FLAGS

Question 1

THE 5 DIFFERENT TYPES OF FLAGS

Answer 1

Red
Orange
Yellow
Blue
Black

Question 2

RED FLAGS - NATURE

Answer 2

Signs of serious pathology

Question 3

RED FLAGS - EXAMPLES

Answer 3

Cauda equina syndrome
Fracture
Tumour
Unremitting night pain
Sudden weight loss (10lbs over 3 months)
Bladder and bowel incontinence
Previous history of cancer
Saddle anaesthesia

Question 4

ORANGE FLAGS - NATURE

Answer 4

Psychiatric symptoms

Question 5

ORANGE FLAGS - EXAMPLES

Answer 5

Depression
Anxiety

Question 6

YELLOW FLAGS - NATURE

Answer 6

Beliefs, appraisals and judgements
Emotional Responses
Pain behaviour (including pain and coping strategies)

Question 7

YELLOW FLAGS - EXAMPLES

Answer 7

Beliefs, appraisals and judgements
* Unhelpful beliefs about pain
* Indication of injury as uncontrollable or likely to worsen.
* Expectations of poor treatment outcome
* Delayed return to work
Emotional Responses
* Distress not meeting criteria for diagnosis of mental disorder
* Worry, fears, anxiety
Pain behaviour (including pain and coping strategies)
* Avoidance of activities due to expectations of pain and possible reinjury.
* Over-reliance on passive treatments

Question 8

BLUE FLAGS - NATURE

Answer 8

Perceptions about the relationship between work and health

Question 9

BLUE FLAGS - EXAMPLES

Answer 9

Belief that work is too onerous and likely to cause further injury
Belief that workplace supervisor and workmates are unsupportive

Question 10

BLACK FLAGS - NATURE

Answer 10

System or contextual obstacles

Question 11

BLACK FLAGS - EXAMPLES

Answer 11

Legislation restricting options for return to work
Conflict with insurance staff over injury claim
Overly solicitous family and health care providers
Heavy work, with little opportunity to modify duties

Question 11

YELLOW FLAGS - FURTHER DETAIL

Answer 11

Obstacles that can be classed as yellow flags include many aspects of thoughts, feelings and behaviours.

• Catastrophising – thinking the worst
• Finding painful experiences unbearable, reporting extreme pain disproportionate to the condition
• Having unhelpful beliefs about pain and work – for instance, ‘if I go back to work my pain will get worse’
• Becoming preoccupied with health, over-anxious, distressed and low in mood
• Fear of movement and of re-injury
• Uncertainty about what the future holds
• Changes in behaviour or recurring behaviours
• Expecting other people or interventions to solve the problems (being passive in the process) and serial visits to various practitioners for help with no improvement

Question 12

BLUE FLAGS - FURTHER DETAIL

Answer 12

Blue flags can be considered in terms of the employee and the workplace. The employee often has fears and misconceptions about work and health based on their own previous experiences or those of others in the company they work for, or stories from the neighbours.

• Concerns about whether the person is able to meet the demands of the job
• Low job satisfaction
• Little or poor support at work
• A perception that the job is very stressful
• An accommodating approach in the workplace to providing altered duties or modified work options to facilitate a return to work
• Poor communication between employer and employee.

Question 13

BLACK FLAGS - FURTHER DETAIL

Answer 13

There is some overlap between blue and black flags, but they can be primarily distinguished by the black flags being those that are outside the immediate control of the employee and/or the team trying to facilitate the return to work.

• Misunderstandings among those involved
• Financial issues and/or claims procedures
• Sensationalist media reports
• Family and friends with strong unhelpful beliefs influencing the employee
• Social isolation and becoming disconnected from the workforce