Identification and management of yellow flags in chronic low back pain by Chiropractic Master's students at a University of Technology teaching clinic

Abstract

Chronic low back pain (CLBP) is one of the leading causes of disability worldwide, preventing many people from performing day to day tasks. Low back pain is the third most common reason for visits to the doctors, right after skin disorders and osteoarthritis. Even though doctors of chiropractic treat more than just back pain, many patients initially visit a chiropractor looking for relief from this persuasive condition. Yellow flags are psychosocial issues that can be indicative of long-term chronicity in low back pain. It is therefore appropriate for chiropractors to know how to manage yellow flags in patients with low back pain, since the two are related. The aim of this study, therefore, is to investigate the identification, knowledge, and the management of yellow flags at teaching clinic by chiropractic master’s students. AIM AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe the identification and management of yellow flags in chronic low back pain by chiropractic master’s students at a university of technology teaching clinic. METHODOLOGY A qualitative, exploratory, descriptive study was conducted. Master’s degree chiropractic students, who had been clinically active for five months and treated a minimum of five low back pain patients were interviewed to establish their identification and management of yellow flags in CLBP. Semi-structured interviews were conducted in English, which were then transcribed to a Microsoft Word document. The transcripts were analysed using Tsech’s eight steps of thematic analysis to establish the themes, categories and codes. RESULTS AND DISCUSSION This qualitative, descriptive study explored 10 chiropractic master’s students’ identification and management of yellow flags in their chronic low back pain patients. It was found that the chiropractic master’s students had limited understanding of psychosocial factors. Their lack of information and clinical expertise lead to uncertainty pertaining to the identification, assessment and management of yellow flags. The participants acknowledged their shortcomings and suggested numerous limitations to the integration of psychosocial assessments as part of routine practice. The lack of formal education in the theory, assessment and management was the most frequently cited barrier among those raised by the participants. The review of the chiropractic curricula was outside the purview of this study. Nevertheless, considering the comparable findings reported in the literature further supported this, it may suggest a need for chiropractic education of yellow flag assessment and management to be reviewed and strengthened. CONCLUSIONS This is the first South African study that had been conducted on registered master’s degree chiropractic students’ identification and management of yellow flags in chronic low back pain. This study will add to the existing literature and enable other registered master’s degree students and new graduate chiropractors to have a better understanding of the of the management of yellow flag patients.