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 - TY - GEN 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) 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 351 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 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-403424 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 - GEN A1 - Wippert, Pia-Maria A1 - Puschmann, Anne-Katrin A1 - Drießlein, David A1 - Banzer, Winfried A1 - Beck, Heidrun A1 - Schiltenwolf, Marcus A1 - Schneider, Christian A1 - Mayer, Frank T1 - Personalized treatment suggestions BT - the validity and applicability of the risk-prevention-index social in low back pain exercise treatments T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe N2 - 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. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 690 KW - back pain diagnosis KW - pain screening KW - exercise treatment KW - yellow flags Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-471993 SN - 1866-8364 IS - 690 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 -