TY - JOUR A1 - Wippert, Pia-Maria A1 - Fliesser, Michael A1 - Krause, Matthias T1 - Risk and protective factors in the clinical rehabilitation of chronic back pain JF - Journal of pain research N2 - 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. KW - yellow flags KW - life events KW - clinical pain research Y1 - 2017 U6 - https://doi.org/10.2147/JPR.S134976 SN - 1178-7090 VL - 10 SP - 1569 EP - 1579 PB - Dove Medical Press CY - Albany, Auckland ER - TY - JOUR A1 - Fliesser, Michael A1 - De Witt Huberts, Jessie A1 - Wippert, Pia-Maria T1 - The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain BT - a longitudinal study JF - BMC health services research N2 - Background In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. Methods Strength of relationship predictions were made using Brunner & Marmot’s model of ‘social determinants of health’. Subsequently, a longitudinal study was conducted with 66 patients receiving in-patient treatment for chronic back pain. Sociodemographic variables, four SES indicators (education, job position, income, multidimensional index) and back pain intensity and disability were obtained at baseline. Both pain dimensions were assessed again 6 months later. Using linear regression, the predictive strength of each SES indicator on pain intensity and disability was estimated and compared to the theory based prediction. Results Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = −0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = −0.30, p < 0.05) and job position (beta = 0.29, p < 0.05). Here, multidimensional index and income had no significant influence. Conclusions The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes. KW - Socioeconomic status KW - Indicators of socioeconomic status, Health inequality KW - Education KW - Job position KW - Income KW - Chronic back pain Y1 - 2017 U6 - https://doi.org/10.1186/s12913-017-2735-9 SN - 1472-6963 VL - 17 PB - BioMed Central CY - London ER - TY - JOUR A1 - Fliesser, Michael A1 - De Witt Huberts, Jessie A1 - Wippert, Pia-Maria T1 - The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain- a longitudinal study JF - BMC health services research N2 - Background: In health research, indicators of socioeconomic status (SES) are often used interchangeably and often lack theoretical foundation. This makes it difficult to compare results from different studies and to explore the relationship between SES and health outcomes. To aid researchers in choosing appropriate indicators of SES, this article proposes and tests a theory-based selection of SES indicators using chronic back pain as a health outcome. Results: Chronic back pain intensity was best predicted by the multidimensional index (beta = 0.31, p < 0.05), followed by job position (beta = 0.29, p < 0.05) and education (beta = -0.29, p < 0.05); whereas, income exerted no significant influence. Back pain disability was predicted strongest by education (beta = -0.30, p < 0.05) and job position (beta = 0. 29, p < 0.05). Here, multidimensional index and income had no significant influence. Conclusions: The choice of SES indicators influences predictive power on both back pain dimensions, suggesting SES predictors cannot be used interchangeably. Therefore, researchers should carefully consider prior to each study which SES indicator to use. The introduced framework can be valuable in supporting this decision because it allows for a stable prediction of SES indicator influence and their hierarchy on a specific health outcomes. KW - socioeconomic status KW - Indicators of socioeconomic status KW - health inequality KW - education KW - job position KW - income KW - chronic back pain Y1 - 2017 U6 - https://doi.org/10.1186/s12913-017-2735-9 SN - 1472-6963 VL - 17 PB - BioMed Central CY - London ER -