Abstract
Introduction
Yellow flags are psychosocial indicators which are associated with a greater likelihood of progression to persistent pain and disability and are referred to as obstacles to recovery. It is not known how effective clinicians are in detecting them. Our objective was to determine if clinicians were able to detect them in secondary care.
Methods
111 new referrals in a specialist spine clinic completed the Oswestry Disability Index (ODI) and a range of other validated questionnaires including the yellow flag questionnaire adapted from the psychosocial flags framework. Clinicians blinded to the patient data completed a standardized form to determine which and how many yellow flags they had identified.
Results
The average number of yellow flags per patient was 5 (range: 0–9). Clinician sensitivity in detecting yellow flags was poor, identifying only 2 on average. The most common yellow flag reported by patients was fear of movement or injury (88%), and this was also the yellow flag most frequently missed by clinicians, being identified correctly in only 45% of patients. The most commonly misidentified was patient uncertainty, in 28% of patients. Patients who reported more yellow flags were more likely to score higher on their ODI (p<0.01), Modified somatic perception score (p<0.01) and Modified Zung Depression Index (p<0.01). They also had poorer Low Back Outcome Scores (LBOS) (p<0.01).
Conclusion
Clinician sensitivity in detecting yellow flags is poor. Improved identification of obstacles to recovery may improve outcomes. Clinicians may improve detection of these obstacles by having a simple set of questions completed by the patient.
