Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation

Abstract

BackgroundPsychosocial variables are known to play an important role in musculoskeletal pain. Recent efforts incorporating psychological theory into rehabilitative medicine, as part of patient‐centred care or psychologically informed physical therapy, have gained broader acceptance. The fear‐avoidance model is the dominant psychosocial model and has introduced a variety of phenomena which assess psychological distress (i.e., yellow flags). Yellow flags, such as fear, anxiety and catastrophizing, are useful concepts for musculoskeletal providers but reflect a narrow range of psychological responses to pain.ObjectiveClinicians lack a more comprehensive framework to understand psychological profiles of each patient and provide individualised care. This narrative review presents the case for applying personality psychology and the Big‐Five trait model (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience) to musculoskeletal medicine. These traits have strong associations with various health outcomes and provide a robust framework to understand patient emotion, motivation, cognition and behaviour.Key ResultsHigh conscientiousness is associated with positive health outcomes and health promoting behaviours. High neuroticism with low conscientiousness increases the odds of negative health outcomes. Extraversion, agreeableness and openness have less direct effects but have positive correlations with important health behaviours, including active coping, positive affect, rehabilitation compliance, social connection and education level.Clinical ApplicationThe Big‐Five model offers an evidence‐based way for MSK providers to better understand the personality of their patients and how it relates to health. These traits offer the potential for additional prognostic factors, tailored treatments and psychological intervention.

Personality and Pain Outcomes in Rheumatic Disease: The Mediating Role of Psychological Flexibility

“…Extraversion (i.e., the preference for social interactions) correlates with positive emotions, approach motivation, as well as the use of healthy coping strategies in chronic pain [ 22 ]. In addition, consciousness (i.e., the tendency toward structure and discipline), openness to intellectual experiences (i.e., the capacity to associate various concepts, curiosity, and creativity), and agreeableness (i.e., interpersonal warmth, kindness, and cooperation) are thought to have rather indirect effects on health-related outcomes in chronic pain through different lifestyle choices and emotion management skills [ 22 , 23 , 24 ].…”

“…In this way, PI can be considered as a transdiagnostic process linking dispositional features and pain outcomes through the unwillingness to experience noxious stimulation [ 35 , 36 ]. At the same time, high extraversion, consciousness, openness, and agreeableness are viewed as protective personality traits that promote better coping with pain-related difficulties [ 22 , 24 ]. Moreover, PF was found to mediate the relationship between personality and well-being in the general population.…”