Questions during the subjective examination investigating the worker’s beliefs and feelings towards the problem, home situation and influences from or on the workplace are an effective way of deepening rapport and obtaining a first hand impression of how the worker is coping.

Some questions to address coping issues for a worker with pain include (phrased in one's own style):

• Have you had time off work in the past for your injuries?
• What do you understand is the cause of your pain?
• What are you expecting will help you?
• How are your employer/ co-workers/ family responding to your condition?
• What are you doing to cope with your pain?
• When do you think you will return to work?
• Do you enjoy your job?
• Have any injuries in the past taken a long time to improve?
• Are you worried about not getting better?
• The key issue/question you must answer is "What can be done to help this person experience less distress and disability?"

Alternatively, you may decide to ask the worker to complete a questionnaire to initiate awareness of issues that need to be explored and potentially addressed or resolved. Links to various questionnaires can be found on the outcome measures page.

The following factors predict poor outcomes:

• The presence of a belief that all pain is always harmful/ potentially severely disabling
• Fear-avoidance behaviour (avoiding movement or activity due to misplaced anticipation of harm from any increase in pain) and reduced activity levels
• Tendency to low mood and withdrawal from social interaction
• An expectation that passive treatment rather than active participation in therapy would help.

A resource document has been created to provide more detail about yellow flags. The document contains information about risk categories including attitudes and beliefs about pain and dysfunction, behaviours, compensation issues, diagnosis and treatment, emotions, family and work.

A guide to assessing and managing red and yellow flags for workers compensation patients [268 KB]

A worker may be considered to be 'at risk' if:

• there is a cluster of a few very salient yellow flag factors
• there is a group of several less important yellow flag factors that combine cumulatively.

The presence of risk factors should alert the clinician to addressing or resolving these issues early, preventing them from becoming entrenched and causing or contributing to poor or delayed health outcomes. They are often easier to address at early stages. Psychological referrals will assist more difficult therapeutic situations. Therapeutic rapport and fostering self-efficacy is essential to ensure successful treatment outcomes.

Suggested steps to help those workers who may be 'at risk':

• Provide a positive expectation that the worker will return to work and normal activity. This is true of the majority of injuries other than catastrophic injuries. Encourage a regular expression of interest from the employer.
• Help to maintain positive cooperation between the individual, the employer, the claims and rehabilitation staff and other health professionals. Encourage collaboration wherever possible.
• Make a concerted effort to communicate that having more time off work reduces the likelihood of a successful return to work. In fact, longer periods off work result in reduced probability of ever returning to work and to normal life activities.
• Keep the worker active and at work if at all possible, even for a small part of the day. This will help to maintain work habits and work relationships. Consider reasonable requests for selected duties and modifications to the workplace.
• Promote self-management and self-responsibility. Encourage the development of self-efficacy to return to work. Be aware that developing self-efficacy will depend on incentives and feedback from treatment providers and others. If recovery is hindered by fear of movement, fear of pain or fear or re-injury, these issues need to be specifically addressed.