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cp1 w2 Tutorial

This document provides information on the biopsychosocial model and assessing patients for red and yellow flags. It lists examples of red and yellow flags, how they can affect treatment and prognosis. It describes Waddell signs which are indicators of non-organic pain behaviors. The document also provides examples of case studies for different conditions like neck pain, whiplash, lower back pain, and hip injury. It lists potential red and yellow flags to assess, appropriate tests and measures, strategies for addressing fear avoidance and providing reassurance, and functional goals for treatment.

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89 views6 pages

cp1 w2 Tutorial

This document provides information on the biopsychosocial model and assessing patients for red and yellow flags. It lists examples of red and yellow flags, how they can affect treatment and prognosis. It describes Waddell signs which are indicators of non-organic pain behaviors. The document also provides examples of case studies for different conditions like neck pain, whiplash, lower back pain, and hip injury. It lists potential red and yellow flags to assess, appropriate tests and measures, strategies for addressing fear avoidance and providing reassurance, and functional goals for treatment.

Uploaded by

api-508474347
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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CP1 – Week 2 Tutorial

Biopsychosocial Model

List some red flags List some yellow flags


Cauda equina syndrome Diabetes – slow wound healing
Unexplained weight loss Stress
Jaundice Anxiety
Hypothyroidism Depression
Non-mechanical nocturnal pain Chronic pain
Cancer Poor coping skills
Chronic drug uses Difficulty at work or home
Previous history of receiving worker’s
compensation

Why are these important? How do they affect treatment and prognosis of the patient?
Yellow flags can affect prognosis to be poor – more visits might require to achieve the goal

What are Waddell signs?


1) Superficial or nonanatomic tenderness—widespread sensitivity to light touch in the lumbar
region and pain referred to other areas such as thoracic, sacrum, or pelvis.

2) Simulation—axial loading (light pressure to the skull should not significantly increase low back
pain. Passive rotation of the shoulders and pelvis together in a standing patient should not
reproduce low back pain.

3) Distractions—difference of 40 to 45 degrees between the supine and seated straight leg raising
tests.

4) Regional disturbances—sensory or motor disturbance (“giving way”) that is not neurologically


correlated.

5) Overreaction—inappropriate overreaction such as guarding, limping, rubbing the affected area,


bracing oneself, grimacing, or sighing are all signs of illness behavior.
How do these affect treatment and prognosis of the patient?
Even just two signs of Waddell evaluation can be correlated with more depressive and anxiety
symptoms. Underlying psychological distress can affect prognosis to be poor.

Have a look at the Waddell questionnaire.

What information does the questionnaire give us?


What do you think is good about it?
Is there anything missing or any disadvantages of this questionnaire?
Case Studies:
Neck pain

Potential red/yellow flags Tests/outcome measures Fear Avoidance/Reassurance Functional Goals


Any cardiovascular signs To rule out red flags Tissue sparing exercise Improve ROM

Left sided neck and shoulder Screen yellow flags Stretching away from the painful side Improve ADL
pain accompanied by chest pain
Neck flexion movement pattern Reactivation exercise
Pain referring to the L) upper
extremity

Age <40

Whiplash

Potential red/yellow flags Tests/outcome measures Fear Avoidance/Reassurance Functional Goals


Fracture CT scan Tissue sparing exercise Improve ROM
Mechanism of injury
Concussion Stretching away from the painful side Improve ADL
Neurological deficits
Haemorrhage Reactivation exercise Back to work
Self-harm related injury
Lower back pain

Potential red/yellow flags Tests/outcome measures Fear Avoidance/Reassurance Functional Goals


AAA – Age AAA test Tissue sparing techniques
Metastases – bowel Vitals Cat-Camel
Metastatic prostate cancer Biochemistry assays Getting out of the bed
Unexplained weight loss Imaging Sitting on the chair and getting up
Compression fracture Improve ROM
Osteopenia Orthopaedic test Strengthening and conditioning
Spondylolisthesis Pain scale Quadraped bird-dog
Spina bifida occulta ADL Hip hinge
Manual handling techniques

Widespread pain
Previous Hx of back pain
Anxiety and depression
Job dissatisfaction
Low expectation of recovery
Receiving compensation

Hip Injury

Potential red/yellow flags Tests/outcome measures Fear Avoidance/Reassurance Functional Goals


Headaches

Potential red/yellow flags Tests/outcome measures Fear Avoidance/Reassurance Functional Goals

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