Author(s): BOU SADER, L., LEPERS, R., COSTE, A., SCHMIT, C., DUFOREZ, F., MILLOUR, G., HAUSSWIRTH, C., Institution: INSERM CAPS (COGNITION ACTION ET PLASTICITÉ SENSORIMOTRICE), Country: FRANCE, Abstract-ID: 2802

INTRODUCTION:
Exercise is widely recommended as a first-line intervention for individuals with chronic non-specific low back pain (CNLBP) because of its well-established benefits on physical function and mental health (1,2). However, in a subset of individuals, long-term adherence to exercise-based rehabilitation may be limited by pain exacerbation, fatigue, or discomfort during or after physical activity, which can reduce engagement and compromise treatment effectiveness (3,4). To address these limitations, complementary strategies targeting pain management, stress regulation, and sleep quality are often integrated to optimize rehabilitation outcomes (5). Among these, massage occupies a distinctive position by combining autonomic modulation with direct mechanosensory stimulation, and has demonstrated benefits for pain reduction, autonomic regulation, and sleep improvement (6–8). In parallel, robotic massage systems are emerging as standardized, accessible, and reproducible complementary alternatives to manual massage approaches (9). This study investigated whether autonomous robotic massage, applied alone or combined with exercise, could enhance psychophysiological outcomes in individuals with CNLBP.
METHODS:
Thirty participants (17 women, 13 men) with CNLBP were randomly allocated to one of three 5-week interventions (10 sessions): robotic massage alone (RM, 30 min), exercise followed by robotic massage (EX+RM, 15 min each), or exercise followed by relaxation (EX+RE, 15 min each). Outcomes included functional capacity (Oswestry Disability Index, Biering–Sørensen and Shirado–Ito tests), perceived stress (Perceived Stress Scale), salivary cortisol, sleep (actigraphy and Subjective Sleep Quality), pain and overall well-being (visual analog scale), and quality of life (EQ-5D-5L), assessed before and after the intervention.
RESULTS:
Pain intensity and salivary cortisol levels decreased significantly following RM and EX+RM, but not after EX+RE. Actigraphy showed comparable improvements in sleep efficiency across all groups; however, sleep fragmentation decreased in the RM and EX+RM groups and increased in the EX+RE group (p = 0.007). Immobile time also increased predominantly in the EX+RM group (p < 0.05). Perceived stress, subjective sleep quality, trunk flexor and extensor endurance, disability, well-being, and quality of life improved to a similar extent in all groups.
CONCLUSION:
Autonomous robotic massage improved pain, sleep fragmentation and physiological stress in CNLBP, consistent with evidence linking massage to autonomic downregulation and sleep enhancement (10). Robotic massage may complement exercise-based rehabilitation; future work should test its effects in physically active and athletic populations.
[1] Chen 2022 / [2] Li 2023 / [3] Palazzo 2016 / [4] Rice 2019 / [5] Navarro-Ledesma 2024 / [6] Field 2016 / [7] Weerapong 2005 / [8] Nazari 2015 / [9] Kerautret 2023 / [10] Diego 2009