Journal of Occupational Rehabilitation

, Volume 19, Issue 1, pp 64–80 | Cite as

Early Patient Screening and Intervention to Address Individual-Level Occupational Factors (“Blue Flags”) in Back Disability

  • William S. ShawEmail author
  • Danielle A. van der Windt
  • Chris J. Main
  • Patrick Loisel
  • Steven J. Linton
  • the “Decade of the Flags” Working Group


Objective To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability. Methods A 3-day conference workshop including 21 leading researchers and clinicians (the “Decade of the Flags Working Group”) was held to review the scientific evidence concerning clinical, occupational, and policy factors in back disability and the development of feasible assessment and intervention strategies. Results The Working Group identified seven workplace variables to include in early screening by clinicians: physical job demands, ability to modify work, job stress, workplace social support or dysfunction, job satisfaction, expectation for resuming work, and fear of re-injury. Five evaluation criteria for screening methods were established: reliability, predictive performance, feasibility, acceptability, and congruence with plausible interventions. An optimal screening method might include a stepped combination of questionnaire, interview, and worksite visit. Future research directions include improving available assessment methods, adopting simpler and more uniform conceptual frameworks, and tying screening results to plausible interventions. Discussion There is a clear indication that occupational factors influence back disability, but to expand clinician practices in this area will require that patient screening methods show greater conceptual clarity, feasibility, and linkages to viable options for intervention.


Back pain Back disability Occupational factors Screening Early intervention 



The authors would like to acknowledge other members of the “Decade of the Flags” Working Group who contributed to the discussions and conclusions presented in this article: Mansel Aylward, Kim Burton, Peter Croft, Michael Feuerstein, Charles Greenough, Elaine Hay, Nick Kendall, Clement Leech, Michael Nicholas, Ceri Phillips, Glenn Pransky, Mick Sullivan, Johan Vlaeyen, Michael von Korff, Gordon Waddell, and Paul Watson. Also, special thanks to the Conference Organizing Committee at Keele University: Jo Bailey, Jan Cohen, Kate Dunn, Zoe Mayson, Sue Weir, Ross Wilkie, and Gwenllian Wynne-Jones. Sponsors of the 3-day conference included HCML, Healthcare RM, Ceridian, Rolls-Royce, and Rehab Works, Ltd.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • William S. Shaw
    • 1
    • 2
    Email author
  • Danielle A. van der Windt
    • 3
    • 4
  • Chris J. Main
    • 4
  • Patrick Loisel
    • 5
    • 6
  • Steven J. Linton
    • 7
    • 8
  • the “Decade of the Flags” Working Group
    • 9
  1. 1.Liberty Mutual Research Institute for SafetyHopkintonUSA
  2. 2.Department of Family Medicine & Community HealthUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.EMGO InstituteVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Arthritis Research Campaign National Primary Care CentreKeele UniversityStaffordshireUK
  5. 5.Centre for Action in Work Disability Prevention and RehabilitationHôpital Charles LeMoyneLongueuilCanada
  6. 6.Université de SherbrookeLongueuilCanada
  7. 7.Department of Behavioral, Social and Legal Sciences—Psychology & Örebro Medical Center HospitalÖrebro UniversityÖrebroSweden
  8. 8.Department of Occupational and Environmental MedicineÖrebroSweden
  9. 9.StaffordshireUK

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