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 Falls remain a major cause of childhood morbidity and mortality . It is suggested that backward walking ( BW ) may offer some benefits especially in balance and motor control ability beyond those experienced through forward walking ( FW ) , and may be a potential intervention for prevention of falls . The objective of this study was to investigate the effects of BW on balance in boys . Methods Sixteen healthy boys ( age : 7.19 ± 0.40 y ) were r and omly assigned to either an experimental or a control group . The experimental group participated in a BW training program ( 12-week , 2 times weekly , and 25-min each time ) but not the control group . Both groups had five dynamic balance assessment s with a Biodex Stability System ( anterior/posterior , medial/lateral , and overall balance index ) before , during and after the training ( week- 0 , 4 , 8 , 12 , 24 ) . Six control and six experimental boys participated in a study comparing kinematics of lower limbs between FW and BW after the training ( week-12 ) . Results The balance of experimental group was better than that of control group after 8 weeks of training ( P < 0.01 ) , and was still better than that of control group ( P < 0.05 ) , when the BW training program had finished for 12 weeks . The kinematic analysis indicated that there was no difference between control and experimental groups in the kinematics of both FW and BW gaits after the BW training ( P > 0.05 ) . Compared to FW , the duration of stance phase of BW tended to be longer , while the swing phase , stride length , walking speed , and moving ranges of the thigh , calf and foot of BW decreased ( P < 0.01 ) . Conclusion Backward walking training in school-aged boys  can improve balance Objective : To compare the effects of backward walking training and forward walking training on spatiotemporal gait parameters , and gross motor function measures in children with cerebral palsy . Design : R and omized controlled clinical trial . Setting : Physical therapy clinics . Subjects : A total of 30 children with hemiparetic cerebral palsy of both sexes ( 10 to 14 years of age , classified as I or II by gross motor function classification system ) participated in this study . They were r and omly assigned into two equal groups . Interventions : Both groups received a conventional physical therapy program for 12 successive weeks ( three sessions per week ) . The experimental group additionally received ( 25 min ) backward walking training . The control group additionally received ( 25 min ) forward walking training . Outcome measures : Baseline , posttreatment , and follow-up assessment for spatiotemporal gait parameters and gross motor functions were evaluated by using three dimensional gait analysis system and gross motor function measures . Results : There was a significant improvement in step length , walking velocity , cadence , stance phase , and swing phase percentage and gross motor function measures ( Dimensions D and E ) of the experimental group ( 0.55 ±0.16 , 0.53 ±0.19 , 121.73 ±2.89 , 54.73 ±1.67 , 44.40 ±1.40 , 90.20 ±6.44 , 82.47 ±12.82 ) , respectively , than the control group ( 0.39 ±0.13 , 0.46 ±0.20 , 125.80 ±2.96 , 50.27 ±1.62 , 49.47 ±1.55 , 82.47 ±7.05 , 80.47 ±12.61 ) , respectively , ( p < 0.05 ) . The significant improvement of all measured outcomes of the experimental group was maintained at 1 month follow-up assessment ( p < 0.05 ) . Conclusion : In addition to a conventional physical therapy program , backward walking training is more effective than forward walking training on spatiotemporal gait parameters , and gross motor function measures in children with hemiparetic cerebral palsy This study investigated the effect of a backward training program on the physical and fitness condition of young women . Twenty-six healthy female university students ( aged 18 - 23 years ) took part in three different baseline tests : body composition , a submaximal treadmill test , and a 20-m shuttle run test . Subjects were divided into a training group ( n = 13 ) and a control group ( n = 13 ) . The training group completed a six-week backward run/walk training program . The control group was restricted to their daily activities similar to the four weeks prior to the onset of the baseline tests . The training group showed a significant ( p = 0.01 ) decrease in O(2 ) consumption during both submaximal forward and backward exercise on the treadmill ( 32 % decrease during backward and 30 % decrease during forward exercise ) . A significant ( p = 0.01 ) decrease in percentage body fat ( 2.4 % ) , a 19.7 % decrease in the sum of skinfolds ( p = 0.001 ) and significantly ( p = 0.013 ) improved predicted VO(2max ) values from the forward 20-m shuttle run test ( 5.2 % ) were also found in the case of the training group . The findings suggest that backward walk/run training improves cardiorespiratory fitness for both forward and backward exercise and causes significant changes in body composition in young women BACKGROUND Treadmill gait training as a therapeutic re source in the rehabilitation of children with cerebral palsy has recently been the focus of many studies ; however , little is still known regarding its effect on static and functional balance in children . OBJECTIVE The aim of the present study was to compare the effects of treadmill training and over ground gait training in children with cerebral palsy . METHOD A r and omized controlled trial with blinded evaluator was conducted with children with cerebral palsy between three and 12 years of age categorized in Levels I to III of the Gross Motor Function Classification System . Assessment s were performed before and after the intervention and involved the Berg balance scale as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed . The experimental group was su bmi tted to treadmill training and the control group performed gait training over the ground . The intervention consisted of two 30-minute sessions per week for seven weeks . RESULTS Both groups exhibited better functional balance after the protocol . The experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group . CONCLUSIONS Treadmill training had a greater effect on functional balance and mediolateral oscillation in comparison to over ground gait training in children with cerebral palsy . TRIAL REGISTRATION RBR-5v3kg9.(Brazilian Registry of Clinical Trials ) Properly conducted r and omised trials can aid clinical decision-making by providing unbiased estimates of the average size of treatment effects . This paper , the first of two , discusses how readers of clinical trials can extract simple estimates of treatment effect size from trial reports when trial outcomes are measured on a continuous scale . When making decisions about therapy for individual patients , these estimates can be modified on the basis of patient characteristics . Modified estimates of treatment effect size can be used to determine if the effect of treatment is likely to be large enough to be " clinical ly worthwhile " . This approach optimises clinical decision-making by combining unbiased estimates of the size of treatment effect from clinical trials with clinical intuition and patient preferences Objective : The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy . Design : In this r and omized controlled trial , 18 ambulatory children with diplegic or tetraplegic cerebral palsy were r and omly assigned to an experimental group or a control group . The experimental group received 30 mins of repetitive locomotor training with an applied technology ( Gait Trainer GT I ) plus 10 mins of passive joint mobilization and stretching exercises . The control group received 40 mins of conventional physiotherapy . Each subject underwent a total of 10 treatment sessions over a 2-wk period . Performance on the 10-m walk test , 6-min walk test , WeeFIM scale , and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up . Results : The experimental group showed significant posttreatment improvement on the 10-m walk test , 6-min walk test , hip kinematics , gait speed , and step length , all of which were maintained at the 1-mo follow-up assessment . No significant changes in performance parameters were observed in the control group . Conclusions : Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity , endurance , spatiotemporal , and kinematic gait parameters in patients with cerebral palsy Objective : To study the effect of additional backward walking training on postural control in children with hemiparetic cerebral palsy . Design : R and omized controlled study . Setting : Physical therapy clinics . Subjects : Thirty spastic hemiparetic cerebral palsied children of both sexes ( 10 - 14 years , 14 girls and 16 boys ) . Intervention : Children were r and omly assigned into two equal groups : experimental and control groups . Both groups received a traditional physical therapy program for 12 weeks . Experimental group additionally received backward walking training which was provided 25 min/day , 3 days/week for 3 successive months . Outcome measures : Baseline and post-treatment assessment for overall , anteroposterior , and mediolateral stability indices were evaluated by using Biodex balance system . Results : After treatment ; two way ANOVA revealed significant improvement in overall , anteroposterior and mediolateral stability indices of experimental group at the most stable level ( level 12 ) and moderately unstable level ( level 7 ) ( 1.40 ± 0.44 and 1.73 ± 0.51 ; 1.11 ± 0.34 and 2.13 ± 0.52 ; 1.93 ± 0.51 and 2.68 ± 0.52 ) respectively , than control group ( 1.77 ± 0.44 and 2.17 ± 0.56 ; 1.44 ± 0.44 and 2.54 ± 0.49 ; 2.39 ± 0.65 and 3.11 ± 0.49 ) respectively , ( P < 0.05 ) . There were significant improvement in all measured variables for both groups at both levels ( P < 0.05 ) . Conclusion : Additional backward walking training to traditional physical therapy program yields improvement in postural stability indices in children with spastic hemiparetic cerebral palsy than traditional physical therapy alone 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 . Objective : To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-five subjects with stroke , who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis , r and omly allocated to two groups , control ( n = 12 ) and experimental ( n = 13 ) . Interventions : Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks . Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week . Main measures : Gait was measured using the Stride Analyzer . Gait parameters of interest were walking speed , cadence , stride length , gait cycle and symmetry index . Measures were made at baseline before commencement of training ( pre-training ) and at the end of the three-week training period ( post-training ) . Results : After a three-week training period , subjects in experimental group showed more improvement than those in control group for walking speed ( change score : 8.609 ± 6.95 versus 3.659 ± 2.92 , p-value = 0.032 ) , stride length ( change score : 0.0909 ± 0.076 versus 0.00649 ± 0. 
    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 Falls remain a major cause of childhood morbidity and mortality . It is suggested that backward walking ( BW ) may offer some benefits especially in balance and motor control ability beyond those experienced through forward walking ( FW ) , and may be a potential intervention for prevention of falls . The objective of this study was to investigate the effects of BW on balance in boys . Methods Sixteen healthy boys ( age : 7.19 ± 0.40 y ) were r and omly assigned to either an experimental or a control group . The experimental group participated in a BW training program ( 12-week , 2 times weekly , and 25-min each time ) but not the control group . Both groups had five dynamic balance assessment s with a Biodex Stability System ( anterior/posterior , medial/lateral , and overall balance index ) before , during and after the training ( week- 0 , 4 , 8 , 12 , 24 ) . Six control and six experimental boys participated in a study comparing kinematics of lower limbs between FW and BW after the training ( week-12 ) . Results The balance of experimental group was better than that of control group after 8 weeks of training ( P < 0.01 ) , and was still better than that of control group ( P < 0.05 ) , when the BW training program had finished for 12 weeks . The kinematic analysis indicated that there was no difference between control and experimental groups in the kinematics of both FW and BW gaits after the BW training ( P > 0.05 ) . Compared to FW , the duration of stance phase of BW tended to be longer , while the swing phase , stride length , walking speed , and moving ranges of the thigh , calf and foot of BW decreased ( P < 0.01 ) . Conclusion Backward walking training in school-aged boys  can improve balance Objective : To compare the effects of backward walking training and forward walking training on spatiotemporal gait parameters , and gross motor function measures in children with cerebral palsy . Design : R and omized controlled clinical trial . Setting : Physical therapy clinics . Subjects : A total of 30 children with hemiparetic cerebral palsy of both sexes ( 10 to 14 years of age , classified as I or II by gross motor function classification system ) participated in this study . They were r and omly assigned into two equal groups . Interventions : Both groups received a conventional physical therapy program for 12 successive weeks ( three sessions per week ) . The experimental group additionally received ( 25 min ) backward walking training . The control group additionally received ( 25 min ) forward walking training . Outcome measures : Baseline , posttreatment , and follow-up assessment for spatiotemporal gait parameters and gross motor functions were evaluated by using three dimensional gait analysis system and gross motor function measures . Results : There was a significant improvement in step length , walking velocity , cadence , stance phase , and swing phase percentage and gross motor function measures ( Dimensions D and E ) of the experimental group ( 0.55 ±0.16 , 0.53 ±0.19 , 121.73 ±2.89 , 54.73 ±1.67 , 44.40 ±1.40 , 90.20 ±6.44 , 82.47 ±12.82 ) , respectively , than the control group ( 0.39 ±0.13 , 0.46 ±0.20 , 125.80 ±2.96 , 50.27 ±1.62 , 49.47 ±1.55 , 82.47 ±7.05 , 80.47 ±12.61 ) , respectively , ( p < 0.05 ) . The significant improvement of all measured outcomes of the experimental group was maintained at 1 month follow-up assessment ( p < 0.05 ) . Conclusion : In addition to a conventional physical therapy program , backward walking training is more effective than forward walking training on spatiotemporal gait parameters , and gross motor function measures in children with hemiparetic cerebral palsy This study investigated the effect of a backward training program on the physical and fitness condition of young women . Twenty-six healthy female university students ( aged 18 - 23 years ) took part in three different baseline tests : body composition , a submaximal treadmill test , and a 20-m shuttle run test . Subjects were divided into a training group ( n = 13 ) and a control group ( n = 13 ) . The training group completed a six-week backward run/walk training program . The control group was restricted to their daily activities similar to the four weeks prior to the onset of the baseline tests . The training group showed a significant ( p = 0.01 ) decrease in O(2 ) consumption during both submaximal forward and backward exercise on the treadmill ( 32 % decrease during backward and 30 % decrease during forward exercise ) . A significant ( p = 0.01 ) decrease in percentage body fat ( 2.4 % ) , a 19.7 % decrease in the sum of skinfolds ( p = 0.001 ) and significantly ( p = 0.013 ) improved predicted VO(2max ) values from the forward 20-m shuttle run test ( 5.2 % ) were also found in the case of the training group . The findings suggest that backward walk/run training improves cardiorespiratory fitness for both forward and backward exercise and causes significant changes in body composition in young women BACKGROUND Treadmill gait training as a therapeutic re source in the rehabilitation of children with cerebral palsy has recently been the focus of many studies ; however , little is still known regarding its effect on static and functional balance in children . OBJECTIVE The aim of the present study was to compare the effects of treadmill training and over ground gait training in children with cerebral palsy . METHOD A r and omized controlled trial with blinded evaluator was conducted with children with cerebral palsy between three and 12 years of age categorized in Levels I to III of the Gross Motor Function Classification System . Assessment s were performed before and after the intervention and involved the Berg balance scale as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed . The experimental group was su bmi tted to treadmill training and the control group performed gait training over the ground . The intervention consisted of two 30-minute sessions per week for seven weeks . RESULTS Both groups exhibited better functional balance after the protocol . The experimental group had higher Berg balance scale scores and exhibited lesser mediolateral oscillation with eyes open in comparison to the control group . CONCLUSIONS Treadmill training had a greater effect on functional balance and mediolateral oscillation in comparison to over ground gait training in children with cerebral palsy . TRIAL REGISTRATION RBR-5v3kg9.(Brazilian Registry of Clinical Trials ) Properly conducted r and omised trials can aid clinical decision-making by providing unbiased estimates of the average size of treatment effects . This paper , the first of two , discusses how readers of clinical trials can extract simple estimates of treatment effect size from trial reports when trial outcomes are measured on a continuous scale . When making decisions about therapy for individual patients , these estimates can be modified on the basis of patient characteristics . Modified estimates of treatment effect size can be used to determine if the effect of treatment is likely to be large enough to be " clinical ly worthwhile " . This approach optimises clinical decision-making by combining unbiased estimates of the size of treatment effect from clinical trials with clinical intuition and patient preferences Objective : The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy . Design : In this r and omized controlled trial , 18 ambulatory children with diplegic or tetraplegic cerebral palsy were r and omly assigned to an experimental group or a control group . The experimental group received 30 mins of repetitive locomotor training with an applied technology ( Gait Trainer GT I ) plus 10 mins of passive joint mobilization and stretching exercises . The control group received 40 mins of conventional physiotherapy . Each subject underwent a total of 10 treatment sessions over a 2-wk period . Performance on the 10-m walk test , 6-min walk test , WeeFIM scale , and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up . Results : The experimental group showed significant posttreatment improvement on the 10-m walk test , 6-min walk test , hip kinematics , gait speed , and step length , all of which were maintained at the 1-mo follow-up assessment . No significant changes in performance parameters were observed in the control group . Conclusions : Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity , endurance , spatiotemporal , and kinematic gait parameters in patients with cerebral palsy Objective : To study the effect of additional backward walking training on postural control in children with hemiparetic cerebral palsy . Design : R and omized controlled study . Setting : Physical therapy clinics . Subjects : Thirty spastic hemiparetic cerebral palsied children of both sexes ( 10 - 14 years , 14 girls and 16 boys ) . Intervention : Children were r and omly assigned into two equal groups : experimental and control groups . Both groups received a traditional physical therapy program for 12 weeks . Experimental group additionally received backward walking training which was provided 25 min/day , 3 days/week for 3 successive months . Outcome measures : Baseline and post-treatment assessment for overall , anteroposterior , and mediolateral stability indices were evaluated by using Biodex balance system . Results : After treatment ; two way ANOVA revealed significant improvement in overall , anteroposterior and mediolateral stability indices of experimental group at the most stable level ( level 12 ) and moderately unstable level ( level 7 ) ( 1.40 ± 0.44 and 1.73 ± 0.51 ; 1.11 ± 0.34 and 2.13 ± 0.52 ; 1.93 ± 0.51 and 2.68 ± 0.52 ) respectively , than control group ( 1.77 ± 0.44 and 2.17 ± 0.56 ; 1.44 ± 0.44 and 2.54 ± 0.49 ; 2.39 ± 0.65 and 3.11 ± 0.49 ) respectively , ( P < 0.05 ) . There were significant improvement in all measured variables for both groups at both levels ( P < 0.05 ) . Conclusion : Additional backward walking training to traditional physical therapy program yields improvement in postural stability indices in children with spastic hemiparetic cerebral palsy than traditional physical therapy alone 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 . Objective : To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-five subjects with stroke , who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis , r and omly allocated to two groups , control ( n = 12 ) and experimental ( n = 13 ) . Interventions : Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks . Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week . Main measures : Gait was measured using the Stride Analyzer . Gait parameters of interest were walking speed , cadence , stride length , gait cycle and symmetry index . Measures were made at baseline before commencement of training ( pre-training ) and at the end of the three-week training period ( post-training ) . Results : After a three-week training period , subjects in experimental group showed more improvement than those in control group for walking speed ( change score : 8.609 ± 6.95 versus 3.659 ± 2.92 , p-value = 0.032 ) , stride length ( change score : 0.0909 ± 0.076 versus 0.00649 ± 0. 
    Output:
    