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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke , but little is known about the effects of an enriched sound environment on recovery from neural damage in humans . In humans , music listening activates a wide-spread bilateral network of brain regions related to attention , semantic processing , memory , motor functions , and emotional processing .  Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups . The potential role of music in neurological rehabilitation , however , has not been systematic ally investigated . This single-blind , r and omized , and controlled trial was design ed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke . In the acute recovery phase , 60 patients with a left or right hemisphere middle cerebral artery ( MCA ) stroke were r and omly assigned to a music group , a language group , or a control group . During the following two months , the music and language groups listened daily to self-selected music or audio books , respectively , while the control group received no listening material . In addition , all patients received st and ard medical care and rehabilitation . All patients underwent an extensive neuropsychological assessment , which included a wide range of cognitive tests as well as mood and quality of life question naires , one week ( baseline ) , 3 months , and 6 months after the stroke . Fifty-four patients completed the study . Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups . The music group also experienced less depressed and confused mood than the control group . These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood . The neural mechanisms potentially underlying these effects are discussed This article reports on two studies that examine the relationship between measurements of activities of daily living ( ADL ) and cognitive skills performance . Study 1 is a post hoc analysis of ADL improvement scores collected on acute stroke patients who were either given or not given cognitive skills remediation .  An examination of individual ADL scores showed significantly higher personal hygiene , bathing , and toilet activity improvement scores for patients receiving  cognitive skills remediation .  In Study 2 , cognitive skills and ADL pre- and posttest scores for stroke patients were measured by occupational therapists , who also implemented an ADL as well as a cognitive skills remediation program as part of the patient 's therapy . Some significant positive correlations between initial cognitive skills measurements and ADL outcome were found . The best correlate of patients ' ADL performance at discharge was performance on an auditory attention task . Verbal comprehension correlated with overall ADL improvement , and overall cognitive skills improvement correlated with overall ADL improvement . Implication s of these two studies are discussed The purpose of this study was to evaluate the effectiveness and maintenance of occupational therapy training  of intellectual functions . Gain in generalization , by which is meant the transfer of newly-learned skills to novel but appropriate tasks , was also studied . Sixty-seven patients with acquired brain damage underwent 14 weeks of training in one of the following four groups , to which selection was r and omized : Intellectual Function Training ( IFT ) plus a regular rehabilitation programme ( R ) ( n = 15 ) , Intellectual Housework Training ( IHT ) plus R ( n = 19 ) , and IFT + IHT + R ( n = 15 ) . The fourth group , which received regular rehabilitation only ( R ) ( n = 18 ) was the control . A four-group , pretest-posttest , follow-up , controlled experimental test design was adopted . The training result was assessed with the Intellectual Function Assessment ( IFA ) , the Intellectual Housework Assessment ( IHA ) and 15 psychometric tests . Comparison between the IFT , the IHT and the IFT + IHT groups respectively and the R group indicated some areas of function where individualized intellectual training was more effective than a regular rehabilitation programme of occupational therapy . The development of intellectual functions within each group was obvious in most areas , but less so within the R group than in the others . The maintenance of training effects could not be demonstrated satisfactorily . Generalization gains were demonstrated in 4/5 " theoretical " intellectual functional areas assessed with IFA , and in 3/7 " practical " intellectual functional areas assessed with IHA OBJECTIVES To determine whether cognitive impairment affects access to , or quality of , rehabilitation services , and to examine the effects of functional outcomes in stroke patients . DESIGN Secondary analysis of prospect i ve cohort of stroke patients followed for 6 months after stroke . SETTING S Eleven large-volume US Department of Veterans Affairs hospitals nationwide . PARTICIPANTS Stroke patients ( N=272 ) who were c and i date s for rehabilitation . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score . Functional outcomes were performance of activities of daily living ( ADLs ) , measured by the FonFIM , and instrumental activities of daily living ( IADLs ) , measured by Lawton , at 6-month follow-up . RESULTS Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients . Although most cognition-related treatment elements were similar for both groups , cognitive goals were more frequently charted in impaired patients . Controlling for baseline function and rehabilitation process , cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients ; cognition did not significantly influence ADL performance . CONCLUSIONS Quality of , and access to , rehabilitative care was equivalent for patients with and without cognitive impairment . Despite a similar rehabilitation process , cognitively impaired stroke patients experienced worse recovery of IADLs This pilot study used survey methodology to gather initial information from Canadian occupational therapists on 1 ) the delivery of cognitive rehabilitation services for survivors of traumatic brain injury and 2 ) the therapeutic approaches and modalities used currently to manage residual cognitive impairments . A question naire was developed , field-tested and mailed to 27 sample sites across Canada , selected non-r and omly . Twenty returned question naires ( 74 % ) were included in the data pool . The findings revealed that a wide range of cognitive impairments were seen very often , with impairments in memory being most common . Respondents used both a cognitive remediation and compensatory approach and a combination of therapeutic modalities to address impairments of orientation , attention , and memory . There was an interesting and overlapping range of specific modalities identified . Inpatient and outpatient services were offered to survivors , primarily within the first year post-injury . These occupational therapists used various re sources to develop expertise in cognitive rehabilitation . Possible implication s of the pilot study findings for Canadian occupational therapists are high-lighted and discussed 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 . The purpose of this study was to determine whether a cognitive skills remediation program could help acute stroke patients regain important thinking skills .  Patients in a community hospital stroke program were pre-tested in three skill areas --visual scanning , visual-spatial orientation , and time judgment-- and r and omly assigned to a treatment ( n = 16 ) or control ( n = 17 ) group . The treatment group received cognitive skill retraining on a one-to-one basis for 30 minutes per day , 3 days per week , for 3 weeks . The retraining involved the use of paper and pencil tasks , simple cuing procedures , positive reinforcement , and immediate feedback . Although the control group did not receive this treatment , conventional therapies continued for both groups . Patients receiving treatment had overall and separate skill improvement scores that were significantly higher than those for control patients . The implication s of this type of treatment program are discussed OBJECTIVE To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments . DESIGN R and omized crossover . SETTING Rehabilitation hospital . PARTICIPANTS Thirty-three adult subjects following an acute stroke . INTERVENTION Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner . Tasks were taught using errorless learning or trial and error learning .  Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam . MAIN OUTCOME MEASURES Days until subject was able to demonstrate retention of the task , and success or failure at carry-over to a similar task . RESULTS No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments . Carry-over was significantly better when trial and error learning was used for learning sock donning . CONCLUSIONS When choosing the best learning method for patients undergoing rehabilitation for stroke , the nature of the task should be considered . Additional research is needed to identify the best approach for teaching activities of daily living and facilitating carry-over of learning in individuals with acute stroke Objective : To compare the effectiveness of the transfer of training and functional approaches in improving perceptual and functional abilities after stroke . Design : Patients identified as having perceptual problems were r and omly allocated to either the transfer of training approach or the functional approach for perceptual treatment . On completion of six weeks of treatment , each patient was reassessed for perceptual and functional abilities . Subjects and setting : Eighty in patients on the Nottingham Stroke Unit . Interventions y : Perceptual treatment was given for 2.5 hours per week for six weeks . Main outcome measures : Rivermead Perceptual Assessment Battery , Barthel ADL Index and Edmans ADL index . Results : There was no significant difference between the treatment groups on patient characteristics or impairments . The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores , individual perceptual subtest scores , or functional ability total scores ( Mann – Whitney U 642.5–798.0 , p > 0.05 ) . Wilcoxon matched pairs signed ranks tests showed a significant improvement in both groups after treatment on perceptual and functional abilities ( perceptual z = 6.02 , p < 0.001 , functional z = 6.72 , p < 0.001 ) . Conclusions : These results indicated that the improvement in perceptual abilities was equivalent using either of the two approaches . This could be due to spontaneous recovery or the effects of the Stroke Unit PRIMARY OBJECTIVE The present study reports the results of 103 persons with acquired brain injury who were r and omly assigned to one of three 20-session analogy problem-solving skill training groups  , namely : online training ( through computer video conferencing with interactive software ) ; computer-assisted training ( through interactive patient-directed software ) ; therapist administered training ( face-to-face therapist guided training activities ) ; and a " no-treatment " control group . RESEARCH DESIGN Pre- and post-test quasi-experimental design . MAIN OUTCOME AND RESULTS Individuals ' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period . Overall , the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery ( except in the case of the control group ) . The continuous " human touch " characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving . CONCLUSION The statistically significantly improvement in problem 
    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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke , but little is known about the effects of an enriched sound environment on recovery from neural damage in humans . In humans , music listening activates a wide-spread bilateral network of brain regions related to attention , semantic processing , memory , motor functions , and emotional processing .  Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups . The potential role of music in neurological rehabilitation , however , has not been systematic ally investigated . This single-blind , r and omized , and controlled trial was design ed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke . In the acute recovery phase , 60 patients with a left or right hemisphere middle cerebral artery ( MCA ) stroke were r and omly assigned to a music group , a language group , or a control group . During the following two months , the music and language groups listened daily to self-selected music or audio books , respectively , while the control group received no listening material . In addition , all patients received st and ard medical care and rehabilitation . All patients underwent an extensive neuropsychological assessment , which included a wide range of cognitive tests as well as mood and quality of life question naires , one week ( baseline ) , 3 months , and 6 months after the stroke . Fifty-four patients completed the study . Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups . The music group also experienced less depressed and confused mood than the control group . These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood . The neural mechanisms potentially underlying these effects are discussed This article reports on two studies that examine the relationship between measurements of activities of daily living ( ADL ) and cognitive skills performance . Study 1 is a post hoc analysis of ADL improvement scores collected on acute stroke patients who were either given or not given cognitive skills remediation .  An examination of individual ADL scores showed significantly higher personal hygiene , bathing , and toilet activity improvement scores for patients receiving  cognitive skills remediation .  In Study 2 , cognitive skills and ADL pre- and posttest scores for stroke patients were measured by occupational therapists , who also implemented an ADL as well as a cognitive skills remediation program as part of the patient 's therapy . Some significant positive correlations between initial cognitive skills measurements and ADL outcome were found . The best correlate of patients ' ADL performance at discharge was performance on an auditory attention task . Verbal comprehension correlated with overall ADL improvement , and overall cognitive skills improvement correlated with overall ADL improvement . Implication s of these two studies are discussed The purpose of this study was to evaluate the effectiveness and maintenance of occupational therapy training  of intellectual functions . Gain in generalization , by which is meant the transfer of newly-learned skills to novel but appropriate tasks , was also studied . Sixty-seven patients with acquired brain damage underwent 14 weeks of training in one of the following four groups , to which selection was r and omized : Intellectual Function Training ( IFT ) plus a regular rehabilitation programme ( R ) ( n = 15 ) , Intellectual Housework Training ( IHT ) plus R ( n = 19 ) , and IFT + IHT + R ( n = 15 ) . The fourth group , which received regular rehabilitation only ( R ) ( n = 18 ) was the control . A four-group , pretest-posttest , follow-up , controlled experimental test design was adopted . The training result was assessed with the Intellectual Function Assessment ( IFA ) , the Intellectual Housework Assessment ( IHA ) and 15 psychometric tests . Comparison between the IFT , the IHT and the IFT + IHT groups respectively and the R group indicated some areas of function where individualized intellectual training was more effective than a regular rehabilitation programme of occupational therapy . The development of intellectual functions within each group was obvious in most areas , but less so within the R group than in the others . The maintenance of training effects could not be demonstrated satisfactorily . Generalization gains were demonstrated in 4/5 " theoretical " intellectual functional areas assessed with IFA , and in 3/7 " practical " intellectual functional areas assessed with IHA OBJECTIVES To determine whether cognitive impairment affects access to , or quality of , rehabilitation services , and to examine the effects of functional outcomes in stroke patients . DESIGN Secondary analysis of prospect i ve cohort of stroke patients followed for 6 months after stroke . SETTING S Eleven large-volume US Department of Veterans Affairs hospitals nationwide . PARTICIPANTS Stroke patients ( N=272 ) who were c and i date s for rehabilitation . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score . Functional outcomes were performance of activities of daily living ( ADLs ) , measured by the FonFIM , and instrumental activities of daily living ( IADLs ) , measured by Lawton , at 6-month follow-up . RESULTS Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients . Although most cognition-related treatment elements were similar for both groups , cognitive goals were more frequently charted in impaired patients . Controlling for baseline function and rehabilitation process , cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients ; cognition did not significantly influence ADL performance . CONCLUSIONS Quality of , and access to , rehabilitative care was equivalent for patients with and without cognitive impairment . Despite a similar rehabilitation process , cognitively impaired stroke patients experienced worse recovery of IADLs This pilot study used survey methodology to gather initial information from Canadian occupational therapists on 1 ) the delivery of cognitive rehabilitation services for survivors of traumatic brain injury and 2 ) the therapeutic approaches and modalities used currently to manage residual cognitive impairments . A question naire was developed , field-tested and mailed to 27 sample sites across Canada , selected non-r and omly . Twenty returned question naires ( 74 % ) were included in the data pool . The findings revealed that a wide range of cognitive impairments were seen very often , with impairments in memory being most common . Respondents used both a cognitive remediation and compensatory approach and a combination of therapeutic modalities to address impairments of orientation , attention , and memory . There was an interesting and overlapping range of specific modalities identified . Inpatient and outpatient services were offered to survivors , primarily within the first year post-injury . These occupational therapists used various re sources to develop expertise in cognitive rehabilitation . Possible implication s of the pilot study findings for Canadian occupational therapists are high-lighted and discussed 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 . The purpose of this study was to determine whether a cognitive skills remediation program could help acute stroke patients regain important thinking skills .  Patients in a community hospital stroke program were pre-tested in three skill areas --visual scanning , visual-spatial orientation , and time judgment-- and r and omly assigned to a treatment ( n = 16 ) or control ( n = 17 ) group . The treatment group received cognitive skill retraining on a one-to-one basis for 30 minutes per day , 3 days per week , for 3 weeks . The retraining involved the use of paper and pencil tasks , simple cuing procedures , positive reinforcement , and immediate feedback . Although the control group did not receive this treatment , conventional therapies continued for both groups . Patients receiving treatment had overall and separate skill improvement scores that were significantly higher than those for control patients . The implication s of this type of treatment program are discussed OBJECTIVE To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments . DESIGN R and omized crossover . SETTING Rehabilitation hospital . PARTICIPANTS Thirty-three adult subjects following an acute stroke . INTERVENTION Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner . Tasks were taught using errorless learning or trial and error learning .  Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam . MAIN OUTCOME MEASURES Days until subject was able to demonstrate retention of the task , and success or failure at carry-over to a similar task . RESULTS No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments . Carry-over was significantly better when trial and error learning was used for learning sock donning . CONCLUSIONS When choosing the best learning method for patients undergoing rehabilitation for stroke , the nature of the task should be considered . Additional research is needed to identify the best approach for teaching activities of daily living and facilitating carry-over of learning in individuals with acute stroke Objective : To compare the effectiveness of the transfer of training and functional approaches in improving perceptual and functional abilities after stroke . Design : Patients identified as having perceptual problems were r and omly allocated to either the transfer of training approach or the functional approach for perceptual treatment . On completion of six weeks of treatment , each patient was reassessed for perceptual and functional abilities . Subjects and setting : Eighty in patients on the Nottingham Stroke Unit . Interventions y : Perceptual treatment was given for 2.5 hours per week for six weeks . Main outcome measures : Rivermead Perceptual Assessment Battery , Barthel ADL Index and Edmans ADL index . Results : There was no significant difference between the treatment groups on patient characteristics or impairments . The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores , individual perceptual subtest scores , or functional ability total scores ( Mann – Whitney U 642.5–798.0 , p > 0.05 ) . Wilcoxon matched pairs signed ranks tests showed a significant improvement in both groups after treatment on perceptual and functional abilities ( perceptual z = 6.02 , p < 0.001 , functional z = 6.72 , p < 0.001 ) . Conclusions : These results indicated that the improvement in perceptual abilities was equivalent using either of the two approaches . This could be due to spontaneous recovery or the effects of the Stroke Unit PRIMARY OBJECTIVE The present study reports the results of 103 persons with acquired brain injury who were r and omly assigned to one of three 20-session analogy problem-solving skill training groups  , namely : online training ( through computer video conferencing with interactive software ) ; computer-assisted training ( through interactive patient-directed software ) ; therapist administered training ( face-to-face therapist guided training activities ) ; and a " no-treatment " control group . RESEARCH DESIGN Pre- and post-test quasi-experimental design . MAIN OUTCOME AND RESULTS Individuals ' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period . Overall , the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery ( except in the case of the control group ) . The continuous " human touch " characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving . CONCLUSION The statistically significantly improvement in problem 
    Output:
    