@article{PuschmannDriessleinBecketal.2020,
  author    = {Puschmann, Anne-Katrin and Drießlein, David and Beck, Heidrun and Arampatzis, Adamantios and Moreno Catal{\´a}, Maria and Schiltenwolf, Marcus and Mayer, Frank and Wippert, Pia-Maria},
  title     = {Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain},
  series = {Journal of Pain Research},
  volume    = {13},
  journal   = {Journal of Pain Research},
  publisher = {Dove Medical Press},
  address   = {Albany, Auckland},
  issn      = {1178-7090},
  doi       = {10.2147/JPR.S223893},
  pages     = {613 -- 621},
  year      = {2020},
  abstract  = {Purpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain. Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed. Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (± 13.4) years; baseline pain intensity: 27.8 (± 18.4); disability: 14.3 (± 17.9)). In the 1-year follow-up, the stress types "tendency to worry", "social isolation", "work discontent" as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types "tendency to worry", "social isolation", "social conflicts", and "perceived long-term stress" as potential risk factors for both pain intensity and disability. Furthermore, "self-efficacy" ("internality", "self-concept") and "social externality" play a role in reducing pain-related disability. Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.},
  language  = {en}
}
@misc{PuschmannDriessleinBecketal.2020,
  author    = {Puschmann, Anne-Katrin and Drießlein, David and Beck, Heidrun and Arampatzis, Adamantios and Moreno Catal{\´a}, Maria and Schiltenwolf, Marcus and Mayer, Frank and Wippert, Pia-Maria},
  title     = {Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain},
  series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-46013},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-460134},
  pages     = {613 -- 621},
  year      = {2020},
  abstract  = {Purpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain. Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed. Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (± 13.4) years; baseline pain intensity: 27.8 (± 18.4); disability: 14.3 (± 17.9)). In the 1-year follow-up, the stress types "tendency to worry", "social isolation", "work discontent" as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types "tendency to worry", "social isolation", "social conflicts", and "perceived long-term stress" as potential risk factors for both pain intensity and disability. Furthermore, "self-efficacy" ("internality", "self-concept") and "social externality" play a role in reducing pain-related disability. Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.},
  language  = {en}
}
@article{PuertoValenciaArampatzisBecketal.2021,
  author    = {Puerto Valencia, Laura Maria and Arampatzis, Adamantios and Beck, Heidrun and Dreinh{\"o}fer, Karsten E. and Drießlein, Drießlein and Mau, Wilfried and Zimmer, Julia-Marie and Sch{\"a}fer, Michael and Steinfeldt, Friedemann and Wippert, Pia-Maria},
  title     = {RENaBack: Low back pain patients in rehabilitation: Study Protocol for a Multicenter, Randomized Controlled Trial},
  series = {Trials},
  journal   = {Trials},
  publisher = {Springer Nature / BMC},
  address   = {Heidelberg},
  issn      = {1745-6215},
  doi       = {10.1186/s13063-021-05823-3},
  pages     = {1 -- 18},
  year      = {2021},
  abstract  = {Background Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. Methods The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). Discussion An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. Trial registration DRKS, DRKS00020373. Registered on 15 April 2020},
  language  = {en}
}
@misc{PuertoValenciaArampatzisBecketal.2021,
  author    = {Puerto Valencia, Laura Maria and Arampatzis, Adamantios and Beck, Heidrun and Dreinh{\"o}fer, Karsten E. and Drießlein, Drießlein and Mau, Wilfried and Zimmer, Julia-Marie and Sch{\"a}fer, Michael and Steinfeldt, Friedemann and Wippert, Pia-Maria},
  title     = {RENaBack: Low back pain patients in rehabilitation: Study Protocol for a Multicenter, Randomized Controlled Trial},
  series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  publisher = {Universit{\"a}tsverlag Potsdam},
  address   = {Potsdam},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-55468},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-554683},
  pages     = {1 -- 18},
  year      = {2021},
  abstract  = {Background Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. Methods The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). Discussion An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. Trial registration DRKS, DRKS00020373. Registered on 15 April 2020},
  language  = {en}
}
@article{WippertArampatzisBanzeretal.2019,
  author    = {Wippert, Pia-Maria and Arampatzis, Adamantios and Banzer, Winfried and Beck, Heidrun and Hasenbring, Monika Ilona and Schiltenwolf, Marcus and Schneider, Christian and Stengel, Dirk and Platen, Petra and Mayer, Frank},
  title     = {Psychosoziale Risikofaktoren in der Entstehung von chronisch unspezifischen R{\"u}ckenschmerzen},
  series = {Zeitschrift f{\"u}r Sportpsychologie},
  volume    = {26},
  journal   = {Zeitschrift f{\"u}r Sportpsychologie},
  number    = {1},
  publisher = {Hogrefe},
  address   = {G{\"o}ttingen},
  issn      = {1612-5010},
  doi       = {10.1026/1612-5010/a000245},
  pages     = {25 -- 35},
  year      = {2019},
  abstract  = {Chronisch unspezifische R{\"u}ckenschmerzen (CURS) geh{\"o}ren international zu den h{\"a}ufigsten Schmerzph{\"a}nomenen und k{\"o}nnen f{\"u}r Athletinnen und Athleten karrierelimitierend sein. Knapp ein Drittel der j{\"a}hrlichen Trainingsausfallzeiten werden auf CURS zur{\"u}ckgef{\"u}hrt. In der Entstehung von chronischen Schmerzen ist ein multifaktorielles {\"A}tiologiemodell mit einem signifikanten Einfluss psychosozialer Risikofaktoren evident. Obwohl dies in der Allgemeinbev{\"o}lkerung bereits gut erforscht ist, gibt es in der Sportwissenschaft vergleichsweise wenige Arbeiten dar{\"u}ber. Dieses Thema wird daher in drei Multicenterstudien und zahlreichen Teilstudien des MiSpEx-Netzwerks (Medicine in Spine-Exercise-Network, F{\"o}rderzeitraum 2011 - 2018) aufgegriffen. Entsprechend der Empfehlung einer fr{\"u}hzeitigen Diagnostik von Chronifizierungsfaktoren in der „Nationalen Versorgungsleitlinie Kreuzschmerz", besch{\"a}ftigt sich das Netzwerk u. a. mit der {\"U}berpr{\"u}fung, Entwicklung und Evaluation diagnostischer M{\"o}glichkeiten. Der vorliegende Beitrag beschreibt die Entwicklung einer Diagnostik von psychosozialen Risikofaktoren, die einerseits eine Einsch{\"a}tzung des Risikos der Entwicklung von CURS und andererseits eine individuelle Zuweisung zu (Trainings)Interventionen erlaubt. Es wird die Entwicklungsrationale beschrieben und dabei verschiedene methodische Herangehensweisen und Entscheidungssequenzen reflektiert.},
  language  = {de}
}
@misc{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)},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-403424},
  pages     = {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}
}
@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}
}
@misc{GranacherPutaGabrieletal.2018,
  author    = {Granacher, Urs and Puta, Christian and Gabriel, Holger H. W. and Behm, David George and Arampatzis, Adamantios},
  title     = {Neuromuscular Training and Adaptations in Youth Athletes},
  series = {Frontiers in physiology},
  volume    = {9},
  journal   = {Frontiers in physiology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-042X},
  doi       = {10.3389/fphys.2018.01264},
  pages     = {5},
  year      = {2018},
  language  = {en}
}
@article{LesinskiSchmelcherHerzetal.2020,
  author    = {Lesinski, Melanie and Schmelcher, Alina and Herz, Michael and Puta, Christian and Gabriel, Holger and Arampatzis, Adamantios and Laube, Gunnar and B{\"u}sch, Dirk and Granacher, Urs},
  title     = {Maturation-, age-, and sex-specific anthropometric and physical fitness percentiles of German elite young athletes},
  series = {Plos One},
  volume    = {15},
  journal   = {Plos One},
  number    = {8},
  publisher = {Plos One},
  address   = {San Francisco, California},
  issn      = {1932-6203},
  doi       = {10.1371/journal.pone.0237423},
  pages     = {19},
  year      = {2020},
  abstract  = {The aim of this study was to establish maturation-, age-, and sex-specific anthropometric and physical fitness percentile reference values of young elite athletes from various sports. Anthropometric (i.e., standing and sitting body height, body mass, body mass index) and physical fitness (i.e., countermovement jump, drop jump, change-of-direction speed [i.e., T-test], trunk muscle endurance [i.e., ventral Bourban test], dynamic lower limbs balance [i.e., Y-balance test], hand grip strength) of 703 male and female elite young athletes aged 8-18 years were collected to aggregate reference values according to maturation, age, and sex. Findings indicate that body height and mass were significantly higher (p<0.001; 0.95≤d≤1.74) in more compared to less mature young athletes as well as with increasing chronological age (p<0.05; 0.66≤d≤3.13). Furthermore, male young athletes were significantly taller and heavier compared to their female counterparts (p<0.001; 0.34≤d≤0.50). In terms of physical fitness, post-pubertal athletes showed better countermovement jump, drop jump, change-of-direction, and handgrip strength performances (p<0.001; 1.57≤d≤8.72) compared to pubertal athletes. Further, countermovement jump, drop jump, change-of-direction, and handgrip strength performances increased with increasing chronological age (p<0.05; 0.29≤d≤4.13). In addition, male athletes outperformed their female counterpart in the countermovement jump, drop jump, change-of-direction, and handgrip strength (p<0.05; 0.17≤d≤0.76). Significant age by sex interactions indicate that sex-specific differences were even more pronounced with increasing age. Conclusively, body height, body mass, and physical fitness increased with increasing maturational status and chronological age. Sex-specific differences appear to be larger as youth grow older. Practitioners can use the percentile values as approximate benchmarks for talent identification and development.},
  language  = {en}
}
@misc{LesinskiSchmelcherHerzetal.2020,
  author    = {Lesinski, Melanie and Schmelcher, Alina and Herz, Michael and Puta, Christian and Gabriel, Holger and Arampatzis, Adamantios and Laube, Gunnar and B{\"u}sch, Dirk and Granacher, Urs},
  title     = {Maturation-, age-, and sex-specific anthropometric and physical fitness percentiles of German elite young athletes},
  series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  number    = {662},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-48026},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-480268},
  pages     = {21},
  year      = {2020},
  abstract  = {The aim of this study was to establish maturation-, age-, and sex-specific anthropometric and physical fitness percentile reference values of young elite athletes from various sports. Anthropometric (i.e., standing and sitting body height, body mass, body mass index) and physical fitness (i.e., countermovement jump, drop jump, change-of-direction speed [i.e., T-test], trunk muscle endurance [i.e., ventral Bourban test], dynamic lower limbs balance [i.e., Y-balance test], hand grip strength) of 703 male and female elite young athletes aged 8-18 years were collected to aggregate reference values according to maturation, age, and sex. Findings indicate that body height and mass were significantly higher (p<0.001; 0.95≤d≤1.74) in more compared to less mature young athletes as well as with increasing chronological age (p<0.05; 0.66≤d≤3.13). Furthermore, male young athletes were significantly taller and heavier compared to their female counterparts (p<0.001; 0.34≤d≤0.50). In terms of physical fitness, post-pubertal athletes showed better countermovement jump, drop jump, change-of-direction, and handgrip strength performances (p<0.001; 1.57≤d≤8.72) compared to pubertal athletes. Further, countermovement jump, drop jump, change-of-direction, and handgrip strength performances increased with increasing chronological age (p<0.05; 0.29≤d≤4.13). In addition, male athletes outperformed their female counterpart in the countermovement jump, drop jump, change-of-direction, and handgrip strength (p<0.05; 0.17≤d≤0.76). Significant age by sex interactions indicate that sex-specific differences were even more pronounced with increasing age. Conclusively, body height, body mass, and physical fitness increased with increasing maturational status and chronological age. Sex-specific differences appear to be larger as youth grow older. Practitioners can use the percentile values as approximate benchmarks for talent identification and development.},
  language  = {en}
}
@misc{WippertPuschmannArampatzisetal.2018,
  author    = {Wippert, Pia-Maria and Puschmann, Anne-Katrin and Arampatzis, Adamantios and Schiltenwolf, Marcus and Mayer, Frank},
  title     = {Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx)},
  issn      = {1866-8364},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-407391},
  year      = {2018},
  abstract  = {Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28\% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds. Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index - Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves. Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100\%; RPI-S: 75\%-100\%) and specificity (RSI: 76\%-93\%; RPI-S: 71\%-93\%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95\% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95\% CI 0.71 to 1.0)). Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians' decision making and allow stratified treatment and prevention.},
  language  = {en}
}
@article{WippertPuschmannArampatzisetal.2017,
  author    = {Wippert, Pia-Maria and Puschmann, Anne-Katrin and Arampatzis, Adamantios and Schiltenwolf, Marcus and Mayer, Frank},
  title     = {Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx)},
  series = {BMJ Open Sport \& Exercise Medicine},
  volume    = {3},
  journal   = {BMJ Open Sport \& Exercise Medicine},
  number    = {1},
  issn      = {2055-7647},
  doi       = {10.1136/bmjsem-2017-000295},
  year      = {2017},
  abstract  = {Background Low back pain (LBP) is a common pain syndrome in athletes, responsible for 28\% of missed training days/year. Psychosocial factors contribute to chronic pain development. This study aims to investigate the transferability of psychosocial screening tools developed in the general population to athletes and to define athlete-specific thresholds. Methods Data from a prospective multicentre study on LBP were collected at baseline and 1-year follow-up (n=52 athletes, n=289 recreational athletes and n=246 non-athletes). Pain was assessed using the Chronic Pain Grade questionnaire. The psychosocial Risk Stratification Index (RSI) was used to obtain prognostic information regarding the risk of chronic LBP (CLBP). Individual psychosocial risk profile was gained with the Risk Prevention Index - Social (RPI-S). Differences between groups were calculated using general linear models and planned contrasts. Discrimination thresholds for athletes were defined with receiver operating characteristics (ROC) curves. Results Athletes and recreational athletes showed significantly lower psychosocial risk profiles and prognostic risk for CLBP than non-athletes. ROC curves suggested discrimination thresholds for athletes were different compared with non-athletes. Both screenings demonstrated very good sensitivity (RSI=100\%; RPI-S: 75\%-100\%) and specificity (RSI: 76\%-93\%; RPI-S: 71\%-93\%). RSI revealed two risk classes for pain intensity (area under the curve (AUC) 0.92(95\% CI 0.85 to 1.0)) and pain disability (AUC 0.88(95\% CI 0.71 to 1.0)). Conclusions Both screening tools can be used for athletes. Athlete-specific thresholds will improve physicians' decision making and allow stratified treatment and prevention.},
  language  = {en}
}