Psychosocial flag signs: impact on work status following a compensable shoulder injury

Abstract

Background

Psychosocial flag signs (PFSs) refer to fear of pain, negative affect and workplace and environmental risk factors. Abnormal pain response (APR) commonly coexists with exaggerated response to clinical examination or non-organic symptoms. The purposes of this study were to estimate the prevalence of PFS and APR and to examine the relationships between the accumulative number of PFS and patient characteristics and between the work status and factors known to affect a successful return to work.

Methods

Injured workers were examined for presence of PFS and APR. The numeric pain rating scale (NPRS), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Hospital Anxiety and Depression Scale (HADS) and a satisfaction questionnaire were completed.

Results

Sixty-six patients were included. Patients with a higher number of PFS had a higher level of anxiety (<0.0001) and depression (0.01) and reported less satisfaction with co-workers’ support (p = .04) and the overall job condition (p = .01). The multivariable logistic regression showed statistically significant relationships between the work status and the number of PFS (p = .008), QuickDASH score (p = .001) and satisfaction with the support received from co-workers (p = .013).

Conclusions

The number of PFS is a good representative of perceived psychological well-being and appears to be an independent indicator of success at work after a compensable shoulder injury.

Keywords:

• Abnormal pain response
• flag signs
• workers compensation
• shoulder joint

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Practice Based Research Funds of the Sunnybrook Health Sciences Centre, grant #: PBR-2016.