Screening for Yellow Flags in Orthopaedic Physical Therapy: A Clinical Framework

Area of Science:

• Physical Therapy
• Musculoskeletal Pain Management
• Psychological Factors in Health

Background:

• Psychological factors significantly impact physical function, pain levels, and healthcare costs in musculoskeletal conditions.
• Clinical guidelines advocate for screening psychological factors (yellow flags) in physical therapy to enhance prognosis and shared decision-making.
• Despite recommendations, yellow flag screening remains infrequent due to clinician uncertainty regarding integration and application.

Purpose of the Study:

• To present a practical framework for implementing routine yellow flag screening in physical therapy.
• To guide clinicians on integrating screening into musculoskeletal care for improved patient outcomes.
• To facilitate informed decision-making and care coordination based on psychological screening results.

Main Methods:

• A 3-step framework for yellow flag screening is proposed: (1) standardized screening instrument and process, (2) interpretation for shared decision-making, and (3) monitoring treatment progress.
• The framework aims to inform treatment pathway selection and improve interdisciplinary communication.
• Case examples are provided to illustrate the application of the screening framework.

Main Results:

• The 3-step framework facilitates the integration of yellow flag screening into routine physical therapy practice.
• Screening results help determine appropriate treatment pathways, ranging from standard physical therapy to specialized interventions or referrals.
• The framework supports clinicians and patients in making informed decisions about care.

Conclusions:

• Routine yellow flag screening is essential for optimizing care in patients with musculoskeletal pain.
• The proposed framework provides a clear, actionable approach for physical therapists to implement screening.
• Integrating yellow flag screening enhances personalized treatment planning and interprofessional collaboration.