@article{GerthDolkKlassertetal.2016, author = {Gerth, Sabrina and Dolk, Thomas and Klassert, Annegret and Fliesser, Michael and Fischer, Martin H. and Nottbusch, Guido and Festman, Julia}, title = {Adapting to the surface: A comparison of handwriting measures when writing on a tablet computer and on paper}, series = {Human movement science : a journal devoted to pure and applied research on human movement}, volume = {48}, journal = {Human movement science : a journal devoted to pure and applied research on human movement}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0167-9457}, doi = {10.1016/j.humov.2016.04.006}, pages = {62 -- 73}, year = {2016}, abstract = {Our study addresses the following research questions: Are there differences between handwriting movements on paper and on a tablet computer? Can experienced writers, such as most adults, adapt their graphomotor execution during writing to a rather unfamiliar surface for instance a tablet computer? We examined the handwriting performance of adults in three tasks with different complexity: (a) graphomotor abilities, (b) visuomotor abilities and (c) handwriting. Each participant performed each task twice, once on paper and once on a tablet computer with a pen. We tested 25 participants by measuring their writing duration, in air time, number of pen lifts, writing velocity and number of inversions in velocity. The data were analyzed using linear mixed-effects modeling with repeated measures. Our results reveal differences between writing on paper and on a tablet computer which were partly task-dependent. Our findings also show that participants were able to adapt their graphomotor execution to the smoother surface of the tablet computer during the tasks. (C) 2016 Elsevier B.V. All rights reserved.}, language = {en} } @article{FliesserDeWittHubertsWippert2018, author = {Fliesser, Michael and De Witt Huberts, Jessie and Wippert, Pia-Maria}, title = {Education, job position, income or multidimensional indices?}, series = {BMJ Open}, volume = {8}, journal = {BMJ Open}, publisher = {BMJ Publishing Group}, address = {London}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-020207}, pages = {1 -- 7}, year = {2018}, abstract = {Objective: To investigate associations between socioeconomic status (SES) indicators (education, job position, income, multidimensional index) and the genesis of chronic low back pain (CLBP). Design: Longitudinal field study (baseline and 6-month follow-up). Setting: Four medical clinics across Germany. Participants: 352 people were included according to the following criteria: (1) between 18 and 65 years of age, (2) intermittent pain and (3) an understanding of the study and the ability to answer a questionnaire without help. Exclusion criteria were: (1) pregnancy, (2) inability to stand upright, (3) inability to give sick leave information, (4) signs of serious spinal pathology, (5) acute pain in the past 7 days or (6) an incomplete SES indicators questionnaire. Outcome measures: Subjective intensity and disability of CLBP. Results: Analysis showed that job position was the best single predictor of CLBP intensity, followed by a multidimensional index. Education and income had no significant association with intensity. Subjective disability was best predicted by job position, succeeded by the multidimensional index and education, while income again had no significant association. Conclusion: The results showed that SES indicators have different strong associations with the genesis of CLBP and should therefore not be used interchangeably. Job position was found to be the single most important indicator. These results could be helpful in the planning of back pain care programmes, but in general, more research on the relationship between SES and health outcomes is needed.}, language = {en} } @article{GerthKlassertDolketal.2016, author = {Gerth, Sabrina and Klassert, Annegret and Dolk, Thomas and Fliesser, Michael and Fischer, Martin H. and Nottbusch, Guido and Festman, Julia}, title = {Is Handwriting Performance Affected by the Writing Surface?}, series = {Frontiers in psychology}, volume = {7}, journal = {Frontiers in psychology}, publisher = {Frontiers Research Foundation}, address = {Lausanne}, issn = {1664-1078}, doi = {10.3389/fpsyg.2016.01308}, pages = {18}, year = {2016}, abstract = {Due to their multifunctionality, tablets offer tremendous advantages for research on handwriting dynamics or for interactive use of learning apps in schools. Further, the widespread use of tablet computers has had a great impact on handwriting in the current generation. But, is it advisable to teach how to write and to assess handwriting in pre- and primary schoolchildren on tablets rather than on paper? Since handwriting is not automatized before the age of 10 years, children's handwriting movements require graphomotor and visual feedback as well as permanent control of movement execution during handwriting. Modifications in writing conditions, for instance the smoother writing surface of a tablet, might influence handwriting performance in general and in particular those of non-automatized beginning writers. In order to investigate how handwriting performance is affected by a difference in friction of the writing surface, we recruited three groups with varying levels of handwriting automaticity: 25 preschoolers, 27 second graders, and 25 adults. We administered three tasks measuring graphomotor abilities, visuomotor abilities, and handwriting performance (only second graders and adults). We evaluated two aspects of handwriting performance: the handwriting quality with a visual score and the handwriting dynamics using online handwriting measures [e.g., writing duration, writing velocity, strokes and number of inversions in velocity (NIV)]. In particular, NIVs which describe the number of velocity peaks during handwriting are directly related to the level of handwriting automaticity. In general, we found differences between writing on paper compared to the tablet. These differences were partly task-dependent. The comparison between tablet and paper revealed a faster writing velocity for all groups and all tasks on the tablet which indicates that all participants—even the experienced writers—were influenced by the lower friction of the tablet surface. Our results for the group-comparison show advancing levels in handwriting automaticity from preschoolers to second graders to adults, which confirms that our method depicts handwriting performance in groups with varying degrees of handwriting automaticity. We conclude that the smoother tablet surface requires additional control of handwriting movements and therefore might present an additional challenge for learners of handwriting.}, language = {en} } @article{GerthKlassertDolketal.2016, author = {Gerth, Sabrina and Klassert, Annegret and Dolk, Thomas and Fliesser, Michael and Fischer, Martin H. and Nottbusch, Guido and Festman, Julia}, title = {Is Handwriting Performance Affected by the Writing Surface? Comparing Tablet vs. Paper}, series = {Frontiers in psychology}, volume = {7}, journal = {Frontiers in psychology}, publisher = {Frontiers Research Foundation}, address = {Lausanne}, issn = {1664-1078}, doi = {10.3389/fpsyg.2016.01308}, pages = {18}, year = {2016}, language = {en} } @article{BontrupTaylorFliesseretal.2019, author = {Bontrup, Carolin and Taylor, William R. and Fliesser, Michael and Visscher, Rosa and Green, Tamara and Wippert, Pia-Maria and Zemp, Roland}, title = {Low back pain and its relationship with sitting behaviour among sedentary office workers}, series = {Applied ergonomics : human factors in technology and society}, volume = {81}, journal = {Applied ergonomics : human factors in technology and society}, publisher = {Elsevier}, address = {Oxford}, issn = {0003-6870}, doi = {10.1016/j.apergo.2019.102894}, pages = {8}, year = {2019}, abstract = {The relationships between sedentary lifestyle, sitting behaviour, and low back pain (LBP) remain controversial. In this study, we investigated the relationship between back pain and occupational sitting habits in 64 call-centre employees. A textile pressure mat was used to evaluate and parameterise sitting behaviour over a total of 400 h, while pain questionnaires evaluated acute and chronic LBP. Seventy-five percent of the participants reported some level of either chronic or acute back pain. Individuals with chronic LBP demonstrated a possible trend (t-test not significant) towards more static sitting behaviour compared to their pain-free counterparts. Furthermore, a greater association was found between sitting behaviour and chronic LBP than for acute pain/disability, which is plausibly due to a greater awareness of pain-free sitting positions in individuals with chronic pain compared to those affected by acute pain.}, language = {en} } @article{WippertFliesser2016, author = {Wippert, Pia-Maria and Fliesser, Michael}, title = {National doping prevention guidelines : Intent, efficacy and lessons learned}, series = {Substance abuse treatment, prevention, and policy}, volume = {11}, journal = {Substance abuse treatment, prevention, and policy}, publisher = {BioMed Central}, address = {London}, issn = {1747-597X}, doi = {10.1186/s13011-016-0079-9}, pages = {7}, year = {2016}, abstract = {Background Doping presents a potential health risk for young athletes. Prevention programs are intended to prevent doping by educating athletes about banned substances. However, such programs have their limitations in practice. This led Germany to introduce the National Doping Prevention Plan (NDPP), in hopes of ameliorating the situation among young elite athletes. Two studies examined 1) the degree to which the NDPP led to improved prevention efforts in elite sport schools, and 2) the extent to which newly developed prevention activities of the national anti-doping agency (NADA) based on the NDPP have improved knowledge among young athletes within elite sports schools. Methods The first objective was investigated in a longitudinal study (Study I: t0 = baseline, t1 = follow-up 4 years after NDPP introduction) with N = 22 teachers engaged in doping prevention in elite sports schools. The second objective was evaluated in a cross-sectional comparison study (Study II) in N = 213 elite sports school students (54.5 \% male, 45.5 \% female, age M = 16.7 ± 1.3 years (all students had received the improved NDDP measure in school; one student group had received additionally NADA anti-doping activities and a control group did not). Descriptive statistics were calculated, followed by McNemar tests, Wilcoxon tests and Analysis of Covariance (ANCOVA). Results Results indicate that 4 years after the introduction of the NDPP there have been limited structural changes with regard to the frequency, type, and scope of doping prevention in elite sport schools. On the other hand, in study II, elite sport school students who received further NADA anti-doping activities performed better on an anti-doping knowledge test than students who did not take part (F(1, 207) = 33.99, p <0.001), although this difference was small. Conclusion The integration of doping-prevention in elite sport schools as part of the NDPP was only partially successful. The results of the evaluation indicate that the introduction of the NDPP has contributed more to a change in the content of doping prevention activities than to a structural transformation in anti-doping education in elite sport schools. Moreover, while students who did receive additional education in the form of the NDPP"booster sessions" had significantly more knowledge about doping than students who did not receive such education, this difference was only small and may not translate to actual behavior.}, language = {en} } @article{WippertFliesser2016, author = {Wippert, Pia-Maria and Fliesser, Michael}, title = {National doping prevention guidelines: Intent, efficacy and lessons learned - A 4-year evaluation}, series = {Substance abuse treatment, prevention, and policy}, volume = {11}, journal = {Substance abuse treatment, prevention, and policy}, publisher = {BioMed Central}, address = {London}, issn = {1747-597X}, doi = {10.1186/s13011-016-0079-9}, pages = {7}, year = {2016}, abstract = {Background: Doping presents a potential health risk for young athletes. Prevention programs are intended to prevent doping by educating athletes about banned substances. However, such programs have their limitations in practice. This led Germany to introduce the National Doping Prevention Plan (NDPP), in hopes of ameliorating the situation among young elite athletes. Two studies examined 1) the degree to which the NDPP led to improved prevention efforts in elite sport schools, and 2) the extent to which newly developed prevention activities of the national anti-doping agency (NADA) based on the NDPP have improved knowledge among young athletes within elite sports schools. Methods: The first objective was investigated in a longitudinal study (Study I: t0 = baseline, t1 = follow-up 4 years after NDPP introduction) with N = 22 teachers engaged in doping prevention in elite sports schools. The second objective was evaluated in a cross-sectional comparison study (Study II) in N = 213 elite sports school students (54. 5 \% male, 45.5 \% female, age M = 16.7 +/- 1.3 years (all students had received the improved NDDP measure in school; one student group had received additionally NADA anti-doping activities and a control group did not). Descriptive statistics were calculated, followed by McNemar tests, Wilcoxon tests and Analysis of Covariance (ANCOVA). Results: Results indicate that 4 years after the introduction of the NDPP there have been limited structural changes with regard to the frequency, type, and scope of doping prevention in elite sport schools. On the other hand, in study II, elite sport school students who received further NADA anti-doping activities performed better on an anti-doping knowledge test than students who did not take part (F(1, 207) = 33.99, p < 0.001), although this difference was small. Conclusion: The integration of doping-prevention in elite sport schools as part of the NDPP was only partially successful. The results of the evaluation indicate that the introduction of the NDPP has contributed more to a change in the content of doping prevention activities than to a structural transformation in anti-doping education in elite sport schools. Moreover, while students who did receive additional education in the form of the NDPP "booster sessions" had significantly more knowledge about doping than students who did not receive such education, this difference was only small and may not translate to actual behavior.}, language = {en} } @article{ZempFliesserWippertetal.2016, author = {Zemp, Roland and Fliesser, Michael and Wippert, Pia-Maria and Taylor, William R. and Lorenzetti, Silvio}, title = {Occupational sitting behaviour and its relationship with back pain - A pilot study}, series = {Applied ergonomics : human factors in technology and society}, volume = {56}, journal = {Applied ergonomics : human factors in technology and society}, publisher = {Elsevier}, address = {Oxford}, issn = {0003-6870}, doi = {10.1016/j.apergo.2016.03.007}, pages = {84 -- 91}, year = {2016}, abstract = {Nowadays, working in an office environment is ubiquitous. At the same time, progressively more people suffer from occupational musculoskeletal disorders. Therefore, the aim of this pilot study was to analyse the influence of back pain on sitting behaviour in the office environment. A textile pressure mat (64-sensor-matrix) placed on the seat pan was used to identify the adopted sitting positions of 20 office workers by means of random forest classification. Additionally, two standardised questionnaires (Korff, BPI) were used to assess short and long-term back pain in order to divide the subjects into two groups (with and without back pain). Independent t-test indicated that subjects who registered back pain within the last 24 h showed a clear trend towards a more static sitting behaviour. Therefore, the developed sensor system has successfully been introduced to characterise and compare sitting behaviour of subjects with and without back pain. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licensesiby-nc-nd/4.0/).}, language = {en} } @article{WippertFliesserKrause2017, author = {Wippert, Pia-Maria and Fliesser, Michael and Krause, Matthias}, title = {Risk and protective factors in the clinical rehabilitation of chronic back pain}, series = {Journal of pain research}, volume = {10}, journal = {Journal of pain research}, publisher = {Dove Medical Press}, address = {Albany, Auckland}, issn = {1178-7090}, doi = {10.2147/JPR.S134976}, pages = {1569 -- 1579}, year = {2017}, abstract = {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.}, language = {en} } @article{FliesserDeWittHubertsWippert2017, author = {Fliesser, Michael and De Witt Huberts, Jessie and Wippert, Pia-Maria}, title = {The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain}, series = {BMC health services research}, volume = {17}, journal = {BMC health services research}, publisher = {BioMed Central}, address = {London}, issn = {1472-6963}, doi = {10.1186/s12913-017-2735-9}, year = {2017}, abstract = {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.}, language = {en} } @article{FliesserDeWittHubertsWippert2017, author = {Fliesser, Michael and De Witt Huberts, Jessie and Wippert, Pia-Maria}, title = {The choice that matters: the relative influence of socioeconomic status indicators on chronic back pain- a longitudinal study}, series = {BMC health services research}, volume = {17}, journal = {BMC health services research}, publisher = {BioMed Central}, address = {London}, issn = {1472-6963}, doi = {10.1186/s12913-017-2735-9}, pages = {8}, year = {2017}, abstract = {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.}, language = {en} }