Rolli Salathé C1,2, Trippolini MA3, Terribilini LC1, Oliveri M3, Elfering A1,4
1University of Bern, Psychology, Bern, Switzerland, 2Universitäre Fernstudien Schweiz, Psychology, Brig, Switzerland, 3Rehaklinik Bellikon, SUVA Care, Work Rehabilitation, Bellikon, Switzerland, 4University of Geneva, CISA, National Centre of Competence in Research, Affective Sciences, Geneva, Switzerland
Background: Psychosocial factors such as fear-avoidance beliefs or catastrophic thoughts (Buer & Linton, 2002) represent major barriers to return to work (RTW) in injured workers with chronic musculoskeletal pain, causing a substantial burden to the individual and the society (Iles, Davidson, & Taylor, 2008). Psychosocial factors are well described by the clinical flags approach (Nicholas, Linton, Watson, Main, 2011), are represented by the yellow flags; and are assessed by a plethora of distinct self-report scales measuring uniquely one single belief or risk factor of this multidimensional construct. Therefore, there is a need for a concise screening tool that attempts to measure the measures the multidimensionality of psychological factors that are known to influence outcomes of patients with chronic MSK.
Purpose: The aim of this study is to develop and evaluate the Yellow Flag Questionnaire (YFQ).
Methods: The development of the YFQ followed three phases. First, a preliminary questionnaire based on a pool of items with corresponding constructs was created. Second, psychometric evaluations were calculated using structure equation modeling and confirmatory factor analysis on data from 666 workers. Third, the validation analyses consisting of internal consistency and construct validity were performed on data from 253 injured workers.
Results: Results confirm the step-wise approach to the development the YFQ, a multidimensional screening questionnaire. By using established questions, expert rounds, item-quality criteria scores and statistical methods, a substantial reduction of the initial 148 items was achieved keeping its intended goal i.e., guiding clinical work with a questionnaire that reflects a variety of distinct yellow domains. The 32 items were assigned to 7 domains, with indices of fit indicating a good fit of a model with 32 items divided into seven interrelated domains.
Conclusion(s): The Seven-Domain YFQ demonstrated good psychometric properties and construct validity with high internal item qualities, external item qualities and judgmental item qualities.
Implications: Within its seven domains, the YFQ includes many relevant risk factors that would otherwise need to be appraised with multiple questionnaires. The current electronic version of the YFQ visualizes the total scores as well as sub-scores of each domain in a bar diagram (from 0 to 100% total score). Therefore, it's expected that the YFQ would guide conversations between health care professionals and patients. Ultimately, domains with elevated scores may be addressed by individually tailored interventions such as education and cognitive behavioral therapy combined with physical therapy (Maher, Underwood, Buchbinder, 2017). In addition, the YFQ could be implemented to measure effects of education programs aimed to alter maladaptive attitudes and beliefs.
Literature:
Buer N, Linton SJ. Pain. 2002;99(3):485-491.
Iles RA, Davidson M, Taylor NF. Occup Environ Med. 2008;65(8):507-517.
Maher C, Underwood M, Buchbinder R. Lancet. 2017;389(10070):736-747.
Nicholas MK, Linton SJ, Watson PJ, Main CJ. Phys Ther. 2011;91(5):737-753.
Keywords: Screening, Assessment, Risk Factors
Funding acknowledgements: All authors declare that they have no financial or non-financial competing of interests related to this study.
Purpose: The aim of this study is to develop and evaluate the Yellow Flag Questionnaire (YFQ).
Methods: The development of the YFQ followed three phases. First, a preliminary questionnaire based on a pool of items with corresponding constructs was created. Second, psychometric evaluations were calculated using structure equation modeling and confirmatory factor analysis on data from 666 workers. Third, the validation analyses consisting of internal consistency and construct validity were performed on data from 253 injured workers.
Results: Results confirm the step-wise approach to the development the YFQ, a multidimensional screening questionnaire. By using established questions, expert rounds, item-quality criteria scores and statistical methods, a substantial reduction of the initial 148 items was achieved keeping its intended goal i.e., guiding clinical work with a questionnaire that reflects a variety of distinct yellow domains. The 32 items were assigned to 7 domains, with indices of fit indicating a good fit of a model with 32 items divided into seven interrelated domains.
Conclusion(s): The Seven-Domain YFQ demonstrated good psychometric properties and construct validity with high internal item qualities, external item qualities and judgmental item qualities.
Implications: Within its seven domains, the YFQ includes many relevant risk factors that would otherwise need to be appraised with multiple questionnaires. The current electronic version of the YFQ visualizes the total scores as well as sub-scores of each domain in a bar diagram (from 0 to 100% total score). Therefore, it's expected that the YFQ would guide conversations between health care professionals and patients. Ultimately, domains with elevated scores may be addressed by individually tailored interventions such as education and cognitive behavioral therapy combined with physical therapy (Maher, Underwood, Buchbinder, 2017). In addition, the YFQ could be implemented to measure effects of education programs aimed to alter maladaptive attitudes and beliefs.
Literature:
Buer N, Linton SJ. Pain. 2002;99(3):485-491.
Iles RA, Davidson M, Taylor NF. Occup Environ Med. 2008;65(8):507-517.
Maher C, Underwood M, Buchbinder R. Lancet. 2017;389(10070):736-747.
Nicholas MK, Linton SJ, Watson PJ, Main CJ. Phys Ther. 2011;91(5):737-753.
Keywords: Screening, Assessment, Risk Factors
Funding acknowledgements: All authors declare that they have no financial or non-financial competing of interests related to this study.
Topic: Disability & rehabilitation; Musculoskeletal: spine; Pain & pain management
Ethics approval required: Yes
Institution: Department of Work Rehabilitation, Rehaklinik Bellikon, SUVA Care, Bellikon, Switzerland
Ethics committee: The ethical committee of Aargau canton, Switzerland approved the study
Ethics number: -
All authors, affiliations and abstracts have been published as submitted.
