TY - JOUR A1 - Hasenbring, Monika Ilona A1 - Levenig, Claudia A1 - Hallner, D. A1 - Puschmann, Anne-Katrin A1 - Weiffen, A. A1 - Kleinert, Jens A1 - Belz, J. A1 - Schiltenwolf, Marcus A1 - Pfeifer, A. -C. A1 - Heidari, Jahan . A1 - Kellmann, M. A1 - Wippert, Pia-Maria T1 - Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport T1 - Psychosocial Risk Factors for chronic Back Pain in the General Population and in Competitive Sports BT - Von der Modellbildung zum klinischen Screening – ein Review aus dem MiSpEx-Netzwerk BT - From theory to clinical screening—a review from the MiSpEx network A Review from the MiSpEx Network JF - Manuelle Medizin N2 - 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. N2 - Background 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. Methods 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 ≥18 years and a follow-up of at least 3 months. Results We identified 16 eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) 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). Conclusion 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. KW - Chronischer Rückenschmerz KW - Psychosoziale Risikofaktoren KW - Screening KW - Prognose KW - Chronic back pain KW - Psychosocial risk factors KW - Screening KW - Prognosis Y1 - 2018 U6 - https://doi.org/10.1007/s00337-018-0450-1 SN - 0025-2514 SN - 1433-0466 VL - 56 IS - 5 SP - 359 EP - 373 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Hasenbring, Monika Ilona A1 - Levenig, Claudia A1 - Hallner, D. A1 - Puschmann, Anne-Katrin A1 - Weiffen, A. A1 - Kleinert, Jens A1 - Belz, J. A1 - Schiltenwolf, Marcus A1 - Pfeifer, A. -C. A1 - Heidari, Jahan A1 - Kellmann, M. A1 - Wippert, Pia-Maria T1 - Psychosocial risk factors for chronic back pain in the general population and in competitive sports BT - from theory to clinical screening- a review fromthe MiSpEx network BT - Von der Modellbildung zum klinischen Screening – ein Review aus dem MiSpEx-Netzwerk JF - Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der Österreichischen Schmerzgesellschaft und der Deutschen Interdisziplinären Vereinigung für Schmerztherapie N2 - 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 ae18 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. T2 - Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport KW - Chronic back pain KW - Psychosocial risk factors KW - Screening KW - Prognosis Y1 - 2018 U6 - https://doi.org/10.1007/s00482-018-0307-5 SN - 0932-433X SN - 1432-2129 VL - 32 IS - 4 SP - 259 EP - 273 PB - Springer CY - Heidelberg ER - TY - GEN A1 - Hasenbring, Monika Ilona A1 - Levenig, Claudia A1 - Hallner, D. A1 - Puschmann, Anne-Katrin A1 - Weiffen, A. A1 - Kleinert, Jens A1 - Belz, Johanna A1 - Schiltenwolf, Marcus A1 - Pfeifer, Ann-Christin A1 - Heidari, Jahan A1 - Kellmann, Michael A1 - Wippert, Pia-Maria T1 - Screeninginstrumente BT - mehr Licht als Schatten T2 - Der Schmerz : Organ der Deutschen Gesellschaft zum Studium des Schmerzes, der Österreichischen Schmerzgesellschaft und der Deutschen Interdisziplinären Vereinigung für Schmerztherapie Y1 - 2018 U6 - https://doi.org/10.1007/s00482-018-0340-4 SN - 0932-433X SN - 1432-2129 VL - 32 IS - 6 SP - 479 EP - 481 PB - Springer Medizin Verlag GmbH CY - Heidelberg ER - TY - JOUR A1 - Puschmann, Anne-Katrin A1 - Drießlein, David A1 - Beck, Heidrun A1 - Arampatzis, Adamantios A1 - Moreno Catalá, Maria A1 - Schiltenwolf, Marcus A1 - Mayer, Frank A1 - Wippert, Pia-Maria T1 - Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain BT - A Prospective Longitudinal Study JF - Journal of Pain Research N2 - 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. KW - low back pain KW - psychosocial risk factors KW - stress KW - self-efficacy KW - MiSpEx Y1 - 2019 U6 - https://doi.org/10.2147/JPR.S223893 SN - 1178-7090 VL - 13 SP - 613 EP - 621 PB - Dove Medical Press CY - Albany, Auckland ER - TY - GEN A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Schiltenwolf, Marcus A1 - Wiebking, Christine A1 - Mayer, Frank T1 - BACK PAIN: THE STUDY OF MECHANISMS AND THE TRANSLATION IN INTERVENTIONS WITHIN THE MISPEX NETWORK T2 - Psychosomatic medicine Y1 - 2016 SN - 0033-3174 SN - 1534-7796 VL - 78 SP - A91 EP - A91 PB - Elsevier CY - Philadelphia ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Drießlein, David A1 - Arampatzis, Adamantios A1 - Banzer, Winfried A1 - Beck, Heidrun A1 - Schiltenwolf, Marcus A1 - Schmidt, Hendrik A1 - Schneider, Christian A1 - Mayer, Frank T1 - Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network) JF - Pain reports N2 - 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. KW - Back pain prognosis KW - Back pain diagnosis KW - Pain screening KW - PROGRESS/TRIPOD KW - Prediction of disability/intensity KW - Yellow flags KW - Exercise Y1 - 2017 U6 - https://doi.org/10.1097/PR9.0000000000000623 VL - 9 SP - 1 EP - 11 PB - Wolters Kluwer Health CY - Riverwoods, IL ER - TY - JOUR A1 - Niederer, Daniel A1 - Vogt, Lutz A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Pfeifer, Ann-Christin A1 - Schiltenwolf, Marcus A1 - Banzer, Winfried A1 - Mayer, Frank T1 - Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: study protocol for a multicentre, single-blind randomized controlled trial JF - Trials N2 - Background: Arising from the relevance of sensorimotor training in the therapy of nonspecific low back pain patients and from the value of individualized therapy, the present trial aims to test the feasibility and efficacy of individualized sensorimotor training interventions in patients suffering from nonspecific low back pain. Methods and study design: A multicentre, single-blind two-armed randomized controlled trial to evaluate the effects of a 12-week (3 weeks supervised centre-based and 9 weeks home-based) individualized sensorimotor exercise program is performed. The control group stays inactive during this period. Outcomes are pain, and pain-associated function as well as motor function in adults with nonspecific low back pain. Each participant is scheduled to five measurement dates: baseline (M1), following centre-based training (M2), following home-based training (M3) and at two follow-up time points 6 months (M4) and 12 months (M5) after M1. All investigations and the assessment of the primary and secondary outcomes are performed in a standardized order: questionnaires - clinical examination biomechanics (motor function). Subsequent statistical procedures are executed after the examination of underlying assumptions for parametric or rather non-parametric testing. Discussion: The results and practical relevance of the study will be of clinical and practical relevance not only for researchers and policy makers but also for the general population suffering from nonspecific low back pain. KW - Sensorimotor training KW - Motor control KW - Low back pain KW - Exercise KW - Functional capacity KW - Individualized intervention Y1 - 2016 U6 - https://doi.org/10.1186/s13063-016-1645-1 SN - 1745-6215 VL - 17 PB - BioMed Central CY - London ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Drießlein, David A1 - Beck, Heidrun A1 - Schneider, Christian A1 - Puschmann, Anne-Katrin A1 - Banzer, Winfried A1 - Schiltenwolf, Marcus T1 - The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain BT - A Randomized Controlled Trial JF - Journal of Clinical Medicine N2 - 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 KW - low-back pain KW - multidisciplinary pain treatment KW - sensorimotor exercise training KW - classical conditioning KW - executive function KW - MiSpEx Network Y1 - 2019 U6 - https://doi.org/10.3390/jcm9010115 SN - 2077-0383 VL - 9 IS - 115 PB - MDPI CY - Basel ER - TY - JOUR A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Arampatzis, Adamantios A1 - Schiltenwolf, Marcus A1 - Mayer, Frank T1 - Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx) JF - BMJ Open Sport & Exercise Medicine N2 - 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. Y1 - 2017 U6 - https://doi.org/10.1136/bmjsem-2017-000295 SN - 2055-7647 VL - 3 IS - 1 ER -