Correlation between the optimal screening for prediction of referral and outcome yellow flag tool and patient-reported legacy outcome measures in patients undergoing shoulder surgery

Abstract

BackgroundThe Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool is a 10-item multidimensional screening tool utilized to evaluate pain-related psychological traits in individuals with musculoskeletal pain conditions. The validity of postoperatively collected OSPRO-YF is unclear. This study sought to assess validity of the OSPRO-YF by comparing it to PRO scores in both pre- and postoperative settings. HypothesisThe authors hypothesized that OSPRO-YF overall score would correlate with shoulder and global function PROs at pre- and postoperative timepoints. MethodsA review of 101 patients undergoing shoulder surgery by one sports medicine orthopedic surgeon at a large academic institution was conducted. 90 and 54 patients had complete pre- and postoperative PRO responses. OSPRO-YF, American Shoulder and Elbow Surgeons Evaluation Form (ASES), and Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS-CAT) were routinely administered before and after surgery at the senior author’s clinic visits. Concurrent validity of OSPRO-YF at either timepoint was assessed by comparing scores with PROs cross-sectionally using Pearson correlations and multiple comparison corrections. ResultsPreoperatively, higher OSPRO-YF total score was associated with greater concurrent PROMIS-CAT Pain Interference (r=0.43; p<0.01) and Depression (r=0.36; p=0.05) and lower ASES (r=-0.34; p<0.01). Higher postoperative OSPRO-YF was also associated with greater concurrent PROMIS-CAT Pain Interference (r=0.43; p<0.01) and Depression (r=0.36; p<0.01) and lower ASES (r=-0.34; p=0.01). ASES had strong correlation with SANE and Pain scores at both pre- and postoperative timepoints. SANE was not significantly associated with OSPRO-YF total score or number of YFs at either timepoints. ConclusionThe study findings support the clinical validity of the 10-item OSPRO-YF tool when administered before or after shoulder surgery. For patients exhibiting suboptimal recovery or those identified as high risk at initial screening, assessment of pain-related psychological distress postoperatively may be particularly beneficial in guiding rehabilitation.