Psychometric Properties of the OSPRO-YF Screening Tool in Patients with Shoulder Pathology

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools

Purpose

STarT Back Screening Tool and OSPRO-YF scales have been reported to be accurate tools for estimating risk for the development of persistent pain or prolonged disability in primary care settings. We performed a comparison of construct convergent and known-group validity and ceiling floor effect (CFE) of these tools using a common sample of patients seen at a tertiary care spine centre.

Methods

This was a cross-sectional study of patients with and without a work-related back injury. The Hospital Anxiety and Depression Scale (HADS) was used as the reference outcome measure for convergent validity. For known-group validity, we examined the ability of the scales to differentiate between different levels of compensation, presence of non-organic signs, and work status. The CFE values were calculated.

Results

Fifty consecutive injured workers were included along with 50 patients without an active compensation claim related to their low back pain. STarTBack and OSPRO-YF had moderate to high associations with the depression component of the HADS (0.69 to 0.77 respectively) with a statistically significant difference in favour of the OSPRO-YF. STarTBack's risk stratification categories were able to differentiate patients with a compensable injury, non-organic signs, and inability to work (p values ranging from 0.002 to < 0.001). The physical activity and work fear-avoidance beliefs constructs of the OSPRO-YF consistently outperformed other yellow flag constructs (p values ranging from 0.008 to < 0.001). The psychological sub-score of STarTBack showed a ceiling effect. There was a floor effect for the negative affect domain of OSPRO-YF. Neither total score had a floor or ceiling effect.

Conclusions

STarTBack and OSPRO-YF are short screening tools with acceptable convergent and known-group construct validity and no floor or ceiling effect of their total score. Both tools could assist with the identification, evaluation, and management of psychological distress in patients presenting to tertiary care spine centres.

Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements

OBJECTIVE: To predict 30- and 180-day improvements in disability and pain for patients seeking physical therapy care for low back pain (LBP). DESIGN: Longitudinal cohort. METHODS: Baseline assessment was completed by 259 patients with chief complaint of LBP, and the assessment includes psychosocial measures (Keele STarT Back Screening [SBST] and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag [OSPRO-YF] tools), the Optimal Screening for Prediction of Referral and Outcome Review of Symptoms (OSPRO-ROS) and the Review of Symptoms Plus (OSPRO-ROS+) tools, the Charlson Comorbidity Index (CCI), the Area Deprivation Index (ADI), and the National Institute of Health Chronic Pain Criteria (NIH-CP). Using the Modified Low Back Disability Questionnaire (MDQ) and the Numeric Pain Rating Scale (NPRS) as primary outcomes, statistical analysis determined multiple sets of predictor variables with similar model performance. RESULTS: The parsimonious "best model" for prediction of the 180-day MDQ change included 3 predictors (Admit MDQ, NIH-CP, and OSPRO ROS+) because it had the lowest penalized goodness-of-fit statistic (BIC = -35.21) and the highest explained variance (R2 = 0.295). The parsimonious "best model" for 180-day NPRS change included 2 variables (Admit NPRS and OSPRO-ROS+) with the lowest penalized goodness-of-fit statistic (BIC = -18.2) and the highest explained variance (R2 = 0.190). CONCLUSION: There were many model options with similar statistical performance when using established measures to predict MDQ and NPRS outcomes. A potential variable set for a standard predictive model that balances statistical performance with pragmatic considerations included the OSPRO-ROS+, OSPRO-YF, NIH-CP definition, and admit MDQ and NPRS scores. J Orthop Sports Phys Ther 2022;52(10):685-693. Epub: 12 August 2022. doi:10.2519/jospt.2022.11018.