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: ABSTRACT Purpose : The aim of this prospect i ve , r and omized , controlled study was to investigate the effects of the addition of Pilates-based exercises to st and ard exercise programs performed after total knee arthroplasty on quality of life and balance . Method : Forty-six volunteers were divided into two groups . The control group ( n = 17 ) was assigned a st and ard exercise program after discharge ; the study group ( n = 17 ) was assigned Pilates-based exercises along with the st and ard exercise program . We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program . We also recorded sociodemographic data , Berg Balance test scores , and Short Form-36 ( SF-36 ) health-related quality of life measurements . Results : When we compared the differences between pre- and post-treatment balance scores of the groups , we found a significant change in favor of the Pilates-based exercise group ( 13.64 ± 1.45 ; p < 0.01 ) . The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function ( p = 0.001 ) , physical role restriction ( p = 0.01 ) , and physical component score ( p = 0.001 ) . Conclusions : Pilates-based exercises performed along with st and ard exercise programs were more effective for improving balance and quality of life  than st and ard exercise programs alone BACKGROUND Falls are a common adverse event among people with stroke . Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6 - 12 months recall , with inconsistent findings . OBJECTIVES To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke . DESIGN Secondary analysis of a r and omized clinical trial . SETTING Multisite academic and clinical institutions . PARTICIPANTS Data from 181 participants with stroke ( age 60.67 ± 11.77 years , post stroke 4.51 ± 4.78 years ) were included . METHODS Study participants completed baseline testing and were prospect ively asked about falls . A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls : age , endurance ( 6 minute walk test ) , number of medications , motor control ( Fugl-Meyer lower extremity score ) , depression ( Patient Health Question naire-9 ) , physical activity ( number of steps per week ) , and cognition ( Mini Mental Status Exam score ) . A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls : gait velocity ( comfortable 10 Meter Walk ) , Berg Balance Scale ( BBS ) , Timed Up and Go ( TUG ) , and Functional Reach Test ( FRT ) . Receiver operating characteristic ( ROC ) and area under the curve ( AUC ) were used to determine the cutoff scores for significant predictors of recurrent falls . MAIN OUTCOME MEASUREMENT The number of falls during the 42-week follow-up period . RESULTS Baseline measures that significantly predicted the number of falls included increased number of medications , higher depression scores , and decreased FRT . Cutoff scores for the number of medications were 8.5 with an AUC of 0.68 . Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62 . FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66 . CONCLUSIONS Number of medications , depression scores , and decreased FRT distance at baseline were associated with increased number of falls . Increased medications might indicate multiple comorbidities or polypharmacy effect ; increased depression scores may indicate psychological status ; and decreased functional reach distance could indicate dynamic balance impairments . LEVEL OF EVIDENCE II This longitudinal , observational study explored the relationship between physical performance tests , self-reported outcomes , and accidental falling , before and after total knee arthroplasty ( TKA ) . Thirty-seven patients were r and omly selected from a larger study of falling before and after surgery conducted at a UK National Health Service Orthopaedic Unit . Physical performance tests were the  Berg Balance Score ( BBS ) , Timed Up and Go ( TUG ) , and H and Grip Strength ( HGS ) . Self-reported outcomes incorporated the Western Ontario and McMaster 's Osteoarthritis Index ( WOMAC ) , Activities Balance Confidence Scale ( ABC-UK ) , Geriatric Depression Scale ( GDS ) , and accidental falls . Paired pre- and postoperative data were available on 22 patients . A total of 22.7 % patients fell before and after TKA . Postoperative improvement in BBS and TUG was found in 41 % and 50 % of patients , respectively , HGS did not change . BBS showed a consistent moderate-to-strong association with other physical tests both before and after surgery ; TUG ( rs −0.76 ; rs −0.90 ) , maximal HGS ( r 0.49 ; r 0.48 ) , and self-report measures ; ABC-UK ( r 0.52 ; r 0.74 ) , WOMAC stiffness ( r −0.53 ; r −0.48 ) , and WOMAC function ( r −0.56 ; r −0.45 ) . Although self-report question naires are an efficient , cost-effective approach to outcome assessment in TKA , there is a growing case for inclusion of physical performance tests . The Berg Balance Score may be a useful addition to outcome assessment in patients with TKA OBJECTIVE To compare the improvement in disability , kinesiophobia , pain , and quality of life obtained by means of home-based functional exercises aim ed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty ( TKA ) advice to stay active after discharge from a rehabilitation unit . DESIGN R and omized controlled trial with 6-months ' follow-up . SETTING Patients ' homes . PARTICIPANTS Patients ( N=110 ; 40 men ; mean age , 67y ) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA . INTERVENTIONS In the experimental group , before returning home , the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months , and were given a book containing theoretical information about the management of kinesiophobia . In the control group , the patients were advised to stay active and gradually recover their usual activities . MAIN OUTCOME MEASURES Repeated- measures analysis of covariance with baseline values as the covariates ( P<.05 ) was used to assess the effect of treatment on disability , fear-avoidance beliefs , pain intensity , and quality of life . RESULTS The analysis revealed a significant time by group interaction in all the variables in favor of the experimental group . Post hoc analysis showed that the effect of the group was statistically significant at the end of home training and follow-up . The treatment effect was clinical ly tangible in terms of disability and quality of life , and persisted for 6 months after the intervention ended . CONCLUSIONS A home-based program based on functional exercises and the management of kinesiophobia was useful in changing the course of disability , fear-avoidance beliefs , pain , and the quality of life in patients with TKA Objective : To evaluate whether balance training after total knee replacement surgery improves functional outcomes and to determine whether postoperative balance is associated with mobility . Design : A prospect i ve intervention study and r and omized controlled trial with an intention-to-treat analysis . Setting : The rehabilitation center of a university-based teaching hospital . Participants : A total of 130 patients with knee osteoarthritis who had undergone total knee replacement surgery were recruited to attend an outpatient rehabilitation program . They were r and omly allocated to additional balance rehabilitation and functional rehabilitation groups . Interventions : During the eight-week outpatient rehabilitation program , both groups received general functional training . Patients in the balance rehabilitation group received an additional balance-based rehabilitation program . Primary outcome measures : The functional reach test , single-leg stance test , 10-m walk test , Timed Up and Go Test , timed chair-st and test , stair-climb test , and Western Ontario and McMaster Universities Osteoarthritis Index were measured at baseline , eight weeks ( T1 ) , and 32 weeks ( T2 ) . Results : The balance rehabilitation group patients demonstrated significant improvement in the results of the functional reach test at T1 ( 37.6 ±7.8 cm ) and T2 ( 39.3 ±9.7 cm ) compared with the baseline assessment ( 11.5 ±2.9 cm ) and Timed Up and Go Test at T1 ( 8.9 ±1.2 seconds ) and T2 ( 8.0 ±1.9 seconds ) compared with the baseline assessment ( 12.5 ±1.8 seconds ) . Moreover , the balance rehabilitation group patients exhibited significantly greater improvements in balance and mobility than did the functional rehabilitation group patients ( all P < 0.001 ) . Furthermore , improved balance was significantly associated with improved mobility at T2 . Conclusion : Postoperative outpatient rehabilitation with balance training improves the balance , mobility , and functional outcomes in patients with knee osteoarthritis after total knee replacement Background and Purpose : Sensorimotor training has proven to be an efficient approach for recovering balance control following total knee replacement ( TKR ) . The purpose of this trial was to evaluate the influence of specific balance-targeted training using a dynamometric platform on the overall state of balance in older adults undergoing TKR . Methods : This was a r and omized controlled clinical trial conducted at a university hospital rehabilitation unit . Patients meeting the inclusion criteria were r and omly assigned to a control group or an experimental group . Both groups participated in the same 4-week postoperative rehabilitation training protocol . Participants in the experimental group performed additional balance training with a dynamometric platform consisting of tests related to stability challenges , weight-shifting , and moving to the limits of stability . The primary outcome measure was the overall state of balance rated according to the Berg Balance Scale . Secondary outcomes in terms of balance were the Timed Up and Go Test , Functional Reach Test , and Romberg open and closed-eyes tests . Data processing included between-group analysis of covariance , minimal detectable change assessment for the primary outcome measure , and effect size estimation . Confidence intervals ( CIs ) were set at 95 % . Results : Forty-three participants meeting the inclusion criteria and having signed the informed consent were r and omly assigned to 2 groups . Thirty-seven completed the training ( 86.1 % ) . Significant between-group differences in balance performance were found as measured with the Berg Balance Scale ( P = .03 ) and Functional Reach Test ( P = .04 ) with a CI = 95 % . Significant differences were not recorded for the Timed Up and Go Test or Romberg open and closed-eyes tests ( P > .05 ) . Furthermore , Cohen 's effect size result ed in a value of d = 0.97 , suggesting a high practical significance of the trial . Discussion and Conclusions : According to the Berg Balance Scale and Functional Reach Test , participants with TKR who have followed a 4-week training program using a dynamometric platform improved balance performance to a higher extent than a control group training without such a device . The inclusion of this instrument in the functional training protocol may be beneficial for recovering balance following TKR Purpose To prospect ively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty ( TKA )  and to determine the incidence of falls as well as their risk factors . Methods A total of 108 patients ( 17 male , 91 female ) over 60 years of age who underwent TKA were enrolled and who were living independently in community . 75 patients fulfilled our inclusion criteria and 74 ( 8 male , 66 female ) of them agreed to participate . Baseline assessment ( physical examination , physical performance tests , and self-administered question naire )  were conducted between 6 and 12 months after the last arthroplasty and the follow-up assessment was performed 6 months after the baseline assessment . Monthly pre-stamped postcards were sent to assess the incidence of falls . Results Of the 74 patients enrolled , 70 ( 94.6 % ) completed a 6-month prospect i ve observation . 23 of 70 patients ( 32.9 % ) fell during the observational period . Postoperative range of knee flexion , ranges of knee flexion and extension and ankle plantar flexion were significantly lower in fallers than in non-fallers ( P = 0.016 , P = 0.037 , P = 0.014 , respectively ) . In the multivariate analysis , postoperative range of knee flexion ( OR 0.277 , 95%CI 0.088–0.869 , P = 0.028 ) and ankle plantar flexion ( OR 0.594 , 95%CI 0.374–0.945 , P = 0.028 ) were determined to be significant risk factors . Conclusion Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people . For patients with limited knee flexion and ankle plantar flexion , improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary Background Patients with total knee arthroplasty ( TKA ) have impaired balance and movement control . Exercise interventions have not targeted these impairments in this population . Objectives The purpose s of this study were : ( 1 ) to determine the feasibility of applying a balance exercise program in patients with TKA , ( 2 ) to investigate whether a functional training ( FT ) program supplemented with a balance exercise program ( FT+B program ) could improve physical function compared with an 
    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: ABSTRACT Purpose : The aim of this prospect i ve , r and omized , controlled study was to investigate the effects of the addition of Pilates-based exercises to st and ard exercise programs performed after total knee arthroplasty on quality of life and balance . Method : Forty-six volunteers were divided into two groups . The control group ( n = 17 ) was assigned a st and ard exercise program after discharge ; the study group ( n = 17 ) was assigned Pilates-based exercises along with the st and ard exercise program . We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program . We also recorded sociodemographic data , Berg Balance test scores , and Short Form-36 ( SF-36 ) health-related quality of life measurements . Results : When we compared the differences between pre- and post-treatment balance scores of the groups , we found a significant change in favor of the Pilates-based exercise group ( 13.64 ± 1.45 ; p < 0.01 ) . The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function ( p = 0.001 ) , physical role restriction ( p = 0.01 ) , and physical component score ( p = 0.001 ) . Conclusions : Pilates-based exercises performed along with st and ard exercise programs were more effective for improving balance and quality of life  than st and ard exercise programs alone BACKGROUND Falls are a common adverse event among people with stroke . Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6 - 12 months recall , with inconsistent findings . OBJECTIVES To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke . DESIGN Secondary analysis of a r and omized clinical trial . SETTING Multisite academic and clinical institutions . PARTICIPANTS Data from 181 participants with stroke ( age 60.67 ± 11.77 years , post stroke 4.51 ± 4.78 years ) were included . METHODS Study participants completed baseline testing and were prospect ively asked about falls . A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls : age , endurance ( 6 minute walk test ) , number of medications , motor control ( Fugl-Meyer lower extremity score ) , depression ( Patient Health Question naire-9 ) , physical activity ( number of steps per week ) , and cognition ( Mini Mental Status Exam score ) . A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls : gait velocity ( comfortable 10 Meter Walk ) , Berg Balance Scale ( BBS ) , Timed Up and Go ( TUG ) , and Functional Reach Test ( FRT ) . Receiver operating characteristic ( ROC ) and area under the curve ( AUC ) were used to determine the cutoff scores for significant predictors of recurrent falls . MAIN OUTCOME MEASUREMENT The number of falls during the 42-week follow-up period . RESULTS Baseline measures that significantly predicted the number of falls included increased number of medications , higher depression scores , and decreased FRT . Cutoff scores for the number of medications were 8.5 with an AUC of 0.68 . Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62 . FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66 . CONCLUSIONS Number of medications , depression scores , and decreased FRT distance at baseline were associated with increased number of falls . Increased medications might indicate multiple comorbidities or polypharmacy effect ; increased depression scores may indicate psychological status ; and decreased functional reach distance could indicate dynamic balance impairments . LEVEL OF EVIDENCE II This longitudinal , observational study explored the relationship between physical performance tests , self-reported outcomes , and accidental falling , before and after total knee arthroplasty ( TKA ) . Thirty-seven patients were r and omly selected from a larger study of falling before and after surgery conducted at a UK National Health Service Orthopaedic Unit . Physical performance tests were the  Berg Balance Score ( BBS ) , Timed Up and Go ( TUG ) , and H and Grip Strength ( HGS ) . Self-reported outcomes incorporated the Western Ontario and McMaster 's Osteoarthritis Index ( WOMAC ) , Activities Balance Confidence Scale ( ABC-UK ) , Geriatric Depression Scale ( GDS ) , and accidental falls . Paired pre- and postoperative data were available on 22 patients . A total of 22.7 % patients fell before and after TKA . Postoperative improvement in BBS and TUG was found in 41 % and 50 % of patients , respectively , HGS did not change . BBS showed a consistent moderate-to-strong association with other physical tests both before and after surgery ; TUG ( rs −0.76 ; rs −0.90 ) , maximal HGS ( r 0.49 ; r 0.48 ) , and self-report measures ; ABC-UK ( r 0.52 ; r 0.74 ) , WOMAC stiffness ( r −0.53 ; r −0.48 ) , and WOMAC function ( r −0.56 ; r −0.45 ) . Although self-report question naires are an efficient , cost-effective approach to outcome assessment in TKA , there is a growing case for inclusion of physical performance tests . The Berg Balance Score may be a useful addition to outcome assessment in patients with TKA OBJECTIVE To compare the improvement in disability , kinesiophobia , pain , and quality of life obtained by means of home-based functional exercises aim ed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty ( TKA ) advice to stay active after discharge from a rehabilitation unit . DESIGN R and omized controlled trial with 6-months ' follow-up . SETTING Patients ' homes . PARTICIPANTS Patients ( N=110 ; 40 men ; mean age , 67y ) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA . INTERVENTIONS In the experimental group , before returning home , the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months , and were given a book containing theoretical information about the management of kinesiophobia . In the control group , the patients were advised to stay active and gradually recover their usual activities . MAIN OUTCOME MEASURES Repeated- measures analysis of covariance with baseline values as the covariates ( P<.05 ) was used to assess the effect of treatment on disability , fear-avoidance beliefs , pain intensity , and quality of life . RESULTS The analysis revealed a significant time by group interaction in all the variables in favor of the experimental group . Post hoc analysis showed that the effect of the group was statistically significant at the end of home training and follow-up . The treatment effect was clinical ly tangible in terms of disability and quality of life , and persisted for 6 months after the intervention ended . CONCLUSIONS A home-based program based on functional exercises and the management of kinesiophobia was useful in changing the course of disability , fear-avoidance beliefs , pain , and the quality of life in patients with TKA Objective : To evaluate whether balance training after total knee replacement surgery improves functional outcomes and to determine whether postoperative balance is associated with mobility . Design : A prospect i ve intervention study and r and omized controlled trial with an intention-to-treat analysis . Setting : The rehabilitation center of a university-based teaching hospital . Participants : A total of 130 patients with knee osteoarthritis who had undergone total knee replacement surgery were recruited to attend an outpatient rehabilitation program . They were r and omly allocated to additional balance rehabilitation and functional rehabilitation groups . Interventions : During the eight-week outpatient rehabilitation program , both groups received general functional training . Patients in the balance rehabilitation group received an additional balance-based rehabilitation program . Primary outcome measures : The functional reach test , single-leg stance test , 10-m walk test , Timed Up and Go Test , timed chair-st and test , stair-climb test , and Western Ontario and McMaster Universities Osteoarthritis Index were measured at baseline , eight weeks ( T1 ) , and 32 weeks ( T2 ) . Results : The balance rehabilitation group patients demonstrated significant improvement in the results of the functional reach test at T1 ( 37.6 ±7.8 cm ) and T2 ( 39.3 ±9.7 cm ) compared with the baseline assessment ( 11.5 ±2.9 cm ) and Timed Up and Go Test at T1 ( 8.9 ±1.2 seconds ) and T2 ( 8.0 ±1.9 seconds ) compared with the baseline assessment ( 12.5 ±1.8 seconds ) . Moreover , the balance rehabilitation group patients exhibited significantly greater improvements in balance and mobility than did the functional rehabilitation group patients ( all P < 0.001 ) . Furthermore , improved balance was significantly associated with improved mobility at T2 . Conclusion : Postoperative outpatient rehabilitation with balance training improves the balance , mobility , and functional outcomes in patients with knee osteoarthritis after total knee replacement Background and Purpose : Sensorimotor training has proven to be an efficient approach for recovering balance control following total knee replacement ( TKR ) . The purpose of this trial was to evaluate the influence of specific balance-targeted training using a dynamometric platform on the overall state of balance in older adults undergoing TKR . Methods : This was a r and omized controlled clinical trial conducted at a university hospital rehabilitation unit . Patients meeting the inclusion criteria were r and omly assigned to a control group or an experimental group . Both groups participated in the same 4-week postoperative rehabilitation training protocol . Participants in the experimental group performed additional balance training with a dynamometric platform consisting of tests related to stability challenges , weight-shifting , and moving to the limits of stability . The primary outcome measure was the overall state of balance rated according to the Berg Balance Scale . Secondary outcomes in terms of balance were the Timed Up and Go Test , Functional Reach Test , and Romberg open and closed-eyes tests . Data processing included between-group analysis of covariance , minimal detectable change assessment for the primary outcome measure , and effect size estimation . Confidence intervals ( CIs ) were set at 95 % . Results : Forty-three participants meeting the inclusion criteria and having signed the informed consent were r and omly assigned to 2 groups . Thirty-seven completed the training ( 86.1 % ) . Significant between-group differences in balance performance were found as measured with the Berg Balance Scale ( P = .03 ) and Functional Reach Test ( P = .04 ) with a CI = 95 % . Significant differences were not recorded for the Timed Up and Go Test or Romberg open and closed-eyes tests ( P > .05 ) . Furthermore , Cohen 's effect size result ed in a value of d = 0.97 , suggesting a high practical significance of the trial . Discussion and Conclusions : According to the Berg Balance Scale and Functional Reach Test , participants with TKR who have followed a 4-week training program using a dynamometric platform improved balance performance to a higher extent than a control group training without such a device . The inclusion of this instrument in the functional training protocol may be beneficial for recovering balance following TKR Purpose To prospect ively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty ( TKA )  and to determine the incidence of falls as well as their risk factors . Methods A total of 108 patients ( 17 male , 91 female ) over 60 years of age who underwent TKA were enrolled and who were living independently in community . 75 patients fulfilled our inclusion criteria and 74 ( 8 male , 66 female ) of them agreed to participate . Baseline assessment ( physical examination , physical performance tests , and self-administered question naire )  were conducted between 6 and 12 months after the last arthroplasty and the follow-up assessment was performed 6 months after the baseline assessment . Monthly pre-stamped postcards were sent to assess the incidence of falls . Results Of the 74 patients enrolled , 70 ( 94.6 % ) completed a 6-month prospect i ve observation . 23 of 70 patients ( 32.9 % ) fell during the observational period . Postoperative range of knee flexion , ranges of knee flexion and extension and ankle plantar flexion were significantly lower in fallers than in non-fallers ( P = 0.016 , P = 0.037 , P = 0.014 , respectively ) . In the multivariate analysis , postoperative range of knee flexion ( OR 0.277 , 95%CI 0.088–0.869 , P = 0.028 ) and ankle plantar flexion ( OR 0.594 , 95%CI 0.374–0.945 , P = 0.028 ) were determined to be significant risk factors . Conclusion Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people . For patients with limited knee flexion and ankle plantar flexion , improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary Background Patients with total knee arthroplasty ( TKA ) have impaired balance and movement control . Exercise interventions have not targeted these impairments in this population . Objectives The purpose s of this study were : ( 1 ) to determine the feasibility of applying a balance exercise program in patients with TKA , ( 2 ) to investigate whether a functional training ( FT ) program supplemented with a balance exercise program ( FT+B program ) could improve physical function compared with an 
    Output:
    