The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Assessment tool is a tool that helps clinicians quickly identify a variety of psychological risk factors, often referred to as “yellow flags,” that might affect how someone with musculoskeletal pain responds to treatment. It’s designed for use in everyday care settings, giving clinicians a way to identify psychological distress and mental health concerns early on, so they can adjust treatment accordingly.
How does it work?
At first glance, it looks like a standard questionnaire. But instead of giving a single score, it works more like a calculator. Based on a person’s responses, it estimates what they would score if they were to complete common, full-length questionnaires measuring depressive symptoms, anxiety, anger, fear-avoidance beliefs (for work and physical activity), kinesiophobia, pain catastrophizing, pain anxiety, self-efficacy (for rehabilitation and pain), and pain acceptance. The OSPRO-YF then flags any scores that fall in the highest population quartile (top 25%), a range that might suggest a higher level of concern.
What does it estimate?
The OSPRO-YF estimates scores for 11 questionnaires across 3 domains:
Negative Mood
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- Patient Health Questionnaire (PHQ-9; depressive symptoms)
- State-Trait Anxiety Inventory (STAI)
- State-Trait Anger Expression Inventory (STAXI)
Negative or Maladaptive Coping
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- Fear-Avoidance Beliefs Questionnaire physical activity subscale (FABQ-PA)
- Fear-Avoidance Beliefs Questionnaire work subscale (FABQ-W)
- Pain Catastrophizing Scale (PCS)
- Tampa Scale for Kinesiophobia (TSK-11)
- Pain Anxiety Symptoms Scale (PASS-20)
Positive Affect and Coping
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- Pain Self-Efficacy Questionnaire (PSEQ)
- Self-Efficacy for Rehabilitation outcome scale (SER)
- Chronic Pain Acceptance Questionnaire (CPAQ)
Want more information on these questionnaires and what they assess? Go here.
How is it scored?
The OSPRO-YF requires the use of specialized equations to generate its estimates. You can score the tool at the scoring website, or the equations can be embedded into the EHR. Scoring information and resources are provided in the menu at the top of this page.
Is there a cost to use it?
No! The tool is free to use for clinical applications and in research. Please contact us if you have an interest in using it for commercial purposes.
