The psychosocial flags framework: overcoming obstacles to work

Back pain is a common health problem characterised by symptoms that follow an episodic pattern. While many people cope with numerous episodes without recourse to healthcare or need for sick leave, others struggle and progress to disability. The determinants of disability lie in the psychosocial domain rather than being due to a more serious injury or illness. These psychosocial factors can be conceptualised as obstacles to work participation. They reflect aspects of the person, their workplace and the context in which they live, and can be considered as flags that a person is going to struggle to stay at work or return to work with an episode of back pain. The key to helping that person is to identify and address the pertinent psychosocial obstacles, which can be done using the evidence-informed Psychosocial Flags Framework. Effective return-to-work relies on early intervention combining work-focused healthcare and workplace accommodation, which requires communication and cooperation between the players (person; healthcare; workplace) – this will be facilitated by a shift in the culture around work and health to adopt the principle of recovering while working.