Does the presence of psychosocial "yellow flags" alter patient-provider communication for work-related, acute low back pain?

J Occup Environ Med. 2009 Sep;51(9):1032-40. doi: 10.1097/JOM.0b013e3181b2f539.


Objective: To determine whether patterns of patient-provider communication might vary depending on psychosocial risk factors for back disability.

Methods: Working adults (N = 97; 64% men; median age = 38 years) with work-related low back pain completed a risk factor questionnaire and then agreed to have provider visits audiotaped. Verbal exchanges were divided into utterances and coded for content, then compared among low-, medium-, and high-risk patients.

Results: Among high-risk patients only, providers asked more biomedical questions, patients provided more biomedical information, and providers used more language to engage patients and facilitate communication. There were no group differences in psychosocial exchanges.

Conclusions: Clinicians may recognize the need for more detailed assessment of patients with multiple psychosocial factors, but increases in communication are focused on medical explanations and therapeutic regimen, not on lifestyle and psychosocial factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Age Factors
  • Analysis of Variance
  • Cohort Studies
  • Communication
  • Disability Evaluation
  • Female
  • Humans
  • Incidence
  • Low Back Pain / epidemiology
  • Low Back Pain / etiology
  • Low Back Pain / psychology
  • Male
  • Mental Health*
  • Middle Aged
  • Occupational Diseases / diagnosis*
  • Occupational Diseases / epidemiology
  • Occupational Diseases / psychology*
  • Physician-Patient Relations*
  • Predictive Value of Tests
  • Probability
  • Psychology
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Stress, Psychological
  • Surveys and Questionnaires
  • Workplace