Yellow Flags (week 2) Flashcards
Yellow flags
factors that increase the risk of developing or perpetuating long term disability, persistent pain and work loss
Fear avoidance
When fear to move is high and lasts for a long time
Pain catastrophizing- affects what diagnoses most
pt feels helpless in dealing with pain. Worse prognosis with neck and back pain
Questionnaires to look for yellow flags- and what does it predict
Orebro- Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ)- looks at perceived mental and physical health and predicting persistent pain, disability
2) PROMIS- depression and anxiety- screening for anxiety
PTs ability to identify yellow flags for low back pain
PTs are poor at doing this and this is what questionnaires are for
4 pathways to go with PT when concerning yellow flags and referral
1) Standard PT
2) psychologically informed PT
3) PIPT with referral
4) immediate referral
Standard PT vs PIPT
Standard PT- low impact of yellow flags, no symptoms of mental illness
PIPT- moderate affects of yellow flags, no symptoms of mental illness
PIPT with referral vs immediate referral
PIPT with referral- moderate to high yellow flags and symptoms of mental illness
Immediate referral- signs of severe mental illness- depression, suicidal tendencies, PT/self-management not appropriate
Components of the PROMIS Questionnaire
1) Pain interference questionnaire
2) Physical Function questionnaire
3) Depression/anxiety questionnaire
Scoring of the PROMIS
Raw score vs T score
- Raw score- sum of numbers on the questionnaire
-T-score- number of standard deviations from the mean. with T score on the PROMIS- 50= the mean
Suicideal idealation- % of suicides where they talked about PCP first
90%
How to handle suicidal idealation patients
If score high depression scores and mention suicide, ask details about plan, access to means, intent, if significant evidence of risk call EMS
Standard deviation of the PROMIS pain interference and PROMIS physical function questionnaires
10
