b'REHAB CouncilThe Yellow FlagRisk FormBy Dr. Donald C. DeFabioChair, ANJC Physical Rehabilitation and Performance Council More than a Pain Classification ToolCHIRO Assist YFRF Scoring & Pain Classification Sub-groupsPerhaps the most important service we offer our patients is an accurate diagnosis. Once we have a working diagnosis the process of selecting the appropriate treatment plan and procedures can begin. A process that evolves as the patientCut-Off continues under care.Scores forCommon Patterns TreatmentDisability RiskOne component of data collection and assessing effectiveness of treatment is the use of Outcome Assessment Tools (OATS)High questions:- CMTthat are often regionalized to a body part or function. For1,2,6,10,12example, the Neck Disability Index, Oswestry, and LowerLow 50 Peripheral Neurogenic - ExerciseExtremity Functional Scale are common OATS used on anNociception Nerve Pain - Modalitieseveryday basis by clinicians and often required by carriers to substantiate care. -Sensorimotor TECHNIQUE Council Moderate =High questions:activitiesHowever, beyond assessing pain or function, we also need to3,4,5,6,7,8,10 -CMTassess the psychological health of our patients, too. OverridingAffective Pain- Exerciseemotional issues or negative thought patterns impact both51-64 Mechanism-Cognitive health and the response to treatment. We have all seen theEmotionalBehavioral patients who are fearful of activities because they might getTherapyworse, which leads to deconditioning as well as those patients who identify on their pain/disability to the point where it definesHigh questions:OUR HEALTH Severe 65 1, 2, 9, 10, 11, 12, 13 - Exercisethem in life. These negative behaviors are classified a Yellow Flags and are an impediment to recovery and predispose theCentral Sensitivity - Cognitive patient to chronic pain. Fear Avoidance Behavioral Pain Mechanism Therapy The good news is there is one OAT that can be used for any body part, for classification of the patient into the appropriateChart 1treatment classification and to monitor the patient during theObviously, patients scoring in the moderate- and severe-risk treatment process. The form is the Yellow Flag Risk Form,categories will require additional behavioral modification and (YFRF, See Figure 1), and Kolski and OConner have developedpain management skills. Moderate-risk scoring patients benefit a classification algorithm using the YFRF to direct patientsfrom diaphragmatic breathing, mindfulness, and a gradual towards the most appropriate treatment for optimal outcomes. return to activity with an emphasis on functional goals. In OConner established that one of the monumental errors inaddition, the higher risk patients will require more intensive chronic pain is the assumption that if they get more functionalcognitive behavioral therapy, nerve flossing techniques and they will have less pain. but function is not sensitive enoughspecific verbal cueing to facilitate their gradual increase in to understand pain. In a cross-sectional study of 400 patientsactivity. Kolski and OConner have a highly detailed treatment at different practices, including chiropractic private practice,algorithm for all the subgroups in their text, A World of Hurt.outpatient rehab and hospital based rehab, she comparedFor everyday practice, start using the YFRF and look for functional measures to pain questionnaires and found thatpatterns for the moderate- and high-risk patients. It is pain-related questionnaires are as sensitive as function toimportant to emphasize that pain does not mean harm, and predict function but functional measures are not sensitive topositive reinforcement is essential. Coping strategies for pain pain. Essentially, the YFRF is sensitive to predict functionalmanagement and cardiovascular activities are applicable in all disability and represents the entire body in one tool. No needthe groups. Finally, be prepared to collaborate with therapists for body specific tools.to address the cognitive and emotional therapy.The YFRF is a 13-question OAT that scores each question onREFERENCES:a 0-10 scale. It scores domains related to pain (sleep, fearA World of Hurt, A Guide to Classifying Pain. Kolski MC, OConnor A. 2017 Thomas Land, avoidance, self-efficacy, depression) to indicate the risk for longSt. Louis Mo.term disability and chronic pain. Additionally, there are distinctDonald DeFabio, DC, DACBSP, DABCO, in is private practice in patterns that can be evaluated to establish the underlying causeBerkeley Heights and is the team chiropractic physician for a local of the pain perception, leading to the patient being properlyuniversity. He conducts Relevant Rehab, and his exercise protocols classified into the correct sub-group for treatment. (See Chart 1) can be found on his YouTube Channel.16 I Spring 2020 www.anjc.info'