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Table 2 Observation protocol for PTs’ assessment of red and yellow flags

From: Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care

Definition of red flags Examples of PTs’ questions to assess red flags
Trauma Have you experienced any trauma related to your pain?
Severe diagnosis Have you had cancer or any other severe diagnosis?
Severe spinal pathology Have you experienced radiating leg pain?
Patterns or symptoms not related to mechanical pain How is your health in general?
Numbness and paresthesia in the perianal region Have you had any bowel and bladder disorders?
Difficulty with micturition  
Weakness or numbness in the legs related to back pain Have you felt any weakness or numbness in your legs?
Definition of yellow flags Examples of PTs’ questions to assess yellow flags
Beliefs, appraisal, and judgments
Unhelpful beliefs about pain What are your thoughts about the pain?
Expectations of poor treatment outcome What are your thoughts about recovery?
What do you think about your capability to work?
Which factors do you think affect your pain?
Emotional responses
Distress not meeting the criteria for diagnosis of mental disorder Are you worried about your pain?
How does the pain affect your mood?
Worry, fears and anxiety Are you distressed about the pain?
Are you avoiding doing any activities due to pain?
Pain behavior and coping strategies
Avoidance of activities due to expectations of pain and possible re-injury Do you avoid activities due to pain?
What are you doing when having pain?
Over-reliance on passive treatments What are your thoughts about pain relief?
What activities are difficult for you due to pain?