Diagnosis of psychosocial risk factors in prevention of low back pain in athletes (MiSpEx)

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 nonathletes). 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.

Psychosocial Moderators and Mediators of Sensorimotor Exercise in Low Back Pain: A Randomized Multicenter Controlled Trial

“…They provide insight into a possible interaction between pain and exercise, and its dose-response relationship. Further research in this area is needed for the development of diagnostic tools ( 76 , 77 ) and personalized therapy modules with reinforcing effects for self-management care ( 35 ). This would lead to a great benefit for future therapy and prevention concepts.…”

Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population

“…Since the etiology of non-specific LBP is indeed multifactorial ( Cholewicki et al, 2005 ), this pathology is not only related to neuromuscular deficits. Psychosocial factors like cognitive beliefs, emotional states, distress, or social context also play an important role related to the appearance and evolution of chronic LBP ( Refshauge and Maher, 2006 ; Wippert et al, 2017 ). These factors were outside the scope of the current study and were not considered in the analysis.…”

“…For example, pain perception and pain modulation in athletes can be different compared to normally active controls ( Tesarz et al, 2012 , 2013 ). Recently, it has been reported that athletes show significantly lower psychosocial risk profiles and prognostic risks compared to non-athletes ( Wippert et al, 2017 ). Although both muscle strength and neuromuscular control of trunk stability have been often investigated in non-athletes, knowledge regarding these properties in elite athletes with and without non-specific LBP is limited ( Trompeter et al, 2017 ).…”

Assessment and classification of peripheral pain in athletes: a scoping review protocol

“…Some general population psychosocial risk factor assessment tools have been applied successfully to athletes with thresholds being developed for identifying athletes at risk of going on to develop chronic low back pain. 15 Improved understanding and assessment has paved the way for athletic back pain specific biopsychosocial management approaches (neuroscience education and cognitive functional therapy) to be developed. 16 17 Reporting guidelines, injury classification and coding systems have facilitated injury assessment models for a range of common peripheral sports injuries including ankle sprains and femoral acetabular impingement.…”

“…Some general population psychosocial risk factor assessment tools have been applied successfully to athletes with thresholds being developed for identifying athletes at risk of going on to develop chronic low back pain. 15 Improved understanding and assessment has paved the way for athletic back pain specific biopsychosocial management approaches (neuroscience education and cognitive functional therapy) to be developed. 16 17 …”