Abstract
Objective
To investigate the Optimal Screening for Prediction of Referral and Outcome Yellow
Flag (OSPRO-YF) tool for longitudinal monitoring of pain associated distress with
the goal of improving prediction of 50% reduction in pain intensity and disability
outcomes.
Design
Cohort study with 12-month follow-up after initial care episode.
Setting
Ambulatory care, participants seeking care from outpatient physical therapy clinics.
Participants
Participants (N=440) were seeking care for primary complaint of neck, low back, knee,
or shoulder pain. This secondary analysis included 440 subjects (62.5% female; mean
age, 45.1±17y) at baseline with n=279 (63.4%) providing follow-up data at 12 months.
Interventions
Not applicable.
Main Outcome Measures
A 50% reduction (baseline to 12-mo follow-up) in pain intensity and self-reported
disability.
Results
Trends for prediction accuracy were similar for all versions of the OSPRO-YF. For
predicting 50% reduction in pain intensity, model fit met the statistical criterion
for improvement (P<.05) with each additional time point added from baseline. Model discrimination improved
statistically when the 6-month to 12-month change was added to the model (area under
the curve=0.849, P=.003). For predicting 50% reduction in disability, there was no evidence of improvement
in model fit or discrimination from baseline with the addition of 4-week, 6-month,
or 12-month changes (P>.05).
Conclusions
These results suggested that longitudinal monitoring improved prediction accuracy
for reduction in pain intensity but not for disability reduction. Differences in OSPRO-YF
item sets (10 vs 17 items) or scoring methods (simple summary score vs yellow flag
count) did not affect predictive accuracy for pain intensity, providing flexibility
for implementing this tool in practice settings.
Keywords
List of abbreviations:
AIC (Akaike information criterion), AUC (area under the curve), MSK (musculoskeletal), OSPRO (Optimal Screening for Prediction of Referral and Outcome), OSPRO-YF (Optimal Screening for Prediction of Referral and Outcome Yellow Flag), SBST (STarT Back Screening Tool)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 26, 2020
Footnotes
Supported by the 2013 Clinical Research Network grant from the Academy of Orthopaedic Physical Therapy (formerly known as the Orthopaedic Section of the American Physical Therapy Association). The funding body had no role in the design of the study, analysis, and interpretation of the data or in writing this article.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
