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 Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care Background Coronary artery bypass graft ( CABG ) is a st and ard surgical option for patients with diffuse and significant arterial plaque . This procedure , however , is not free of postoperative complications , especially pulmonary and cognitive disorders . Objective This study aim ed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG .  Methods Neuropsychological and pulmonary function  tests were applied , prior to and following CABG , to 39 patients r and omized into two groups as follows : Group 1 ( control ) – 20 patients underwent one physiotherapy session daily ; and Group 2 ( intensive physiotherapy ) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital . Non-paired and paired Student t tests were used to compare continuous variables . Variables without normal distribution were compared between groups by using Mann-Whitney test , and , within the same group at different times , by using Wilcoxon test . The chi-square test assessed differences of categorical variables . Statistical tests with a p value ≤ 0.05 were considered significant . Results Changes in pulmonary function were not significantly different between the groups . However , while Group 2 patients showed no decline in their neurocognitive function , Group 1 patients showed a decline in their cognitive functions ( P ≤ 0.01 ) . Conclusion Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day , providing patients with better psychosocial conditions and less morbidity Background . Functional training and muscle strength training may improve upper limb motor recovery after stroke . Combining these as functional strength training ( FST ) might enhance the benefit , but it is unclear whether this is better than conventional physical therapy ( CPT ) . Comparing FST with CPT is not straightforward . Objective . This study aim ed at assessing the feasibility of conducting a phase III trial comparing CPT with FST for upper limb recovery . Methods . R and omized , observer-blind , phase II trial . Subjects had upper limb weakness within 3 months of anterior circulation infa rct ion . Subjects were r and omized to CPT ( no extra therapy ) , CPT + CPT , and CPT + FST . Intervention lasted 6 weeks . Primary outcome measure was the Action Research Arm Test ( ARAT ) . Measurements were taken before treatment began , after 6 weeks of intervention , and 12 weeks thereafter . Attrition rate was calculated and differences between groups were interpreted using descriptive statistics . ARAT data were used to inform a power calculation . Results . Thirty subjects were recruited ( 8 % of people screened ) .  Attrition rate was 6.7 % at outcome and 40 % at follow-up . At outcome the CPT + FST group showed the largest increase in ARAT score and this was above the clinical ly important level of 5.7 points . Median ( interquartile range ) increases were 11.5 ( 21.0 ) for CPT ; 8.0 ( 13.3 ) for CPT + CPT ; and 19.5 ( 22.0 ) for CPT + FST . The estimated sample size for an adequately powered subsequent phase III trial was 279 subjects at outcome . Conclusion . Further work toward a phase III clinical trial appears justifiable Background Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay , yet the economic implication s are not known . The aim of this study was to determine from a health service perspective if the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone . Methods Cost utility and cost effectiveness analyses were undertaken alongside a multi-center , single-blind r and omized controlled trial with a 30-day follow up after discharge . Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities . The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday .  Incremental cost utility ratio was reported as cost per quality adjusted life year ( QALY ) gained and an incremental cost effectiveness ratio ( ICER ) was reported as cost for a minimal clinical ly important difference ( MCID ) in functional independence . Results 996 patients ( mean age 74 ( st and ard deviation 13 ) years ) were r and omly assigned to the intervention ( n = 496 ) or the control group ( n = 500 ) . Mean difference in cost of AUD$1,673 ( 95 % confidence interval ( CI ) -271 to 3,618 ) was a saving in favor of the intervention group . The incremental cost utility ratio found a saving of AUD$41,825 ( 95 % CI -2,817 to 74,620 ) per QALY gained for the intervention group . The ICER found a saving of AUD$16,003 ( 95 % CI -3,074 to 87,361 ) in achieving a MCID in functional independence for the intervention group . If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96 % and 95 % , respectively . A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome . Conclusions From a health service perspective , the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday , compared to Monday to Friday rehabilitation alone , is likely to be cost saving per QALY gained and for a MCID in functional independence . Trial registration Australian and New Zeal and Clinical Trials Registry November 2009 BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Background and Purpose — Very early rehabilitation , with an emphasis on mobilization , may contribute to improved outcomes after stroke . We hypothesized that a very early rehabilitation protocol would be safe and feasible . Methods — We performed a r and omized , controlled trial with blinded outcome assessment . Patients at < 24 hours after stroke were recruited from 2 Melbourne metropolitan stroke units . Patients were r and omly assigned to receive st and ard care ( SC ) or SC plus very early mobilization ( VEM ) until discharge or 14 days ( whichever was sooner ) . The primary safety outcome was the number of deaths at 3 months . The primary feasibility outcome was a higher “ dose ” of mobilization achieved in VEM . Secondary safety outcomes included adverse events ( including falls and early neurologic deterioration ) , compliance with physiologic monitoring criteria , and patient fatigue after interventions . Secondary feasibility outcomes included “ contamination ” of st and ard care . Results — Overall , 18 % of patients screened were suitable for recruitment . Seventy-one patients were recruited and r and omized , with 2 dropouts by 12 months . The majority experienced ischemic strokes ( 87 % ) . The group mean±SD age was 74.7±12.5 years , and 58 % ( n=41 ) had a National Institutes of Health Stroke Scale score > 7 . There was no significant difference in the number of deaths between groups ( SC , 3 of 33 ; VEM , 8 of 38 ; P=0.20 ) . Almost all deaths occurred in patients with severe stroke . Secondary safety outcomes were similar between groups . The intervention protocol was successfully delivered , achieving VEM dose targets ( double SC , P=0.003 ) and faster time to first mobilization ( P<0.001 ) . Conclusions — VEM of patients within 24 hours of acute stroke appears safe and feasible . Intervention efficacy and cost-effectiveness are currently being tested in a large r and omized , controlled trial Abstract Background Many in patients receive little or no rehabilitation on weekends . Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence , quality of life and length of stay compared to 5 days per week of rehabilitation . Methods This was a multicenter , single-blind ( assessors ) r and omized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne , Australia . Patients were eligible if they were adults ( aged ≥18 years ) admitted for rehabilitation for any orthopedic , neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management . Participants were r and omly allocated to usual care Monday to Friday rehabilitation ( control ) or to Monday to Saturday rehabilitation ( intervention ) . The additional Saturday rehabilitation comprised physiotherapy and occupational therapy . The primary outcomes were functional independence ( functional independence measure ( FIM ) ; measured on an 18 to 126 point scale ) , health-related quality of life ( EQ-5D utility index ; measured on a 0 to 1 scale , and EQ-5D visual analog scale ; measured on a 0 to 100 scale ) , and patient length of stay . Outcome measures were assessed on admission , discharge ( primary endpoint ) , and at 6 and 12 months post discharge . Results We r and omly assigned 996 adults ( mean ( SD ) age 74 ( 13 ) years ) to Monday to Saturday rehabilitation ( n = 496 ) or usual care Monday to Friday rehabilitation ( n = 500 ) . Relative to admission scores , intervention group participants had higher functional independence ( mean difference ( MD ) 2.3 , 95 % confidence interval ( CI ) 0.5 to 4.1 , P = 0.01 ) and health-related quality of life ( MD 0.04 , 95 % CI 0.01 to 0.07 , P = 0.009 ) on discharge and may have had a shorter length of stay by 2 days ( 95 % CI 0 to 4 , P = 0.1 ) when compared to control group participants . Intervention group participants were 17 % more likely to have achieved a clinical ly significant change in functional independence of 22 FIM points or more ( risk ratio ( RR ) 1.17 , 95 % CI 1.03 to 1.34 ) and 18 % more likely to have achieved a clinical ly significant change in health-related quality of life ( RR 1.18 , 95 % CI 1.04 to 1.34 ) on discharge compared to the control group . There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up . There was no difference in the number of adverse events between the groups ( incidence rate ratio = 0.81 , 95 % CI 0.61 to 1.08 ) . Conclusions Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN126090009732 
    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 Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care Background Coronary artery bypass graft ( CABG ) is a st and ard surgical option for patients with diffuse and significant arterial plaque . This procedure , however , is not free of postoperative complications , especially pulmonary and cognitive disorders . Objective This study aim ed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG .  Methods Neuropsychological and pulmonary function  tests were applied , prior to and following CABG , to 39 patients r and omized into two groups as follows : Group 1 ( control ) – 20 patients underwent one physiotherapy session daily ; and Group 2 ( intensive physiotherapy ) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital . Non-paired and paired Student t tests were used to compare continuous variables . Variables without normal distribution were compared between groups by using Mann-Whitney test , and , within the same group at different times , by using Wilcoxon test . The chi-square test assessed differences of categorical variables . Statistical tests with a p value ≤ 0.05 were considered significant . Results Changes in pulmonary function were not significantly different between the groups . However , while Group 2 patients showed no decline in their neurocognitive function , Group 1 patients showed a decline in their cognitive functions ( P ≤ 0.01 ) . Conclusion Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day , providing patients with better psychosocial conditions and less morbidity Background . Functional training and muscle strength training may improve upper limb motor recovery after stroke . Combining these as functional strength training ( FST ) might enhance the benefit , but it is unclear whether this is better than conventional physical therapy ( CPT ) . Comparing FST with CPT is not straightforward . Objective . This study aim ed at assessing the feasibility of conducting a phase III trial comparing CPT with FST for upper limb recovery . Methods . R and omized , observer-blind , phase II trial . Subjects had upper limb weakness within 3 months of anterior circulation infa rct ion . Subjects were r and omized to CPT ( no extra therapy ) , CPT + CPT , and CPT + FST . Intervention lasted 6 weeks . Primary outcome measure was the Action Research Arm Test ( ARAT ) . Measurements were taken before treatment began , after 6 weeks of intervention , and 12 weeks thereafter . Attrition rate was calculated and differences between groups were interpreted using descriptive statistics . ARAT data were used to inform a power calculation . Results . Thirty subjects were recruited ( 8 % of people screened ) .  Attrition rate was 6.7 % at outcome and 40 % at follow-up . At outcome the CPT + FST group showed the largest increase in ARAT score and this was above the clinical ly important level of 5.7 points . Median ( interquartile range ) increases were 11.5 ( 21.0 ) for CPT ; 8.0 ( 13.3 ) for CPT + CPT ; and 19.5 ( 22.0 ) for CPT + FST . The estimated sample size for an adequately powered subsequent phase III trial was 279 subjects at outcome . Conclusion . Further work toward a phase III clinical trial appears justifiable Background Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay , yet the economic implication s are not known . The aim of this study was to determine from a health service perspective if the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone . Methods Cost utility and cost effectiveness analyses were undertaken alongside a multi-center , single-blind r and omized controlled trial with a 30-day follow up after discharge . Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities . The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday .  Incremental cost utility ratio was reported as cost per quality adjusted life year ( QALY ) gained and an incremental cost effectiveness ratio ( ICER ) was reported as cost for a minimal clinical ly important difference ( MCID ) in functional independence . Results 996 patients ( mean age 74 ( st and ard deviation 13 ) years ) were r and omly assigned to the intervention ( n = 496 ) or the control group ( n = 500 ) . Mean difference in cost of AUD$1,673 ( 95 % confidence interval ( CI ) -271 to 3,618 ) was a saving in favor of the intervention group . The incremental cost utility ratio found a saving of AUD$41,825 ( 95 % CI -2,817 to 74,620 ) per QALY gained for the intervention group . The ICER found a saving of AUD$16,003 ( 95 % CI -3,074 to 87,361 ) in achieving a MCID in functional independence for the intervention group . If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96 % and 95 % , respectively . A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome . Conclusions From a health service perspective , the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday , compared to Monday to Friday rehabilitation alone , is likely to be cost saving per QALY gained and for a MCID in functional independence . Trial registration Australian and New Zeal and Clinical Trials Registry November 2009 BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Background and Purpose — Very early rehabilitation , with an emphasis on mobilization , may contribute to improved outcomes after stroke . We hypothesized that a very early rehabilitation protocol would be safe and feasible . Methods — We performed a r and omized , controlled trial with blinded outcome assessment . Patients at < 24 hours after stroke were recruited from 2 Melbourne metropolitan stroke units . Patients were r and omly assigned to receive st and ard care ( SC ) or SC plus very early mobilization ( VEM ) until discharge or 14 days ( whichever was sooner ) . The primary safety outcome was the number of deaths at 3 months . The primary feasibility outcome was a higher “ dose ” of mobilization achieved in VEM . Secondary safety outcomes included adverse events ( including falls and early neurologic deterioration ) , compliance with physiologic monitoring criteria , and patient fatigue after interventions . Secondary feasibility outcomes included “ contamination ” of st and ard care . Results — Overall , 18 % of patients screened were suitable for recruitment . Seventy-one patients were recruited and r and omized , with 2 dropouts by 12 months . The majority experienced ischemic strokes ( 87 % ) . The group mean±SD age was 74.7±12.5 years , and 58 % ( n=41 ) had a National Institutes of Health Stroke Scale score > 7 . There was no significant difference in the number of deaths between groups ( SC , 3 of 33 ; VEM , 8 of 38 ; P=0.20 ) . Almost all deaths occurred in patients with severe stroke . Secondary safety outcomes were similar between groups . The intervention protocol was successfully delivered , achieving VEM dose targets ( double SC , P=0.003 ) and faster time to first mobilization ( P<0.001 ) . Conclusions — VEM of patients within 24 hours of acute stroke appears safe and feasible . Intervention efficacy and cost-effectiveness are currently being tested in a large r and omized , controlled trial Abstract Background Many in patients receive little or no rehabilitation on weekends . Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence , quality of life and length of stay compared to 5 days per week of rehabilitation . Methods This was a multicenter , single-blind ( assessors ) r and omized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne , Australia . Patients were eligible if they were adults ( aged ≥18 years ) admitted for rehabilitation for any orthopedic , neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management . Participants were r and omly allocated to usual care Monday to Friday rehabilitation ( control ) or to Monday to Saturday rehabilitation ( intervention ) . The additional Saturday rehabilitation comprised physiotherapy and occupational therapy . The primary outcomes were functional independence ( functional independence measure ( FIM ) ; measured on an 18 to 126 point scale ) , health-related quality of life ( EQ-5D utility index ; measured on a 0 to 1 scale , and EQ-5D visual analog scale ; measured on a 0 to 100 scale ) , and patient length of stay . Outcome measures were assessed on admission , discharge ( primary endpoint ) , and at 6 and 12 months post discharge . Results We r and omly assigned 996 adults ( mean ( SD ) age 74 ( 13 ) years ) to Monday to Saturday rehabilitation ( n = 496 ) or usual care Monday to Friday rehabilitation ( n = 500 ) . Relative to admission scores , intervention group participants had higher functional independence ( mean difference ( MD ) 2.3 , 95 % confidence interval ( CI ) 0.5 to 4.1 , P = 0.01 ) and health-related quality of life ( MD 0.04 , 95 % CI 0.01 to 0.07 , P = 0.009 ) on discharge and may have had a shorter length of stay by 2 days ( 95 % CI 0 to 4 , P = 0.1 ) when compared to control group participants . Intervention group participants were 17 % more likely to have achieved a clinical ly significant change in functional independence of 22 FIM points or more ( risk ratio ( RR ) 1.17 , 95 % CI 1.03 to 1.34 ) and 18 % more likely to have achieved a clinical ly significant change in health-related quality of life ( RR 1.18 , 95 % CI 1.04 to 1.34 ) on discharge compared to the control group . There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up . There was no difference in the number of adverse events between the groups ( incidence rate ratio = 0.81 , 95 % CI 0.61 to 1.08 ) . Conclusions Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN126090009732 
    Output:
    