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The flags model: Indicators of poor outcomes or delayed recovery

The flags model identifies indicators of poor outcomes or delayed recovery.

Red Flags

Medical

Serious pathology/diagnosis

Co-morbidity (i.e. co-existence of other diseases)

Failure of treatment

Yellow Flags

Psychosocial

Beliefs about pain & injury (e.g. that there is a major underlying illness/disease, that avoidance of activity will help recovery, that there is a need for passive physical treatments rather than active self-management)

Psychological distress (e.g. depression, anger, bereavement, frustration)

Unhelpful coping strategies (e.g. fear of pain and aggravation, catastrophising, illness behaviour, overreaction to medical problems)

Perceived inconsistencies and ambiguities in information about the injury and its implications

Failure to answer patients’ and families’ worries about the nature of the injury and its implications

Blue Flags

Perceived features of work or the social environment

High demand/low control

Unsupportive management style

Perceived time pressure

Lack of job satisfaction

Work is physically uncomfortable

Black Flags

Not matters of perception, affect all workers equally

Employer’s rehabilitation policy deters gradual reintegration or mobility

Threats to financial security

Qualification criteria for compensation (eg where inactivity is a qualification criterion)

Financial incentives

Lack of contact with the workplace

Duration of sickness absence

References:

Psychology, Personal Injury and Rehabilitation, A Report of a Working Party of the International Underwriting Association of London and the Association of British Insurers, 2004.

Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain, Risk Factors for Long-Term Disability and Work Loss, Accident Compensation Commission, New Zealand, January 1997.