Applying the flag system within a biopsychosocial framework: a case series in physiotherapy practice - The Annals of the ”Ștefan cel Mare” University

Paper title:	Applying the flag system within a biopsychosocial framework: a case series in physiotherapy practice
DOI:	https://doi.org/10.4316/SAM.2025.0221
Published in:	Volume XVIII issue 2/ 2025
Publishing date:	2025
Pages:
Author(s):	Gabriela Iuliana Cazac
Abstract.	Musculoskeletal pain represents a leading cause of disability and functional limitation, requiring assessment approaches that extend beyond a purely biomedical perspective. Contemporary physiotherapy increasingly adopts the biopsychosocial model, which acknowledges the interaction between biological, psychological, occupational, and social factors influencing pain and recovery. Within this context, the flag system provides a structured framework for identifying multidimensional risk factors associated with pain chronicity and delayed rehabilitation. The purpose of this article is to illustrate the clinical application of the flag system in physiotherapy practice through a series of representative clinical cases. A descriptive case series methodology was employed, including three anonymized cases commonly encountered in musculoskeletal and occupational rehabilitation. Each case was assessed using structured screening for red, yellow, orange, blue, and black flags, guiding clinical reasoning and individualized intervention planning. The results demonstrate that functional limitations and delayed recovery were more strongly associated with psychosocial, occupational, and systemic factors than with physical impairment alone. The identification of relevant flags supported targeted interventions, interdisciplinary collaboration, and appropriate referral when necessary. In conclusion, the case series highlights the practical value of integrating the flag system within a biopsychosocial framework. This approach enhances clinical decision-making, supports personalized care, and may contribute to the prevention of pain chronicity in physiotherapy practice.
Keywords:	flag system, biopsychosocial approach, clinical case series, physiotherapy
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