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 Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice OBJECTIVES To analyze the feasibility and efficacy of a novel system ( Gamepad [ GAMing Experience in PArkinson 's Disease ] ) for biofeedback rehabilitation of balance and gait in Parkinson disease ( PD ) . DESIGN R and omized controlled trial . SETTING Clinical rehabilitation gym . PARTICIPANTS Subjects with PD ( N=42 ) were r and omized into experimental and physiotherapy without biofeedback groups . INTERVENTIONS Both groups underwent 20 sessions of training for balance and gait . The experimental group performed tailored functional tasks using Gamepad . The system , based on wearable inertial sensors , provided users with real-time visual and acoustic feedback about their movement during the exercises . The physiotherapy group underwent individually structured physiotherapy without feedback . MAIN OUTCOME MEASURES Assessment s were performed by a blinded examiner preintervention , postintervention , and at 1-month follow-up . Primary outcomes were the Berg Balance Scale ( BBS ) and 10-m walk test ( 10MWT ) . Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Question naire . RESULTS Gamepad was well accepted by participants . Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining ( experimental group-physiotherapy without biofeedback group : mean , 2.3±3.4 points ; P=.047 ) and at follow-up ( experimental group-physiotherapy without biofeedback group : mean , 2.7±3.3 points ; P=.018 ) . Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group ( experimental group-physiotherapy without biofeedback group : -1.6±1.5 mm ; P=.003 ) . No significant between-group differences were found in the other outcomes . CONCLUSIONS Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month . After training , 10MWT data were comparable between groups . Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical setting s , to enhance gait improvements , and to increase transfer of training effects to real-life context Objective : Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinson ’s disease and the effectiveness of this treatment on balance parameters in comparison to a traditional l and -based physical therapy . Design : A r and omized single-blind controlled trial . Setting : Out patients . Subjects : Thirty-four patients with Parkinson ’s disease in Hoehn-Yahr stage 2.5–3 . Intervention : Group 1 hydrotherapy treatment , group 2 l and -based rehabilitation treatment . The two groups underwent the same rehabilitation period ( 60 minutes of treatment , five days a week for two months ) . Main measures : The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes , using a stabilometric platform . Secondary outcome measures were Unified Parkinson ’s Disease Rating Scale II and III , Timed Up and Go Test , Berg Balance Scale , Activities-specific Balance Confidence Scale , Falls Efficacy Scale , Falls diary and Parkinson ’s Disease Question naire-39 . Results : Hydrotherapy treatment proved to be feasible and safe . Patients in both groups had a significant improvement in all outcome variables . There was a better improvement in patients who underwent hydrotherapy than in patients treated with l and -based therapy in the centre of pressure sway area closed eyes ( mean SD change : 45.4 SD64.9 vs. 6.9 SD45.3 , p = 0.05 ) , Berg Balance Scale ( 51.2 SD3.1 vs. 6.0 SD3.1 , p = 0.005 ) , Activities-specific Balance Confidence Scale ( 16.8 SD10.6 vs. 4.1 SD5.4 , p = 0.0001 ) , Falls Efficacy Scale ( −5.9 SD4.8 vs. −1.9 SD1.4 , p = 0.003 ) , Parkinson ’s Disease Quetionnaire-39 ( −18.4 SD12.9 vs. −8.0 SD7.0 , p = 0.006 ) and falls diary ( −2.4 SD2.2 vs. −0.4 SD0.5 , p = 0.001 ) . Conclusion : Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease OBJECTIVE To examine the effectiveness of dance on motor functions , cognitive functions , and mental symptoms of Parkinson 's disease ( PD ) . DESIGN This study employed a quasi-r and omised , between-group design . SETTING Dance , PD exercise , and all assessment s were performed in community halls in different regions of Japan . PARTICIPANTS Forty-six mild-moderate PD patients participated . INTERVENTION Six PD patient associations that agreed to participate in the study were r and omly assigned to a dance group , PD exercise group , or non-intervention group . The dance and PD exercise groups performed one 60-min session per week for 12 weeks . Control group patients continued with their normal lives . All groups were assessed before and after the intervention . MAIN OUTCOME MEASURES We used the Timed Up- and -Go Test ( TUG ) and Berg Balance Scale ( BBS ) to assess motor function , the Frontal Assessment Battery at bedside ( FAB ) and Mental Rotation Task ( MRT ) to assess cognitive function , and the Apathy Scale ( AS ) and Self-rating Depression Scale ( SDS ) to assess mental symptoms of PD . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) was used for general assessment of PD . RESULTS When comparing results before and after intervention , the dance group showed a large effect in TUG time ( ES=0.65 , p=0.006 ) , TUG step number ( ES=0.66 , p=0.005 ) , BBS ( ES=0.75 , p=0.001 ) , FAB ( ES=0.77 , p=0.001 ) , MRT response time ( ES=0.79 , p<0.001 ) , AS ( ES=0.78 , p<0.001 ) , SDS ( ES=0.66 , p=0.006 ) and UPDRS ( ES=0.88 , p<0.001 ) . CONCLUSIONS Dance was effective in improving motor function , cognitive function , and mental symptoms in PD patients . General symptoms in PD also improved . Dance is an effective method for rehabilitation in PD patients PURPOSE This study was undertaken to evaluate the effects of an inpatient 2-month multidisciplinary rehabilitative program of task-oriented exercises , cognitive-behavioral training , and occupational therapy on motor impairment , activities of daily living , and quality of life ( QoL ) in subjects with long- duration Parkinson 's disease ( PD ) . METHODS Subjects were r and omly selected for an experimental ( multidisciplinary rehabilitative care ) and a control group ( general physiotherapy ) and were assessed before treatment , after 8 weeks ( post-treatment ) , and 12 months after the end of treatment . Medications were not adjusted during training . Outcome measures were the Movement Disorder Society Unified Parkinson 's Disease Rating Scale , Part III ( primary outcome ) , the Berg Balance Scale , the Functional Independence Measure , and the 39-Parkinson 's Disease Question naire . A linear mixed model for repeated measures was used for each outcome . RESULTS Seventy subjects with PD ( 46 females ; mean age , 74 ± 7 years ; mean disease duration , 15 ± 3 years , modified Hoehn & Yahr stage , 2.5 - 4 ) were r and omized , 64 completed the study ( experimental = 32 ; control = 32 ) . A significant effect of time , group , and time by group interaction were noted for all outcomes . The primary outcome showed a between-group difference in favor of the experimental group of 2 
    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 Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - BACKGROUND Evidence s have shown that physiotherapy programs may improve the balance of individuals with Parkinson 's disease ( PD ) , although it is not clear which specific exercise program is better . AIM The aim of this study was to compare the effectiveness of balance versus resistance training on postural control measures in PD patients . DESIGN R and omized controlled trial . SETTING The study was conducted in a physiotherapy outpatient clinic of a university hospital . POPULATION A total of 40 PD participants were r and omly divided into two groups : balance training ( BT ) and resistance training ( RT ) . METHODS The BT group focused on balance training , functional independence and gait while the RT group performed resistance exercises emphasizing the lower limbs and trunk , both supervised by trained physiotherapists . Therapy sessions were held twice a week ( at 60 minutes ) , totaling 24 sessions . The primary outcome was evaluated by force platform with center of pressure sway measures in different balance conditions and the secondary outcome was evaluated by Balance Evaluation Systems Test ( BESTest ) scale to determine the effects of the intervention on postural control . RESULTS Significant improvement of postural control ( pre vs. post 15.1 vs. 9.6 cm2 ) was only reported in favor of BT group ( d=1.17 ) for one-legged st and condition on force platform . The st and ardized mean difference between groups was significantly ( P<0.02 ) , with 36 % of improvement for BT vs. 0.07 % for RT on this condition . Significant improvement ( P<0.05 ) was also observed in favor of BT ( in mean 3.2 % ) for balance gains in some BESTest scores , when compared to RT group ( -0.98 % ) . CONCLUSIONS Postural control in Parkinson 's disease is improved when training by a directional and specific balance program than a resistance training program . CLINICAL REHABILITATION IMPACT Balance training is superior to resistance training in regard to improving postural control of individuals with PD . Gold st and ard instruments ( high in cost and difficult to access ) were used to assess balance , as well as scales with clinical applicability ( low cost , easily acceptable , applicable and valid ) , which can guide the management of physiotherapists both in their decision-making and in clinical practice OBJECTIVES To analyze the feasibility and efficacy of a novel system ( Gamepad [ GAMing Experience in PArkinson 's Disease ] ) for biofeedback rehabilitation of balance and gait in Parkinson disease ( PD ) . DESIGN R and omized controlled trial . SETTING Clinical rehabilitation gym . PARTICIPANTS Subjects with PD ( N=42 ) were r and omized into experimental and physiotherapy without biofeedback groups . INTERVENTIONS Both groups underwent 20 sessions of training for balance and gait . The experimental group performed tailored functional tasks using Gamepad . The system , based on wearable inertial sensors , provided users with real-time visual and acoustic feedback about their movement during the exercises . The physiotherapy group underwent individually structured physiotherapy without feedback . MAIN OUTCOME MEASURES Assessment s were performed by a blinded examiner preintervention , postintervention , and at 1-month follow-up . Primary outcomes were the Berg Balance Scale ( BBS ) and 10-m walk test ( 10MWT ) . Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Question naire . RESULTS Gamepad was well accepted by participants . Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining ( experimental group-physiotherapy without biofeedback group : mean , 2.3±3.4 points ; P=.047 ) and at follow-up ( experimental group-physiotherapy without biofeedback group : mean , 2.7±3.3 points ; P=.018 ) . Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group ( experimental group-physiotherapy without biofeedback group : -1.6±1.5 mm ; P=.003 ) . No significant between-group differences were found in the other outcomes . CONCLUSIONS Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month . After training , 10MWT data were comparable between groups . Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical setting s , to enhance gait improvements , and to increase transfer of training effects to real-life context Objective : Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinson ’s disease and the effectiveness of this treatment on balance parameters in comparison to a traditional l and -based physical therapy . Design : A r and omized single-blind controlled trial . Setting : Out patients . Subjects : Thirty-four patients with Parkinson ’s disease in Hoehn-Yahr stage 2.5–3 . Intervention : Group 1 hydrotherapy treatment , group 2 l and -based rehabilitation treatment . The two groups underwent the same rehabilitation period ( 60 minutes of treatment , five days a week for two months ) . Main measures : The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes , using a stabilometric platform . Secondary outcome measures were Unified Parkinson ’s Disease Rating Scale II and III , Timed Up and Go Test , Berg Balance Scale , Activities-specific Balance Confidence Scale , Falls Efficacy Scale , Falls diary and Parkinson ’s Disease Question naire-39 . Results : Hydrotherapy treatment proved to be feasible and safe . Patients in both groups had a significant improvement in all outcome variables . There was a better improvement in patients who underwent hydrotherapy than in patients treated with l and -based therapy in the centre of pressure sway area closed eyes ( mean SD change : 45.4 SD64.9 vs. 6.9 SD45.3 , p = 0.05 ) , Berg Balance Scale ( 51.2 SD3.1 vs. 6.0 SD3.1 , p = 0.005 ) , Activities-specific Balance Confidence Scale ( 16.8 SD10.6 vs. 4.1 SD5.4 , p = 0.0001 ) , Falls Efficacy Scale ( −5.9 SD4.8 vs. −1.9 SD1.4 , p = 0.003 ) , Parkinson ’s Disease Quetionnaire-39 ( −18.4 SD12.9 vs. −8.0 SD7.0 , p = 0.006 ) and falls diary ( −2.4 SD2.2 vs. −0.4 SD0.5 , p = 0.001 ) . Conclusion : Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease OBJECTIVE To examine the effectiveness of dance on motor functions , cognitive functions , and mental symptoms of Parkinson 's disease ( PD ) . DESIGN This study employed a quasi-r and omised , between-group design . SETTING Dance , PD exercise , and all assessment s were performed in community halls in different regions of Japan . PARTICIPANTS Forty-six mild-moderate PD patients participated . INTERVENTION Six PD patient associations that agreed to participate in the study were r and omly assigned to a dance group , PD exercise group , or non-intervention group . The dance and PD exercise groups performed one 60-min session per week for 12 weeks . Control group patients continued with their normal lives . All groups were assessed before and after the intervention . MAIN OUTCOME MEASURES We used the Timed Up- and -Go Test ( TUG ) and Berg Balance Scale ( BBS ) to assess motor function , the Frontal Assessment Battery at bedside ( FAB ) and Mental Rotation Task ( MRT ) to assess cognitive function , and the Apathy Scale ( AS ) and Self-rating Depression Scale ( SDS ) to assess mental symptoms of PD . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) was used for general assessment of PD . RESULTS When comparing results before and after intervention , the dance group showed a large effect in TUG time ( ES=0.65 , p=0.006 ) , TUG step number ( ES=0.66 , p=0.005 ) , BBS ( ES=0.75 , p=0.001 ) , FAB ( ES=0.77 , p=0.001 ) , MRT response time ( ES=0.79 , p<0.001 ) , AS ( ES=0.78 , p<0.001 ) , SDS ( ES=0.66 , p=0.006 ) and UPDRS ( ES=0.88 , p<0.001 ) . CONCLUSIONS Dance was effective in improving motor function , cognitive function , and mental symptoms in PD patients . General symptoms in PD also improved . Dance is an effective method for rehabilitation in PD patients PURPOSE This study was undertaken to evaluate the effects of an inpatient 2-month multidisciplinary rehabilitative program of task-oriented exercises , cognitive-behavioral training , and occupational therapy on motor impairment , activities of daily living , and quality of life ( QoL ) in subjects with long- duration Parkinson 's disease ( PD ) . METHODS Subjects were r and omly selected for an experimental ( multidisciplinary rehabilitative care ) and a control group ( general physiotherapy ) and were assessed before treatment , after 8 weeks ( post-treatment ) , and 12 months after the end of treatment . Medications were not adjusted during training . Outcome measures were the Movement Disorder Society Unified Parkinson 's Disease Rating Scale , Part III ( primary outcome ) , the Berg Balance Scale , the Functional Independence Measure , and the 39-Parkinson 's Disease Question naire . A linear mixed model for repeated measures was used for each outcome . RESULTS Seventy subjects with PD ( 46 females ; mean age , 74 ± 7 years ; mean disease duration , 15 ± 3 years , modified Hoehn & Yahr stage , 2.5 - 4 ) were r and omized , 64 completed the study ( experimental = 32 ; control = 32 ) . A significant effect of time , group , and time by group interaction were noted for all outcomes . The primary outcome showed a between-group difference in favor of the experimental group of 2 
    Output:
    