Obstacles to return to work
The “flags” framework has been introduced to help identify obstacles to being
active and working, and to support people with musculoskeletal conditions to
return to work. For more information about using these flags to help people
back to work see Kendall et al. 2009 (http://www.tsoshop.co.uk/flags).
Yellow flags are factors related to the patient, including
negative beliefs about health and work, fear of re-injury, and
low expectation of return to work
Blue flags are factors related to work, such as high physical
or psychological job demands, lack of flexibility or ability to
modify duties, perception of poor support from supervisors
or co-workers, and low job satisfaction
Black flags are organisational obstacles and factors related
to health care, such as ineffective treatments, long waiting
times for specialist appointments, or lack of occupational
rehabilitation service.
Key messages and practical recommendations for health
care providers
• Most musculoskeletal problems can be accommodated at work
» » Need to identify obstacles and plan to overcome them
• Use fit notes to communicate with employers
• The worker knows best and can suggest workplace modifications
• Discuss a return to work date and record this in the notes
» » Agree clear and realistic goals
• Encourage the patient to keep in touch with work
Study of Work And Pain (SWAP)
• The Arthritis Research UK Primary Care
Centre will soon start a pilot cluster-
randomised trial to investigate the clinical
and cost-effectiveness of providing a
vocational advice service in primary care.
• Using a stepped care approach the
vocational advisor will support patients
to identify and overcome obstacles to
returning to work.
• The main outcome measure will be the
numbers of days of work absence over
a period of 12 months follow up. Further
outcomes will include self efficacy, pain
interference, general health and work
performance.
Useful Links (leaflet): http://www.tsoshop.co.uk/
gempdf/Advising_Patients_About_Work.pdf
For more information visit:
www.keele.ac.uk/pchs/disseminatingourresearch/newslettersandresources/bulletins/