@article{WippertRectorKuhnetal.2017,
  author    = {Wippert, Pia-Maria and Rector, Michael V. and Kuhn, Gisela and Wuertz-Kozak, Karin},
  title     = {Stress and Alterations in Bones},
  series = {Frontiers in endocrinology},
  volume    = {8},
  journal   = {Frontiers in endocrinology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-2392},
  doi       = {10.3389/fendo.2017.00096},
  pages     = {7},
  year      = {2017},
  abstract  = {Decades of research have demonstrated that physical stress (PS) stimulates bone remodeling and affects bone structure and function through complex mechanotransduction mechanisms. Recent research has laid ground to the hypothesis that mental stress (MS) also influences bone biology, eventually leading to osteoporosis and increased bone fracture risk. These effects are likely exerted by modulation of hypothalamic-pituitary-adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids and cytokines, as demonstrated in human and animal studies. Furthermore, molecular cross talk between mental and PS is thought to exist, with either synergistic or preventative effects on bone disease progression depending on the characteristics of the applied stressor. This mini review will explain the emerging concept of MS as an important player in bone adaptation and its potential cross talk with PS by summarizing the current state of knowledge, highlighting newly evolving notions (such as intergenerational transmission of stress and its epigenetic modifications affecting bone) and proposing new research directions.},
  language  = {en}
}
@article{WippertFliesserKrause2017,
  author    = {Wippert, Pia-Maria and Fliesser, Michael and Krause, Matthias},
  title     = {Risk and protective factors in the clinical rehabilitation of chronic back pain},
  series = {Journal of pain research},
  volume    = {10},
  journal   = {Journal of pain research},
  publisher = {Dove Medical Press},
  address   = {Albany, Auckland},
  issn      = {1178-7090},
  doi       = {10.2147/JPR.S134976},
  pages     = {1569 -- 1579},
  year      = {2017},
  abstract  = {Objectives: Chronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients' lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors. Methods: A total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models. Results: Through interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort-reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS. Discussion: These findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research. Conclusion: In particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings.},
  language  = {en}
}
@article{WippertPuschmannDriessleinetal.2017,
  author    = {Wippert, Pia-Maria and Puschmann, Anne-Katrin and Drießlein, David and Arampatzis, Adamantios and Banzer, Winfried and Beck, Heidrun and Schiltenwolf, Marcus and Schmidt, Hendrik and Schneider, Christian and Mayer, Frank},
  title     = {Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network)},
  series = {Pain reports},
  volume    = {9},
  journal   = {Pain reports},
  publisher = {Wolters Kluwer Health},
  address   = {Riverwoods, IL},
  doi       = {10.1097/PR9.0000000000000623},
  pages     = {1 -- 11},
  year      = {2017},
  abstract  = {Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges. Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S). Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined. Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95\% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly. Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments.},
  language  = {en}
}