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 evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility Background : Multiple Sclerosis ( MS ) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated . The objective of this study is to underst and the effect of Pilates exercises and aquatic training for a 12 week period on the dynamic balance of MS patients . Methods : The research method is semi-experimental . As a result , among the female patients visiting the MS clinic of Kashani hospital in Esfahan , 57 patients with disease intensity levels between 0 and 4.5 were taken as sample s. The average length of the disease was 8 ± 2 years , 20;40 years old , and they were r and omly divided into three groups of Pilates exercise group , aquatic training group , and the control group . The exercise schedule for the experiment groups consisted of 12 weeks , three sessions per week , and 1 hour for each session . The dynamic balance of the patients , before and after the exercises was measured by Six Spot Step Test . Results : The adjusted mean differences of Timed Up and Go Test ( TUGT ) scores of the experimental groups are significantly different ( P<0.05 ) . Therefore , it can be said that Pilates exercise interventions and aquatic training can significantly increase the dynamic balance of the examinees in the post-experiment stage . Conclusions : Performing the Pilate exercises and aquatic training  increases dynamic balance of the MS patients . Considering the role of dynamic balance on physical fitness and enabling the person in doing is daily chores and routines , and its direct effect on the quality of life , it leads the specialists in applying these exercises as a supplementary treatment along with the medicinal treatments for MS patients Fifty‐four multiple sclerosis ( MS ) patients were r and omly assigned to exercise ( EX ) or nonexercise ( NEX ) groups . Before and after 15 weeks of aerobic training , aspects of fitness including maximal aerobic capacity ( Vo2max ) , isometric strength , body composition , and blood lipids were measured . Daily activities , mood , fatigue , and disease status were measured by the Profile of Mood States ( POMS ) , Sickness Impact Profile ( SIP ) , Fatigue Severity Scale ( FSS ) , and neurological examination . Training consisted of 3 × 40‐minute sessions per week of combined arm and leg ergometry . Exp and ed Disability Status Scale ( EDSS ) scores were unchanged , except for improved bowel and bladder function in the EX group . Compared with baseline , the EX group demonstrated significant increases in Vo2max , upper and lower extremity strength , and significant decreases in skinfolds , triglyceride , and very‐low‐density lipoprotein ( VLDL ) . For the EX group , POMS depression and anger scores were significantly reduced at weeks 5 and 10 , and fatigue was reduced at week 10 . The EX group improved significantly on all components of the physical dimension of the SIP and showed significant improvements for social interaction , emotional behavior , home management , total SIP score , and recreation and past times . No changes were observed for EX or NEX groups on the FSS . Exercise training result ed in improved fitness and had a positive impact on factors related to quality of life OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Over an 18-month period , all incident cases of neurological disorders were ascertained prospect ively in an unselected urban population based in 13 general practice s in the London area by a General Practice Linkage Scheme with the National Hospital for Neurology and Neurosurgery . In three of these practice s , the lifetime prevalence of neurological disorders was also assessed . A population of 100 230 patients registered with participating general practice s was followed prospect ively for the onset of neurological disorders . Multiple methods of case finding were used to maintain accuracy . The age- and sex-adjusted incidence rates of neurological disorders were calculated . The lifetime prevalence of neurological disorders was surveyed in 27 658 of the patients . The age- and sex-adjusted incidence rates were calculated for major neurological conditions . [ These are expressed as rates per 100 000 persons per annum , with 95 % confidence intervals ( CI ) in parentheses ] . The commonest of these were first cerebrovascular events , 205 ( CI : 183 , 230 ) ; shingles , 140 ( CI : 104 , 184 ) ; diabetic polyneuropathy , 54 ( CI : 33 , 83 ) ; compressive neuropathies , 49 ( CI : 39 , 61 ) ; epilepsy , 46 ( CI : 36 , 60 ) ; Parkinson 's disease , 19 ( CI : 12 , 27 ) ; peripheral neuropathies , 15 ( CI : 9 , 23 ) ; CNS infections , 12 ( CI : 5 , 13 ) ; post-herpetic neuralgia , 11 ( CI : 6 , 17 ) ; and major neurological injuries , 10 ( CI : 4 , 11 ) . Lifetime prevalence rates are also reported ( expressed as rate per 1000 persons with 95 % CI ) . The most prevalent conditions were : completed stroke , 9 ( CI : 8 , 11 ) ; transient ischaemic attacks , 5 ( CI : 4 , 6 ) ; active epilepsy , 4 ( CI : 4 , 5 ) ; congenital neurological deficit , 3 ( CI : 3 , 4 ) ; Parkinson 's disease , 2 ( CI : 1 , 3 ) ; multiple sclerosis , 2 ( CI : 2 , 3 ) ; diabetic polyneuropathy , 2 ( CI : 1 , 3 ) ; compressive mononeuropathies , 2 ( CI : 2 , 3 ) ; and sub-arachnoid haemorrhage , 1 ( CI : 0.8 , 2 ) . Overall , the onset of 625 neurological disorders was observed per 100 000 population annually . Six percent of the population had at some time had a neurological disorder . This is the first study of the incidence and lifetime prevalence of neurological disorders in recent times ; we found that these disorders give rise to significant morbidity in the community [ Purpose ] This study evaluated the effects of water and l and -based obstacle training on static balance of chronic stroke patients . [ Subjects ] The subjects were r and omly allocated to an  aqua group ( n=15 ) and a l and group ( n=15 ) . [ Methods ] Both groups trained for 40 minutes , 3 times a week for 12 weeks . Static balance was assessed by measuring the mean velocities of mediolateral ( ML ) and anteroposterior ( AP ) , and sway area with the eyes closed . [ Results ] Following the intervention , both groups showed significant changes in ML velocity , AP velocity , and sway area . The static balance of the aqua group was significantly better than the l and group . [ Conclusion ] The results of this study suggest the feasibility and suitability of obstacle training in water for stroke patients OBJECTIVES To assess and compare 2 different protocol s of physiotherapy ( l and or water therapy ) for people with Parkinson 's disease ( PD ) focused on postural stability and self-movement , and to provide method ological information regarding progression within the program for a future larger trial . DESIGN R and omized , controlled , open-label pilot trial . SETTING Out patients , Parkinson 's disease Center of Ferrol-Galicia ( Spain ) . PARTICIPANTS Individuals ( N=11 ) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation ( intervention period plus follow-up ) . INTERVENTIONS After baseline evaluations , participants were r and omly assigned to a l and -based therapy ( active control group ) or a water-based therapy ( experimental group ) . Participants underwent individual sessions for 4 weeks , twice a week , for 45 minutes per session . Both interventions were matched in terms of exercise features , which were structured in stages with clear objectives and progression criteria to pass to the next phase . MAIN OUTCOME MEASURES Participants underwent a first baseline assessment , a posttest immediately after 4 weeks of intervention , and a follow-up assessment after 17 days . Evaluations were performed OFF-dose after withholding medication for 12 hours . Functional assessment s included the Functional Reach Test ( FRT ) , the Berg Balance Scale ( BBS ) , the UPDRS , the 5-m walk test , and the Timed Up and Go test . RESULTS A main effect of both therapies was seen for the FRT . Only the aquatic therapy group improved in the BBS and the UPDRS . CONCLUSIONS In this pilot study , physiotherapy protocol s produced improvement in postural stability in PD that was significantly larger after aquatic therapy . The intervention protocol s are shown to be 
    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: OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility Background : Multiple Sclerosis ( MS ) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated . The objective of this study is to underst and the effect of Pilates exercises and aquatic training for a 12 week period on the dynamic balance of MS patients . Methods : The research method is semi-experimental . As a result , among the female patients visiting the MS clinic of Kashani hospital in Esfahan , 57 patients with disease intensity levels between 0 and 4.5 were taken as sample s. The average length of the disease was 8 ± 2 years , 20;40 years old , and they were r and omly divided into three groups of Pilates exercise group , aquatic training group , and the control group . The exercise schedule for the experiment groups consisted of 12 weeks , three sessions per week , and 1 hour for each session . The dynamic balance of the patients , before and after the exercises was measured by Six Spot Step Test . Results : The adjusted mean differences of Timed Up and Go Test ( TUGT ) scores of the experimental groups are significantly different ( P<0.05 ) . Therefore , it can be said that Pilates exercise interventions and aquatic training can significantly increase the dynamic balance of the examinees in the post-experiment stage . Conclusions : Performing the Pilate exercises and aquatic training  increases dynamic balance of the MS patients . Considering the role of dynamic balance on physical fitness and enabling the person in doing is daily chores and routines , and its direct effect on the quality of life , it leads the specialists in applying these exercises as a supplementary treatment along with the medicinal treatments for MS patients Fifty‐four multiple sclerosis ( MS ) patients were r and omly assigned to exercise ( EX ) or nonexercise ( NEX ) groups . Before and after 15 weeks of aerobic training , aspects of fitness including maximal aerobic capacity ( Vo2max ) , isometric strength , body composition , and blood lipids were measured . Daily activities , mood , fatigue , and disease status were measured by the Profile of Mood States ( POMS ) , Sickness Impact Profile ( SIP ) , Fatigue Severity Scale ( FSS ) , and neurological examination . Training consisted of 3 × 40‐minute sessions per week of combined arm and leg ergometry . Exp and ed Disability Status Scale ( EDSS ) scores were unchanged , except for improved bowel and bladder function in the EX group . Compared with baseline , the EX group demonstrated significant increases in Vo2max , upper and lower extremity strength , and significant decreases in skinfolds , triglyceride , and very‐low‐density lipoprotein ( VLDL ) . For the EX group , POMS depression and anger scores were significantly reduced at weeks 5 and 10 , and fatigue was reduced at week 10 . The EX group improved significantly on all components of the physical dimension of the SIP and showed significant improvements for social interaction , emotional behavior , home management , total SIP score , and recreation and past times . No changes were observed for EX or NEX groups on the FSS . Exercise training result ed in improved fitness and had a positive impact on factors related to quality of life OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Over an 18-month period , all incident cases of neurological disorders were ascertained prospect ively in an unselected urban population based in 13 general practice s in the London area by a General Practice Linkage Scheme with the National Hospital for Neurology and Neurosurgery . In three of these practice s , the lifetime prevalence of neurological disorders was also assessed . A population of 100 230 patients registered with participating general practice s was followed prospect ively for the onset of neurological disorders . Multiple methods of case finding were used to maintain accuracy . The age- and sex-adjusted incidence rates of neurological disorders were calculated . The lifetime prevalence of neurological disorders was surveyed in 27 658 of the patients . The age- and sex-adjusted incidence rates were calculated for major neurological conditions . [ These are expressed as rates per 100 000 persons per annum , with 95 % confidence intervals ( CI ) in parentheses ] . The commonest of these were first cerebrovascular events , 205 ( CI : 183 , 230 ) ; shingles , 140 ( CI : 104 , 184 ) ; diabetic polyneuropathy , 54 ( CI : 33 , 83 ) ; compressive neuropathies , 49 ( CI : 39 , 61 ) ; epilepsy , 46 ( CI : 36 , 60 ) ; Parkinson 's disease , 19 ( CI : 12 , 27 ) ; peripheral neuropathies , 15 ( CI : 9 , 23 ) ; CNS infections , 12 ( CI : 5 , 13 ) ; post-herpetic neuralgia , 11 ( CI : 6 , 17 ) ; and major neurological injuries , 10 ( CI : 4 , 11 ) . Lifetime prevalence rates are also reported ( expressed as rate per 1000 persons with 95 % CI ) . The most prevalent conditions were : completed stroke , 9 ( CI : 8 , 11 ) ; transient ischaemic attacks , 5 ( CI : 4 , 6 ) ; active epilepsy , 4 ( CI : 4 , 5 ) ; congenital neurological deficit , 3 ( CI : 3 , 4 ) ; Parkinson 's disease , 2 ( CI : 1 , 3 ) ; multiple sclerosis , 2 ( CI : 2 , 3 ) ; diabetic polyneuropathy , 2 ( CI : 1 , 3 ) ; compressive mononeuropathies , 2 ( CI : 2 , 3 ) ; and sub-arachnoid haemorrhage , 1 ( CI : 0.8 , 2 ) . Overall , the onset of 625 neurological disorders was observed per 100 000 population annually . Six percent of the population had at some time had a neurological disorder . This is the first study of the incidence and lifetime prevalence of neurological disorders in recent times ; we found that these disorders give rise to significant morbidity in the community [ Purpose ] This study evaluated the effects of water and l and -based obstacle training on static balance of chronic stroke patients . [ Subjects ] The subjects were r and omly allocated to an  aqua group ( n=15 ) and a l and group ( n=15 ) . [ Methods ] Both groups trained for 40 minutes , 3 times a week for 12 weeks . Static balance was assessed by measuring the mean velocities of mediolateral ( ML ) and anteroposterior ( AP ) , and sway area with the eyes closed . [ Results ] Following the intervention , both groups showed significant changes in ML velocity , AP velocity , and sway area . The static balance of the aqua group was significantly better than the l and group . [ Conclusion ] The results of this study suggest the feasibility and suitability of obstacle training in water for stroke patients OBJECTIVES To assess and compare 2 different protocol s of physiotherapy ( l and or water therapy ) for people with Parkinson 's disease ( PD ) focused on postural stability and self-movement , and to provide method ological information regarding progression within the program for a future larger trial . DESIGN R and omized , controlled , open-label pilot trial . SETTING Out patients , Parkinson 's disease Center of Ferrol-Galicia ( Spain ) . PARTICIPANTS Individuals ( N=11 ) with idiopathic PD in stages 2 or 3 according to the Hoehn and Yahr Scale completed the investigation ( intervention period plus follow-up ) . INTERVENTIONS After baseline evaluations , participants were r and omly assigned to a l and -based therapy ( active control group ) or a water-based therapy ( experimental group ) . Participants underwent individual sessions for 4 weeks , twice a week , for 45 minutes per session . Both interventions were matched in terms of exercise features , which were structured in stages with clear objectives and progression criteria to pass to the next phase . MAIN OUTCOME MEASURES Participants underwent a first baseline assessment , a posttest immediately after 4 weeks of intervention , and a follow-up assessment after 17 days . Evaluations were performed OFF-dose after withholding medication for 12 hours . Functional assessment s included the Functional Reach Test ( FRT ) , the Berg Balance Scale ( BBS ) , the UPDRS , the 5-m walk test , and the Timed Up and Go test . RESULTS A main effect of both therapies was seen for the FRT . Only the aquatic therapy group improved in the BBS and the UPDRS . CONCLUSIONS In this pilot study , physiotherapy protocol s produced improvement in postural stability in PD that was significantly larger after aquatic therapy . The intervention protocol s are shown to be 
    Output:
    