Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

George, Steven Z.; Beneciuk, Jason M.; Lentz, Trevor A.; Wu, Samuel S.; Dai, Yunfeng; Bialosky, Joel E.; Zeppieri, Giorgio

doi:10.2519/jospt.2018.7811

Cited by 79Musculoskeletal pain and rehabilitationMusculoskeletal Disorders and RehabilitationMedical Practices and Rehabilitation

Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

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George, Steven Z., Beneciuk, Jason M., Lentz, Trevor A., Wu, Samuel S., Dai, Yunfeng, Bialosky, Joel E., Zeppieri, Giorgio·2018·Journal of Orthopaedic & Sports Physical Therapy

DOI 10.2519/jospt.2018.7811PMC PMC6053060

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Abstract

Study Design: Observational, prospective cohort. Background: Musculoskeletal pain is a common reason to seek health care, and earlier nonpharmacological treatment and enhancement of personalized care options are 2 high-priority areas. Validating concise assessment tools is an important step toward establishing better care pathways. Objectives: To determine the predictive validity of Optimal Screening for Prediction of Referral and Outcome (OSPRO) tools for individuals with neck, low back, shoulder, or knee pain. Methods: A convenience sample (n = 440) was gathered by Orthopaedic Physical Therapy-Investigator Network clinics (n = 9). Participants completed demographic, clinical, and comorbidity questionnaires and the OSPRO tools, and were followed for 12-month outcomes in pain intensity, region-specific disability, quality of life, and comorbidity change. Analyses predicted these 12-month outcomes with models that included the OSPRO review-of-systems (OSPRO-ROS) and yellow flag (OSPRO-YF) tools and planned covariates (accounting for comorbidities and established demographic and clinical factors). Results: The 10-item OSPRO-YF tool (baseline and 4-week change score) consistently added to predictive models for 12-month pain intensity, region-specific disability, and quality of life. The 10-item OSPRO-ROS tool added to a predictive model for quality of life (mental summary score), and 13 additional items of the OSPRO-ROS+ tool added to prediction of 12-month comorbidity change. Other consistent predictors included age, race, income, previous episode of pain in same region, comorbidity number, and baseline measure for the outcome of interest. Conclusion: The OSPRO-ROS and OSPRO-YF tools statistically improved prediction of multiple 12-month outcomes. The additional variance explained was small, and future research is necessary to determine whether these tools can be used as measurement adjuncts to improve management of musculoskeletal pain. J Orthop Sports Phys Ther 2018;48(6):460–475. Epub 7 Apr 2018. doi:10.2519/jospt.2018.7811

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When used in more widespread patient populations, the predictive ability of multidimensional yellow flag instruments is low.
“When used in more widespread patient populations, the predictive ability of multidimensional yellow flag instruments is low (S.Z. George et al., 2018).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as S.Z. George et al., 2018
The Discussion reports that OSPRO-YF added only small amounts of variance to outcome predictions in a cohort spanning neck, shoulder, low-back, and knee pain, and says its predictive ability was similar to that of other screening tools. This supports the claim’s general direction, but the paper measures small incremental predictive contributions from OSPRO-YF; it does not establish that multidimensional yellow-flag instruments generally have low predictive ability across broader patient populations. (LLM, conf=0.82)
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Background
The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System
Mauntel, T. C., Tenan, M. S., Freedman, B. A., Potter, B. K., Provencher, M. T., Tokish, J. M., Lee, I. E., Rhon, D. I., Bailey, J. R., Burns, T. C., et al. (2020) · Military Medicine · doi:10.1093/milmed/usaa304 · Cited by 20 · see citing works
Importance of Outcome Domain for Patients With Musculoskeletal Pain: Characterizing Subgroups and Their Response to Treatment
Zeppieri, G., Bialosky, J., & George, S. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa009 · Cited by 14 · see citing works
Self-citation
Longitudinal Monitoring of Pain Associated Distress With the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Tool: Predicting Reduction in Pain Intensity and Disability
George, S. Z., Li, C., Luo, S., Horn, M. E., & Lentz, T. A. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.05.025 · Cited by 17 · see citing works
Self-citation
American Physical Therapy Association Clinical Practice Guideline Implementation for Neck and Low Back Pain in Outpatient Physical Therapy: A Nonrandomized, Cross-sectional Stepped-Wedge Pilot Study
Beneciuk, J. M., Osborne, R., Hagist, M. B., Crittenden, J., Buzzanca-Fried, K. E., Gao, H., & Wu, S. S. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.10545 · Cited by 16 · see citing works
Self-citation
Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation.
Williams, M. K., Waite, L., Van Wyngaarden, J. J., Meyer, A. R., & Koppenhaver, S. L. (2023) · Musculoskeletal Care · doi:10.1002/msc.1797 · Cited by 15 · see citing works
Injury-related Psychological Distress and the Association with Perceived Running Ability in Injured Runners
Maschke, B., Palmsten, A., Nelson, E. O., Obermeier, M. C., Reams, M., Heiderscheit, B., Russell, H. C., & Chmielewski, T. (2021) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2021.12.005 · Cited by 15 · see citing works
What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis?
Jayakumar, P., Crijns, T. J., Misciagna, W., Manickas-Hill, O., Malay, M., Jiranek, W., Mather, R., & Lentz, T. A. (2024) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000003003 · Cited by 9 · see citing works
“The tool is shown to have good test-retest reliability and predict important outcomes such as pain intensity, magnitude of in-capability, general health status, and use of surgery after nonoperative care among people with musculoskeletal conditions [7, 10, 13, 14, 19, 36].”
MethodSelf-citation
Psychometric Properties of the OSPRO-YF Screening Tool in Patients with Shoulder Pathology.
Razmjou, H., Palinkas, V., Robarts, S., & Kennedy, D. (2020) · Physiotherapy Canada. Physiothérapie Canada · doi:10.3138/ptc-2019-0046 · Cited by 12 · see citing works
The relationships between pain‐associated psychological distress, pain intensity, patient expectations, and physical function in individuals with musculoskeletal pain: A retrospective cohort study
Leech, J. B., Lulofs-MacPherson, K., Klopper, M., Shumway, J., Salvatori, R. T., Rhon, D. I., & Young, J. L. (2023) · PM&R · doi:10.1002/pmrj.12983 · Cited by 11 · see citing works
An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report
Storari, L., Barbari, V., Brindisino, F., Testa, M., & Maselli, F. (2021) · Archives of Physiotherapy · doi:10.1186/s40945-021-00099-x · Cited by 12 · see citing works
Identification of clinically-useful cut scores of the Traumatic Injuries Distress Scale (TIDS) for predicting rate of recovery following musculoskeletal trauma
Walton, D. M., Elliott, J. M., Lee, J. Y., Fakhereddin, M., & Seo, W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248745 · Cited by 11 · see citing works
“The tool showed sound concurrent associations with other metrics of psychological distress, and in a follow-up longitudinal study was able to explain significant linear variance in 12-month recovery outcomes in patients with both acute and chronic symptoms [11].”
Method
Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study
Eucker, S. A., Foley, S., Peskoe, S. B., Gordee, A., Risoli, T. J., Morales, F. L., & George, S. Z. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000001027 · Cited by 11 · see citing works
“It has been shown to be reliable and predict pain and functional outcomes after musculoskeletal care in outpatient physical therapy settings.(5,16,24) The Optimal Screening for Prediction of Referral and Outcome Yellow Flag 4-factor subscores were calculated as described in the study of Butera”
MethodSelf-citation
Pain-Associated Psychological Distress Is of High Prevalence in Patients With Hip Pain: Characterizing Psychological Distress and Phenotypes
Cabell, G. H., Kwon, N. F., Sutton, K. F., Lentz, T. A., Lewis, B. D., Olson, S., & Mather, R. (2023) · Arthroscopy, Sports Medicine, and Rehabilitation · doi:10.1016/j.asmr.2023.100846 · Cited by 12 · see citing works
Self-citation
Predicting the number of physical therapy visits and patient satisfaction in individuals with temporomandibular disorder: A cohort study
Prodoehl, J., Kraus, S. L., & Stein, A. B. (2021) · Journal of Oral Rehabilitation · doi:10.1111/joor.13272 · Cited by 11 · see citing works
Transition from acute to chronic low back pain in a community-based cohort
Burke, C. A., Fillipo, R., George, S. Z., Kapos, F. P., Kosinski, A. S., Ford, E., Danyluk, S. T., Kingsbury, C. A., Seebeck, K., Lewis, C. E., et al. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104704 · Cited by 11 · see citing works
Self-citation
Artificial Intelligence in Physical Therapy Education: Evaluating Clinical Reasoning Performance in Musculoskeletal Care Using ChatGPT
Hao, J., Yao, Z., & Siu, K. (2025) · Musculoskeletal Care · doi:10.1002/msc.70177 · Cited by 10 · see citing works
“Well‐ established tools such as the OSPRO (George et al. 2018) and IFMOPT cervical framework (Rushton et al. 2023) should be integrated into subjective and objective examination processes to support effective triage and referral when necessary.”
The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study
Beresford, L. S., & Norwood, T. (2021) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/31349 · Cited by 10 · see citing works
“Participants in our sample were not automatically excluded if they endorsed symptoms found on the Optimal Screening for Prediction of Referral and Outcome-Review of Systems (OSPRO-ROS) tool [37].”
Treatment monitoring as a component of psychologically informed physical therapy: a case series of patients at high risk for persistent low back pain related disability
Beneciuk, J., Ballengee, L. A., & George, S. (2019) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2019.03.004 · Cited by 6 · see citing works
Self-citation
Efficient Screening for Fear of Movement in Outpatient Settings: Short Form and Computer Adaptive Tests for Fear Avoidance and Negative Pain Coping
Lentz, T. A., Kallen, M. A., Deutscher, D., & George, S. Z. (2021) · Physical Therapy · doi:10.1093/ptj/pzab256 · Cited by 9 · see citing works
Self-citation
The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial
Myers, H. S., Keefe, F. J., George, S. Z., Kennedy, J. S., Lake, A. D., Martinez, C., & Cook, C. E. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04588-9 · Cited by 9 · see citing works
“Participant retention is promoted through contact between the physical therapist and the patient along with participant Optimal Screening for Prediction of Referral and Outcome [48] OSPRO-ROS Baseline Concurent Validity (pain) r = 0.31 [49] Comorbidities, Systemic Pathology A review-of-systems screening tool that incl…”
BackgroundMethodInfluentialSelf-citation
Heterogeneity of pain-related psychological distress in patients seeking care for shoulder pathology
Levin, J. M., Baker, R. L., Goltz, D. E., Wickman, J. R., Lentz, T. A., Cook, C. E., George, S. Z., Klifto, C. S., & Anakwenze, O. A. (2021) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2021.09.009 · Cited by 8 · see citing works
Self-citation
Patient-defined outcomes for pain, fatigue, emotional distress, and interference with activities did not differ by age for individuals with musculoskeletal pain
Wilson, A. T., George, S., & Bialosky, J. (2019) · PAIN Reports · doi:10.1097/pr9.0000000000000798 · Cited by 6 · see citing works
“Optimal Screening for Prediction of Referral and Outcome (OSPRO) cross-sectional(19,30) and longitudinal cohorts.(20) Data were collected for the cross-sectional cohort from March 2013 to May 2014 at participating physical therapy clinical sites in Florida (n 5 11).”
BackgroundSelf-citation
Blood Flow Restriction Training for Subacromial Pain: Two Case Reports
Miller, M. W., Zeppieri, G., Farmer, K. W., & Pozzi, F. (2022) · JOSPT Cases · doi:10.2519/josptcases.2022.10867 · Cited by 7 · see citing works
Self-citation
Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes
Flynn, S., Gordee, A., Kuchibhatla, M., George, S., & Eucker, S. (2021) · Academic Emergency Medicine · doi:10.1111/acem.14328 · Cited by 8 · see citing works
Self-citation
Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools.
Robarts, S., Razmjou, H., Yee, A., & Finkelstein, J. (2022) · Physiotherapy Canada. Physiothérapie Canada · doi:10.3138/ptc-2021-0026 · Cited by 6 · see citing works
Dry needling in addition to standard physical therapy treatment for sub-acromial pain syndrome: a randomized controlled trial protocol
Hando, B., Rhon, D. I., Cleland, J. A., & Snodgrass, S. J. (2018) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2018.10.010 · Cited by 7 · see citing works
Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial
Eucker, S. A., Glass, O., Staton, C. A., Knisely, M. R., O’Regan, A., Larco, C. D., Mill, M., Dixon, A., TumSuden, O., Walker, E., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061661 · Cited by 6 · see citing works
Guideline adherent screening and referral: do third year Doctor of Physical Therapy students identify red and yellow flags within descriptive patient cases? a United States based survey study
Bourassa, M., Kolb, W., Barrett, D., & Wassinger, C. A. (2023) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2023.2170743 · Cited by 4 · see citing works
Defying Stereotypes
Mulcahy, J., Beresford, L. S., & DeLaRosby, A. (2023) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0000000000000414 · Cited by 6 · see citing works
Psychometric properties of the Optimal Screening for Prediction of Referral and Outcome Yellow Flags (OSPRO-YF) in patients with lumbar spine pain
Robarts, S., Razmjou, H., Yee, A., Palinkas, V., & Finkelstein, J. (2019) · European Journal of Physiotherapy · doi:10.1080/21679169.2019.1706633 · Cited by 5 · see citing works
Validation of the Keele STarT MSK Tool for Patients with Musculoskeletal Pain in United States-Based Outpatient Physical Therapy Settings.
Beneciuk, J., Michener, L. A., Sigman, E., Harrison, T., Buzzanca-Fried, K. E., Lu, X.-L., Shan, G., & Hill, J. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.340 · Cited by 6 · see citing works
Self-citation
Impact of different acute low back pain definitions on the predictors and on the risk of transition to chronic low back pain: a prospective longitudinal cohort study
Osagie, R. O., Tufa, I., Fonseca, A. A., Pagé, M. G., Lacasse, A., Stone, L. S., Rainville, P., Roy, M., Tétreault, P., Fortin, M., et al. (2025) · Pain · doi:10.1097/j.pain.0000000000003669 · Cited by 5 · see citing works
“30,36,51 Although psychosocial factors Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. consistently predict poorer outcomes, 7,24,29 there is inconsistency regarding specific risk factors identified across studies.”
Derivation of a Risk Assessment Tool for Prediction of Long-Term Pain Intensity Reduction After Physical Therapy
Horn, M., George, S., Li, C., Luo, S., & Lentz, T. A. (2021) · Journal of Pain Research · doi:10.2147/jpr.s305973 · Cited by 5 · see citing works
“We did not conduct imputation for missing data because previous outcomes prediction analyses using the OSPRO cohort have demonstrated no meaningful differences between imputed and complete case analyses.(9,10,23)”
MethodSelf-citation
The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain.
Spoonemore, S. L., McConnell, R., Owen, W. E., Young, J., Clewley, D., & Rhon, D. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100532 · Cited by 5 · see citing works
Referral, enrollment, and health care use in a comprehensive patient-centered management program for osteoarthritis of the hip and knee
Lentz, T., Roundy, P. E., Poehlein, E., Green, C., Mather, R. C., & Jiranek, W. (2024) · Osteoarthritis and Cartilage Open · doi:10.1016/j.ocarto.2024.100532 · Cited by 4 · see citing works
Self-citation
Sensory and Psychological Factors Predict Exercise-Induced Shoulder Injury Responses in a High-Risk Phenotype Cohort
Butera, K. A., Bishop, M. D., Greenfield, W. H., Staud, R. M., Wallace, M. R., Borsa, P. A., Fillingim, R. B., & George, S. Z. (2021) · Journal of Pain · doi:10.1016/j.jpain.2020.12.002 · Cited by 4 · see citing works
Self-citation
STarT-Lower Extremity Screening Tool at Six-weeks Predicts Pain and Physical Function 12-months after Traumatic Lower Extremity Fracture
Wyngaarden, J. J. V., Noehren, B. W., Matuszewski, P. E., & Archer, K. R. (2021) · Injury · doi:10.1016/j.injury.2021.03.051 · Cited by 4 · see citing works
Can Physical Therapy Deliver Clinically Meaningful Improvements in Pain and Function Through a Mobile App? An Observational Retrospective Study
Beresford, L. S., & Norwood, T. (2022) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2022.100186 · Cited by 4 · see citing works
“Approximately 47% (383/814) of participants had some history of comorbid conditions, and more than one-third (281) endorsed adverse symptoms found on the OSPRO-ROS.(29) Table 4 presents the results for both pain and function from multilevel random intercept models with significant controls.”
BackgroundMethodInfluential
Does psychological distress predict risk of orthopaedic surgery and postoperative opioid prescribing in patients with hip pain? A retrospective study
Sutton, K. F., Cabell, G. H., Ashley, L., Lentz, T. A., Lewis, B. D., Olson, S., & Mather, R. C. I. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07418-w · Cited by 4 · see citing works
“…mood (depression, trait anxiety, and trait anger); negative coping (fear-avoidance for work, fear-avoidance for physical activity, pain catastrophizing, kinesophobia, and pain anxiety); and positive affect/coping (pain self-efficacy, self-efficacy for rehabilitation, and pain acceptance) [26, 37].”
BackgroundSelf-citation
Injury Prevention Considerations in Adolescent Overhead-Throwing Athletes
Zaremski, J., Zeppieri, G., & Tripp, B. L. (2019) · Current Physical Medicine and Rehabilitation Reports · doi:10.1007/s40141-019-00224-9 · Cited by 4 · see citing works
Self-citation
Four Variables Were Sufficient for Low Back Pain: Determining Which Patient-Reported Tools Pain and Disability Improvements
Neeley, D. K., George, S. Z., Minick, K. I., Snow, G. L., & Brennan, G. P. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.11018 · Cited by 4 · see citing works
Self-citation
Interrater reliability of the modified prone instability test for lumbar segmental instability in individuals with mechanical low back pain
Larkin, E. R., Calley, D. Q., & Hollman, J. H. (2024) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2024.2352934 · Cited by 2 · see citing works
Characterizing Acute Low Back Pain in a Community-Based Cohort: Results from a Feasibility Cohort Study
Burke, C. A., Taylor, K. A., Fillipo, R., George, S. Z., Kapos, F. P., Danyluk, S., Kingsbury, C. A., Seebeck, K., Lewis, C. E., Ford, E., et al. (2024) · Journal of Pain Research · doi:10.2147/jpr.s474586 · Cited by 3 · see citing works
Self-citation
Patient‐centered outcomes: Domain importance predicts health care use following physical therapy
Zeppieri, G., George, S., Bialosky, J., & Lentz, T. A. (2021) · PM & R : the journal of injury, function, and rehabilitation · doi:10.1002/pmrj.12680 · Cited by 1 · see citing works
“Median (min, max) 47 (18-75) 44 (18-75) 53 (18-74) 44 (19-75)”
Self-citation
Assessing and Comparing Musculoskeletal Knowledge and Red Flag Identification Skills: A Cross-Sectional Study of Physical Therapists and Primary Care Physicians
Almedlej, R. F., Abdelkader, S., Alodaibi, F., & Alsobayel, H. (2024) · International Journal of Physical Therapy Research & Practice · doi:10.62464/ijoprp.v3i7.44 · Cited by 2 · see citing works
“The use of red flag screening tools such as the Optimal Screening for Predicting Referral and Outcome-Review of Systems (George et al., 2018) may enhance patient safety.”
Method
Presentation and physical therapy management using a neuroplasticity approach for patients with hypermobility-related upper cervical instability: a brief report
Chalela, S., & Russek, L. N. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1459115 · Cited by 2 · see citing works
Patient and physical therapist perspectives on spinal manipulative therapy for low back pain and associated clinical outcomes: protocol for a prospective, single-arm intervention study
Beneciuk, J. M., Bialosky, J. E., Hayes, J. R., Buzzanca-Fried, K. E., Rowe, R., Cristello, S., Harrison, T., Vickers, R., & Shan, G. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-099932 · Cited by 2 · see citing works
Self-citation
Acute Intermittent Hypoxia Did Not Alter Pain Sensitivity or Pain Intensity Ratings for Individuals with Chronic Low Back Pain: A Pilot Study
George, S. Z., & Horn, M. E. (2024) · Journal of Pain Research · doi:10.2147/jpr.s433685 · Cited by 2 · see citing works
“26 Participants also completed the 10 item Oswestry Disability Questionnaire (ODQ) 27,28 and two items from the NIH Research Task Force (RTF) minimal data set for chronic LBP that allow for categorization of high impact chronic pain.”
Self-citation
Changes in Pain-Related Psychological Distress After Surgery in Patients with Musculoskeletal Injury
Cabell, G. H., Kim, B. I., Wu, K. A., Luo, E. J., Bulleit, C. H., Morriss, N. J., Lentz, T. A., & Lau, B. C. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22060857 · Cited by 1 · see citing works
“The OSPRO-YF is a self-report tool that provides practitioners with a comprehensive assessment of general and pain-specific psychological distress without overburdening the patient [7,8].”
Self-citation
Transitions in Psychological Distress Phenotypes and Patient‐Reported Outcomes Among Patients Undergoing Total Joint Arthroplasty
Ramirez, M. M., Lentz, T. A., George, S. Z., Coles, T., Brookhart, M. A., Brennan, G. P., Nelson, A. E., Allen, K. D., Bolognesi, M. P., & Horn, M. E. (2026) · ACR Open Rheumatology · doi:10.1002/acr2.70155 · Cited by 2 · see citing works
Self-citation
Pain and Disability Following Exercise-Induced Injury in Prognostic and Intervention Studies: The Why May Be More Important Than the How
Bishop, M. D., & George, S. Z. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001097 · Cited by 1 · see citing works
Self-citation
Cortisol as a Marker of Pain and Distress After Acute Musculoskeletal Trauma
Jesin, J. A., & Walton, D. M. (2024) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001188 · Cited by 1 · see citing works
“6 – 8 With few exceptions, these are almost exclusively standardized self-report tools that are best positioned as metrics of beliefs, emotions, values, or expectations related to the trauma and resulting symptoms.”
Background
Statistical Analyis Plan for Assessing Psychological Phenotypes of Patients with Low Back Pain in the Military Health System v1Preprint
Rhon, D. I., Lentz, T. A., & George, S. Z. (2023) · doi:10.17504/protocols.io.6qpvr4k1ogmk/v1 · Cited by 1 · see citing works
Self-citation
Characterization of Acute Low Back Pain in a Community-Based CohortPreprint
Taylor, K. A., Burke, C. A., George, S. Z., Danyluk, S. T., Kingsbury, C. A., Kapos, F., Seebeck, K., Lewis, C. E., Ford, E., Plez, C., et al. (2023) · medRxiv · doi:10.1101/2023.10.02.23296149
Self-citation
The effect of predictive nursing on the mental state, compliance and sleep quality of senile cervicitis: An observational study
Rao, D.-F., Chen, X., Li, F., Chen, X., Chen, J., Yu, Q., & Zhang, X. (2024) · Medicine · doi:10.1097/md.0000000000038095
Italian versions of the optimal screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and the Örebro Musculoskeletal pain screening questionnaire (ÖMPQ-21) and their short forms, in patients with low back pain: Cross-cultural adaptation, reliability and validity.
Bonetti, F., Angilecchia, D., Agostini, A., Marighetto, P., Minnucci, S., Giglioni, G., Pellicciari, L., & Chiarotto, A. (2024) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2024.103206
Elevated body mass index and obesity are associated with pain-associated psychological distress in patients with hip pain
Ashley, L., Sutton, K. F., Cabell, G. H., Lentz, T. A., Lewis, B. D., Olson, S., & Mather, R. (2024) · Archives of Orthopaedic and Trauma Surgery · doi:10.1007/s00402-024-05665-z
“…mood (depression, trait anxiety, and trait anger); negative coping (fear-avoid-ance for work, fear-avoidance for physical activity, pain cata-strophizing, kinesophobia, and pain anxiety); and positive affect/coping (pain self-efficacy, self-efficacy for rehabilitation, and pain acceptance [30, 31].”
Self-citation
Der Einsatz eines psychosozialen Screenings von Physiotherapeut*innen in Österreich
Kopfauf, M., & Taxer, B. (2023) · MSK – Muskuloskelettale Physiotherapie · doi:10.1055/a-2452-1354
Aortic dissection disguised as musculoskeletal condition: a case report and review of literature
Li, X., & Chen, Z. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-09135-4
“Given that many patients have undergone prior empiric treatment for musculoskeletal conditions, recognition of atypical pain is critical for proper medical referral, alongside considering demographic information [18].”
Optimal screening for prediction of referral and outcome score is a strong predictor of shoulder pain and function in glenohumeral osteoarthritis and rotator cuff arthropathy
Kobayashi, J. K., Sow, M., & Aibinder, W. (2026) · JSES International · doi:10.1016/j.jseint.2026.101637
“1,4,6,12 While Patient-Reported Outcomes Measurement Information System Upper Extremity evaluates patients with upper extremity pathology, it consists of 46 questions, tailored more at evaluating function.”
Artificial Intelligence in Physical Therapy: A Narrative Review of Artificial Intelligence Applications Across the Patient and Client Management Model
Hao, J., & Siu, K. (2026) · Health Science Reports · doi:10.1002/hsr2.72748
Mapping evidence on psychosocial factors in patients with shoulder pain: a scoping review
Almeida, L. A., Whitman, D., Barbosa, G. M., Morgan‐Daniel, J., Mazuquin, B., Beneciuk, J. M., & Pozzi, F. (2026) · Pain Management · doi:10.1080/17581869.2026.2736032
Self-citation
Pain resilience therapy vs. pain neuroscience education for adults with chronic low back pain: a pragmatic randomized controlled trial
Tatta, J., Palombaro, K. M., Bezner, J. R., Pignataro, R. M., & Rothschild, C. E. (2026) · European Journal of Physiotherapy · doi:10.1080/21679169.2026.2736261

The Optimal Screening for Prediction of Referral and Outcome (OSPRO) in patients with musculoskeletal pain conditions: a longitudinal validation cohort from the USA
George, S. Z., Beneciuk, J. M., Lentz, T. A., & Wu, S. S. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015188 · Cited by 40 · see citing works
Self-citation
Longitudinal Monitoring of Pain Associated Distress With the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Tool: Predicting Reduction in Pain Intensity and Disability
George, S. Z., Li, C., Luo, S., Horn, M. E., & Lentz, T. A. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.05.025 · Cited by 17 · see citing works
Self-citation
Prediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort Study
Beneciuk, J. M., Lentz, T. A., He, Y., Wu, S. S., & George, S. Z. (2018) · Physical Therapy · doi:10.1093/ptj/pzy021 · Cited by 44 · see citing works
Self-citation
Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions in the Emergency Department
Foster, J. A., George, S. Z., Gordee, A., Kuchibhatla, M. N., & Eucker, S. A. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.282
Self-citation
Psychometric Evaluation of the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool: Factor Structure, Reliability, and Validity
Butera, K. A., George, S. Z., & Lentz, T. A. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.09.003 · Cited by 45 · see citing works
Self-citation

Authors: George, S. Z., Beneciuk, J. M., Lentz, T. A., Wu, S. S., Dai, Y., Bialosky, J. E., & Zeppieri, G.
ORCID: George, Steven Z.
Beneciuk, Jason M.
Lentz, Trevor A.
Dai, Yunfeng
Bialosky, Joel E.
Zeppieri, Giorgio
Venue: Journal of Orthopaedic & Sports Physical Therapy
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Published: 2018-06
Volume: 48
Issue: 6
Pages: 460-475
ISSN: 0190-6011 (ISSN-L)
1938-1344
DOI: 10.2519/jospt.2018.7811
PMC: PMC6053060
OpenAlex: W2795524226
Cited by: 79
References: 57
Citations by year: 2026: 5 · 2025: 6 · 2024: 14 · 2023: 10 · 2022: 8 · 2021: 16 · 2020: 8 · 2019: 9 · 2018: 3
FWCI: 5.81
Type: journal article
Language: en
Open access: green
europepmc.org
Locations: Journal of Orthopaedic and Sports Physical Therapy (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR001427)
National Center for Advancing Translational Sciences
Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD055929)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: musculoskeletal pain, neck pain, low back pain, shoulder pain, knee pain, yellow flags, review of systems, predictive validity, outcome prediction, comorbidities, disability, quality of life, pain intensity, referral decisions, orthopaedic physical therapy
MeSH terms: Aged, Disability Evaluation, Female, Humans, Male, Middle Aged, Pain Measurement, Prospective Studies, Quality of Life, Referral and Consultation, Treatment Outcome, Musculoskeletal Pain

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Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

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