Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

Abstract

Study Design Observational, prospective cohort Background Musculoskeletal pain is a common reason to seek healthcare and earlier non-pharmacological treatment and enhancement of personalized care options are two high priority areas. Validating concise assessment tools is an important step in establishing better care pathways. Objectives To determine the predictive validity of Optimal Screening for Prediction of Referral and Outcome (OSPRO) tools for individuals with neck, low back, shoulder, or knee pain. Methods A convenience sample (n = 440) was gathered by Orthopaedic Physical Therapy-Investigator Network clinics (n = 9). Participants completed questionnaires for demographic, clinical, comorbidity, and the OSPRO tools and were followed for 12-month outcomes in pain intensity, region-specific disability, quality of life, and comorbidity change. Analyses predicted these 12-month outcomes with models that included the OSPRO review of systems and yellow flag tools and planned covariates (accounting for comorbidities and established demographic and clinical factors). Results The 10 item OSPRO yellow flag tool (baseline and 4 week change score) consistently added to predictive models for 12-month pain intensity, region-specific disability, and quality of life. The 10 item OSPRO review of system tool added to a predictive model for quality of life (mental summary score) and 13 additional items of the OSPRO review of system+ tool added to prediction of 12-month comorbidity change. Other consistent predictors included age, race, income, previous episode of pain in same region, comorbidity number, and baseline measure for the outcome of interest. Conclusion The OSPRO review of system and yellow flag tools statistically improved prediction of multiple 12 month outcomes. The additional variance explained was small and future research is necessary to determine if these tools can be used as measurement adjuncts to improve management of musculoskeletal pain.

Psychometric Evaluation of the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool: Factor Structure, Reliability, and Validity

“…Using this method, OSPRO-YF scores predicted 12-month pain severity, disability, and health care utilization outcomes following physical therapy. 5,23,40 However, to date additional psychometric properties of the OSPRO-YF have not been further investigated. A better understanding of the underlying constructs measured by the tool is necessary even though the tool was developed with an established theoretical structure.…”

Assessing psychosocial profile in the physical therapy setting

“…The predictive validity of the OSPRO‐YF has been established with a separate cohort of patients with neck ( n = 98), shoulder ( n = 107), low back ( n = 118), or knee ( n = 82) conditions (George et al, ). The results demonstrated that the OSPRO‐YF at baseline and at 4 weeks was a statistically significant predictor of 12‐month pain intensity, disability, and quality of life.…”

“…The results demonstrated that the OSPRO‐YF at baseline and at 4 weeks was a statistically significant predictor of 12‐month pain intensity, disability, and quality of life. However, the amount of variance explained by the OSPRO‐YF was small ( R 2 = 0.04–0.07) (George et al, ).…”

“…For example, the OSPRO‐YF 10‐item measure has a score that ranges from 3 to 53. In order to predict a 2‐point increase in pain intensity at 12 months, a 30‐point change score would need to occur on the OSPRO‐YF (George et al, ). Therefore, the OSPRO‐YF is best used as a concise measure of yellow flags that may be contributing to the patient's clinical presentation.…”

Psychosocial factors in low back pain: letting go of our misconceptions can help management

“…Beliefs, attitudes, fears and emotional responses are omnipresent across all types of LBP presentations, and these can be measured with validated assessment tools (eg, Start Back Screening Tool, Orebro Musculoskeletal Pain Questionnaire, or Optimal Screening for Prediction of Referral and Outcome tool) 7. Systematically using these tools provides the clinician an opportunity to further explore psychosocial factors in clinical practice.…”