What is The Flag System?
There are many ways to classify the pathologies that patients suffer from when they visit a physiotherapist. The flag system is frequently used when it comes to the classification of injuries.
First of all, it’s important to rule out certain conditions and to know how to differentiate cause from effect. Afterward, physiotherapy techniques are used in order to obtain the desired results.
What is the flag system?
The concept, which sounds rather strange, is actually an effective triage method. As a triage tool, it allows therapists to classify the pathology that a patient is suffering from and it also helps to chart the best therapeutic path to take. Since it’s a triage tool, it may also suggest that the best option is to refer the patient to another specialist.
The system gained popularity as physiotherapists began to take both physiological and social factors into account when it came to treating patients. In other words, physiotherapists no longer look at an injury as an isolated pathology.
The flag system classifies different attributes by color into two main groups: clinical flags and psycho-social flags. The clinical flags represent attributes that are directly related to the patient’s pathology and they usually recommend a referral to another specialist.
On the other hand, the psycho-social flags represent attributes that worsen the patient’s prognosis. In other words, it represents the bio-psychosocial attributes that the patient will have to overcome in order to achieve a full recovery.
Flag system: clinical
Red flags
Red flags indicate that a serious pathology may exist and that the patient should seek urgent medical care. If a physiotherapist detects a red flag, the first course of action is to refer the patient to a specialist in the corresponding department.
Examples of red flags include neurological, circulatory, infectious, and systemic diseases. Muscular and skeletal system diseases can also be interpreted as red flags.
Orange flags
An orange flag indicates psychiatric symptoms. In this case, the physiotherapist may investigate if the pathology is influenced by psychological factors.
They may also refer the patient to a specialist in order to ensure a full recovery. Examples of orange flags are stress, depression, personality disorders, etc.
Psycho-social flag system
Yellow flags
Yellow flags refer to the intrinsic characteristics related to thoughts and attitudes. When it comes to yellow flags the following aspects are considered: beliefs, emotional attitudes, and pain response.
Belief has to do with whether the patient believes that they’ll recover. An emotional attitude has to do with the stress or anxiety that the patient is experiencing. The pain response is defined by how the patient handles pain.
Blue flags
Blue flags refer to the relationship between the patient’s health and their job. Do you think that your job is too stressful? Do your co-workers make your life more difficult? These are a few questions that the psychotherapist may ask in order to investigate the presence of blue flags.
Black flags
Black flags are the final category in the flag system. They address the factors that the patient has no control over. It may include attributes such as financial problems or a high-stress job, etc.
Sometimes blue flags may be confused with black flags. The difference between the two is that blue flags are perceptions that the patient may have about their job and black flags have to do with the real and verifiable contextual obstacles that the patient may be facing.
An efficient flag system
As you can see, the flag system deals with diverse issues. On one hand, it’s used to identify issues such as, and for example, if the patient has a tumor and needs to be referred to oncology. It also allows for the identification of psycho-social aspects which are important in order to achieve a full recovery.
The importance of the flag system is due to the fact that it combines both the physical and psychological aspects that are affected by an injury.
Nowadays we know that stress or the fear of feeling pain when doing a specific activity during therapy can delay recovery. It’s important to see patients as living beings, not just a series of muscles and bones.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
- K. Grimmer-Somers, M. Prior y J. Robertson. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain. J Pain Res. 2008; 1: 15–25.
- J. Rainville, R. Smeets, T. Bendix, et al. Fear-avoidance beliefs and pain avoidance in low back pain – translating research into clinical practice. The Spine Journal. Volume 11, Issue 9, September 2011, Pages 895-903.
- J. Vlaeven, S. Linton. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. Volume 85, Issue 3, 1 April 2000, Pages 317-332.