Audit Toolkit – Clinical assessment of psychosocial yellow flags for ALBP


This toolkit assists an audit of patient records in cases where acute LBP patient are thought to be at risk of long-term work loss and disability. A person may be at risk if:

  • There is a cluster of a few very salient factors
  • There is a group of several less important factors that combine cumulatively
  • There is good agreement that the following factors are important and consistently predict poor outcomes:
  • Presence of a belief that back pain is harmful or potentially severely disabling
  • Fear-avoidance behaviour (avoiding a movement or activity due to misplaced anticipation of pain) and reduced activity levels
  • Tendency to low mood and withdrawal from social interaction
  • An expectation that passive treatments rather than active participation will help

How to undertake the audit:

Round 1: Audit the records of all acute LBP patients suspected of being at risk of long-term work loss and disability in a given period (e.g. the last 2 months), recording your findings using the excel checklist provided here (right click and ‘save as’). Determine levels of compliance (i.e. the frequency with which each factor was considered), reflect on your findings, and decide upon and introduce changes in practice as required.

Round 2: Repeat after a similar period has elapsed (e.g. 2 months) recording your findings under sheet 2 in the excel checklist and review findings.


New Zealand Guidelines Group (2004) New Zealand Acute Low Back Pain Guide, incorporating the guide to assessing psychosocial yellow flags in acute low back pain.