Yellow Flags…

Yellow Flags have great utility when dealing with someone who has low back pain or pain in general. They determine someone’s psychosocial risk factors for treatment and their potential outcome. Multiple studies have shown that psychological factors may be more strongly associated with change in pain intensity, number of physician visits, and physical disability than physical factors such as strength and range of motion (Lentz et al. 2016). Some yellow flags are (Gifford 2014) …

  • Reporting severely high pain levels, especially in acute stages as well as radiation of pain.
  • Self reported high disability
  • Poor beliefs and coping skills
    • Specific beliefs about pain and treatment: Pessimistic beliefs about pain and the value of various treatment or diagnoses.
    • Fear Avoidance: fears about pain and harm with movement and activity
    • Pain Coping Styles and Strategies: maladaptive coping styles such as waiting for the pain to go away, combination of avoidance and rest, high levels of medication, ongoing use of supports, aids, and therapists
  • Psychological Distress
    • Exaggerated attention to bodily symptoms
    • Anxiety
    • Anger
    • Development of depression
  • Pain Behavior
    • High levels of pain behavior in the simplest of tasks
    • Use of extended rest and reduced activity level/withdrawal
    • Avoidance of normal activity
    • Poor or reduced sleep
    • High intake of alcohol or other substances
  • Socio-economic Factors: Litigation and worker compensation
    • Incapacity rates will be higher where there are more generous allowances for disability
    • Workers are more likely to be absent from work where compensation wages closely approximate working wages
    • Those engaged in litigation will remain off work longer
    • Level of incapacity will improve on the completion of litigation or receipt on compensation

Obviously there are many ways of determining such yellow flags and possible outcome. The first one is your subjective exam. You can gain a whole lot of knowledge from a subjective exam especially when looking for relevant injury factors as well as psychological factors.

The second way is to use outcome measures such as the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) and the Optimal Screening for Prediction of Referral and Outcome – Yellow Flags questionnaire (OSPRO-YF). They are two very good outcome measures but the ÖMPQ is limited in their capacity to dictate which specific psychological factors should be addressed. The OSPRO-YF is a relatively new outcome measure but provides a viable option for assessing more psychological factors. Adding questionnaires like these can allow for both a broader view of the patients experience as well as a specific insight into cause, outcome, and viable treatment options.

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