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 and Purpose — Additional exercise therapy has been shown to have a positive impact on function after acute stroke and research is now focusing on methods to increase the amount of therapy that is delivered . This r and omized controlled trial examined the impact of additional family-mediated exercise ( FAME ) therapy on outcome after acute stroke . Methods — Forty participants with acute stroke were r and omly assigned to either a control group who received routine therapy with no formal input from their family members or a FAME group , who received routine therapy and additional lower limb FAME therapy for 8 weeks . The primary outcome measure used was the lower limb section of the Fugl-Meyer Assessment modified by Lindmark . Other measures of impairment , activity , and participation were completed at baseline , postintervention , and at a 3-month follow-up . Results — Statistically significant differences in favor of the FAME group were noted on all measures of impairment and activity postintervention ( P<0.05 ) . These improvements persisted at the 3-month follow-up but only walking was statistically significant ( P<0.05 ) . Participants in the FAME group were also significantly more integrated into their community at follow-up ( P<0.05 ) . Family members in the FAME group reported a significant decrease in their levels of caregiver strain at the follow-up when compared with those in the control group ( P<0.01 ) . Conclusions — This evidence -based FAME intervention can serve to optimize patient recovery and family involvement after acute stroke at the same time as being mindful of available re sources BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone Background Stroke is a leading cause of disability among adults worldwide . Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke . The main objective of this r and omised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke . Methods / Design A prospect i ve multi-centre single blind r and omised controlled trial will be conducted . Forty patients with acute stroke will be r and omised into either an experimental or control group . The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises . The control group will receive routine therapy with no additional formal input from their family members . Participants will be assessed at baseline , post intervention and followed up at three months using a series of st and ardised outcome measures . A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s ) assisting in the delivery of exercises using a qualitative methodology . The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study . Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their ' family members/friends ' . Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future , it is important to reduce the burden of this illness on the individual , the family and society . Family mediated exercises can maximise the carry over outside formal physiotherapy sessions , giving patients the opportunity for informal practice .Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry ( NCT00666744 Background . Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons . Objective . Investigate whether an exercise intervention can enhance mobility , prevent falls , and increase physical activity among community-dwelling people after stroke . Method . A r and omized trial with blinding of physical outcome assessment was conducted through local stroke clubs . Both groups , on average 5.9 years poststroke , received exercise classes , advice , and a home program for 12 months . The experimental group ( EG ) program ( n = 76 ) aim ed to improve walking , prevent falls and increase physical activity . The control group ( CG ) program ( n = 75 ) aim ed to improve upper-limb and cognitive functions . The primary outcomes were walking capacity , walking speed measured before and after the intervention , and fall rates monitored monthly . Results . At 12 months , the EG walked 34 m further in 6 minutes ( 95 % confidence interval [ CI ] = 19 - 50 ; P < .001 ) and 0.07 m/s faster over 10 m ( 95 % CI = 0.01 - 0.14 ; P = .03 ) than the CG . The EG had 129 falls , and the CG had 133 . There were no differences in proportion of fallers ( relative risk = 1.22 ; 95 % CI = 0.91 - 1.62 ; P = .19 ) or the rate of falls between groups ( incidence rate ratio = 0.96 ; 95 % CI = 0.59 - 1.51 ; P = .88 ) . Conclusion . The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls Abstract Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke . Design R and omised controlled trial . Setting General practice registers , social services departments , a primary care rehabilitation service , and a geriatric day hospital . Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months : 86 were allocated to the intervention group and 82 to the control group . Interventions Leaflets describing local transport services for disabled people ( control group ) and leaflets with assessment and up to seven intervention sessions by an occupational therapist ( intervention group ) . Main outcome measures Responses to postal question naires at four and 10 months : primary outcome measure was response to whether participant got out of the house as much as he or she would like , and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale , Nottingham leisure question naire , and general health question naire . Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months ( relative risk 1.72 , 95 % confidence interval 1.25 to 2.37 ) and 10 months ( 1.74 , 1.24 to 2.44 ) . The treatment group reported more journeys outdoors in the month before assessment at both four months ( median 37 in intervention group , 14 in control group : P < 0.01 ) and 10 months ( median 42 in intervention group , 14 in control group : P < 0.01 ) . At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group , but there were no significant differences in the other secondary outcomes . No significant differences were observed in these measures at 10 months . Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy 
    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 and Purpose — Additional exercise therapy has been shown to have a positive impact on function after acute stroke and research is now focusing on methods to increase the amount of therapy that is delivered . This r and omized controlled trial examined the impact of additional family-mediated exercise ( FAME ) therapy on outcome after acute stroke . Methods — Forty participants with acute stroke were r and omly assigned to either a control group who received routine therapy with no formal input from their family members or a FAME group , who received routine therapy and additional lower limb FAME therapy for 8 weeks . The primary outcome measure used was the lower limb section of the Fugl-Meyer Assessment modified by Lindmark . Other measures of impairment , activity , and participation were completed at baseline , postintervention , and at a 3-month follow-up . Results — Statistically significant differences in favor of the FAME group were noted on all measures of impairment and activity postintervention ( P<0.05 ) . These improvements persisted at the 3-month follow-up but only walking was statistically significant ( P<0.05 ) . Participants in the FAME group were also significantly more integrated into their community at follow-up ( P<0.05 ) . Family members in the FAME group reported a significant decrease in their levels of caregiver strain at the follow-up when compared with those in the control group ( P<0.01 ) . Conclusions — This evidence -based FAME intervention can serve to optimize patient recovery and family involvement after acute stroke at the same time as being mindful of available re sources BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone Background Stroke is a leading cause of disability among adults worldwide . Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke . The main objective of this r and omised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke . Methods / Design A prospect i ve multi-centre single blind r and omised controlled trial will be conducted . Forty patients with acute stroke will be r and omised into either an experimental or control group . The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises . The control group will receive routine therapy with no additional formal input from their family members . Participants will be assessed at baseline , post intervention and followed up at three months using a series of st and ardised outcome measures . A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s ) assisting in the delivery of exercises using a qualitative methodology . The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study . Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their ' family members/friends ' . Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future , it is important to reduce the burden of this illness on the individual , the family and society . Family mediated exercises can maximise the carry over outside formal physiotherapy sessions , giving patients the opportunity for informal practice .Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry ( NCT00666744 Background . Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons . Objective . Investigate whether an exercise intervention can enhance mobility , prevent falls , and increase physical activity among community-dwelling people after stroke . Method . A r and omized trial with blinding of physical outcome assessment was conducted through local stroke clubs . Both groups , on average 5.9 years poststroke , received exercise classes , advice , and a home program for 12 months . The experimental group ( EG ) program ( n = 76 ) aim ed to improve walking , prevent falls and increase physical activity . The control group ( CG ) program ( n = 75 ) aim ed to improve upper-limb and cognitive functions . The primary outcomes were walking capacity , walking speed measured before and after the intervention , and fall rates monitored monthly . Results . At 12 months , the EG walked 34 m further in 6 minutes ( 95 % confidence interval [ CI ] = 19 - 50 ; P < .001 ) and 0.07 m/s faster over 10 m ( 95 % CI = 0.01 - 0.14 ; P = .03 ) than the CG . The EG had 129 falls , and the CG had 133 . There were no differences in proportion of fallers ( relative risk = 1.22 ; 95 % CI = 0.91 - 1.62 ; P = .19 ) or the rate of falls between groups ( incidence rate ratio = 0.96 ; 95 % CI = 0.59 - 1.51 ; P = .88 ) . Conclusion . The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls Abstract Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke . Design R and omised controlled trial . Setting General practice registers , social services departments , a primary care rehabilitation service , and a geriatric day hospital . Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months : 86 were allocated to the intervention group and 82 to the control group . Interventions Leaflets describing local transport services for disabled people ( control group ) and leaflets with assessment and up to seven intervention sessions by an occupational therapist ( intervention group ) . Main outcome measures Responses to postal question naires at four and 10 months : primary outcome measure was response to whether participant got out of the house as much as he or she would like , and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale , Nottingham leisure question naire , and general health question naire . Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months ( relative risk 1.72 , 95 % confidence interval 1.25 to 2.37 ) and 10 months ( 1.74 , 1.24 to 2.44 ) . The treatment group reported more journeys outdoors in the month before assessment at both four months ( median 37 in intervention group , 14 in control group : P < 0.01 ) and 10 months ( median 42 in intervention group , 14 in control group : P < 0.01 ) . At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group , but there were no significant differences in the other secondary outcomes . No significant differences were observed in these measures at 10 months . Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy 
    Output:
    