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Original article
Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx)
  1. Pia-Maria Wippert1,
  2. Anne-Katrin Puschmann1,
  3. Adamantios Arampatzis2,
  4. Marcus Schiltenwolf3,
  5. Frank Mayer4
  1. 1 Department of Sociology of Health and Physical Activity, Universität Potsdam, Potsdam, Germany
  2. 2 Department of Training and Movement Sciences, Humboldt-Universitat zu Berlin, Berlin, Germany
  3. 3 Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
  4. 4 Centre of Sports Medicine, University Outpatient Clinic, Universität Potsdam, Potsdam, Germany
  1. Correspondence to Pia-Maria Wippert, Department of Sociology of Health and Physical ActivityUniversität PotsdamPotsdamGermany; wippert{at}uni-potsdam.de

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.

  • psychology
  • back injuries
  • rehabilitation
  • prevention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjsem-2017-000295

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    Footnotes

    • Contributors All authors substantially contributed to the conception and realisation of the studies. PMW wrote the first draft of the manuscript and all authors critically revised the manuscript for important intellectual content. PW was responsible for methodological design and analysis related to all psychosocial factors; PMW, AKP and MS provided scientific and practical information for the psychosocial content. AKP provided the statistical analysis and information. AA and FM provided all scientific information for biomechanical and medical content. FM conceived of the study as principal investigator. All authors read and approved the final manuscript.

    • Funding The present study was funded by the German Federal Institute of Sport Science on behalf of the Federal Ministry of the Interior of Germany. It was realised within MiSpEx – the National Research Network for Medicine in Spine Exercise (grant-number: 080102A/11-14). All sources of funding for the research reported are declared. The funder did not influence data collection, analysis, interpretation or writing of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethics approval from the University of Potsdam, Germany (number 36/2011).

    • Provenance and peer review Not commissioned; internally peer reviewed.