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 People with Multiple Sclerosis ( PwMS ) are less physically active than the general population and pragmatic approaches design ed to equip them with the skills and confidence to participate in long-term physical activity are required . OBJECTIVE The objective of this study was to determine the feasibility of a pragmatic exercise intervention in PwMS . METHODS A voluntary sample of 30 PwMS ( male n = 4 , female n = 26 ; mean age = 40 years ; range = 24 - 49 years ) , with mild to moderate disability ( EDSS ≤ 5.5 ) , were recruited from eligible participants attending outpatient clinics . A total of 28 participants were r and omised to a 10 week pragmatic exercise intervention ( 2 × supervised and 1 × home-based session per week ) or usual care . Clinical , functional and quality of life ( MSQoL-54 ) outcomes were assessed at baseline , immediately and 3 months after the intervention . RESULTS Attrition was low ( 2 participants lost to immediate follow-up and 4 participants lost to 3 month follow-up ) , with high compliance rates ( > 75 % of all sessions ) . The intervention group achieved progression of exercise volume ( 24.3 ± 7.0 to 30.9 ± 5.5 min per session ) , intensity ( 60.4 ± 8.8 to 67.7 ± 6.9 % HR max ) and training impulse ( min × average HR = training impulse/load [ arbitrary units ; AU ] ) ( 2600 ± 1105 to 3210 ± 1269AU ) during the intervention , whilst significantly increasing(P = 0.050 ) their physical composite score ( MSQOL-54 ) at 10 weeks and readiness to exercise ( P = 0.003 ) at 3 months compared with usual care . CONCLUSION This pragmatic intervention was feasible for PwMS , but further research is needed to assess its long-term impact on physical activity behaviour Background : Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis ( PwMS ) . Objective : The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up . Methods : We conducted a parallel-arm , r and omised controlled trial : 120 PwMS ( Exp and ed Disability Status Scale ( EDSS ) 1.0–6.5 ) r and omised to a three-month exercise intervention plus usual care , or usual care only . Two supervised plus one home-exercise session ( weeks 1–6 ) were followed by one supervised and two home-exercise sessions ( weeks 7–12 ) . Cognitive-behavioural techniques promoted long-term exercise behaviour change . Outcomes were blindly assessed at baseline and at three and nine months after r and omisation . The primary outcome was self-reported exercise behaviour ( Godin Leisure Time Exercise Question naire ( GLTEQ ) ) . Secondary outcomes included fatigue and health-related quality of life ( HRQoL ) . Results : The intervention increased self-reported exercise ( 9.6 points ; 95 % CI : 2.0 to 17.3 points ; p = 0.01 ) and improved fatigue ( p < 0.0001 ) and many HRQoL domains ( p ≤ 0.03 ) at three months . The improvements in emotional well-being ( p = 0.01 ) , social function ( p = 0.004 ) and overall quality of life ( p = 0.001 ) were sustained for nine months . Conclusion : This pragmatic approach to implementing exercise increases self-reported exercise behaviour , improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS This prospect i ve , observational study examined the effects of change in the symptoms of fatigue and depression on  physical activity  over time in persons with relapsing-remitting multiple sclerosis ( RRMS ) . Adults with a confirmed diagnosis of RRMS completed a battery of question naires at baseline ( n = 269 ) and six-month follow-up ( n = 263 ) . The data were analyzed using linear panel analysis and covariance modeling in Mplus 3.0 . The panel model fit the data ( χ2 = 24.00 , df = 15 , p = 0.07 , SRMR = 0.04 , CFI = 0.98 ) and demonstrated that changes in both fatigue ( path coefficient = −0.09 ) and depressive symptoms ( path coefficient = −0.12 ) were significantly associated with residual change in physical activity . Such findings support the importance of fatigue and depression for predicting longitudinal changes in physical activity in adults with RRMS Background Fatigue is a common and troubling symptom for people with multiple sclerosis ( MS ) . Aim To evaluate the effectiveness and cost-effectiveness of a six-session group-based programme for managing MS-fatigue ( Fatigue : Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ( FACETS ) ) . Methods Three-centre parallel arm r and omised controlled trial with economic evaluation . Patients with MS and significant fatigue were r and omised to FACETS plus current local practice ( FACETS ) or current local practice alone ( CLP ) , using concealed computer-generated r and omisation . Participant blinding was not possible . Primary outcomes were fatigue severity ( Fatigue Assessment Instrument ) , self-efficacy ( Multiple Sclerosis-Fatigue Self-Efficacy ) and disease-specific quality of life ( Multiple Sclerosis Impact Scale ( MSIS-29 ) ) at 1 and 4 months postintervention ( follow-up 1 and 2 ) . Quality adjusted life years ( QALYs ) were calculated ( EuroQoL 5-Dimensions question naire and the Short-form 6-Dimensions question naire ) . Results Between May 2008 and November 2009 , 164 patients were r and omised ; primary outcome data were available for 146 ( 89 % ) . Statistically significant differences favour the intervention group on fatigue self-efficacy at follow-up 1 ( mean difference ( MD ) 9 , 95 % CI ( 4 to 14 ) , st and ardised effect size ( SES ) 0.54 , p=0.001 ) and follow-up 2 ( MD 6 , 95 % CI ( 0 to 12 ) , SES 0.36 , p=0.05 ) and fatigue severity at follow-up 2 ( MD −0.36 , 95 % CI ( −0.63 to −0.08 ) , SES −0.35 , p=0.01 ) but no differences for MSIS-29 or QALYs . No adverse events reported . Estimated cost per person for FACETS is £ 453 ; findings suggest an incremental cost-effectiveness ratio of £ 2157 per additional person with a clinical ly significant improvement in fatigue . Conclusions FACETS is effective in reducing fatigue severity and increasing fatigue self-efficacy . However , it is difficult to assess the additional cost in terms of cost-effectiveness ( ie , cost per QALY ) as improvements in fatigue are not reflected in the QALY outcomes , with no significant differences between FACETS and CLP . The strengths of this trial are its pragmatic nature and high external validity . Trial registration : Current Controlled Trials IS RCT N76517470 Objective : A stratified , r and omised , waitlist controlled study over 12 months assessed the effectiveness of rehabilitation in persons with multiple sclerosis ( MS ) in an Australian community cohort . Methods : Patients with definite MS ( n = 101 ) recruited from a tertiary hospital data base , r and omised to a treatment group ( n = 49 ) for individualised rehabilitation programme or a control waitlist group ( n = 52 ) . Functional Independence Measure ( FIM ) was used to assess “ activity ” while the Multiple Sclerosis Impact Scale ( MSIS-29 ) and General Health Question naire ( GHQ-28 ) assessed “ participation ” and quality of life ( QoL ) . Assessment s were at baseline and 12 months . Results : Analysis of data from 98 patients ( treatment n = 48 , control n = 50 ) showed reduced disability in the treatment group , with statistically significant differences in post-treatment FIM motor scores for the two groups ( p<0.001 ) . There was a clinical and statistically significant improvement in FIM ( motor ) total scores ( p<0.001 ) , and the FIM motor domains of : transfer ( p<0.001 ) , locomotion ( p<0.001 ) , self-care ( p<0.001 ) and the FIM cognitive subscale ( p<0.016 ) . In the treated group , 70.8 % improved compared with 13 % of controls . Significantly more patients in the control group deteriorated over the study period ( 58.7 % vs 16.7 % ; p<0.001 ) . There were no differences between the control and treatment group scores on the MSIS-physical ( p = 0.18 ) , MSIS-psychological ( p = 0.45 ) or GHQ subscales . Conclusion : An individualised rehabilitation programme reduces disability in persons with MS compared with no intervention . The impact of rehabilitation on QoL needs further evaluation . More information on the effectiveness of the various components of the multidisciplinary rehabilitation programmes are now needed . Australian clinical trials registry : Trials registration number : ACTRNO12605000676617 Purpose : Participation in physical activity for people with Multiple sclerosis ( MS ) is important but can be difficult to sustain long-term . Facilitators for long-term adherence include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . This is the basis of Blue Prescription , a novel physiotherapy approach aim ed at optimising long-term adherence with physical activity . We evaluated the feasibility and short-term benefits of Blue Prescription in people with MS . Methods : Twenty-seven people with MS ( mean age : 51 ± 11 years , with a range of MS type and disability ) were assessed at baseline and immediately post-intervention with the MS Impact Scale , MS Self-efficacy Scale , and European Quality of Life Question naire . Change in outcomes were analysed with Wilcoxon signed ranks tests . Results : All participants , irrespective of level of disability , were able to choose a physical activity and to engage in it . The physical component MS Impact Scale score significantly improved by a median change of 6.5 ( 95 % CI = −10.5 to −2.0 ; p = 0.007 ; effect size = 0.38 ) . There were no other significant changes in outcomes . Conclusion : Blue Prescription appears feasible and potentially beneficial , particularly in reducing the negative impacts of MS upon individuals , and thus warrants further evaluation . Implication s for Rehabilitation Facilitators for long-term adherence for disabled people include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . Blue Prescription is a physiotherapy approach aim ed at optimising long-term adherence with physical activity for people with multiple sclerosis . Blue Prescription appears to reduce the negative impacts of multiple sclerosis upon individuals 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 Fatigue : Take Control is a novel program to teach fatigue management to people with multiple sclerosis ( MS ) following recommendations in the Fatigue and Multiple Sclerosis guideline . Fatigue : Take Control includes six 2-hour group sessions with DVD viewing , discussion and homework and accompanying participant and leader workbooks . While many people have participated in Fatigue : Take Control programs , its efficacy has not been determined . The objective of this study was to determine whether participation in Fatigue : Take Control reduces fatigue and increases self-efficacy in people with MS . Thirty participants were r and omly assigned to a group who immediately participated in the program ( FTC ) or a wait-list group ( WL ) . The primary outcome was the Modified Fatigue Impact Scale ( MFIS ) and secondary outcomes were the Multiple Sclerosis Self-Efficacy Scale ( MSSE ) and the Fatigue Severity Scale ( FSS ) . The MFIS was administered on 10 occasions . Other measures were administered on four occasions . A mixed model tested the effects using all observations . Compared with the WL , the FTC group had significantly more improvement on the MFIS [ F(1 , 269 ) = 7.079 , p = 0.008 ] and the MSSE [ F(1 , 111 ) = 5.636 , p = 0.019 ] . No significant effect was found for the FSS . Across all visits , fatigue was significantly lower and self-efficacy was significantly higher for the FTC group compared with the WL group . This pilot study demonstrated significant effects in fatigue and self-efficacy among subjects taking the Fatigue : Take Control program  , suggesting that this comprehensive program based on the Fatigue and Multiple Sclerosis guideline may be beneficial in MS Physical activity is associated with many benefits , but persons with multiple sclerosis ( MS ) are less physically active than the general population . There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population . This r and omized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS . Physically inactive 
    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 People with Multiple Sclerosis ( PwMS ) are less physically active than the general population and pragmatic approaches design ed to equip them with the skills and confidence to participate in long-term physical activity are required . OBJECTIVE The objective of this study was to determine the feasibility of a pragmatic exercise intervention in PwMS . METHODS A voluntary sample of 30 PwMS ( male n = 4 , female n = 26 ; mean age = 40 years ; range = 24 - 49 years ) , with mild to moderate disability ( EDSS ≤ 5.5 ) , were recruited from eligible participants attending outpatient clinics . A total of 28 participants were r and omised to a 10 week pragmatic exercise intervention ( 2 × supervised and 1 × home-based session per week ) or usual care . Clinical , functional and quality of life ( MSQoL-54 ) outcomes were assessed at baseline , immediately and 3 months after the intervention . RESULTS Attrition was low ( 2 participants lost to immediate follow-up and 4 participants lost to 3 month follow-up ) , with high compliance rates ( > 75 % of all sessions ) . The intervention group achieved progression of exercise volume ( 24.3 ± 7.0 to 30.9 ± 5.5 min per session ) , intensity ( 60.4 ± 8.8 to 67.7 ± 6.9 % HR max ) and training impulse ( min × average HR = training impulse/load [ arbitrary units ; AU ] ) ( 2600 ± 1105 to 3210 ± 1269AU ) during the intervention , whilst significantly increasing(P = 0.050 ) their physical composite score ( MSQOL-54 ) at 10 weeks and readiness to exercise ( P = 0.003 ) at 3 months compared with usual care . CONCLUSION This pragmatic intervention was feasible for PwMS , but further research is needed to assess its long-term impact on physical activity behaviour Background : Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis ( PwMS ) . Objective : The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up . Methods : We conducted a parallel-arm , r and omised controlled trial : 120 PwMS ( Exp and ed Disability Status Scale ( EDSS ) 1.0–6.5 ) r and omised to a three-month exercise intervention plus usual care , or usual care only . Two supervised plus one home-exercise session ( weeks 1–6 ) were followed by one supervised and two home-exercise sessions ( weeks 7–12 ) . Cognitive-behavioural techniques promoted long-term exercise behaviour change . Outcomes were blindly assessed at baseline and at three and nine months after r and omisation . The primary outcome was self-reported exercise behaviour ( Godin Leisure Time Exercise Question naire ( GLTEQ ) ) . Secondary outcomes included fatigue and health-related quality of life ( HRQoL ) . Results : The intervention increased self-reported exercise ( 9.6 points ; 95 % CI : 2.0 to 17.3 points ; p = 0.01 ) and improved fatigue ( p < 0.0001 ) and many HRQoL domains ( p ≤ 0.03 ) at three months . The improvements in emotional well-being ( p = 0.01 ) , social function ( p = 0.004 ) and overall quality of life ( p = 0.001 ) were sustained for nine months . Conclusion : This pragmatic approach to implementing exercise increases self-reported exercise behaviour , improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS This prospect i ve , observational study examined the effects of change in the symptoms of fatigue and depression on  physical activity  over time in persons with relapsing-remitting multiple sclerosis ( RRMS ) . Adults with a confirmed diagnosis of RRMS completed a battery of question naires at baseline ( n = 269 ) and six-month follow-up ( n = 263 ) . The data were analyzed using linear panel analysis and covariance modeling in Mplus 3.0 . The panel model fit the data ( χ2 = 24.00 , df = 15 , p = 0.07 , SRMR = 0.04 , CFI = 0.98 ) and demonstrated that changes in both fatigue ( path coefficient = −0.09 ) and depressive symptoms ( path coefficient = −0.12 ) were significantly associated with residual change in physical activity . Such findings support the importance of fatigue and depression for predicting longitudinal changes in physical activity in adults with RRMS Background Fatigue is a common and troubling symptom for people with multiple sclerosis ( MS ) . Aim To evaluate the effectiveness and cost-effectiveness of a six-session group-based programme for managing MS-fatigue ( Fatigue : Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ( FACETS ) ) . Methods Three-centre parallel arm r and omised controlled trial with economic evaluation . Patients with MS and significant fatigue were r and omised to FACETS plus current local practice ( FACETS ) or current local practice alone ( CLP ) , using concealed computer-generated r and omisation . Participant blinding was not possible . Primary outcomes were fatigue severity ( Fatigue Assessment Instrument ) , self-efficacy ( Multiple Sclerosis-Fatigue Self-Efficacy ) and disease-specific quality of life ( Multiple Sclerosis Impact Scale ( MSIS-29 ) ) at 1 and 4 months postintervention ( follow-up 1 and 2 ) . Quality adjusted life years ( QALYs ) were calculated ( EuroQoL 5-Dimensions question naire and the Short-form 6-Dimensions question naire ) . Results Between May 2008 and November 2009 , 164 patients were r and omised ; primary outcome data were available for 146 ( 89 % ) . Statistically significant differences favour the intervention group on fatigue self-efficacy at follow-up 1 ( mean difference ( MD ) 9 , 95 % CI ( 4 to 14 ) , st and ardised effect size ( SES ) 0.54 , p=0.001 ) and follow-up 2 ( MD 6 , 95 % CI ( 0 to 12 ) , SES 0.36 , p=0.05 ) and fatigue severity at follow-up 2 ( MD −0.36 , 95 % CI ( −0.63 to −0.08 ) , SES −0.35 , p=0.01 ) but no differences for MSIS-29 or QALYs . No adverse events reported . Estimated cost per person for FACETS is £ 453 ; findings suggest an incremental cost-effectiveness ratio of £ 2157 per additional person with a clinical ly significant improvement in fatigue . Conclusions FACETS is effective in reducing fatigue severity and increasing fatigue self-efficacy . However , it is difficult to assess the additional cost in terms of cost-effectiveness ( ie , cost per QALY ) as improvements in fatigue are not reflected in the QALY outcomes , with no significant differences between FACETS and CLP . The strengths of this trial are its pragmatic nature and high external validity . Trial registration : Current Controlled Trials IS RCT N76517470 Objective : A stratified , r and omised , waitlist controlled study over 12 months assessed the effectiveness of rehabilitation in persons with multiple sclerosis ( MS ) in an Australian community cohort . Methods : Patients with definite MS ( n = 101 ) recruited from a tertiary hospital data base , r and omised to a treatment group ( n = 49 ) for individualised rehabilitation programme or a control waitlist group ( n = 52 ) . Functional Independence Measure ( FIM ) was used to assess “ activity ” while the Multiple Sclerosis Impact Scale ( MSIS-29 ) and General Health Question naire ( GHQ-28 ) assessed “ participation ” and quality of life ( QoL ) . Assessment s were at baseline and 12 months . Results : Analysis of data from 98 patients ( treatment n = 48 , control n = 50 ) showed reduced disability in the treatment group , with statistically significant differences in post-treatment FIM motor scores for the two groups ( p<0.001 ) . There was a clinical and statistically significant improvement in FIM ( motor ) total scores ( p<0.001 ) , and the FIM motor domains of : transfer ( p<0.001 ) , locomotion ( p<0.001 ) , self-care ( p<0.001 ) and the FIM cognitive subscale ( p<0.016 ) . In the treated group , 70.8 % improved compared with 13 % of controls . Significantly more patients in the control group deteriorated over the study period ( 58.7 % vs 16.7 % ; p<0.001 ) . There were no differences between the control and treatment group scores on the MSIS-physical ( p = 0.18 ) , MSIS-psychological ( p = 0.45 ) or GHQ subscales . Conclusion : An individualised rehabilitation programme reduces disability in persons with MS compared with no intervention . The impact of rehabilitation on QoL needs further evaluation . More information on the effectiveness of the various components of the multidisciplinary rehabilitation programmes are now needed . Australian clinical trials registry : Trials registration number : ACTRNO12605000676617 Purpose : Participation in physical activity for people with Multiple sclerosis ( MS ) is important but can be difficult to sustain long-term . Facilitators for long-term adherence include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . This is the basis of Blue Prescription , a novel physiotherapy approach aim ed at optimising long-term adherence with physical activity . We evaluated the feasibility and short-term benefits of Blue Prescription in people with MS . Methods : Twenty-seven people with MS ( mean age : 51 ± 11 years , with a range of MS type and disability ) were assessed at baseline and immediately post-intervention with the MS Impact Scale , MS Self-efficacy Scale , and European Quality of Life Question naire . Change in outcomes were analysed with Wilcoxon signed ranks tests . Results : All participants , irrespective of level of disability , were able to choose a physical activity and to engage in it . The physical component MS Impact Scale score significantly improved by a median change of 6.5 ( 95 % CI = −10.5 to −2.0 ; p = 0.007 ; effect size = 0.38 ) . There were no other significant changes in outcomes . Conclusion : Blue Prescription appears feasible and potentially beneficial , particularly in reducing the negative impacts of MS upon individuals , and thus warrants further evaluation . Implication s for Rehabilitation Facilitators for long-term adherence for disabled people include choice over activity and control over level of engagement , coupled with support , advice and encouragement from a physiotherapist . Blue Prescription is a physiotherapy approach aim ed at optimising long-term adherence with physical activity for people with multiple sclerosis . Blue Prescription appears to reduce the negative impacts of multiple sclerosis upon individuals 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 Fatigue : Take Control is a novel program to teach fatigue management to people with multiple sclerosis ( MS ) following recommendations in the Fatigue and Multiple Sclerosis guideline . Fatigue : Take Control includes six 2-hour group sessions with DVD viewing , discussion and homework and accompanying participant and leader workbooks . While many people have participated in Fatigue : Take Control programs , its efficacy has not been determined . The objective of this study was to determine whether participation in Fatigue : Take Control reduces fatigue and increases self-efficacy in people with MS . Thirty participants were r and omly assigned to a group who immediately participated in the program ( FTC ) or a wait-list group ( WL ) . The primary outcome was the Modified Fatigue Impact Scale ( MFIS ) and secondary outcomes were the Multiple Sclerosis Self-Efficacy Scale ( MSSE ) and the Fatigue Severity Scale ( FSS ) . The MFIS was administered on 10 occasions . Other measures were administered on four occasions . A mixed model tested the effects using all observations . Compared with the WL , the FTC group had significantly more improvement on the MFIS [ F(1 , 269 ) = 7.079 , p = 0.008 ] and the MSSE [ F(1 , 111 ) = 5.636 , p = 0.019 ] . No significant effect was found for the FSS . Across all visits , fatigue was significantly lower and self-efficacy was significantly higher for the FTC group compared with the WL group . This pilot study demonstrated significant effects in fatigue and self-efficacy among subjects taking the Fatigue : Take Control program  , suggesting that this comprehensive program based on the Fatigue and Multiple Sclerosis guideline may be beneficial in MS Physical activity is associated with many benefits , but persons with multiple sclerosis ( MS ) are less physically active than the general population . There is a critical need for research on methods of increasing and sustaining the physical activity levels of this population . This r and omized controlled trial examined the efficacy of an Internet-delivered and theory-based behavioral intervention that was supplemented with video coaching for increasing and sustaining physical activity over time in persons with MS . Physically inactive 
    Output:
    