Rethinking yellow flags

Stewart, Jennie; Kempenaar, Larissa; Lauchlan, Douglas

doi:10.1016/j.math.2010.11.005

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…The education of physiotherapists should provide a key understanding of behavioural learning principles as well as skills training to manage both red flags and yellow flags (Main and George, 2011). Stewart, Kempenaar, and Lauchlan (2011) have highlighted the need of a deep understanding of the role of psychological factors in this context, so that assessment of yellow flags in back pain is not reduced to a mechanical procedure according to a checklist.…”

Section: Discussionmentioning

confidence: 99%

“…The necessity of integrating psychological factors in standard physiotherapy care of patients with low back pain has been highlighted in several recent studies (Linton and Shaw, 2011;Main and George, 2011;Nicholas et al, 2011;Shaw, Main, and Johnston, 2011;Stewart, Kempenaar, and Lauchlan, 2011). Implications for training stress the need to develop the professional role and education of physiotherapists to meet the demands of evidence-based treatment (Main and George, 2011).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

Demmelmaier

Denison

Lindberg

et al. 2011

Physiotherapy Theory and Practice

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The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0-10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

Demmelmaier

Denison

Lindberg

et al. 2011

Physiotherapy Theory and Practice

View full text Add to dashboard Cite

show abstract

“…2 Appreciating the impact of the disorder on an individual's function and life is paramount in treatment planning. Distress and an inability to work can prove barriers to treatment compliance, 8 whereas determining a patient's expectations and beliefs has been shown to be an instrumental part of establishing a therapeutic relationship, affecting outcomes. 9,10 Pain, nature and behaviour…”

Section: Impact Of Stiffness On Activities Of Daily Livingmentioning

confidence: 99%

Conservative management of the post-traumatic stiff elbow: a physiotherapist’s perspective

Jones

2016

Shoulder & Elbow

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“…However, considering only cognitive and behavioral factors constitutes a threatening reductionism of the biopsychosocial model that has underlain their identification. Stewart et al published an interesting paper questioning the current ideas and clinical applications related to psychosocial factors ( 114 ). They deplored the narrowness and superficiality of the way the biopsychosocial model has been understood and applied in most research works and guidelines.…”

Section: Interventions Focusing On Psychosocial Risk Factors In Non-smentioning

confidence: 99%

Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care

et al. 2015

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Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients’ or HCPs’ overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.

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Rethinking yellow flags

Cited by 18 publications

References 14 publications

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

Conservative management of the post-traumatic stiff elbow: a physiotherapist’s perspective

Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care

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