Assessment, Blue and Black Flags and Return to Work

Occupational health and physiotherapy should work as an integrated team, intervene early and accept that people do not need to be pain-free to return to work. Stratification with the Örebro or STarT Back tools keeps low-risk workers from receiving more information than they need. Blue flags concern the person's relationship with work: control over the job, colleagues, managers and the demands of tasks. Perceived uncertainty, including fear of reinjury, doubt about doing the pre-injury job and the need for accommodations, is a strong predictor of poor return to work. Black flags are wider policies and mandated requirements, such as a police officer's armored vest, that rehabilitation must account for. For low-risk workers, the advice is to stay active and at work and to reduce fear around specific tasks. Medium to high-risk workers may need line managers involved, task modifications and careful exploration of blue and black flags. Rehabilitation should include the person's real work tasks, as in sport, and avoid fear-based language and images.