Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions in the Emergency Department

Musculoskeletal pain is one of the most common reasons for Emergency Department (ED) visits, yet pain reporting is limited to the 0-10 numeric rating scale, and its impact tends to be underestimated by healthcare providers. The Optimal Screening for Prediction of Referral and Outcome (OSPRO) Review of Symptoms (ROS) and Yellow Flag (YF) Assessment Tools identify somatic symptoms and psychological factors affecting pain-related outcomes previously validated in outpatient physical therapy populations. The purpose of this study was to assess the construct validity of the OSPRO instruments for measuring pain psychological factors in ED patients with musculoskeletal pain. Of 215 adult ED patients presenting with musculoskeletal neck, back, or extremity pain, 165 completed the OSPRO-ROS, OSPRO-YF, Functional Comorbidity Index (FCI) and Patient-Reported Outcomes Measurement Information System (PROMIS-29) and were included in this analysis. Spearman correlation coefficients were calculated between OSPRO-ROS or OSPRO-YF scores and each of the seven PROMIS-29 domains. Moderate associations were found between total OSPRO-ROS or total OSPRO-YF and several PROMIS-29 domains. Moreover, moderate subdomain-specific associations were identified, such as YF-negative coping with PROMIS fatigue (r = 0.43 [95% CI: 0.29, 0.55]) and impaired physical function (r = -0.40 [95% CI: -0.52, -0.25]), as well as YF-negative mood with PROMIS depression (r = 0.50 [95% CI: 0.37, 0.61]). These findings suggest the OSPRO assessments may improve physician understanding of ED patients’ pain experience and the biopsychosocial factors that may inform their treatment.