Lumbar disorders: screening for yellow flags
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Lumbar disorder screening - An explanation of yellow flag screening for patients with lumbar disorders
Yellow Flags (PDF 106KB) are psychosocial factors that increase the risk of developing or perpetuating long-term disability and work loss associated with low back pain.
Kendall et al. (1997) developed guidelines for assessing ‘yellow flags’ in acute low back pain, outlining factors that should be assessed particularly when progress is slower than expected. The presence of such factors is a prompt for further detailed assessment and early intervention. ‘Red flags’ and ‘yellow flags’ are not mutually exclusive and intervention may be required to address both clinical and psychosocial risk factors.
There is good agreement that the following factors are important and consistently predict poor recovery outcomes:
Below are some questions to assist you in identifying potential psychosocial barriers to recovery. These questions are to be phrased in your own words.
Suggestions for early behavioural management of low back pain.
The Keele STarT Back Screening Tool is a brief, validated tool (Hill et al 2008), designed to screen primary care patients with low back pain for prognostic indicators that are relevant to initial decision making.
The instrument is being used by a range of clinicians to systematically identify patients ‘at risk' of persistent symptoms.
The 9-item tool is designed to classify patients into one of three subgroups for targeted primary care management:
For patients who are identified at high risk of persistent symptoms referral to psychology and counselling services should be considered. A list of local services are available in the Psychology and counselling services information sheet (PDF 164KB).
Further information regarding assessing psychosocial yellow flags in acute low back pain as well as details of the acute low back pain screening questionnaire (PDF 589KB) is available on the New Zealand Guidelines Group website.