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 Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : OBJECTIVE To identify the determinants of improvement in walking capacity following therapeutic exercise in chronic stroke survivors . DESIGN A secondary analysis of data obtained from a prospect i ve , single-blind , r and omized controlled intervention trial . SUBJECTS Sixty-three community-dwelling individuals ( mean age = 65 years , age range = 50 - 87 years ) with a chronic stroke ( post-stroke duration : mean = 5.5 years , range = 1 - 28 years ) . METHODS Subjects were r and omized into a leg exercise group ( n = 32 ) or an arm exercise group ( n = 31 ) . Subjects in each group underwent 3 1-hour exercise sessions per week for 19 weeks . Walking capacity , cardiorespiratory fitness , isometric knee extensor muscle strength , balance ability , and balance confidence were evaluated before and after the interventions . Multiple regression analysis was performed to identify the determinants of improvement in walking capacity . RESULTS After controlling for age , gender , post-stroke duration , and baseline walking capacity , gain in paretic leg muscle strength and peak oxygen consumption remained independently associated with gain in walking capacity ( R2 = 0.229 ) . CONCLUSION Enhancement of cardiorespiratory fitness and paretic leg muscle strength are both significant determinants in improving walking capacity among chronic stroke survivors . However , the rather weak relationship ( R2 = 0.229 ) indicates that other factors not measured in this study may also contribute to the improvement in walking capacity Objective : To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis . Design : R and omized , single-blind , controlled pilot study . Setting : Inpatient rehabilitation hospital . Subjects : Twenty-five subjects were r and omly assigned to either the experimental group or the control group , with 13 and 12 subjects , respectively . Interventions : All subjects received a routine physical therapy . The subjects in the experimental group also received community-based ambulation training , which was performed for an hour , once a day , three times a week for a four-week period . Main measures : Ten-metre walk test , 6-minute walk test , community walk test , walking ability question naire and activities-specific balance confidence scale before and after the intervention . Results : The change values of the 10-m walk test ( 0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s ) , community walk test ( −13.61 ± 10.31 minutes versus −3.27 ± 11.99 minutes ) , walking ability question naire ( 6.15 ± 3.60 score versus 2.75 ± 2.38 score ) and activities-specific balance confidence scale ( 17.45 ± 11.55 score versus 2.55 ± 10.14 score ) were significantly higher in the experimental group than in the control group ( P < 0.05 ) . At post-test , the 10-m walk test was significantly higher in the experimental group than in the control group ( 0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s ) ( P < 0.05 ) . In the experimental group , there were significant differences for all variables between pre-test and post-test ( P < 0.01 ) , whereas the subjects of the control group showed a significant difference in only the walking ability question naire ( P < 0.01 ) . Conclusions : The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Background and Purpose — Balance impairment is common after stroke ; modified yoga may be able to improve balance and other important poststroke variables . Scientific- evidence is needed to support such treatment interventions . The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance , balance self-efficacy , fear of falling ( FoF ) , and quality of life after stroke . Methods — This was a prospect i ve , r and omized , pilot study of yoga-based rehabilitation for people with chronic stroke . All yoga sessions were taught by a registered yoga therapist , occurred twice per week for 8 weeks and included seated , st and ing , and floor postures with relaxation and meditation .  Balance was assessed with the Berg Balance Scale , balance self-efficacy with the Activities-specific Balance Confidence Scale , FoF with a dichotomous yes/no question , and quality of life with the Stroke Specific Quality of Life scale . Results — There were no significant differences between wait-list control ( n=10 ) and yoga ( n=37 ) groups in baseline or follow-up scores . However , using within-group comparisons , yoga group data demonstrated significant improvement in balance ( Berg Balance Scale , 41.3±11.7 vs 46.3±9.1 ; P<0.001 ) and FoF ( 51 % vs 46 % with FoF ; P<0.001 ) . Conclusions — A group yoga-based rehabilitation intervention  for people with chronic stroke has potential in improving multiple poststroke variables . Group yoga may be complementary to rehabilitation , may be possible in medical-based and community-based setting s , and may be cost-effective . Further testing of group yoga-based rehabilitation interventions is warranted . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique Identifier : NCT01109602 Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the 
    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 Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : OBJECTIVE To identify the determinants of improvement in walking capacity following therapeutic exercise in chronic stroke survivors . DESIGN A secondary analysis of data obtained from a prospect i ve , single-blind , r and omized controlled intervention trial . SUBJECTS Sixty-three community-dwelling individuals ( mean age = 65 years , age range = 50 - 87 years ) with a chronic stroke ( post-stroke duration : mean = 5.5 years , range = 1 - 28 years ) . METHODS Subjects were r and omized into a leg exercise group ( n = 32 ) or an arm exercise group ( n = 31 ) . Subjects in each group underwent 3 1-hour exercise sessions per week for 19 weeks . Walking capacity , cardiorespiratory fitness , isometric knee extensor muscle strength , balance ability , and balance confidence were evaluated before and after the interventions . Multiple regression analysis was performed to identify the determinants of improvement in walking capacity . RESULTS After controlling for age , gender , post-stroke duration , and baseline walking capacity , gain in paretic leg muscle strength and peak oxygen consumption remained independently associated with gain in walking capacity ( R2 = 0.229 ) . CONCLUSION Enhancement of cardiorespiratory fitness and paretic leg muscle strength are both significant determinants in improving walking capacity among chronic stroke survivors . However , the rather weak relationship ( R2 = 0.229 ) indicates that other factors not measured in this study may also contribute to the improvement in walking capacity Objective : To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis . Design : R and omized , single-blind , controlled pilot study . Setting : Inpatient rehabilitation hospital . Subjects : Twenty-five subjects were r and omly assigned to either the experimental group or the control group , with 13 and 12 subjects , respectively . Interventions : All subjects received a routine physical therapy . The subjects in the experimental group also received community-based ambulation training , which was performed for an hour , once a day , three times a week for a four-week period . Main measures : Ten-metre walk test , 6-minute walk test , community walk test , walking ability question naire and activities-specific balance confidence scale before and after the intervention . Results : The change values of the 10-m walk test ( 0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s ) , community walk test ( −13.61 ± 10.31 minutes versus −3.27 ± 11.99 minutes ) , walking ability question naire ( 6.15 ± 3.60 score versus 2.75 ± 2.38 score ) and activities-specific balance confidence scale ( 17.45 ± 11.55 score versus 2.55 ± 10.14 score ) were significantly higher in the experimental group than in the control group ( P < 0.05 ) . At post-test , the 10-m walk test was significantly higher in the experimental group than in the control group ( 0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s ) ( P < 0.05 ) . In the experimental group , there were significant differences for all variables between pre-test and post-test ( P < 0.01 ) , whereas the subjects of the control group showed a significant difference in only the walking ability question naire ( P < 0.01 ) . Conclusions : The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Background and Purpose — Balance impairment is common after stroke ; modified yoga may be able to improve balance and other important poststroke variables . Scientific- evidence is needed to support such treatment interventions . The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance , balance self-efficacy , fear of falling ( FoF ) , and quality of life after stroke . Methods — This was a prospect i ve , r and omized , pilot study of yoga-based rehabilitation for people with chronic stroke . All yoga sessions were taught by a registered yoga therapist , occurred twice per week for 8 weeks and included seated , st and ing , and floor postures with relaxation and meditation .  Balance was assessed with the Berg Balance Scale , balance self-efficacy with the Activities-specific Balance Confidence Scale , FoF with a dichotomous yes/no question , and quality of life with the Stroke Specific Quality of Life scale . Results — There were no significant differences between wait-list control ( n=10 ) and yoga ( n=37 ) groups in baseline or follow-up scores . However , using within-group comparisons , yoga group data demonstrated significant improvement in balance ( Berg Balance Scale , 41.3±11.7 vs 46.3±9.1 ; P<0.001 ) and FoF ( 51 % vs 46 % with FoF ; P<0.001 ) . Conclusions — A group yoga-based rehabilitation intervention  for people with chronic stroke has potential in improving multiple poststroke variables . Group yoga may be complementary to rehabilitation , may be possible in medical-based and community-based setting s , and may be cost-effective . Further testing of group yoga-based rehabilitation interventions is warranted . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique Identifier : NCT01109602 Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the 
    Output:
    