New Zealand Guidelines Group
New Zealand Guidelines Group - New Zealand Guideline - Completed

Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss

Appendix 3: What methods can be used to identify Psychosocial Yellow Flags?

There are two major methods that can be used:

  • structured questionnaire
  • clinical assessment
A combination of both can also be used. The method chosen will depend on the clinical setting, and the treatment provider’s personal confidence at assessing these issues.

The advantages and disadvantages of the various methods are listed in Table 2. Become familiar with these in order to be able to counteract any disadvantages for the method chosen.

Table 2: Advantages and disadvantages of questionnaires and clinical assessments
Advantages of questionnaires
  • Quick to administer
  • Useful for screening large numbers
  • Little skill needed
  • Interpretation is usually unequivocal
  • Can be statistically based on evidence
Disadvantages of questionnaires
  • Require time to score, need to check for missing information
  • Unsuitable for those with reading problems
  • May not be applicable to all members of a community, eg, new immigrants
  • May only predict one goal, eg, work loss but not pain
  • May be too sensitive to time of measurement
  • Susceptible to confounding factors, such as social desirability, or ‘impression management’ such as the person telling you what they think you want to hear
Advantages of clinical assessments
  • Clinician can adapt readily to characteristics of the individual
  • Incorporates clinical experience
  • Facilitates establishing potential goals for intervention
  • Less susceptible to confounding factors, such as social desirability or ‘impression management’
  • Judgements about severity can be made
Disadvantages of clinical assessments
  • Potentially time consuming
  • May result in confused picture unless clinical skill level is adequate
  • Possibility of observer bias or prejudice Advantages of combinations of questionnaires with clinical assessments
  • Improved accuracy
  • Clinician can integrate quantitative information with clinical data
  • Can use two stage process with questionnaire as first stage filter to target clinical assessments Disadvantages of combinations of questionnaires with clinical assessments
  • Require more resources, including the need for adequate organisation and training
  • More time needed, potential for delays

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New Zealand Guidelines Group
New Zealand