Appendix C:
Risk Factors of Chronicity

A. Risk factors (Documentation):

1.   Abnormal illness behavior (Waddell's, SF-36)

2.   Job dissatisfaction

3.   Past Hx of >4 episodes

4.   Symptoms > 1 wk w/o health provision

5.   Severe pain intensity (Triple VAS) (>69%)

6.   New condition / injury related to pre-existing
      structural pathology or skeletal anomaly

7.   Weak back extensor musculature
      (Static back endurance test)

8.   Smokes 1 pack or greater / day

9.   Poor self-rated health (SF/HSQ-36 or -12)

10.   Heavy Job Classification

B. Yellow Flags

Symptoms

Yellow Flag	Reference
Number of pain sites	Linton, 1998;   Linton, 1997
Duration of symptoms	Cherkin, 1996;   Von Korff, 1993;   Linton 1998;   Linton 1997
Duration of symptoms before the 1st visit	Van den Hoogen, 1997
Past history of numerous episodes	Frank, 1996;   Cherkin, 1996;   Hazard, 1996;   Burton, 1995
Past hospitalization or surgery for similar complaint	Van den Hoogen, 1997;   Hazard, 1996;   Lancourt, 1992
Severe pain intensity	Frank, 1996;   Cherkin, 1996;   Von Korff, 1993;   Linton, 1998;   Hazard, 1996
Frequency of painful episodes over the last 3 months	Linton, 1998;   Linton, 1997
Sciatica	Frank, 1996;   Cherkin, 1996;   Burton, 1995;   Salim, 1998;   Lancourt, 1992

Psycho-social

Anxiety	Cherkin, 1996
Locus of control	Burton, 1995
Depression	Cherkin, 1996;   Linton, 1998;   Linton, 1997;   Klennerman, 1995
Catastrophizing	Burton, 1995
Self-rated health as poor	Cherkin, 1996;   Waddell, 1996
Heavy smoker	Waddell, 1996;   Cats-Baril, 1991;   Hazard, 1996
Belief that you shouldn’t work with your current pain	Linton, 1998;   Linton, 1997
Job dissatisfaction	Cherkin, 1996;   Cats-Baril, 1991
Anticipation of trouble sitting or standing at work 6 weeks into the future	Hazard, 1996
Anticipation of disability 6 months into the future	Hazard, 1996

Function

Does physical activity make your pain worse?	Linton, 1998;   Linton, 1997
Tolerance for light work	Linton, 1998;   Linton, 1997
Is sleep affected by your pain?	Linton, 1998;   Linton, 1997

Disability

Heavy job demand	Waddell, 1996
Past disability for the same/similar complaint in prior 12 months	Hazard, 1996
Disabled at present	Hazard, 1996

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