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 Recent evidence has demonstrated the efficacy of Virtual Reality ( VR ) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied . Objectives To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients . Methods A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital . We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale ( It-NIHSS ) between 1 and 3 and without severe neuropsychological impairments interfering with recovery . Patients were allocated to two treatments groups , receiving combined VR and upper limb conventional ( ULC ) therapy or ULC therapy alone . The treatment programs consisted of 2 hours of daily therapy , delivered 5 days per week , for 4 weeks . The outcome measures were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scales . Results Both treatments significantly improved F-M UE and FIM scores , but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone . The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 ( P < 0.001 ) pts and 3.2 ± 1.2 ( P = 0.007 ) pts , respectively . Conclusions VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities . Trial registration Italian Ministry of Health IRCCS Research Programme Background . Six months after a stroke , the hemiplegic arm often remains compromised . More innovative approaches to motor rehabilitation are needed . Objective . The authors compared a motor learning — based approach in a virtual environment with more conventional upper extremity therapy in a pilot trial . Methods . This prospect i ve , single-blinded , r and omized controlled trial compared reinforced feedback in a virtual environment ( RFVE ; n = 27 ) with a control intervention ( n = 20 ) of progressive therapy for the affected upper extremity . Both treatments were provided for 4 weeks , 5 days per week , with 1-hour treatment sessions daily . The primary outcomes were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scores . Kinematic outcomes included mean duration ( MD ) , mean linear velocity ( MLV ) , and number of submovements to measure the motor performance . Analyses of the primary outcomes were performed per protocol and by intention to treat . Results . F-M UE scores improved significantly in the RFVE group compared with the conventional therapy group ( “ intention to treat ” = 5.10 points , P = .004 ; ANCOVA = 4.26 points , P < .01 ) . Several of the kinematic parameters improved in the RFVE group ( MD , P < .01 ; MLV , P < .01 ) . FIM improvements did not differ . Conclusions . Both rehabilitation therapies improved arm motor performance and functional activity , but the RFVE therapy induced more robust results in patients exposed to late rehabilitation treatment BACKGROUND Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation . There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness . Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke . METHODS In this r and omised , controlled , single-blind , parallel-group trial we enrolled adults ( aged 18 - 85 years ) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more ( measured with the Chedoke-McMaster scale ) within 3 months of r and omisation from 14 in-patient stroke rehabilitation units from four countries ( Canada [ 11 ] , Argentina [ 1 ] , Peru [ 1 ] , and Thail and [ 1 ] ) . Participants were r and omly allocated ( 1:1 ) by a computer-generated assignment at enrolment to receive a programme of structured , task-oriented , upper extremity sessions ( ten sessions , 60 min each ) of either non-immersive virtual reality using the Nintendo Wii gaming system ( VRWii ) or simple recreational activities ( playing cards , bingo , Jenga , or ball game ) as add-on therapies to conventional rehabilitation over a 2 week period . All investigators assessing outcomes were masked to treatment assignment . The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test ( WMFT ) at the end of the 2 week intervention period , analysed in the intention-to-treat population . This trial is registered with Clinical Trials.gov , number NTC01406912 . FINDINGS The study was done between May 12 , 2012 , and Oct 1 , 2015 . We r and omly assigned 141 patients : 71 received VRWii therapy and 70 received recreational activity . 121 ( 86 % ) patients ( 59 in the VRWii group and 62 in the recreational activity group ) completed the final assessment and were included in the primary analysis . Each group improved WMFT performance time relative to baseline ( decrease in median time from 43·7 s [ IQR 26·1 - 68·0 ] to 29·7 s [ 21·4 - 45·2 ] , 32·0 % reduction for VRWii vs 38·0 s [ IQR 28·0 - 64·1 ] to 27·1 s [ 21·2 - 45·5 ] , 28·7 % reduction for recreational activity ) . Mean time of conventional rehabilitation during the trial was similar between groups ( VRWii , 373 min [ SD 322 ] vs recreational activity , 397 min [ 345 ] ; p=0·70 ) as was the total duration of study intervention ( VRWii , 528 min [ SD 155 ] vs recreational activity , 541 min [ 142 ] ; p=0·60 ) . Multivariable analysis adjusted for baseline WMFT score , age , sex , baseline Chedoke-McMaster , and stroke severity revealed no significant difference between groups in the primary outcome ( adjusted mean estimate of difference in WMFT : 4·1 s , 95 % CI -14·4 to 22·6 ) . There were three serious adverse events during the trial , all deemed to be unrelated to the interventions ( seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group ) . Overall incidences of adverse events and serious adverse events were similar between treatment groups . INTERPRETATION In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment , non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function , as measured by WMFT . Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant , as long as it is intensive enough and task-specific . Simple , low-cost , and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies . FUNDING Heart and Stroke Foundation of Canada and Ontario Ministry of Health BACKGROUND Age-associated motor and cognitive deficits increase the risk of falls , a major cause of morbidity and mortality . Because of the significant ramifications of falls , many interventions have been proposed , but few have aim ed to prevent falls via an integrated approach targeting both motor and cognitive function . We aim ed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality ( VR ) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone . METHODS We carried out this r and omised controlled trial at five clinical centres across five countries ( Belgium , Israel , Italy , the Netherl and s , and the UK ) . Adults aged 60 - 90 years with a high risk of falls based on a history of two or more falls in the 6 months before the study and with varied motor and cognitive deficits were r and omly assigned by use of computer-based allocation to receive 6 weeks of either treadmill training plus VR or treadmill training alone . R and omisation was stratified by subgroups of patients ( those with a history of idiopathic falls , those with mild cognitive impairment , and those with Parkinson 's disease ) and sex , with stratification per clinical site . Group allocation was done by a third party not involved in onsite study procedures . Both groups aim ed to train three times per week for 6 weeks , with each session lasting about 45 min and structured training progression individualised to the participant 's level of performance . The VR system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen , which was specifically design ed to reduce fall risk in older adults by including real-life challenges such as obstacles , multiple pathways , and distracters that required continual adjustment of steps . The primary outcome was the incident rate of falls during the 6 months after the end of training , which was assessed in a modified intention-to-treat population . Safety was assessed in all patients who were assigned a treatment . This study is registered with Clinical Trials.gov , NCT01732653 . FINDINGS Between Jan 6 , 2013 , and April 3 , 2015 , 302 adults were r and omly assigned to either the treadmill training plus VR group ( n=154 ) or treadmill training alone group ( n=148 ) . Data from 282 ( 93 % ) participants were included in the prespecified , modified intention-to-treat analysis . Before training , the incident rate of falls was similar in both groups ( 10·7 [ SD 35·6 ] falls per 6 months for treadmill training alone vs 11·9 [ 39·5 ] falls per 6 months for treadmill training plus VR ) . In the 6 months after training , the incident rate was significantly lower in the treadmill training plus VR group than it had been before training ( 6·00 [ 95 % CI 4·36 - 8·25 ] falls per 6 months ; p<0·0001 vs before training ) , whereas the incident rate did not decrease significantly in the treadmill training alone group ( 8·27 [ 5·55 - 12·31 ] falls per 6 months ; p=0·49 ) . 6 months after the end of training , the incident rate of falls was also significantly lower in the treadmill training plus VR group than in the treadmill training group ( incident rate ratio 0·58 , 95 % CI 0·36 - 0·96 ; p=0·033 ) . No serious training-related adverse events occurred . INTERPRETATION In a diverse group of older adults at high risk for falls , treadmill training plus VR led to reduced fall rates  compared with treadmill training alone . FUNDING European Commission BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Introduction Ubiquity of Alzheimer 's disease ( AD ) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction . However , evidence of neuroplasticity notwithst and ing , there are few scientifically rigorous , ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline . This pilot study will examine the ability of virtual reality ( VR ) cognitive training to improve cognition and cerebral blood flow ( CBF ) in middle-aged individuals at high AD risk due to parental history . Methods The design is an assessor-blind , parallel group , r and omized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history . The experimental group will be trained with adaptive “ real-world ” VR tasks targeting sustained and selective attention , working memory , covert rule deduction , and planning , while walking on a treadmill . One active control group will perform the VR tasks without treadmill walking ; another will walk on a treadmill while 
    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 Recent evidence has demonstrated the efficacy of Virtual Reality ( VR ) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied . Objectives To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients . Methods A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital . We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale ( It-NIHSS ) between 1 and 3 and without severe neuropsychological impairments interfering with recovery . Patients were allocated to two treatments groups , receiving combined VR and upper limb conventional ( ULC ) therapy or ULC therapy alone . The treatment programs consisted of 2 hours of daily therapy , delivered 5 days per week , for 4 weeks . The outcome measures were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scales . Results Both treatments significantly improved F-M UE and FIM scores , but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone . The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 ( P < 0.001 ) pts and 3.2 ± 1.2 ( P = 0.007 ) pts , respectively . Conclusions VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities . Trial registration Italian Ministry of Health IRCCS Research Programme Background . Six months after a stroke , the hemiplegic arm often remains compromised . More innovative approaches to motor rehabilitation are needed . Objective . The authors compared a motor learning — based approach in a virtual environment with more conventional upper extremity therapy in a pilot trial . Methods . This prospect i ve , single-blinded , r and omized controlled trial compared reinforced feedback in a virtual environment ( RFVE ; n = 27 ) with a control intervention ( n = 20 ) of progressive therapy for the affected upper extremity . Both treatments were provided for 4 weeks , 5 days per week , with 1-hour treatment sessions daily . The primary outcomes were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scores . Kinematic outcomes included mean duration ( MD ) , mean linear velocity ( MLV ) , and number of submovements to measure the motor performance . Analyses of the primary outcomes were performed per protocol and by intention to treat . Results . F-M UE scores improved significantly in the RFVE group compared with the conventional therapy group ( “ intention to treat ” = 5.10 points , P = .004 ; ANCOVA = 4.26 points , P < .01 ) . Several of the kinematic parameters improved in the RFVE group ( MD , P < .01 ; MLV , P < .01 ) . FIM improvements did not differ . Conclusions . Both rehabilitation therapies improved arm motor performance and functional activity , but the RFVE therapy induced more robust results in patients exposed to late rehabilitation treatment BACKGROUND Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation . There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness . Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke . METHODS In this r and omised , controlled , single-blind , parallel-group trial we enrolled adults ( aged 18 - 85 years ) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more ( measured with the Chedoke-McMaster scale ) within 3 months of r and omisation from 14 in-patient stroke rehabilitation units from four countries ( Canada [ 11 ] , Argentina [ 1 ] , Peru [ 1 ] , and Thail and [ 1 ] ) . Participants were r and omly allocated ( 1:1 ) by a computer-generated assignment at enrolment to receive a programme of structured , task-oriented , upper extremity sessions ( ten sessions , 60 min each ) of either non-immersive virtual reality using the Nintendo Wii gaming system ( VRWii ) or simple recreational activities ( playing cards , bingo , Jenga , or ball game ) as add-on therapies to conventional rehabilitation over a 2 week period . All investigators assessing outcomes were masked to treatment assignment . The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test ( WMFT ) at the end of the 2 week intervention period , analysed in the intention-to-treat population . This trial is registered with Clinical Trials.gov , number NTC01406912 . FINDINGS The study was done between May 12 , 2012 , and Oct 1 , 2015 . We r and omly assigned 141 patients : 71 received VRWii therapy and 70 received recreational activity . 121 ( 86 % ) patients ( 59 in the VRWii group and 62 in the recreational activity group ) completed the final assessment and were included in the primary analysis . Each group improved WMFT performance time relative to baseline ( decrease in median time from 43·7 s [ IQR 26·1 - 68·0 ] to 29·7 s [ 21·4 - 45·2 ] , 32·0 % reduction for VRWii vs 38·0 s [ IQR 28·0 - 64·1 ] to 27·1 s [ 21·2 - 45·5 ] , 28·7 % reduction for recreational activity ) . Mean time of conventional rehabilitation during the trial was similar between groups ( VRWii , 373 min [ SD 322 ] vs recreational activity , 397 min [ 345 ] ; p=0·70 ) as was the total duration of study intervention ( VRWii , 528 min [ SD 155 ] vs recreational activity , 541 min [ 142 ] ; p=0·60 ) . Multivariable analysis adjusted for baseline WMFT score , age , sex , baseline Chedoke-McMaster , and stroke severity revealed no significant difference between groups in the primary outcome ( adjusted mean estimate of difference in WMFT : 4·1 s , 95 % CI -14·4 to 22·6 ) . There were three serious adverse events during the trial , all deemed to be unrelated to the interventions ( seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group ) . Overall incidences of adverse events and serious adverse events were similar between treatment groups . INTERPRETATION In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment , non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function , as measured by WMFT . Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant , as long as it is intensive enough and task-specific . Simple , low-cost , and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies . FUNDING Heart and Stroke Foundation of Canada and Ontario Ministry of Health BACKGROUND Age-associated motor and cognitive deficits increase the risk of falls , a major cause of morbidity and mortality . Because of the significant ramifications of falls , many interventions have been proposed , but few have aim ed to prevent falls via an integrated approach targeting both motor and cognitive function . We aim ed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality ( VR ) to target both cognitive aspects of safe ambulation and mobility would lead to fewer falls than would treadmill training alone . METHODS We carried out this r and omised controlled trial at five clinical centres across five countries ( Belgium , Israel , Italy , the Netherl and s , and the UK ) . Adults aged 60 - 90 years with a high risk of falls based on a history of two or more falls in the 6 months before the study and with varied motor and cognitive deficits were r and omly assigned by use of computer-based allocation to receive 6 weeks of either treadmill training plus VR or treadmill training alone . R and omisation was stratified by subgroups of patients ( those with a history of idiopathic falls , those with mild cognitive impairment , and those with Parkinson 's disease ) and sex , with stratification per clinical site . Group allocation was done by a third party not involved in onsite study procedures . Both groups aim ed to train three times per week for 6 weeks , with each session lasting about 45 min and structured training progression individualised to the participant 's level of performance . The VR system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen , which was specifically design ed to reduce fall risk in older adults by including real-life challenges such as obstacles , multiple pathways , and distracters that required continual adjustment of steps . The primary outcome was the incident rate of falls during the 6 months after the end of training , which was assessed in a modified intention-to-treat population . Safety was assessed in all patients who were assigned a treatment . This study is registered with Clinical Trials.gov , NCT01732653 . FINDINGS Between Jan 6 , 2013 , and April 3 , 2015 , 302 adults were r and omly assigned to either the treadmill training plus VR group ( n=154 ) or treadmill training alone group ( n=148 ) . Data from 282 ( 93 % ) participants were included in the prespecified , modified intention-to-treat analysis . Before training , the incident rate of falls was similar in both groups ( 10·7 [ SD 35·6 ] falls per 6 months for treadmill training alone vs 11·9 [ 39·5 ] falls per 6 months for treadmill training plus VR ) . In the 6 months after training , the incident rate was significantly lower in the treadmill training plus VR group than it had been before training ( 6·00 [ 95 % CI 4·36 - 8·25 ] falls per 6 months ; p<0·0001 vs before training ) , whereas the incident rate did not decrease significantly in the treadmill training alone group ( 8·27 [ 5·55 - 12·31 ] falls per 6 months ; p=0·49 ) . 6 months after the end of training , the incident rate of falls was also significantly lower in the treadmill training plus VR group than in the treadmill training group ( incident rate ratio 0·58 , 95 % CI 0·36 - 0·96 ; p=0·033 ) . No serious training-related adverse events occurred . INTERPRETATION In a diverse group of older adults at high risk for falls , treadmill training plus VR led to reduced fall rates  compared with treadmill training alone . FUNDING European Commission BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Introduction Ubiquity of Alzheimer 's disease ( AD ) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction . However , evidence of neuroplasticity notwithst and ing , there are few scientifically rigorous , ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline . This pilot study will examine the ability of virtual reality ( VR ) cognitive training to improve cognition and cerebral blood flow ( CBF ) in middle-aged individuals at high AD risk due to parental history . Methods The design is an assessor-blind , parallel group , r and omized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history . The experimental group will be trained with adaptive “ real-world ” VR tasks targeting sustained and selective attention , working memory , covert rule deduction , and planning , while walking on a treadmill . One active control group will perform the VR tasks without treadmill walking ; another will walk on a treadmill while 
    Output:
    