title: Effectiveness evaluation of an integrated automatic thermomechanic massage system (SMATH® system) in non-specific sub-acute and chronic low back pain - a randomized double-blinded controlled trial, comparing SMATH therapy versus sham therapy: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Low back pain (LBP) is a major health problem in modern society, with 70-85% of the population experiencing LBP at some time in their lives. Each year, 5-10% of the workforce misses work due to LBP, most for less than 7 days. Almost 10% of all patients are at risk of developing chronic pain and disability. Little clinical evidence is available for the majority of treatments used in LBP therapy. However, moderate evidence exists for interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation, and cognitive behavioral therapy for subacute and chronic LBP. The SMATH® system (system for automatic thermomechanic massage in health) is a new medical device (MD) that combines basic principles of mechanical massage, thermotherapy, acupressure, infrared therapy, and moxibustion. SMATH® is suitable for automatic multidisciplinary treatment on patients with non-specific sub-acute and chronic LBP.
  
  
  METHODS
  This paper describes the protocol for a double-blinded, sham-controlled, randomized, single-center short term clinical trial in patients with non-specific sub-acute and chronic LBP aged 18 to 70 years. The primary outcome will be the effectiveness of SMATH® versus sham therapy (medical device without active principles) determined by evaluating self perceived physical function with Roland Morris Disability Questionnaire (RMDQ) scores after 4 weeks of treatment (end of treatment). Major secondary outcome will be effectiveness of SMATH® determined by evaluating self perceived physical function comparing RMDQ scores between end of treatment and baseline. The trial part of the study will take 7 months while observational follow-up will take 11 months. The sample size will be 72 participants (36 for each arm). The project has been approved by the Ethical Committee of Cremona Hospital, Italy on 29 November 2010.
  
  
  CONCLUSIONS
  Compared to other medical specialties, physical and rehabilitation medicine (PRM) has not yet received the deserved recognition from clinicians and researchers in the scientific community, especially for medical devices. The best way to change this disadvantage is through well-conducted clinical research in sham-controlled randomized trials. Sham treatment groups are essential for improving the level of evidence-based practice in PRM. The present trial will counter the general lack of evidence concerning medical devices used in LBP therapy.
  
  
  BACKGROUND
  ISRCTN: ISRCTN08714168.
authors.affiliation: Hospital Istituti Ospitalieri di Cremona, Physical and Rehabilitation Medicine Department, Cremona, Italy. buselli.paolo@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Buselli
authors.forename: Roberto
authors.initials: R
authors.lastname: Bosoni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Busè
authors.forename: Paola
authors.initials: P
authors.lastname: Fasoli
authors.forename: Elide
authors.initials: E
authors.lastname: La Scala
authors.forename: Rita
authors.initials: R
authors.lastname: Mazzolari
authors.forename: Federica
authors.initials: F
authors.lastname: Zanetti
authors.forename: Sara
authors.initials: S
authors.lastname: Messina
mesh_terms: D019050:Acupressure; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002985:Clinical Protocols; D004311:Double-Blind Method; D006801:Humans; D006979:Hyperthermia, Induced; D007259:Infrared Rays / Q000627:therapeutic use; D017116:Low Back Pain / Q000628:therapy*; D008405:Massage / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D009071:Moxibustion; D017063:Outcome Assessment, Health Care; D012107:Research Design; D018401:Sample Size