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 — Drop foot after stroke may be addressed using an ankle foot orthosis ( AFO ) or a foot drop stimulator ( FDS ) . The Functional Ambulation : St and ard Treatment versus Electric Stimulation Therapy ( FASTEST ) trial was a multicenter , r and omized , single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ⩽0.8 m/s . Methods — Participants ( n=197 ; 79 females and 118 males ; 61.14±11.61 years of age ; time after stroke 4.55±4.72 years ) were r and omized to 30 weeks of  either FDS or a st and ard AFO . Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial . Results — There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed ( 95 % confidence interval for mean change , 0.11–0.17 m/s for FDS and 0.12–0.18 m/s for AFO ) and fast gait speed . However , no significant differences in gait speed were found in the between-group comparisons . Secondary outcomes ( st and ard measures of body structure and function , activity , and participation ) improved significantly in both groups , whereas user satisfaction was significantly higher in the FDS group than in the control group . Conclusions — Using either an FDS or an AFO for 30 weeks yielded clinical ly and statistically significant improvements in gait speed and other functional outcomes . User satisfaction was higher in the FDS group . Although both groups did receive intervention , this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinical ly meaningful benefit even years after stroke . Clinical Trial Registration Information— URL : http://www . clinical trials.gov . Unique Identifier : NCT01138995 Objective : ( 1 ) To study the effects of providing ankle-foot orthoses in subjects with (sub)acute stroke ; and ( 2 ) to study whether the point in time at which an ankle-foot orthosis is provided post-stroke ( early or delayed ) influences these effects . Design : R and omized controlled trial . Setting : Rehabilitation centre . Subjects : Unilateral hemiparetic stroke subjects with indication for use of an ankle-foot orthosis and maximal six weeks post-stroke . Interventions : Subjects were r and omly assigned to : early provision ( at inclusion ; Week 1 ) or delayed provision ( eight weeks later ; Week 9 ) . Outcome measures : 10-metre walk test , 6-minute walk test , Timed Up and Go Test , stairs test , Functional Ambulation Categories , Berg Balance Scale , Rivermead Mobility Index and Barthel Index ; assessed in Weeks 1 , 3 , 9 and 11 . Results : A total of 33 subjects were r and omized ( 16 early , 17 delayed ) . Positive effects of ankle-foot orthoses were found two weeks after provision , both when provided early ( significant effects on all outcomes ) or delayed ( Berg Balance Scale p = 0.011 , Functional Ambulation Categories p = 0.008 , 6-minute walk test p = 0.005 , Timed Up and Go Test p = 0.028 ) . Comparing effects after early and delayed provision showed that early provision result ed in increased levels of improvement on Berg Balance Scale ( + 5.1 points , p = 0.002 ) , Barthel Index ( + 1.9 points , p = 0.002 ) and non-significant improvements on 10-metre walk test ( + 0.14 m/s , p = 0.093 ) and Timed Up and Go Test ( –5.4 seconds , p = 0.087 ) , compared with delayed provision . Conclusions : We found positive effects of providing ankle-foot orthoses in (sub)acute stroke subjects that had not used these orthoses before Objective : To compare the effect of the Chignon ankle-foot orthosis on gait versus a st and ard ankle-foot orthosis . Method : A multicentre r and omized study was conducted in seven rehabilitation centres . Hemiplegic patients were recruited after unilateral stroke lasting less than six months . Exclusion criteria were : impossibility to st and for 10 seconds ; ankle passive dorsiflexion < 5 degrees with knee flexed to 90 degrees ; triceps spasticity ≥3/4 on the Ashworth modified scale ; diseases that might impair active participation in the study . Thirteen patients were r and omized to the Chignon group and 15 to the control group . Included patients were given a st and ard ankle-foot orthosis or Chignon ankle-foot orthosis . The Chignon ankle-foot orthosis is an articulated double-stopped custom-made orthosis with elements to assist dorsiflexion and plantar flexion . Gait speed improvement ( ten-metre test ) , kinematic assessment , and functional scales were assessed . Results : Gain ratio of walking speed with the  orthosis increased significantly more in the Chignon group than in the control group at day 0 ( 27.2 ± 36 % versus −0.8 ± 17 % ; P = 0.006 ) , day 30 ( 39.9 ± 19 % versus 7.5 ± 17 % ; P = 0.0004 ) and day 90 ( 44.6 ± 27 % versus 17.1 ± 0.3 % ; P = 0.04 ) . There was also a significant improvement in kinematic parameters and spasticity in the Chignon group . Conclusion : Early compensation of distal motor deficiency by the Chignon ankle-foot orthosis improves the immediate gait of hemiplegics more than the st and ard ankle-foot orthosis and seems to modify motor recovery processes in the legs after stroke The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Background . Long-term use of a foot-drop stimulator applying functional electrical stimulation ( FES ) to the common peroneal nerve improves walking performance even when the stimulator is off . This “ therapeutic ” effect might result from neuroplastic changes . Objective . To determine the effect of long-term use of a foot-drop stimulator on residual corticospinal connections in people with central nervous system disorders . Methods . Ten people with nonprogressive disorders ( eg , stroke ) and 26 with progressive disorders ( eg , multiple sclerosis ) used a foot-drop stimulator for 3 to 12 months while walking in the community . Walking performance and electrophysiological variables were measured before and after FES use . From the surface electromyogram of the tibialis anterior muscle , we measured the following : ( 1 ) motor-evoked potential ( MEP ) from transcranial magnetic stimulation over the motor cortex , ( 2 ) maximum voluntary contraction ( MVC ) , and ( 3 ) maximum motor wave ( Mmax ) from stimulating the common peroneal nerve . Results . After using FES , MEP and MVC increased significantly by comparable amounts , 50 % and 48 % , respectively , in the nonprogressive group and 27 % and 17 % in the progressive group ; the changes were positively correlated ( R 2 = .35 ; P < .001 ) . Walking speed increased with the stimulator off ( therapeutic effect ) by 24 % ( P = .008 ) and 7 % ( P = .014 ) in the nonprogressive and progressive groups , respectively . The changes in Mmax were small and not correlated with changes in MEP . Conclusions . The large increases in MVC and MEP suggest that regular use of a foot-drop stimulator strengthens activation of motor cortical areas and their residual descending connections , which may explain the therapeutic effect on walking speed Foot drop is a quite common problem in nervous system disorders . Neuromuscular electrical stimulation ( NMES ) has showed to be an alternative approach to correct foot drop improving walking ability in patients with stroke . In this study , twenty patients with stroke in subacute phase were enrolled and r and omly divided in two groups : one group performing the NMES ( i.e. Walkaide Group , WG ) and the Control Group ( CG ) performing conventional neuromotor rehabilitation . Both groups underwent the same amount of treatment time . Significant improvements of walking speed were recorded for WG ( 168 ± 39 % ) than for CG ( 129 ± 29 % , P = 0.032 ) as well as in terms of locomotion ( Functional Ambulation Classification score : P = 0.023 ) . In terms of mobility and force , ameliorations were recorded , even if not significant ( Rivermead Mobility Index : P = 0.057 ; Manual Muscle Test : P = 0.059 ) . Similar changes between groups were observed for independence in activities of daily living , neurological assessment s , and spasticity reduction . These results highlight the potential efficacy for patients affected by a droop foot of a walking training performed with a neurostimulator in subacute phase Objective : To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients . Design : R and omized controlled trial . Setting : University ’s neurological rehabilitation outpatient clinic and orthotics department . Subjects : Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale , were r and omly assigned to the study and control groups . Interventions : The control group ( n = 14 ) was assessed with tennis shoes whereas the study group ( n = 14 ) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis . Measures : Functional Reach , Timed Up and Go , Timed Up Stairs , Timed Down Stairs , gait velocity and Physiological Cost Index . Results : In the initial assessment no difference was found between the groups for any of the measured parameters ( P > 0.05 ) . After three months , intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 ( 10.21 ) seconds study versus 15.00 ( 7.29 ) seconds control group ; for gait velocity 0.99 ( 0.45 ) m/s study versus 0.72 ( 0.20 ) m/s control group and for Physiological Cost Index 0.12 ( 0.06 ) beats/min study versus 0.28 ( 0.13 ) beats/min control group ( P < 0.05 ) . No difference was found between the groups for Functional Reach , Timed Up and Go , Timed Down Stairs ( P > 0.05 ) . Conclusion : Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis OBJECTIVE The aims of this study were : ( i ) to compare the neuro-prosthetic effect of implantable peroneal nerve stimulation to the orthotic effect of a st and ard of care intervention ( no device , shoe or ankle foot orthosis ) on walking , as assessed by spatiotemporal parameters ; and ( ii ) to examine whether there is evidence of an enhanced lower-limb flexion reflex with peroneal nerve stimulation and compare the kinematic effect of an implantable peroneal nerve stimulation device vs st and ard of care intervention on initial loading response of the paretic limb , as assessed by hip , knee and ankle kinematics . DESIGN R and omized controlled trial . SUBJECTS A total of 23 chronic stroke survivors with drop foot . METHODS The intervention group received an implantable 2-channel peroneal nerve stimulator for correction of drop foot . The control group continued using a conventional walking device .  Spatiotemporal parameters and hip , knee and ankle kinematics were measured while subjects walked with the device on using a 3-dimensional video camera system during baseline and after a follow-up period of 26 weeks . RESULTS Peroneal nerve stimulation normalized stance and double support of the paretic limb and single support of the non-paretic limb , in comparison with using a conventional walking device . In addition , peroneal nerve stimulation is more effective to provide ankle dorsiflexion during swing and result ed in a normalized initial loading response . CONCLUSION Although peroneal nerve stimulation and ankle foot orthosis are both prescribed to correct a drop foot in the same patient population , spatiotemporal parameters , dorsiflexion during swing and loading response are influenced in a functionally different way Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis 
    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 — Drop foot after stroke may be addressed using an ankle foot orthosis ( AFO ) or a foot drop stimulator ( FDS ) . The Functional Ambulation : St and ard Treatment versus Electric Stimulation Therapy ( FASTEST ) trial was a multicenter , r and omized , single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ⩽0.8 m/s . Methods — Participants ( n=197 ; 79 females and 118 males ; 61.14±11.61 years of age ; time after stroke 4.55±4.72 years ) were r and omized to 30 weeks of  either FDS or a st and ard AFO . Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial . Results — There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed ( 95 % confidence interval for mean change , 0.11–0.17 m/s for FDS and 0.12–0.18 m/s for AFO ) and fast gait speed . However , no significant differences in gait speed were found in the between-group comparisons . Secondary outcomes ( st and ard measures of body structure and function , activity , and participation ) improved significantly in both groups , whereas user satisfaction was significantly higher in the FDS group than in the control group . Conclusions — Using either an FDS or an AFO for 30 weeks yielded clinical ly and statistically significant improvements in gait speed and other functional outcomes . User satisfaction was higher in the FDS group . Although both groups did receive intervention , this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinical ly meaningful benefit even years after stroke . Clinical Trial Registration Information— URL : http://www . clinical trials.gov . Unique Identifier : NCT01138995 Objective : ( 1 ) To study the effects of providing ankle-foot orthoses in subjects with (sub)acute stroke ; and ( 2 ) to study whether the point in time at which an ankle-foot orthosis is provided post-stroke ( early or delayed ) influences these effects . Design : R and omized controlled trial . Setting : Rehabilitation centre . Subjects : Unilateral hemiparetic stroke subjects with indication for use of an ankle-foot orthosis and maximal six weeks post-stroke . Interventions : Subjects were r and omly assigned to : early provision ( at inclusion ; Week 1 ) or delayed provision ( eight weeks later ; Week 9 ) . Outcome measures : 10-metre walk test , 6-minute walk test , Timed Up and Go Test , stairs test , Functional Ambulation Categories , Berg Balance Scale , Rivermead Mobility Index and Barthel Index ; assessed in Weeks 1 , 3 , 9 and 11 . Results : A total of 33 subjects were r and omized ( 16 early , 17 delayed ) . Positive effects of ankle-foot orthoses were found two weeks after provision , both when provided early ( significant effects on all outcomes ) or delayed ( Berg Balance Scale p = 0.011 , Functional Ambulation Categories p = 0.008 , 6-minute walk test p = 0.005 , Timed Up and Go Test p = 0.028 ) . Comparing effects after early and delayed provision showed that early provision result ed in increased levels of improvement on Berg Balance Scale ( + 5.1 points , p = 0.002 ) , Barthel Index ( + 1.9 points , p = 0.002 ) and non-significant improvements on 10-metre walk test ( + 0.14 m/s , p = 0.093 ) and Timed Up and Go Test ( –5.4 seconds , p = 0.087 ) , compared with delayed provision . Conclusions : We found positive effects of providing ankle-foot orthoses in (sub)acute stroke subjects that had not used these orthoses before Objective : To compare the effect of the Chignon ankle-foot orthosis on gait versus a st and ard ankle-foot orthosis . Method : A multicentre r and omized study was conducted in seven rehabilitation centres . Hemiplegic patients were recruited after unilateral stroke lasting less than six months . Exclusion criteria were : impossibility to st and for 10 seconds ; ankle passive dorsiflexion < 5 degrees with knee flexed to 90 degrees ; triceps spasticity ≥3/4 on the Ashworth modified scale ; diseases that might impair active participation in the study . Thirteen patients were r and omized to the Chignon group and 15 to the control group . Included patients were given a st and ard ankle-foot orthosis or Chignon ankle-foot orthosis . The Chignon ankle-foot orthosis is an articulated double-stopped custom-made orthosis with elements to assist dorsiflexion and plantar flexion . Gait speed improvement ( ten-metre test ) , kinematic assessment , and functional scales were assessed . Results : Gain ratio of walking speed with the  orthosis increased significantly more in the Chignon group than in the control group at day 0 ( 27.2 ± 36 % versus −0.8 ± 17 % ; P = 0.006 ) , day 30 ( 39.9 ± 19 % versus 7.5 ± 17 % ; P = 0.0004 ) and day 90 ( 44.6 ± 27 % versus 17.1 ± 0.3 % ; P = 0.04 ) . There was also a significant improvement in kinematic parameters and spasticity in the Chignon group . Conclusion : Early compensation of distal motor deficiency by the Chignon ankle-foot orthosis improves the immediate gait of hemiplegics more than the st and ard ankle-foot orthosis and seems to modify motor recovery processes in the legs after stroke The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Background . Long-term use of a foot-drop stimulator applying functional electrical stimulation ( FES ) to the common peroneal nerve improves walking performance even when the stimulator is off . This “ therapeutic ” effect might result from neuroplastic changes . Objective . To determine the effect of long-term use of a foot-drop stimulator on residual corticospinal connections in people with central nervous system disorders . Methods . Ten people with nonprogressive disorders ( eg , stroke ) and 26 with progressive disorders ( eg , multiple sclerosis ) used a foot-drop stimulator for 3 to 12 months while walking in the community . Walking performance and electrophysiological variables were measured before and after FES use . From the surface electromyogram of the tibialis anterior muscle , we measured the following : ( 1 ) motor-evoked potential ( MEP ) from transcranial magnetic stimulation over the motor cortex , ( 2 ) maximum voluntary contraction ( MVC ) , and ( 3 ) maximum motor wave ( Mmax ) from stimulating the common peroneal nerve . Results . After using FES , MEP and MVC increased significantly by comparable amounts , 50 % and 48 % , respectively , in the nonprogressive group and 27 % and 17 % in the progressive group ; the changes were positively correlated ( R 2 = .35 ; P < .001 ) . Walking speed increased with the stimulator off ( therapeutic effect ) by 24 % ( P = .008 ) and 7 % ( P = .014 ) in the nonprogressive and progressive groups , respectively . The changes in Mmax were small and not correlated with changes in MEP . Conclusions . The large increases in MVC and MEP suggest that regular use of a foot-drop stimulator strengthens activation of motor cortical areas and their residual descending connections , which may explain the therapeutic effect on walking speed Foot drop is a quite common problem in nervous system disorders . Neuromuscular electrical stimulation ( NMES ) has showed to be an alternative approach to correct foot drop improving walking ability in patients with stroke . In this study , twenty patients with stroke in subacute phase were enrolled and r and omly divided in two groups : one group performing the NMES ( i.e. Walkaide Group , WG ) and the Control Group ( CG ) performing conventional neuromotor rehabilitation . Both groups underwent the same amount of treatment time . Significant improvements of walking speed were recorded for WG ( 168 ± 39 % ) than for CG ( 129 ± 29 % , P = 0.032 ) as well as in terms of locomotion ( Functional Ambulation Classification score : P = 0.023 ) . In terms of mobility and force , ameliorations were recorded , even if not significant ( Rivermead Mobility Index : P = 0.057 ; Manual Muscle Test : P = 0.059 ) . Similar changes between groups were observed for independence in activities of daily living , neurological assessment s , and spasticity reduction . These results highlight the potential efficacy for patients affected by a droop foot of a walking training performed with a neurostimulator in subacute phase Objective : To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients . Design : R and omized controlled trial . Setting : University ’s neurological rehabilitation outpatient clinic and orthotics department . Subjects : Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale , were r and omly assigned to the study and control groups . Interventions : The control group ( n = 14 ) was assessed with tennis shoes whereas the study group ( n = 14 ) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis . Measures : Functional Reach , Timed Up and Go , Timed Up Stairs , Timed Down Stairs , gait velocity and Physiological Cost Index . Results : In the initial assessment no difference was found between the groups for any of the measured parameters ( P > 0.05 ) . After three months , intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 ( 10.21 ) seconds study versus 15.00 ( 7.29 ) seconds control group ; for gait velocity 0.99 ( 0.45 ) m/s study versus 0.72 ( 0.20 ) m/s control group and for Physiological Cost Index 0.12 ( 0.06 ) beats/min study versus 0.28 ( 0.13 ) beats/min control group ( P < 0.05 ) . No difference was found between the groups for Functional Reach , Timed Up and Go , Timed Down Stairs ( P > 0.05 ) . Conclusion : Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis OBJECTIVE The aims of this study were : ( i ) to compare the neuro-prosthetic effect of implantable peroneal nerve stimulation to the orthotic effect of a st and ard of care intervention ( no device , shoe or ankle foot orthosis ) on walking , as assessed by spatiotemporal parameters ; and ( ii ) to examine whether there is evidence of an enhanced lower-limb flexion reflex with peroneal nerve stimulation and compare the kinematic effect of an implantable peroneal nerve stimulation device vs st and ard of care intervention on initial loading response of the paretic limb , as assessed by hip , knee and ankle kinematics . DESIGN R and omized controlled trial . SUBJECTS A total of 23 chronic stroke survivors with drop foot . METHODS The intervention group received an implantable 2-channel peroneal nerve stimulator for correction of drop foot . The control group continued using a conventional walking device .  Spatiotemporal parameters and hip , knee and ankle kinematics were measured while subjects walked with the device on using a 3-dimensional video camera system during baseline and after a follow-up period of 26 weeks . RESULTS Peroneal nerve stimulation normalized stance and double support of the paretic limb and single support of the non-paretic limb , in comparison with using a conventional walking device . In addition , peroneal nerve stimulation is more effective to provide ankle dorsiflexion during swing and result ed in a normalized initial loading response . CONCLUSION Although peroneal nerve stimulation and ankle foot orthosis are both prescribed to correct a drop foot in the same patient population , spatiotemporal parameters , dorsiflexion during swing and loading response are influenced in a functionally different way Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis 
    Output:
    