Early Identification and Management of Psychological Risk Factors ("Yellow Flags") in Patients With Low Back Pain: A Reappraisal
Early Identification and Management of Psychological Risk Factors ("Yellow Flags") in Patients With Low Back Pain: A Reappraisal
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DOI：
10.2522/ptj.20100224
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发表时间：
2011-05-01
期刊：
影响因子：
3.2
通讯作者：
Main, Chris J.
中科院分区：
文献类型：
--
作者：
Nicholas, Michael K.;Linton, Steven J.;Main, Chris J.
最初，“黄旗”一词用于描述肌肉骨骼疼痛发作后导致残疾的社会心理预后因素。通过早期筛查识别黄旗有望促进干预指南的应用，以实现二级预防。在最近的黄旗概念中，有人建议其适用范围应主要限于心理风险因素，以将其与其他风险因素（例如社会和环境变量）区分开来。本文解决了这一发展中出现的 2 个具体问题：(1) 黄旗是否会影响急性或亚急性腰痛患者的治疗结果？ (2) 干预措施能否针对黄旗以产生更好的结果？已经发现一致的证据支持各种心理因素在预后中的作用，尽管关于哪些因素是最重要的（单独的和组合的）以及它们如何影响结果仍然存在疑问。已发表的早期干预措施报告的结果好坏参半，但总体而言，证据表明，针对黄旗，特别是当黄旗处于高水平时，似乎确实比忽视黄旗或不考虑心理风险因素而向人们提供综合干预措施更能带来一致的积极结果。预后不良的心理危险因素可以在临床上识别并在干预措施中得到解决，但仍然存在与时机、必要技能、治疗内容和背景等问题相关的问题。此外，仍然需要阐明变化机制，并将这种理解更好地融入慢性疼痛和残疾二级预防的更广泛背景中。
Originally the term "yellow flags" was used to describe psychosocial prognostic factors for the development of disability following the onset of musculoskeletal pain. The identification of yellow flags through early screening was expected to prompt the application of intervention guidelines to achieve secondary prevention. In recent conceptualizations of yellow flags, it has been suggested that their range of applicability should be confined primarily to psychological risk factors to differentiate them from other risk factors, such as social and environmental variables. This article addresses 2 specific questions that arise from this development: (1) Can yellow flags influence outcomes in people with acute or subacute low back pain? and (2) Can yellow flags be targeted in interventions to produce better outcomes? Consistent evidence has been found to support the role of various psychological factors in prognosis, although questions remain about which factors are the most important, both individually and in combination, and how they affect outcomes. Published early interventions have reported mixed results, but, overall, the evidence suggests that targeting yellow flags, particularly when they are at high levels, does seem to lead to more consistently positive results than either ignoring them or providing omnibus interventions to people regardless of psychological risk factors. Psychological risk factors for poor prognosis can be identified clinically and addressed within interventions, but questions remain in relation to issues such as timing, necessary skills, content of treatments, and context. In addition, there is still a need to elucidate mechanisms of change and better integrate this understanding into the broader context of secondary prevention of chronic pain and disability.