title: Early patient screening and intervention to address individual-level occupational factors ("blue flags") in back disability.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA. william.shaw@libertymutual.com
authors.forename: William S
authors.initials: WS
authors.lastname: Shaw
authors.forename: Danielle A
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Main
authors.forename: Patrick
authors.initials: P
authors.lastname: Loisel
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Linton
mesh_terms: D001416:Back Pain / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation; D006233:Persons with Disabilities / Q000534:rehabilitation; D006801:Humans; D008403:Mass Screening; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation; D016272:Occupational Health; D011379:Prognosis; D012307:Risk Factors; D017132:Workplace