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: Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 OBJECTIVES First , to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program ; second , to compare the subjective experiences ; and third , to contrast the costs of both programs . DESIGN Single-blind , r and omized , controlled trial . SETTING Neurorehabilitation unit . PARTICIPANTS Chronic out patients with stroke ( N=30 ) with residual hemiparesis . INTERVENTIONS Twenty 45-minute training sessions with the telerehabilitation system , conducted 3 times a week , in the clinic or in the home . MAIN OUTCOME MEASURES First , Berg Balance Scale for balance assessment . The Performance-Oriented Mobility Assessment balance and gait subscales , and the Brunel Balance Assessment were secondary outcome measures . Clinical assessment s were conducted at baseline , 8 weeks ( posttreatment ) , and 12 weeks ( follow-up ) . Second , the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences . Third , cost ( in dollars ) . RESULTS Significant improvement in both groups ( in-clinic group [ control ] and a home-based telerehabilitation group ) from the initial to the final assessment in the Berg Balance Scale ( ηp(2)=.68 ; P=.001 ) , in the balance ( ηp(2)=.24 ; P=.006 ) and gait ( ηp(2)=.57 , P=.001 ) subscales of the Tinetti Performance-Oriented Mobility Assessment , and in the Brunel Balance Assessment ( control : χ(2)=15.0 ; P=.002 ; experimental : χ(2)=21.9 ; P=.001 ) . No significant differences were found between the groups in any balance scale or in the feedback question naires . With regard to subjective experiences , both groups considered the VR system similarly usable and motivating . The in-clinic intervention result ed in more expenses than did the telerehabilitation intervention ( $ 654.72 per person ) . CONCLUSIONS First , VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions , both complemented with a conventional therapy program ; second , the usability of and motivation to use the 2 interventions can be similar ; and third , telerehabilitation interventions can involve savings that vary depending on each scenario Background More than 60 % of new strokes each year are " mild " in severity and this proportion is expected to rise in the years to come . Within our current health care system those with " mild " stroke are typically discharged home within days , without further referral to health or rehabilitation services other than advice to see their family physician . Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention , community reintegration , medication counselling and problem solving with regard to specific concerns that arise . Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization . The purpose of this study is to assess the effectiveness , for individuals who experience a first " mild " stroke , of a sustainable , low cost , multimodal support intervention ( comprising information , education and telephone support ) - " WE CALL " compared to a passive intervention ( providing the name and phone number of a re source person available if they feel the need to ) - " YOU CALL " , on two primary outcomes : unplanned-use of health services for negative events and quality of life . Method / Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites . Baseline measures will be taken within the first month after stroke onset . Participants will be stratified according to comorbidity level and r and omised to one of two groups : YOU CALL or WE CALL . Both interventions will be offered over a six months period . Primary outcomes include unplanned use of heath services for negative event ( frequency calendar ) and quality of life ( EQ-5D and Quality of Life Index ) . Secondary outcomes include participation level ( LIFE-H ) , depression ( Beck Depression Inventory II ) and use of health services for health promotion or prevention ( frequency calendar ) . Blind assessors will gather data at mid-intervention , end of intervention and one year follow up . Discussion If effective , this multimodal intervention could be delivered in both urban and rural environments . For example , existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics , make this intervention , if effective , deliverable and sustainable . Trial Registration IS RCT Objective Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education . This study aim ed to evaluate the effects of an education package which utilised both strategies on the knowledge , health and psychosocial outcomes of stroke patients and carers . Design Multisite , r and omised trial comparing usual care with an education and support package . Setting Two acute stroke units . Participants Patients and their carers ( N=138 ) were r and omised ( control n=67 , intervention n=71 ) of which data for 119 participants ( control n=59 , intervention n=60 ) were analysed . Intervention The package consisted of a computer-generated , tailored written information booklet and verbal reinforcement provided prior to , and for 3 months following , discharge . Outcome measures Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors . The primary outcome was stroke knowledge ( score range : 0–25 ) . Secondary outcomes were : self-efficacy ( 1–10 ) , anxiety and depression ( 0–21 ) , ratings of importance of information ( 1–10 ) , feelings of being informed ( 1–10 ) , satisfaction with information ( 1–10 ) , caregiver burden ( carers ) ( 0–13 ) and quality of life ( patients ) ( 1–5 ) . Results Intervention group participants reported better : self-efficacy for accessing stroke information ( adjusted mean difference ( MD ) of 1.0 , 95 % CI 0.3 to 1.7 , p=0.004 ) ; feeling informed ( MD 0.9 , 95 % CI 0.2 to 1.6 , p=0.008 ) ; and satisfaction with medical ( MD 2.0 , 95 % CI 1.1 to 2.8 , p<0.001 ) ; practical ( MD 1.1 , 95 % CI 0.3 to 1.9 , p=0.008 ) , services and benefits ( MD 0.9 , 95 % CI 0.1 to 1.8 , p=0.036 ) and secondary prevention information ( MD 1.7 , 95 % CI 0.9 to 2.5 , p<0.001 ) . There was no significant effect on other outcomes . Conclusions Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information , but other outcomes were not significantly affected . Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies . Background — Comparison of a multimodal intervention WE CALL ( study initiated phone support/information provision ) versus a passive intervention YOU CALL ( participant can contact a re source person ) in individuals with first mild stroke . Methods and Results — This study is a single-blinded r and omized clinical trial . Primary outcome includes unplanned use of health services ( participant diaries ) for adverse events and quality of life ( Euroquol-5D , Quality of Life Index ) . Secondary outcomes include planned use of health services ( diaries ) , mood ( Beck Depression Inventory II ) , and participation ( Assessment of Life Habits [ LIFE-H ] ) . Blind assessment s were done at baseline , 6 , and 12 months . A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time , with a significance level of 0.01 . We enrolled 186 patients ( WE=92 ; YOU=94 ) with a mean age of 62.5±12.5 years , and 42.5 % were women . No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures ( effect sizes ranged from 0.25 to 0.7 ) . The only significant change for both groups from 6 months to 1 year ( n=139 ) was in the social domains of the LIFE-H ( increment in score , 0.4/9±1.3 [ 95 % confidence interval , 0.1–0.7 ] ; effect size , 0.3 ) . Qualitatively , the WE CALL intervention was perceived as reassuring , increased insight , and problem solving while decreasing anxiety . Only 6 of 94 ( 6.4 % ) YOU CALL participants availed themselves of the intervention . Conclusions — Although the 2 groups improved equally over time , WE CALL intervention was perceived as helpful , whereas YOU CALL intervention 
    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: Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment . We compared the degree of satisfaction of patients undergoing a virtual reality ( VR ) therapy programme at home ( Tele-VR group ) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting ( VR-group ) . The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient 's movement was represented . In tele-therapy , the patient equipment was installed in their homes , connected to the hospital by four ISDN lines at a total b and width of 512 kbit/s . Rehabilitation data were transmitted via one line and videoconferencing via the other three . Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke , were r and omized into VR or Tele-VR groups . A question naire was used at the end of treatment to measure each patient 's degree of satisfaction . Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated , except one . In motor performance , the Tele-VR group improved significantly ( P ≤ 0.05 ) , while the VR group showed no significant change . Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 OBJECTIVES First , to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program ; second , to compare the subjective experiences ; and third , to contrast the costs of both programs . DESIGN Single-blind , r and omized , controlled trial . SETTING Neurorehabilitation unit . PARTICIPANTS Chronic out patients with stroke ( N=30 ) with residual hemiparesis . INTERVENTIONS Twenty 45-minute training sessions with the telerehabilitation system , conducted 3 times a week , in the clinic or in the home . MAIN OUTCOME MEASURES First , Berg Balance Scale for balance assessment . The Performance-Oriented Mobility Assessment balance and gait subscales , and the Brunel Balance Assessment were secondary outcome measures . Clinical assessment s were conducted at baseline , 8 weeks ( posttreatment ) , and 12 weeks ( follow-up ) . Second , the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences . Third , cost ( in dollars ) . RESULTS Significant improvement in both groups ( in-clinic group [ control ] and a home-based telerehabilitation group ) from the initial to the final assessment in the Berg Balance Scale ( ηp(2)=.68 ; P=.001 ) , in the balance ( ηp(2)=.24 ; P=.006 ) and gait ( ηp(2)=.57 , P=.001 ) subscales of the Tinetti Performance-Oriented Mobility Assessment , and in the Brunel Balance Assessment ( control : χ(2)=15.0 ; P=.002 ; experimental : χ(2)=21.9 ; P=.001 ) . No significant differences were found between the groups in any balance scale or in the feedback question naires . With regard to subjective experiences , both groups considered the VR system similarly usable and motivating . The in-clinic intervention result ed in more expenses than did the telerehabilitation intervention ( $ 654.72 per person ) . CONCLUSIONS First , VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions , both complemented with a conventional therapy program ; second , the usability of and motivation to use the 2 interventions can be similar ; and third , telerehabilitation interventions can involve savings that vary depending on each scenario Background More than 60 % of new strokes each year are " mild " in severity and this proportion is expected to rise in the years to come . Within our current health care system those with " mild " stroke are typically discharged home within days , without further referral to health or rehabilitation services other than advice to see their family physician . Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention , community reintegration , medication counselling and problem solving with regard to specific concerns that arise . Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization . The purpose of this study is to assess the effectiveness , for individuals who experience a first " mild " stroke , of a sustainable , low cost , multimodal support intervention ( comprising information , education and telephone support ) - " WE CALL " compared to a passive intervention ( providing the name and phone number of a re source person available if they feel the need to ) - " YOU CALL " , on two primary outcomes : unplanned-use of health services for negative events and quality of life . Method / Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites . Baseline measures will be taken within the first month after stroke onset . Participants will be stratified according to comorbidity level and r and omised to one of two groups : YOU CALL or WE CALL . Both interventions will be offered over a six months period . Primary outcomes include unplanned use of heath services for negative event ( frequency calendar ) and quality of life ( EQ-5D and Quality of Life Index ) . Secondary outcomes include participation level ( LIFE-H ) , depression ( Beck Depression Inventory II ) and use of health services for health promotion or prevention ( frequency calendar ) . Blind assessors will gather data at mid-intervention , end of intervention and one year follow up . Discussion If effective , this multimodal intervention could be delivered in both urban and rural environments . For example , existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics , make this intervention , if effective , deliverable and sustainable . Trial Registration IS RCT Objective Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education . This study aim ed to evaluate the effects of an education package which utilised both strategies on the knowledge , health and psychosocial outcomes of stroke patients and carers . Design Multisite , r and omised trial comparing usual care with an education and support package . Setting Two acute stroke units . Participants Patients and their carers ( N=138 ) were r and omised ( control n=67 , intervention n=71 ) of which data for 119 participants ( control n=59 , intervention n=60 ) were analysed . Intervention The package consisted of a computer-generated , tailored written information booklet and verbal reinforcement provided prior to , and for 3 months following , discharge . Outcome measures Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors . The primary outcome was stroke knowledge ( score range : 0–25 ) . Secondary outcomes were : self-efficacy ( 1–10 ) , anxiety and depression ( 0–21 ) , ratings of importance of information ( 1–10 ) , feelings of being informed ( 1–10 ) , satisfaction with information ( 1–10 ) , caregiver burden ( carers ) ( 0–13 ) and quality of life ( patients ) ( 1–5 ) . Results Intervention group participants reported better : self-efficacy for accessing stroke information ( adjusted mean difference ( MD ) of 1.0 , 95 % CI 0.3 to 1.7 , p=0.004 ) ; feeling informed ( MD 0.9 , 95 % CI 0.2 to 1.6 , p=0.008 ) ; and satisfaction with medical ( MD 2.0 , 95 % CI 1.1 to 2.8 , p<0.001 ) ; practical ( MD 1.1 , 95 % CI 0.3 to 1.9 , p=0.008 ) , services and benefits ( MD 0.9 , 95 % CI 0.1 to 1.8 , p=0.036 ) and secondary prevention information ( MD 1.7 , 95 % CI 0.9 to 2.5 , p<0.001 ) . There was no significant effect on other outcomes . Conclusions Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information , but other outcomes were not significantly affected . Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies . Background — Comparison of a multimodal intervention WE CALL ( study initiated phone support/information provision ) versus a passive intervention YOU CALL ( participant can contact a re source person ) in individuals with first mild stroke . Methods and Results — This study is a single-blinded r and omized clinical trial . Primary outcome includes unplanned use of health services ( participant diaries ) for adverse events and quality of life ( Euroquol-5D , Quality of Life Index ) . Secondary outcomes include planned use of health services ( diaries ) , mood ( Beck Depression Inventory II ) , and participation ( Assessment of Life Habits [ LIFE-H ] ) . Blind assessment s were done at baseline , 6 , and 12 months . A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time , with a significance level of 0.01 . We enrolled 186 patients ( WE=92 ; YOU=94 ) with a mean age of 62.5±12.5 years , and 42.5 % were women . No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures ( effect sizes ranged from 0.25 to 0.7 ) . The only significant change for both groups from 6 months to 1 year ( n=139 ) was in the social domains of the LIFE-H ( increment in score , 0.4/9±1.3 [ 95 % confidence interval , 0.1–0.7 ] ; effect size , 0.3 ) . Qualitatively , the WE CALL intervention was perceived as reassuring , increased insight , and problem solving while decreasing anxiety . Only 6 of 94 ( 6.4 % ) YOU CALL participants availed themselves of the intervention . Conclusions — Although the 2 groups improved equally over time , WE CALL intervention was perceived as helpful , whereas YOU CALL intervention 
    Output:
    