How was it developed?
The OSPRO-YF was developed in response to common complaints by clinicians regarding the lack of concise methods to assess multiple dimensions of psychological distress in clinical practice. The intent was not to create an entirely different questionnaire, but rather develop a more innovative and efficient method to capture information provided by a variety of existing ‘legacy’ psychological questionnaires. To do so, researchers at the University of Florida developed the tool with funding from the Academy of Orthopaedic Physical Therapy (now APTA Orthopedics). The development process consisted of separate sequential studies conducted in two different cohorts: a Development cohort and Validation cohort. The Development cohort was a cross-sectional study that included 431 patients recruited from outpatient physical therapy clinics in Gainesville, FL and Jacksonville, FL. At initial evaluation, patients completed 11 full length ‘legacy’ questionnaires commonly used for assessing psychological distress: PHQ-9, STAI, STAXI, FABQ-PA, FABQ-W, PCS, TSK-11, PASS-20, PSEQ, SER, and CPAQ. Collectively, these questionnaires included 132 items, and completion of the entire questionnaire set took anywhere from 30 to 90 minutes. Then, a series of complex statistical processes (outlined in further detail in the Development paper) helped to identify a small subset of the 136 items that could be used to accurately estimate patient scores and identify yellow flags on these full-length questionnaires.
The second stage of the process consisted of the Validation cohort, designed to understand how the OSPRO-YF would predict important outcomes such as persistent pain, disability, quality of life, and health care use following physical therapy. Recruitment for this cohort was conducted within a nationwide clinical research network of 9 sites. Participants (n=440) completed the OSPRO-YF at baseline in addition other demographic and health –related information. The resulting studies showed the OSPRO-YF was able to predict 12-month pain intensity, region-specific disability, quality of life and subsequent use of surgery.
Which of the three versions should I use?
The OSPRO-YF offers three different versions of the tool, a 7-item, 10-item, and 17-item version. The 7-item version is a subset of the 10-item version which is itself a subset of the 17-item version. Although response burden is lower with shorter versions, there is a trade-off in accuracy for identifying yellow flags, with accuracy values of 85%, 81% and 75% for the 17-item, 10-item, and 7-item versions, respectively. The choice of which version to use depends on your specific setting and needs. Most clinics and research applications have used the 10-item tool because it has a good balance of accuracy and low response burden.
How should I use OSPRO-YF in practice?
OSPRO-YF was designed as a screening tool and is not designed for making medical or mental health diagnoses. Instead, it is best used alongside other information gathered during a clinical visit. One of its most valuable uses is to help start conversations with patients about how mental health and emotional distress can affect musculoskeletal conditions. Talking about these issues early on can help guide care and improve outcomes.
Can it be used in populations other than adults with musculoskeletal conditions?
OSPRO-YF was developed in adult musculoskeletal populations with knee, shoulder, low back or neck pain. It has not yet been rigorously evaluated in other settings or in pediatric samples, although work is underway to determine its generalizability outside of adult orthopedic care.
