Screening for yellow flags in orthopaedic physical therapy: a clinical framework

Review written by Dr Sandy Hilton info

Key Points

  1. To address biological, psychological, and social aspects, it can be efficient to use screening forms for consistency.
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BACKGROUND & OBJECTIVE

Pain and the treatment of pain make up the bulk of physical therapy cases. Neurological distress and disease, the long-term effects of chronic disease, and the emerging challenge of Long Covid all share the need of addressing a biopsychosocial framework in order to individualize interventions.

To address biological, psychological, and social distress, it is efficient to use screening forms for consistency. The authors of this clinical commentary suggested the use of consistent screening for yellow flags in order to identify areas of need at the beginning of care. There are multiple options; this paper used the Optimal Screening for Prediction of Referral and Outcome Yellow Flag tool (OSPRO-YF) as the example (1).

There is consensus in the International Association for the Study of Pain (IASP) in their interdisciplinary education criteria of the importance of psychological distress as well as physical function (2). Multiple clinical practice guidelines also recommend standard screening of yellow flags as well as referral to other professionals as needed for proper management.

Despite these recommendations there is not yet a consistent use of screening for yellow flags in physical therapy (3). The authors of this commentary provided a clear framework that is adaptable to move the conversation about screening for yellow flags, to discussions on how to use the information to guide clinical practice.

Multiple clinical practice guidelines also recommend standard screening of yellow flags as well as referral to other professionals as needed for proper management.
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Screening for yellow flags is appropriate for all patients in physical therapy regardless of their diagnosis.

CLINICAL FRAMEWORK

A three-step framework is proposed to create clinical consistency:

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