Ability of Spine Specialists to Identify Psychosocial Risk Factors as Obstacles to Recovery in Patients with Low Back Pain-Related Disorders

• Published in: Asian spine journal Vol. 15; no. 2; pp. 224 - 233
• Main Authors: Patel, Mohammed Shakil, Lee, Kwang Chear, Dhake, Rakesh Padmakar, Longworth, Stephen, Sell, Philip
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Spine Surgery 01-04-2021; Korean Spine Society; 대한척추외과학회
• Subjects: Back pain; Clinical Study; Flags; Injuries; Low back pain; lower back pain; Mental depression; Orthopedics; Outpatient care facilities; Patients; psychosocial factors; Questionnaires; Risk assessment; Risk factors; Sick leave; Spine; 정형외과학; United Kingdom > UK; Lower back pain; Psychosocial factors; Questionnaires
• ISSN: 1976-1902; 1976-7846
• DOI: 10.31616/asj.2019.0377

Prospective study.
Yellow flags are psychosocial associated with a greater likelihood of progression to persistent pain and disability. These are referred to as obstacles to recovery. Despite their recognized importance, it is unknown how effective clinicians are in detecting them. The primary objective of this study was thus to determine the effectiveness of spine specialist clinicians in detecting the presence of yellow flags in patients presenting to an orthopedic outpatient clinic with low back-related disorders.
Psychosocial factors have been previously studied as important predictors of prognosis in patients with low back pain. However, the ability of spinal specialist to identify them remains unknown.
A prospective, single-center, consecutive cohort study was conducted over a period of 30 months. All new patients with low back-related disorders regardless of pathology completed a Yellow Flag Questionnaire that was adapted from the psychosocial flags framework. Clinicians assessing these patients completed a standardized form to determine which and how many yellow flags they had identified during the consultation.
A total of 130 patients were included in the analysis, and the clinicians reported an average of 5 flags (range, 0-9). Fear of movement or injury was the most frequently reported yellow flag, reported by 87.7% (n=114) of patients. Clinician sensitivity in detecting yellow flags was poor, correctly identifying only 2 flags, on average, of the 5 reported by patients, with an overall sensitivity of only 39%.
The ability of spine specialists to identify yellow flags is poor and can be improved by asking patients to complete a simple screening questionnaire.