Musculoskeletal pain disorders can significantly impact the lives of individuals. This group represent the most common type of work-related injury.
A small portion of work-related injuries have delayed recovery and delayed return to work (RTW). For this group, length of time off is associated with difficulty ever returning to work and negative physical and psychological health outcomes. The impact on these individuals and their families is significant and can result in loss of employment. There are also significant adverse impacts on their employers and at times their co-workers.
It is these negative life impacts and broader impacts on organizations and the community that creates an interest in identifying those injured workers at risk of delayed RTW as early as possible. It is hoped that then adverse outcomes can be avoided.
Reliably identifying these individuals at risk among large case numbers has proved difficult and focusing on injury severity does not seem to be a reliable predictor of ongoing disability and time off work.
However, there is increasing understanding that musculoskeletal pain disorders need to be viewed as a multidimensional, biopsychosocial interaction and that psychosocial factors (yellow flags) can have a major impact on developing persistent pain, disability, and time off work.
The complex interaction of psychosocial factors can mean that it is difficult for clinicians to prioritize the relative importance of different dimensions and at times there is a focus on physical factors alone.
One widely used psychosocial self-report scale is the Orebro Musculoskeletal Pain Screening Questionnaire (Orebro). The Orebro is not limited to back pain like some other screening tools and in its short form it relatively simple to administer.
The short form Orebro has only 10 questions and the cut-off of 50/100 was found to provide direction for detecting those likely to have more lost time. A prospective study by Nicholas et al used a workers compensation insurer to administer the Orebro and found that a score of over 50, high risk score, was associated with a median time off work of 26.6 days compared to a below 50, low risk score, being associated with 10.1 days.
The physicist Niels Bohr is credited with saying: Predictions are difficult, especially about the future.
While we cannot predict the future, the Orebro is a ‘yellow flag’ screening tool that provides valuable information about psychosocial contributors to an injured workers presentation. It has utility in helping understand risk of ongoing pain, disability, and difficulty with RTW.
Screening injured workers with tools like the Orebro hopefully will help identify individual workers that need support in their recovery journey, and that this will make a positive difference in their lives, their family and their community.