@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}
}
@misc{WippertDriessleinBecketal.2020,
  author    = {Wippert, Pia-Maria and Drießlein, David and Beck, Heidrun and Schneider, Christian and Puschmann, Anne-Katrin and Banzer, Winfried and Schiltenwolf, Marcus},
  title     = {The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain},
  series = {Postprints der Universit{\"a}t Potsdam : Mathematisch Naturwissenschaftliche Reihe},
  journal   = {Postprints der Universit{\"a}t Potsdam : Mathematisch Naturwissenschaftliche Reihe},
  number    = {840},
  issn      = {1866-8372},
  doi       = {10.25932/publishup-44581},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-445814},
  pages     = {17},
  year      = {2020},
  abstract  = {Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18-65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linear regression models were used. N = 291 (age 39.7 ± 12.7 years, female = 61.1\%, 77\% CPG = 1) completed training (M1/M4/M5), showing a significantly stronger reduction of mental health complaints (anxiety, vital exhaustion) in people with higher than those with lower pain in multidisciplinary treatment. Compared to regular routines, the self-management-multidisciplinary treatment led to a clinically relevant reduction of pain-disability and significant mental health improvements. Low-cost exercise programs may provide enormous relief for therapeutic processes, rehabilitation aftercare, and thus, cost savings for the health system},
  language  = {en}
}
@misc{WippertPuschmannDriessleinetal.2020,
  author    = {Wippert, Pia-Maria and Puschmann, Anne-Katrin and Drießlein, David and Banzer, Winfried and Beck, Heidrun and Schiltenwolf, Marcus and Schneider, Christian and Mayer, Frank},
  title     = {Personalized treatment suggestions},
  series = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Postprints der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  number    = {690},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-47199},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-471993},
  pages     = {13},
  year      = {2020},
  abstract  = {Background: The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S. Methods: In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18-65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups. Results: A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30\% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41\% of the sample would gain an unfitted treatment without the back pain screening. Conclusion: The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.},
  language  = {en}
}
@article{WippertDriessleinBecketal.2020,
  author    = {Wippert, Pia-Maria and Drießlein, David and Beck, Heidrun and Schneider, Christian and Puschmann, Anne-Katrin and Banzer, Winfried and Schiltenwolf, Marcus},
  title     = {The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain},
  series = {Journal of Clinical Medicine},
  volume    = {9},
  journal   = {Journal of Clinical Medicine},
  number    = {115},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2077-0383},
  doi       = {10.3390/jcm9010115},
  pages     = {15},
  year      = {2020},
  abstract  = {Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18-65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linear regression models were used. N = 291 (age 39.7 ± 12.7 years, female = 61.1\%, 77\% CPG = 1) completed training (M1/M4/M5), showing a significantly stronger reduction of mental health complaints (anxiety, vital exhaustion) in people with higher than those with lower pain in multidisciplinary treatment. Compared to regular routines, the self-management-multidisciplinary treatment led to a clinically relevant reduction of pain-disability and significant mental health improvements. Low-cost exercise programs may provide enormous relief for therapeutic processes, rehabilitation aftercare, and thus, cost savings for the health system},
  language  = {en}
}
@misc{HasenbringLevenigHallneretal.2018,
  author    = {Hasenbring, Monika Ilona and Levenig, Claudia and Hallner, D. and Puschmann, Anne-Katrin and Weiffen, A. and Kleinert, Jens and Belz, J. and Schiltenwolf, Marcus and Pfeifer, A. -C. and Heidari, Jahan . and Kellmann, M. and Wippert, Pia-Maria},
  title     = {Psychosoziale Risikofaktoren f{\"u}r chronischen R{\"u}ckenschmerz in der Allgemeingesellschaft und im Leistungssport},
  series = {Manuelle Medizin},
  volume    = {56},
  journal   = {Manuelle Medizin},
  number    = {5},
  publisher = {Springer},
  address   = {Heidelberg},
  issn      = {0025-2514},
  doi       = {10.1007/s00337-018-0450-1},
  pages     = {359 -- 373},
  year      = {2018},
  abstract  = {Hintergrund Lumbale Ruckenschmerzen und ihre Neigung zur Chronifizierung stellen nicht nur in der Allgemeinbevolkerung, sondern auch im Leistungssport ein bedeutendes Gesundheitsproblem dar. Im Gegensatz zu Nichtathleten ist die Erforschung psychosozialer Risikofaktoren sowie von Screeningfragebogen, die moglichst fruhzeitig die Entwicklung chronischer Schmerzen erkennen und vorhersagen konnen, im Leistungssport noch in den Anfangen. Das vorliegende systematische Review gibt einen uberblick uber den Stand der Risikofaktorenforschung in beiden Feldern und untersucht die pradiktive Qualitat verschiedener Screeningfragebogen bei Nichtathleten. Methodik Die Literatursuche erfolgte zwischen Marz und Juni 2016 in den Datenbanken MEDLINE, PubMed und PsycINFO mit den Suchbegriffen psychosocial screening, low back pain, sciatica und prognosis, athletes. Eingeschlossen wurden prospektive Studien an Patienten mit lumbalen Ruckenschmerzen mit und ohne Ausstrahlung in das Bein, 18Jahre und mit einem Follow-up von mindestens 3-monatiger Dauer. Ergebnisse In das Review zu Screeninginstrumenten wurden 16Studien einbezogen. Alle waren an klinischen Stichproben der Allgemeingesellschaft durchgefuhrt worden. Zu den am haufigsten publizierten Screeningfragebogen gehoren der orebro Musculoskeletal Pain Screening Questionnaire (oMPSQ) mit einer zufriedenstellenden Fruherkennung der Wiederherstellung der Arbeitsfahigkeit sowie das STarT Back Screening Tool (SBT) mit guter Vorhersage schmerzbedingter Beeintrachtigung. Fur die Vorhersage kunftiger Schmerzen eignen sich die Risikoanalyse der Schmerzchronifizierung (RISC-R) und der Heidelberger Kurzfragebogen (HKF). Schlussfolgerungen Psychosoziale Risikofaktoren fur chronische Ruckenschmerzen, wie z.B. chronischer Stress, ungunstige Schmerzverarbeitung und depressive Stimmungslagen, werden zunehmend auch im Leistungssport erkannt. Screeninginstrumente, die sich in der Allgemeingesellschaft als hinreichend vorhersagestark erwiesen haben, werden aktuell im MiSpEx-Forschungsverbund auf ihre Eignung uberpruft.},
  language  = {de}
}
@misc{HasenbringLevenigHallneretal.2018,
  author    = {Hasenbring, Monika Ilona and Levenig, Claudia and Hallner, D. and Puschmann, Anne-Katrin and Weiffen, A. and Kleinert, Jens and Belz, J. and Schiltenwolf, Marcus and Pfeifer, A. -C. and Heidari, Jahan and Kellmann, M. and Wippert, Pia-Maria},
  title     = {Psychosocial risk factors for chronic back pain in the general population and in competitive sports},
  series = {Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der {\"O}sterreichischen Schmerzgesellschaft und der Deutschen Interdisziplin{\"a}ren Vereinigung f{\"u}r Schmerztherapie},
  volume    = {32},
  journal   = {Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der {\"O}sterreichischen Schmerzgesellschaft und der Deutschen Interdisziplin{\"a}ren Vereinigung f{\"u}r Schmerztherapie},
  number    = {4},
  publisher = {Springer},
  address   = {Heidelberg},
  issn      = {0932-433X},
  doi       = {10.1007/s00482-018-0307-5},
  pages     = {259 -- 273},
  year      = {2018},
  abstract  = {Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords "psychosocial screening", "low back pain", "sciatica" and "prognosis", "athletes". We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ae<yen>18 years and a follow-up of at least 3 months. We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the A-rebro Musculoskeletal Pain Screening Questionnaire (A-MPSQ) demonstrated a sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium.},
  language  = {en}
}
@misc{HasenbringLevenigHallneretal.2018,
  author    = {Hasenbring, Monika Ilona and Levenig, Claudia and Hallner, D. and Puschmann, Anne-Katrin and Weiffen, A. and Kleinert, Jens and Belz, Johanna and Schiltenwolf, Marcus and Pfeifer, Ann-Christin and Heidari, Jahan and Kellmann, Michael and Wippert, Pia-Maria},
  title     = {Screeninginstrumente},
  series = {Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der {\"O}sterreichischen Schmerzgesellschaft und der Deutschen Interdisziplin{\"a}ren Vereinigung f{\"u}r Schmerztherapie},
  volume    = {32},
  journal   = {Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der {\"O}sterreichischen Schmerzgesellschaft und der Deutschen Interdisziplin{\"a}ren Vereinigung f{\"u}r Schmerztherapie},
  number    = {6},
  publisher = {Springer Medizin Verlag GmbH},
  address   = {Heidelberg},
  issn      = {0932-433X},
  doi       = {10.1007/s00482-018-0340-4},
  pages     = {479 -- 481},
  year      = {2018},
  language  = {de}
}
@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}
}
@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}
}