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Clinical outcomes and cost-effectiveness of massage chair therapy versus basic physiotherapy in lower back pain patients: A randomized controlled trial


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Introduction: Low back pain is a chronic recurrent symptom, which can lower the patient's quality of life. With technological development of automated home massage systems, now offers a promising alternative to physiotherapy. However, thus far, the effectiveness of such methods has not been evaluated. We aimed to compare the efficacy and cost-effectiveness of a massage chair with those of conventional physiotherapy for the treatment. Methods: This was a randomized controlled trial with a two-group parallel design. Following randomization and allocation, 56 participants were enrolled to receive either physiotherapy (n = 25) or mechanical massage using the massage chair (n = 31). Pain severity was measured using a visual analog scale (VAS) and satisfaction assessed with the McGill Pain Questionnaire (MPQ). Quality of life modification was analyzed using the Functional Rating Index (FRI). Cost-effectiveness was analyzed by comparing the sum of physiotherapy fees and monthly rental fees for chair massage. Results: Physiotherapy and massage chair were both effective for pain control as assessed with the VAS (P < .001), satisfaction as assessed by MPQ (P < .001) and life quality improvement as assessed by FRI (P < .001) in both groups. Both VAS and FRI scores were significantly higher for physiotherapy than for massage chair (P = .03 and P = .03, respectively). There was no significant difference in MPQ between the two groups. Massage chair therapy was more cost-effective than physiotherapy, at only 60.17% of the physiotherapy cost (P < .001). Conclusions: The home massage chair system was cost-effective, but pain control and disability improved more with physiotherapy. However, our results showed that the massage chair is a promising treatment for pain control and quality of life modification, but efficacy is still superior in physiotherapy and the chair is not a replacement for physiotherapy. Trial registration: Clinical Research Information Service, KCT0003157. Retrospectively registered August 2, 2018.
Clinical outcomes and cost-effectiveness of
massage chair therapy versus basic physiotherapy
in lower back pain patients
A randomized controlled trial
Seung-Kook Kim, MD, PhD
, Aran Min, MD, PhD
, Chuljin Jeon, MD
, Taeyun Kim, MD
Soohyun Cho, MD
, Su-Chan Lee, MD, PhD
, Choon-Key Lee, MD, PhD
Introduction: Low back pain is a chronic recurrent symptom, which can lower the patients quality of life. With technological
development of automated home massage systems, now offers a promising alternative to physiotherapy. However, thus far, the
effectiveness of such methods has not been evaluated. We aimed to compare the efcacy and cost-effectiveness of a massage chair
with those of conventional physiotherapy for the treatment.
Methods: This was a randomized controlled trial with a two-group parallel design. Following randomization and allocation, 56
participants were enrolled to receive either physiotherapy (n =25) or mechanical massage using the massage chair (n =31). Pain
severity was measured using a visual analog scale (VAS) and satisfaction assessed with the McGill Pain Questionnaire (MPQ). Quality
of life modication was analyzed using the Functional Rating Index (FRI). Cost-effectiveness was analyzed by comparing the sum of
physiotherapy fees and monthly rental fees for chair massage.
Results: Physiotherapy and massage chair were both effective for pain control as assessed with the VAS (P<.001), satisfaction as
assessed by MPQ (P<.001) and life quality improvement as assessed by FRI (P<.001) in both groups. Both VAS and FRI scores
were signicantly higher for physiotherapy than for massage chair (P=.03 and P=.03, respectively). There was no signicant
difference in MPQ between the two groups. Massage chair therapy was more cost-effective than physiotherapy, at only 60.17% of
the physiotherapy cost (P<.001).
Conclusions: The home massage chair system was cost-effective, but pain control and disability improved more with
physiotherapy. However, our results showed that the massage chair is a promising treatment for pain control and quality of life
modication, but efcacy is still superior in physiotherapy and the chair is not a replacement for physiotherapy.
Trial registration: Clinical Research Information Service, KCT0003157. Retrospectively registered August 2, 2018.
Abbreviations: FRI =Functional Rating Index, LBP =lower back pain, MPQ =McGill Pain Questionnaire, SD =standard
deviation, USD =United States Dollars, VAS =visual analog scale.
Keywords: low back pain, massage chair, massage therapy, mechanical chair, physical therapy, physiotherapy
1. Introduction
Lower back pain (LBP) is one of the common causes of disability
and inability to work, and almost 70% to 75% of the population
experience one attack of pain during their lives.
This medical
problem is compounded by the economic burden it imposes
on patients.
In the United States, the overall cost of treating
LBP is more than 77 billion dollars; 13% of patients receive
physiotherapy and the average cost is 11,151 dollars per
90% of all cases of LBP cases are of unknown
etiology, with benign degenerative issues
and only 5% to 10%
of patients with discogenic nerve compression and spinal
instability require surgical intervention.
Treatment for LBP
involves clinic-based physiotherapy which includes high thermal
muscle relaxation, muscle stimulation, and ultrasound-based
relaxation, all of which have demonstrated efcacy for pain
Currently, symptomatic treatment, including various
exercise and massage therapies, is a promising treatment strategy
to relieve pain. However, there is insufcient evidence to support
the efcacies of these alternative therapies.
Relaxation massage
and movement education, which can be benecial to individuals
who have back pain, have been thoroughly investigated.
Editor: Jianxun Ding.
The authors received no specic funding for this work.
The authors have no conicts of interest to disclose.
Himchan UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah,
United Arab Emirates,
Joint and Arthritis Research, Orthopedic Surgery,
Himchan Hospital, Seoul,
Department of Pharmaceutical Medicine and
Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University,
Incheon, Republic of Korea,
Medical R&D Center, Bodyfriend, Seoul,
Department of Orthopedic Surgery, Joint Center, Busan Himchan Hospital,
Busan, Republic of Korea.
Correspondence: Soohyun Cho, Medical R&D Center, Bodyfriend, 163,
Yangjaechunro, Gangnam-gu, 06032, Seoul, Republic of Korea
Copyright ©2020 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
How to cite this article: Kim SK, Min A, Jeon C, Kim T, Cho S, Lee SC, Lee CK.
Clinical outcomes and cost-effectiveness of massage chair therapy versus basic
physiotherapy in lower back pain patients: A randomized controlled trial.
Medicine 2020;99:12(e19514).
Received: 31 May 2019 / Received in nal form: 16 January 2020 / Accepted:
11 February 2020
Clinical Trial/Experimental Study Medicine®
However, only the effectiveness and safety of vibration therapy
have been assessed through observational studies.
Thus far,
the safety and effectiveness of multifunctional chair systems with
heating, stretching, and relaxation functions have not been
assessed. Furthermore, while such mechanical massage may
reduce medical costs and increase accessibility of treatment, its
cost-effectiveness has not yet been assessed. The purpose of the
present study was to compare clinical outcomes such as pain
control, satisfaction, and quality of life modication, as well as
the cost-effectiveness of massage chair therapy with those of in-
hospital physiotherapy.
2. Methods
2.1. Design overview and randomization
This was a prospective designed randomized controlled trial, and
the evaluator was blinded. This study was approved by our
institutional review board (Himchan-IRB 112294-01-201710-
01) and is registered with the Clinical Research Information
Service (KCT0003157; registered at August 2, 2018). We
employed a two-group parallel design and calculated the required
sample size for a comparative study using a two-sided ttest using
G-power for Windows (version; Brunsbuttel, Germany).
Participants were recruited from an outpatient clinic and
randomly assigned to one of two groups, either physiotherapy
or mechanical massage chair therapy, using a condential
computer program (Phantom, Bodyfriend, Seoul, Korea).
Written informed consent was obtained from all patients before
starting therapeutic intervention.
2.2. Setting and participants
The study was conducted at Himchan Hospital, Busan, Korea.
Participants were spine center outpatient clinic LBP patients
between December 2017 and March 2018 and were enrolled and
randomly assigned to treatment conditions. Inclusion criteria
were as follows:
1) age 20 to 65 years,
2) body mass index (BMI) between 17 and 30kg/m
, and
3) no history of spine surgery.
A total of 61 patients with back pain were recruited after three
weeks of advertising targeted to outpatients. Patients were
excluded if they had pain radiating from the leg, cognitive
impairment affecting the survey, recent vertebral fractures,
serious comorbid underlying diseases, medication including
non-steroidal anti-inammatory drugs (NSAIDs), or evidence
of progressive neurologic decits. The evaluation was restricted
to participants who completed the 3-week follow-up question-
naire and had been randomized to receive either massage chair
therapy or physiotherapy. Finally, 31 (55.36%) participants were
allocated to receive physiotherapy, and 25 (44.64%) were
allocated to receive massage chair therapy.
2.3. Intervention
In each group, patients received up to 6 treatment sessions within 3
weeks. These were conducted by 9 accredited physiotherapists, each
with a minimum experience of 2 years, and the intervention methods
for LBP were authorized by the Korean Physiotherapy Association.
The massage chair therapy protocol was developed by three
doctors employed by the manufacturer who developed the device
(Bodyfriend, Inc., Seoul, Korea). Total massage time was 20 min,
including 3 min of constant stretching, 5 min of vibration mode
and stroke mode, and 40-degree heating of the treatment region.
This protocol is called the back strengthen modeand is one of
the machines most commonly used programs.
The outpatient physiotherapy program was comprised of 5
min of ultrasound massage, 5 min of transcutaneous electrical
nerve stimulation (TENS), 5 min of interferential current therapy,
and 5 min of hot pack application. This approach is commonly
used in patients for LBP.
2.4. Data collection
Before randomization and group allocation, baseline character-
istics such as age, height, body weight, BMI, vital signs, and
history were recorded for all subjects. Subjective pain intensity
was evaluated using the visual analog scale (VAS)
and detailed
characteristics of pain, including location, nature, and the
patientssatisfaction were assessed using the short-term McGill
Pain Questionnaire (MPQ).
Quality of life modication was
assessed using the Functional Rating Index (FRI).
Prior to the
application of both therapies, as well as at 1, 2, and 3 weeks after
the initiation of therapies all of the above-mentioned parameters
were recorded. Following the collection of all data, patients were
asked their opinions about the overall outcomes of their
treatment. The cost of physiotherapy was calculated as the
sum of the cost that was covered under the national health
insurance system and the cost borne by the patient. The massage
chair therapy cost was derived from the monthly rental fee
charged by Bodyfriend.
2.5. Scales
The rst measures are the VAS score and frequency of pain.
Patients were instructed to indicate the severity of their pain on a
scale bar between 0(no pain) and 10(the most extreme pain
experienced ever). We used a scale bar that was specically
designed for back pain evaluation. The advantages of this method
are that it is statistically sensitive and can be applied to either
individuals or a small group.
The second measure is the result of the MPQ score.
MPQ is a self-reporting questionnaire. It comprises three main
question types regarding pain: sensation, emotion, and subjective
pain. It selects the most appropriate word for each of the 20
questions presented and evaluates the severity of the pain on a
scale of 1 to 5. It provides quantitative information about the
degree of treatment and distinguishes pain reduction with greater
sensitivity than other methods.
The third measure is the FRI score.
The FRI measures
quality of life, back pain, and radiating pain intensity on a scale of
0 to 10. Quality of life includes 8 parameters, sleeping, washing,
traveling, lifting, working, performing hobbies, walking, and
standing. In addition, the pain intensity and frequency are
evaluated. Of a total of ve points, The scoring method is
calculated as (total score/40) 100 and converted from 0 to 100,
and a higher score means that the pain is severe, and physical
functional capacity is compromised.
2.6. Statistical analysis
Data are indicated as mean and standard deviation (mean ±
standard deviation, SD). Differences in baseline information
Kim et al. Medicine (2020) 99:12 Medicine
between groups were compared using an independent ttest. Pre-
and post-treatment VAS scores, MPQ results, FRI results and cost
were compared using a two-sided Studentsttest and the
outcomes of each method were assessed via a paired ttest and or
Wilcoxon signed-rank test, as appropriate. All statistical analyses
were performed using SPSS for Windows (version 22.0; SPSS,
Inc., Chicago, IL). Statistical signicance was set at a P-value of
3. Results
3.1. Patient baseline characteristics
Baseline information for patients is presented in Table 1. Mean
participant age was 48.40 ±9.52 years in the physiotherapy
group, and 38.84 ±9.68 years in the massage therapy group
(P=.42). There were no signicant differences between the two
treatment groups in terms of gender (P=.22). The duration of
pain was 10.52 ±12.93 months in the physiotherapy group and
9.90±10.15 months in the massage treatment group; the
difference was not signicant (P=.76).
3.2. Effectiveness of treatment
Clinical outcomes, including the degree of pain reduction and
quality of life modication for each group, are presented in
Table 2. Comparison of pain before and after treatment using the
VAS revealed that pain reduction was effective in both the
physiotherapy and massage chair groups (P<.001 in both cases).
When comparing pain differences in each group on the MPQ
scale, there was signicant pain reduction in both the physical
therapy and massage chair groups (P<.001 in both cases). In
terms of quality of life modication assessed using the FRI, both
physiotherapy and massage chair were effective (P<.001 in both
cases). No complications or aggravation of pain following
treatment were reported.
3.3. Comparison of clinical outcomes between the
intervention methods
The comparison of outcomes between the two groups is shown in
Table 3. On the VAS scale, pain improvement in the
physiotherapy group (1.73 ±1.14) was signicantly higher than
that in the massage chair group (1.16 ±0.78) (P=.03, Fig. 1). The
MPQ score 3 weeks after treatment showed that massage chair
therapy (8.14 ±1.42) was more effective than physiotherapy
(7.35±2.24); however, this difference was not signicant
(P=.27, Fig. 2). A comparison of quality of life modication
based on the FRI scale showed that physiotherapy (2.67 ±1.85)
was signicantly more effective than massage chair therapy
(2.16±1.64; P=.03, Fig. 3).
3.4. Cost of care
The total cost of physiotherapy was determined as the amount set
by the national health insurance. The patients were charged 4.03
United States Dollars (USD) per physical treatment and 9.79 USD
for health insurance; thus, the total cost of therapy was 166.82
USD per month (P<.001, Table 4). The monthly rental fee for
the mechanical massage machine used in this study was 100.38
USD. Thus, the total cost of mechanical chair therapy was
60.17% of that of conventional physiotherapy.
4. Discussion
The results of our study suggest that both clinic-based
physiotherapy and mechanical massage chair demonstrate
effectiveness in pain control, patient satisfaction, and life quality
modication. Clinic-based physiotherapy demonstrated signi-
cant superiority in pain control and life quality modication.
Alternatively, mechanical massage chair therapy was superior in
terms of cost-effectiveness.
The Agency for Health Care Policy and Research guidelines by
the United Kingdom Royal College of General Practitioners
suggests that massage treatments are effective, but not affordable,
for patients with back pain.
However, the various
technologies have been recently advanced and cost-effectiveness
improved compared to the past. Additionally, we sought to
validate the results of a previous study that demonstrated that
massage chair treatment to be less effective than actual massage
In our study, the massage chair was cost-effective and
adequately controlled pain.
Table 1
Patient baseline characteristics.
Physical therapy
(mean ±SD, n =25)
Massage chair
(mean ±SD, n =31) P
Age 48.40 ±9.52 38.84 ±9.68 .42
Gender M:13 F:14 M:15 F:16 .22
LBP duration 10.52 ±12.93 9.90 ±10.15 .76
LBP =low back pain, SD =standard deviation.
Table 2
Effectiveness of pain relief evaluated by VAS, FRI, and MPQ.
Physical therapy
(mean ±SD, n =25) P
Massage chair
(mean ±SD, n =31) P
VAS (pre) 4.48 ±1.16 <.001
4.06 ±1.55 <.001
VAS (3 weeks) 2.64 ±1.47 2.90 ±1.51
MPQ (pre) 36.70 ±5.57 <.001
42.03 ±4.99 <.001
MPQ (3 weeks) 28.60 ±6.16 34.68 ±3.75
FRI (pre) 14.36 ±4.32 <.001
15.10 ±3.21 <.001
FRI (3 weeks) 11.52 ±4.07 12.94 ±3.08
FRI =Functional Rating Index, MPQ =McGill Pain Questionnaire, SD =standard devia tion, VAS =
visual analog scale.
P>.05 is considered statistically signicant.
Table 3
Differences in the degree of pain evaluated by VAS, FRI, and MPQ.
(mean ±SD, n =25)
Massage chair
(mean ±SD, n =31) P
VAS (pre) 4.48 ±1.16 4.06±1.55 .38
VAS (3 weeks) 2.64 ±1.47 2.90±1.51 .54
VAS improvement 1.73±1.14 1.16 ±0.78 .03
MPQ (pre) 36.70 ±5.57 42.03 ±4.99 .08
MPQ (3 weeks) 28.60 ±6.16 34.68 ±3.75 .03
MPQ improvement 8.14 ±1.42 7.35±2.24 .27
FRI (pre) 14.36 ±4.32 15.10 ±3.21 .72
FRI (3 weeks) 11.52 ±4.07 12.94 ±3.08 .21
FRI improvement 2.67 ±1.85 2.16±1.64 .03
FRI =Functional Rating Index, MPQ =McGill Pain Questionnaire, VAS =visual analog scale.
P>.05 is considered statistically signicant.
Kim et al. Medicine (2020) 99:12
Massage therapy displays at least moderate continuous pain
reduction compared to continuous stimuli in subacute, chronic
pain patients and moderate enhancement in function.
Furthermore, massage treatments are associated with a low rate
of serious complications; only 13% of the population receiving
massage therapy complained of therapy-related discomfort.
Here, we used two treatment modes for pain control. The
recovery and stretch modes involve rubbing and tapping designed
to reduce dermal stimulation, which can help control pain based
on gate control theory.
The results of our study suggested that both physiotherapy and
mechanical chair therapy were effective in terms of pain reduction
and overall quality of life modication. However, some measures
of pain control and disability, such as the VAS and FRI, which
reect relatively diverse living improvements and pain control,
showed greater pain reduction after clinic-based physiotherapy.
Notably, massage chair therapy satisfaction as assessed with the
MPQ was not inferior to that of physiotherapy, and the overall
cost of mechanical massage therapy was lower than that of
physiotherapy. These results indicate that mechanical massage
Figure 1. Visual analog scale (VAS) change during the 3-week treatment.
Figure 2. Changes in the McGill Pain Questionnaire (MPQ) score after 3 weeks of intervention.
Kim et al. Medicine (2020) 99:12 Medicine
chair therapy may be a clinically effective and cost-effective
treatment method for LBP. Although this therapy may not yet be
an authorized treatment or covered under many national
insurance systems, our results support its effectiveness as an
alternative to physiotherapy for back pain treatment. Both
physiotherapy and mechanical massage chair therapy effectively
reduced LBP.
The principles behind the two treatments are different. In
clinic-based physiotherapy, extradermal heating therapy causes
distension of the blood vessels in muscles around the spine,
resulting in metabolic acceleration, increased exibility of
ligament tissue, and decreased pain.
Laser therapy uses
short-wavelength non-invasive light to restore anti-inammatory
activity and induce binding of tissues.
TENS, which involves
the use of an electrical current, has been suggested for pain
reduction, but clinical evidence supporting its effectiveness is still
Alternatively, the principle of mechanical massage
therapy can be explained by the gate control theory.
Back pain
is transmitted through mechanical receptors on the skin to the
spinal cord and back to the brain. During this process, when
another sensory signal enters the spinal cord, the gates open or
close before the signal is transferred to the brain. Massage creates
a large number of sensory signals, which may either close or
partially open the spinal cord nerve gates. Closed nerve gates
prevent these stimulation signals from being transmitted to the
central nervous system, thus blocking the path of the pain signal
to the brain during massage. Therefore, it can be applied
conveniently in everyday life and is cost-effective and accessible.
Furthermore, our results indicate that massage chair therapy is
effective in terms of quality of life modication.
There was a signicant difference in the disability score
between the two groups. Conventional physiotherapy was more
effective than massage chair therapy as assessed by the FRI,
which evaluates the emotional effects of pain and evaluates
subjective overall pain intensity in a more detailed manner.
Mechanical massage is a treatment method that can be
administered by a machine without human contact. Finally,
compared to physiotherapy, massage chair therapy requires no
emotional support and human contact, and is associated with a
lack of emotional connection between patients and the medical
practitioner. This is one possible explanation for the reduced
effectiveness in pain control and improvement for disability.
However, massage chair machines can be useful in terms of cost-
effectiveness and accessibility; therefore, while satisfaction with
this treatment was inferior to physiotherapy, it was superior in
terms of cost-effectiveness.
Mechanical massage resulted in pain control satisfaction and
quality of life modication. Furthermore, because of technologi-
cal developments, several systems to assess the health of the body,
vibration function, and temperature control (including heating)
may be developed for pain control. This may become a more
patient-friendly method, as the machine might then converse and
play music via articial intelligence for people who do not prefer
to sit alone in the mechanical massage chair. This would help to
overcome the limitation of machines and would add to their
existing benets, such as easy accessibility and relatively low cost.
Our study is novel in that it is the rst to make use of a
prospective design and randomized control to compare the
effectiveness of mechanical chair massage with conventional
treatment. There were some limitations in our study. First, there is
limited scope for generalization due to the small number of study
participants and short follow-up duration. Although no
Figure 3. Functional Rating Index (FRI) improvement after 3 weeks of intervention.
Table 4
Mean costs of the treatments.
Mean cost
per subject
of subjects
incurring cost P
Physical therapy(n =25) 49.39 166.82 100%
Massage chair(n =31) 100.38 100.38 60.17% >.001
USD =United States Dollars.
P>.05 is considered statistically signicant.
Kim et al. Medicine (2020) 99:12
complications were reported, our results should be interpreted
with caution. Further studies with a multicenter trial design are
needed to compare the efcacies of these two treatment
modalities in a larger group of participants. Second, we did
not identify the origin of pain in our study participants. However,
our study design was prospective and strictly controlled. In
addition, we used multiple clinical scales, which support the
clinical signicance of our ndings. Also, this study has value in
that it is the rst trial of comparison between in-hospital
management and mechanical chair treatment. In future studies,
diagnosis using radiologic and clinical examinations should be
performed before treatment. Despite these limitations, we are the
rst to attempt this trial and thereby demonstrate that mechanical
massage therapy may have a therapeutic advantage in the
treatment of LBP; large-scale, multicenter randomized controlled
trials may corroborate the results of the present study.
5. Conclusions
The results of the present study suggest that physiotherapy
remains superior for pain control and overall satisfaction relative
to the massage chair; nonetheless, the massage chair is effective
for pain control and patient satisfaction. Furthermore, satisfac-
tion following treatment was not inferior while cost-effectiveness
was superior after conventional physiotherapy. With technologi-
cal development, mechanical systems may eventually provide
promising treatment and large-scale studies have to be designed
for continuous evaluation of this technology.
Author contributions
Conceptualization: Seung-kook Kim.
Data curation: Seung-kook Kim, Aran Min.
Formal analysis: Aran Min, Chuljin Jeon.
Methodology: Taeyun Kim.
Supervision: Choon-Key Lee MD.
Visualization: Su-Chan Lee MD.
Writing review & editing: Soohyun Cho.
[1] Andersson GB. Epidemiological features of chronic low-back pain.
Lancet 1999;354:5815.
[2] Devaraj NK. The difcult rheumatology diagnosis. Ethiop J Health Sci
[3] Rashid AA, Devaraj NK, Kahar JA. Patellofemoral pain: a not so trivial
knee injury (a case report). Int J Hum Health Sci 2019;3:1202.
[4] Hahne AJ, Ford JJ, Surkitt LD, et al. Individualized physical therapy is
cost-effective compared with guideline-based advice for people with low
back disorders. Spine (Phila Pa 1976) 2017;42:E16976.
[5] Crow WT, Willis DR. Estimating cost of care for patients with acute low
back pain: a retrospective review of patient records. J Am Osteopath
Assoc 2009;109:22933.
[6] Balagué F, Mannion AF, Pellisé F, et al. Non-specic low back pain.
Lancet 2012;379:48291.
[7] Singh V, Manchikanti L, Benyamin RM, et al. Percutaneous lumbar laser
disc decompression: a systematic review of current evidence. Pain
Physician 2009;12:57388.
[8] Orozco T, Feldman DE, Mazer B, et al. Low back pain: current patterns
of Canadian physiotherapy service delivery. Physiother Can 2017;69:
[9] van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute
and chronic nonspecic low back pain. A systematic review of
randomized controlled trials of the most common interventions. Spine
(Phila Pa 1976) 1997;22:212856.
[10] Kraft K, Kanter S, Janik H. Safety and effectiveness of vibration massage
by deep oscillations: a prospective observational study. Evid Based
Complement Alternat Med 2013;2013:679248.
[11] Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain.
Cochrane Database Syst Rev 2008;CD001929.
[12] Hush JM, Lee H, Yung V, et al. Intercultural comparison of patient
satisfaction with physiotherapy care in Australia and Korea: an
exploratory factor analysis. J Manual Manip Ther 2013;21:10312.
[13] Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity
scale: what is moderate pain in millimetres? Pain 1997;72:957.
[14] Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;
[15] Feise RJ, Michael Menke J. Functional rating index: a new valid and
reliable instrument to measure the magnitude of clinical change in spinal
conditions. Spine (Phila Pa 1976) 2001;26:7886. discussion 87.
[16] Feise RJ, Menke JM. Functional Rating Index: literature review. Med Sci
Monit 2010;16:RA2536.
[17] UK BEAM Trial TeamUnited Kingdom back pain exercise and
manipulation (UK BEAM) randomised trial: cost effectiveness of
physical treatments for back pain in primary care. BMJ 2004;329:1381.
[18] Berliner E. Multisociety letter to the Agency for Healthcare Research and
Quality: serious methodological aws plague technology assessment on
pain management injection therapies for low back pain. Pain Med
[19] Si
sko PK, Videm
sek M, Karpljuk D. The effect of a corporate chair
massage program on musculoskeletal discomfort and joint range of
motion in ofce workers. J Altern Complement Med 2011;17:61722.
[20] Furlan AD, Imamura M, Dryden T, et al. Massage for low back pain: an
updated systematic review within the framework of the Cochrane Back
Review Group. Spine (Phila Pa 1976) 2009;34:166984.
[21] Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial
comparing traditional Chinese medical acupuncture, therapeutic mas-
sage, and self-care education for chronic low back pain. Arch Intern Med
[22] Demmink JH, Helders PJ, Hobaek H, et al. The variation of heating
depth with therapeutic ultrasound frequency in physiotherapy. Ultra-
sound Med Biol 2003;29:1138.
[23] Kubsik A, Klimkiewicz P, Wolda
nska M. Application of laser
therapy in the physiotherapy of patients with multiple sclerosis. Wiad
Lek 2012;65:5561. Article in Polish.
[24] Deyo RA, Walsh NE, Martin DC, et al. A controlled trial of
transcutaneous electrical nerve stimulation (TENS) and exercise for
chronic low back pain. N Engl J Med 1990;322:162734.
Kim et al. Medicine (2020) 99:12 Medicine
... Hence, we focus on the way of managing stress regularly with convenience, having a massage by automated massage chair. Although several studies have evaluated the effect of massage chair on diverse parameters, such as pain control, 23 sleep quality, fatigue, 24 and physiological markers including heart rate and blood pressure, 25,26 none of the previous studies focused on the effect of massage chair on the stress hormones through a randomized controlled trial (RCT). There was the study investigating the serum cortisol level after the use of massage chair; however, it was limited to evaluate general stress responses by measuring a single stress-related hormone, the cortisol, in a short study period. ...
... Previous studies demonstrated that massage chair was effective in improving the sleep quality, 24 fatigue, concentration, and memory 35 and in relieving pain. 23 While none of the previous studies attempted to correlate the use of massage chair with stress management, our study possesses the strength and novelty of Values are presented as means±standard deviation or number (%), or only numbers. ALT = alanine aminotransferase; WBC = white blood cell; NA = not applicable. ...
Objective Since the clinical benefits of a massage chair have not been fully elucidated, we aimed to assess the effects of the long-term use of a massage chair on stress measures in older adults. Design Randomized controlled trial Setting Community. Interventions In total, 80 adults aged 50–75 years were randomly assigned to the intervention group (n=41) and control group (n=39). The intervention group used the massage chair twice a day for 6 months. The control group was educated about lifestyle modification. Main outcome measures The primary outcome was the change in serum cortisol levels in the morning (8 a.m.) and afternoon (1 p.m.), and the secondary outcomes included changes in levels of dehydroepiandrosterone-sulfate (DHEA-S), serotonin, insulin-like growth factor, erythrocyte sedimentation rate, high sensitivity C-reactive protein, and natural killer cell activity, and results from a questionnaire on mood, cognition, and quality of life. Results The use of the massage chair was associated with a decreasing trend in serum cortisol levels at 1 p.m. (-2.68 ug/dL, p = 0.059). Serum DHEA-S levels significantly decreased with the intervention (-9.66 ug/dL, p = 0.003). In addition, the perceived rate of depression and health status considerably improved following the intervention. Conclusions Chronic stress in adults could be effectively managed using a massage chair.
... Kim et al. [22] studied the efficacy of mechanical massage chair therapy (MCT) in relieving chronic lower back pain. As compared to physiotherapy, the authors reported that MCT showed similar improvement in pain management where the result were based on a set of questionnaires. ...
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Manual massage, commonly used by healthy individuals for well-being, is an ancient practice requiring the intervention of a trained and experienced physiotherapist. On the other hand, automated massage is carried out by machines or modalities without or with minimal control of a human operator. In the present review, we provide a literature analysis to gather the effects of automated massage on muscle properties, peripheral circulation and psychophysiological variables as reported through psychometric and neurophysiological evaluations of each modality ranging from massage beds and whole-body vibrations to robotic massage. A computerized search was performed in Google Scholar, PubMed, and ResearchGate using selected key search terms, and the relevant data were extracted. The findings of this review indicate that for vibration massage, whole-body vibration exposure with relatively lower frequency and magnitude can be safely and effectively used to induce improvements in peripheral circulation. As for massage chair and mechanical bed massage, while most studies report on positive changes, the lack of strong clinical evidence renders these findings largely inconclusive. As for robotic massage, we discuss whether technological advances and collaborative robots might reconcile active and passive modes of action control during a massage and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human–machine interactions.
Background: Low back pain (LBP) is currently a major reason for disability worldwide. Therapeutic massage is one of the most popular non-pharmacological methods for managing chronic LBP (CLBP), and the Fateh method is a massage technique based on Iranian Traditional Medicine. Objectives: The current study aimed to compare the effects of Fateh massage with those of acupuncture and physiotherapy on relieving pain and disability in CLBP. Methods: Eighty-four patients with CLBP were categorized into groups that received Fateh massage, acupuncture, or physiotherapy. Each group included 28 randomly assigned patients who completed 10 sessions of therapy. Visual analogue scale (VAS) scores and Roland-Morris disability scores were evaluated at baseline, after intervention, and four weeks later. The findings were analyzed with SPSS software. Results: The baseline VAS and Roland-Morris scores of the three study groups did not indicate significant differences (p > 0.05). All three groups showed significant pre-post improvements in both scores (p < 0.05). At the end of the treatment sessions, the three groups showed no significant difference in the reductions in pain intensity and disability score (p > 0.05). Improvements in disability and pain between the first and third time points were significant in all three groups (p < 0.05 for each group). In addition, the results of massage, physiotherapy, and acupuncture groups were not significantly different (p > 0.05). No adverse events occurred in the patients. Conclusion: The effects of Fateh massage were comparable to those of acupuncture and physiotherapy in reducing pain and disability in patients with CLBP.
Background: Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout. Purpose: To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of relaxation and rejuvenation) and massage chairs on nurses' anxiety, stress, and burnout. Methods: This quality improvement project analyzed 67 paired responses to surveys filled out by nurses before and after their use of serenity lounges at a medical center in Los Angeles between November 2020 and May 2021. Following successful implementation of a serenity lounge on a pilot unit, this project was expanded to a total of 10 units, including COVID-19 cohort units. As part of this expansion, massage chairs were added to 10 serenity lounges, along with items such as wipes, gloves, and shoe covers to enable nurses to adhere to infection control protocols. Results: Analysis of the 67 paired responses to pre- and post-lounge-use surveys revealed a significant reduction in feelings of emotional exhaustion, burnout, frustration, being worn out, stress, and anxiety after use of the serenity lounge. Improvements in feelings of emotional exhaustion, being worn out, and being anxious were also noted after using the massage chair for at least 10 to 20 minutes. Conclusions: These results highlight the importance of providing a holistic approach, including a serene space, massage equipment, and other amenities, to help nurses reduce feelings of anxiety, stress, and burnout, particularly during challenging times such as the COVID-19 pandemic.
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Knee injuries are very common in sports, ranging from trivial knee strains to severe ligament, tendon and/or meniscus tear, knee joint fracture or dislocations. The treatment ranges from the basic rest, ice, compression and elevation (RICE) approach to oral medications and/or surgery. It usually entails some form of physiotherapy especially during the post injury period and with functional loss of motion or stiffness. For the professional sportsman, rehabilitation tends to be more intensive due to pressure to return to the sport as soon as possible. This case report will look at a-not-so-trivial knee injury diagnosed as patellofemoral pain syndrome (PFPS) in a 28 year old recreational athleteInternational Journal of Human and Health Sciences Vol. 03 No. 02 April’19. Page: 120-122
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Background Rheumatoid arthritis is a devastating condition. More so, the diagnosis of seronegative rheumatoid arthritis is often fraught off with much uncertainty and that leads to further suffering to the unfortunate patient. Case Details This is a case of Madam A, who presented with many non-specific symptoms and signs involving many systems which was finally diagnosed as seronegative rheumatoid arthritis. This case explores the challenges in reaching this uncommon diagnosis and how anti-inflammatory drugs can bring a miraculous relief to the patient's suffering. Conclusion The diagnosis of seronegative rheumatoid arthritis often presents a real challenge to the medical practitioner and often requires multiple visits and/or shared multidisciplinary care for confirmation of the diagnosis. Once diagnosed and treated with disease modifying anti- rheumatic drugs, often there is a miraculous relief to the patient's suffering.
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Purpose: The aim of this study was to describe the current patterns of service delivery of Canadian physiotherapy (PT) professionals working in adult musculoskeletal (MSK) outpatient practice. Methods: A total of 846 Canadian PT professionals working with an adult MSK outpatient clientele participated in an online survey about how they would treat a patient with low back pain (LBP). After reading an online clinical vignette about a fictional patient with varying insurance status, participants answered questions about how they would treat the patient (e.g., wait time, frequency and duration of treatment, time allotted for initial evaluation and treatment), about their actual practice (e.g., number of patients seen per day), and about their work setting. Results: The vignette patients with LBP would typically be seen within 2 weeks, especially in private practice, and most would receive care 2–3 times per week for 1–3 months. Initial evaluations and subsequent treatments would take 31–60 minutes. Two-thirds of participants reported treating 6–15 patients a day in their current practice setting. Differences were found between provinces and territories (with the longest wait time in Quebec), practice settings (with a longer wait time in the public sector), and insurance status (patients covered by workers’ compensation are seen more frequently). Conclusion: This study adds to our knowledge of the accessibility of outpatient MSK PT services for patients with LBP in Canada, and it points to potential areas for improvement.
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The aim of this study was to conduct a cross-cultural comparison of the factors that influence patient satisfaction with musculoskeletal physiotherapy care in Australia and Korea. Prospective studies were conducted in Australia and Korea. Patient satisfaction data were collected using the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) from a total of 1666 patients who were attending clinics for physiotherapy treatment of a musculoskeletal condition. Exploratory factor analysis was conducted to identify factors determining patient satisfaction in each cohort. A four-factor solution for the MRPS was found for the Australian and Korean data sets, explaining 61 and 55% of the variance respectively. Communication and respect, convenience and quality time and person-focused care were factors common to both countries. One factor unique to Korea was courtesy and propriety. For both cultures, global patient satisfaction was significantly but weakly correlated with the outcome of treatment. The interpersonal aspect of care, namely effective communication and respect from the therapist, appears to be the predominant and universal factor that influences patient satisfaction with physiotherapy care, although other culturally specific factors were identified. Physiotherapists can maximize patient satisfaction with care by addressing those features that uniquely contribute to patient satisfaction in the cultural context in which they are working.
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The objective of this study is to assess the safety of treatment with vibration massage using a deep oscillation device and the effects on symptom severity and quality of life in patients with primary fibromyalgia syndrome (FMS). Outpatients with FMS performed an observational prospective study with visits 2–4 weeks after the last treatment (control) and after further 2 months (follow-up). Patients were treated with 10 sessions of 45 min deep oscillation massage, 2/week. Primary outcome parameters were safety and tolerability (5-level Likert scale (1 = very good)) (after each treatment session and at control visit). Secondary outcome parameters were symptom severity (Fibromyalgia Impact Questionnaire (FIQ), pain) and quality of life (SF-36). Seventy patients (97.1% females) were included. At control visit, 41 patients (58.6%) reported 63 mild and short-lasting adverse events, mainly worsening of prevalent symptoms such as pain and fatigue. Tolerability was rated as 1.8 (95% confidence interval: 1.53; 2.07). Symptoms and quality of life were significantly improved at both control and follow-up visits (at least P < 0.01 ). In conclusion, deep oscillation massage is safe and well tolerated in patients with FMS and might improve symptoms and quality of life rather sustained.
Study design: A cost-utility analysis within a randomized controlled trial was conducted from the health care perspective. Objective: The aim of this study was to determine whether individualized physical therapy incorporating advice is cost-effective relative to guideline-based advice alone for people with low back pain and/or referred leg pain (≥6 weeks, ≤6 months duration of symptoms). Summary of background data: Low back disorders are a burdensome and costly condition across the world. Cost-effective treatments are needed to address the global burden attributable to this condition. Methods: Three hundred participants were randomly allocated to receive either two sessions of guideline-based advice alone (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial and neurophysiological factors, and incorporating advice (n = 156). Data relating to health care costs, health benefits (EuroQol-5D) and work absence were obtained from participants via questionnaires at 5, 10, 26, and 52-week follow-ups. Results: Total health care costs were similar for both groups: mean difference $27.03 [95% confidence interval (95% CI): -200.29 to 254.35]. Health benefits across the 12-month follow-up were significantly greater with individualized physical therapy: incremental quality-adjusted life years = 0.06 (95% CI: 0.02-0.10). The incremental cost-effectiveness ratio was $422 per quality-adjusted life year gained. The probability that individualized physical therapy was cost-effective reached 90% at a willingness-to-pay threshold of $36,000. A saving of $1995.51 (95% CI: 143.98-3847.03) per worker in income was realized in the individualized physical therapy group relative to the advice group. Sensitivity and subgroup analyses all revealed a dominant position for individualized physical therapy; hence, the base case analysis was the most conservative. Conclusion: Ten sessions of individualized physical therapy incorporating advice is cost-effective compared with two sessions of guideline-based advice alone for people with low back disorders. Level of evidence: 2.
Objective: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. Design: Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. Results: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. Conclusions: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.
Multiple sclerosis is a chronic disease of the nervous system, which main manifestations are disseminated demyelinated the changes in the central nervous system. The pathogenesis of this disease is still not known, the curative treatment is not possible. In connection with the alleged autoimmune genesis of MS patients are administered immunomodulatory drugs. Patients with multiple sclerosis suffer from a number of symptoms associated with this disease. The aim of this article is to present the main clinical symptoms characteristic of MS and to present biological effects of low-energy lasers used in the treatment of multiple sclerosis.
Non-specific low back pain has become a major public health problem worldwide. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain. Mechanical factors, such as lifting and carrying, probably do not have a major pathogenic role, but genetic constitution is important. History taking and clinical examination are included in most diagnostic guidelines, but the use of clinical imaging for diagnosis should be restricted. The mechanism of action of many treatments is unclear, and effect sizes of most treatments are low. Both patient preferences and clinical evidence should be taken into account for pain management, but generally self-management, with appropriate support, is recommended and surgery and overtreatment should be avoided.