males ; mean age , ( S.D. ) = 45.2 ( 11.6 ) years ; mean EDSS ( S.D. ) = 4.1 ( 1.3 ) , mean disease duration ( S.D. ) = 11.0 ( 8.9 ) years ) . Both groups showed a main effect of time on the center of pressure ( CoP ) path length with eyes open ( F = 5.278 , P = .024 ) , sway rate with eyes open ( F = 5.852 , P = .035 ) , Functional Reach Test ( F = 20.841 , P = .001 ) , Four Square Step Test ( F = 9.011 , P = .031 ) and the Fear of Falls self-reported question naire ( F = 17.815 , P = .023 ) . In addition , significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test ( F = 10.173 , P = .009 ) and fear of falling ( F = 6.710 , P = .021 ) . Conclusions We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS Abstract Aim : In this single blind r and omized controlled trial , we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis . Methods : Twenty-five individuals with multiple sclerosis with mild to moderate disability were r and omly assigned to either the control group ( n = 11 ) or the experimental group ( n = 14 ) . The subjects in the control group received treadmill training . Subjects in the experimental group received virtual reality based treadmill training .  Clinical measures and gait parameters were evaluated . Result : Subjects in both the groups significantly improved the walking endurance and speed , cadence and stride length , lower limb joint ranges of motion and powers , during single and dual task gait . Moreover , subjects in the experimental group also improved balance , as indicated by the results of the clinical motor tests ( p < 0.05 ) . Between-group comparisons revealed that the experimental group improved significantly more than control group in hip range of motion and hip generated power at terminal stance at post-training . Conclusion : Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis . Implication of rehabilitation Gait deficits are common in multiple sclerosis ( 85 % ) and worsen during dual task activities . Intensive and progressive treadmill training , with and without virtual reality , is effective on dual task gait in persons with multiple sclerosis . Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip , consequently allowing longer stride length and , consequently , higher gait speed BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Background : The use of interactive video games is exp and ing within rehabilitation . The evidence base is , however , limited . Objective : Our aim was to evaluate the effects of a Nintendo Wii Fit ® balance exercise programme on balance function and walking ability in people with multiple sclerosis ( MS ) . Methods : A multi-centre , r and omised , controlled single-blinded trial with r and om allocation to exercise or no exercise . The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games , twice a week for 6–7 weeks . Primary outcome was the Timed Up and Go test ( TUG ) . In total , 84 participants were enrolled ; four were lost to follow-up . Results : After the intervention , there were no statistically significant differences between groups but effect sizes for the TUG , TUGcognitive and , the Dynamic Gait Index ( DGI ) were moderate and small for all other measures . Statistically significant improvements within the exercise group were present for all measures ( large to moderate effect sizes ) except in walking speed and balance confidence . The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI . Conclusion : In comparison with no intervention , a programme of supervised balance exercise using Nintendo Wii Fit ® did not render statistically significant differences , but presented moderate effect sizes for several measures of balance performance Objectives While the health and well-being benefits of physical activity are recognised , people with multiple sclerosis ( MS ) often face greater barriers than the general population . The Nintendo Wii potentially offers a fun , convenient way of overcoming some of these . The aim was to test the feasibility of conducting a definitive trial of the effectiveness and cost-effectiveness of Mii-vitaliSe ; a home-based , physiotherapist-supported Nintendo Wii intervention . Design A single-centre wait-list r and omised controlled study . Setting MS service in secondary care . Participants Ambulatory , relatively inactive people with clinical ly confirmed MS . Intervention Thirty participants were r and omised to receive Mii-vitaliSe either immediately ( for 12 months ) or after a 6-month wait ( for 6 months ) . Mii-vitaliSe consisted of two supervised Nintendo Wii familiarisation sessions in the hospital followed by home use ( Wii Sports , Sports Resort and Fit Plus software ) with physiotherapist support and personalised re sources . Outcomes Included self-reported physical activity levels , quality of life , mood , self-efficacy , fatigue and assessment s of balance , gait , mobility and h and dexterity at baseline , 6 and 12 months . Interviews ( n=25 ) explored participants ’ experiences and , at study end , the two Mii-vitaliSe facilitators ’ experiences of intervention delivery ( main qualitative findings reported separately ) . Results Mean ( SD ) age was 49.3 ( 8.7 ) years , 90 % female , with 47 % diagnosed with MS < 6 years ago and 60 % new to active gaming .  The recruitment rate  was 31 % ( 95 % CI 20 % to 44 % ) . Outcome data were available for 29 ( 97 % ) at 6 months and 28 ( 93 % ) at 12 months . No serious adverse events were reported during the study . Qualitative data indicated that Mii-vitaliSe was well-received . Mean Wii use across both groups over the initial 6-month intervention period was twice a week for 27 min/day . Mean cost of delivering Mii-vitaliSe was £ 684 per person . Discussion Mii-vitaliSe appears acceptable and a future trial feasible and warranted . These findings will inform its design . Trial registration IS RCT Background Exergaming is a promising new alternative to traditional modes of therapeutic exercise which may be preferable and more effective for people with Multiple Sclerosis ( MS ) . Impaired balance is reported as one of the most disabling aspects of MS . The purpose s of this study were to examine the effects of exergaming on : ( 1 ) postural sway , ( 2 ) gait , ( 3 ) technology acceptance and ( 4 ) flow experience in people with MS . Secondary outcomes were disability : 12‐item Multiple Sclerosis Walking Scale ( MSWS-12 ) and the World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0 ) question naire . Methods Fifty-six adults ( mean age = 52 years , SD = 5.8 ; 38 women ) with a clinical diagnosis of MS and able to walk 100 meters with or without use of a walking aid were included in this study and r and omized into 3 groups . Group 1 received balance training using the Nintendo Wii Fit ™ ( exergaming ) and Group 2 undertook traditional balance training ( non-exergaming ) . Group 3 acted as a control group , receiving no intervention . Exergaming and traditional balance training groups received four weeks of twice weekly balance-orientated exercise . Postural sway was measured using a Kistler ™ force platform . Spatiotemporal parameters of gait were measured using a GAITRite ™ computerised walkway . Technology acceptance and flow experience were measured using the Unified Theory of Acceptance and Use of Technology and the Flow State Scale question naires , respectively . Results There were significant improvements in bipedal postural sway in both intervention groups when compared to the control group ; and no effects of either intervention on gait . There were no significant differences between the interventions in technology acceptance but on several dimensions of flow experience the Wii Fit ™ was superior to traditional balance training . Both interventions showed improvements in disability compared to control . Conclusions In terms of the physical effects of exergaming , the Wii Fit ™ is comparable to traditional balance training . These findings would support the use of the Wii Fit ™ as an effective means of balance and gait training for people with MS , which is both accepted and intrinsically motivating to MS users . Trial registration Controlled Trials IS RCT N13924231 BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Objective . To evaluate the effectiveness of a home-based rehabilitation of balance using the Nintendo Wii Balance Board System ( WBBS ) in patients affected by multiple sclerosis ( MS ) . Methods . In this 24-week , r and omized , 2-period crossover pilot study , 36 patients having an objective balance disorder were r and omly assigned in a 1:1 ratio to 2 counter 
    Output:
    