MAnAging MUSCULOSkELEtAL PROBLEMS
The identification of relevant players with the goal of restoring This is easily remembered by
obstacles that delay recovery the person to activity and work. the phrase:
and return to activity and work
is now divided into three types: Implement it efficiently so that each IDENTIFY flags,
responsible player knows what develop a PLAN,
Yellow Flags are about the actions to take and when. take ACTION.
person – they are largely
psychosocial factors associated
with unfavourable clinical
outcomes and the transition to
persistent pain and disability.
Blue Flags are about the Identifying flags
workplace – they stem largely from
perceptions about the relationship Flags are features of the person, their musculoskeletal problem, and how
between work and health, and are they interact with the world around them. They can be identified by asking
associated with reduced ability to questions or making observations. Flags occur in three main domains and
work and prolonged absence. these are colour coded for convenience:
Black Flags are about the context Person Flags (Yellow) Workplace
in which the person functions, Thoughts ª Lack of job accommodations/
and include relevant people, • Catastrophising (focus on worst modified work
systems and policies. These may possible outcome, or interpretation ª Lack of employer communication
operate at a societal level, or in that uncomfortable experiences are with employees
the workplace. They are especially unbearable)
important since they may block • Dysfunctional beliefs and Context Flags (Black)
the helpful actions of healthcare expectations about pain, work and • Misunderstandings and
and the workplace. Contextual healthcare disagreements between key players
factors that cannot be changed • Negative expectation of recovery (e.g. employee and employer, or with
need to be identified so that they • Preoccupation with health healthcare).
can be navigated around. Black • Financial and compensation
Flags indicate the potential need to Feelings problems.
involve relevant others and/or other • Worry, distress, low mood (may or • Process delays (e.g. due to mistakes,
professionals. may not be diagnosable anxiety or waiting lists, or claim acceptance).
depression) • Overreactions to sensationalist media
This framework is easily • Fear of movement reports.
remembered with the phrase: • Uncertainty (about what’s happened, • Spouse or family member with
“Person, Workplace, Context”. It what’s to be done, and what the negative expectations, fears or beliefs.
places emphasis on appreciating future holds) • Social isolation, social dysfunction.
how Flags contribute to creating • Unhelpful policies/procedures used
an obstacle, and then working Behaviours by company
out how it can be overcome or • Extreme symptom report
bypassed. • Passive coping strategies Multiple flags – psychosocial variables
• Serial ineffective therapy can have a cumulative effect - because
The practical approach to using the Flags interact, people often have
Flags is based on three key Workplace Flags (Blue) multiple obstacles across domains – a
steps - recognising that looking Employee Flag in one domain does not exclude one
for flags should be routine for all • Fear of re-injury from another: rather it makes it more likely.
musculoskeletal problems. • High physical job demand
• Low expectation of resuming work The presence of Flags indicates an
Identify specific obstacles to • Low job satisfaction increased likelihood of an unfavourable
recovery, activity and work. • Low social support or social course of recovery with respect to level of
Develop a plan to target these dysfunction in workplace function and productive activity. They do
obstacles, coordinated among key • Perception of high job not necessarily indicate the presence, or
demand/‘stress’ severity, of persisting pain.
The Backcare Journal 21
backcare Winter 2009/10.indd 21 8/1/10 11:19:48
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