Psychometric Evaluation of the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool: Factor Structure, Reliability, and Validity

Abstract

Psychological characteristics consistently predict clinical outcomes for musculoskeletal pain conditions. The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool assesses negative mood, fear-avoidance, and positive affect/coping. Psychometric testing of the tool is needed to guide clinical use. The purpose of this secondary analysis was to determine the OSPRO-YF factor structure (17- and 10-item versions) and test factor reliability and concurrent validity. Data from 2 musculoskeletal pain cohorts (n1 = 428; n2 = 440) were used. An exploratory factor analysis (EFA) identified the factor structure in the first cohort; a confirmatory factor analysis (CFA) validated the factor structure in the second cohort. EFA yielded 4 factors for the 17-item version (catastrophizing, positive coping, negative mood, fear-avoidance) and 3 factors for the 10-item version (negative coping, negative mood positive affect/coping). CFA indicated good fit for the10-item and 17-item models. Factors from both versions demonstrated moderate to good test-retest reliability. Regression results revealed that factors from both versions contributed significantly to variance in pain intensity, disability, and quality of life. Results indicate the OSPRO-YF is a reliable and valid multidimensional psychological assessment tool for individuals with musculoskeletal pain. Future studies are needed to establish the OSPRO-YF as a prognostic and treatment monitoring tool. PERSPECTIVE: This article presents the psychometric properties of the OSPRO-YF tool. Findings indicate the OSPRO-YF is a reliable and valid multidimensional psychological assessment tool for individuals with musculoskeletal pain. Implementation of the OSPRO-YF tool may better guide clinical decision making and may lead to improved musculoskeletal pain management strategies.

Keywords: Pain-related psychological characteristics; multidimensional screening; musculoskeletal pain; pain; psychological assessment; psychometric evaluation; yellow flags.

Figure 1.. 17-item OSPRO-YF Confirmatory Factor Analysis Results

17-item OSPRO-YF four-factor model structure and resulting standardized parameter estimates; a summary of the fit statistic results is also shown; GFI=Goodness of Fit (>0.9, good); CFI=Comparative Fit Index (>0.95, good; >0.9 acceptable); RMSEA=Root Mean Square Error Approximation (<0.06, good; <0.08, acceptable); p-close refers to a value that tests the RMSEA confidence interval (p-close>0.05, reject null hypothesis of poor fit).

Figure 2.. 10-item OSPRO-YF Confirmatory Factor Analysis Results

10-item OSPRO-YF three-factor model structure and resulting standardized parameter estimates; a summary of the fit statistic results is also shown; GFI=Goodness of Fit (>0.9, good); CFI=Comparative Fit Index (>0.95, good; >0.9 acceptable); RMSEA=Root Mean Square Error Approximation (<0.06, good; <0.08, acceptable); p-close refers to a value that tests the RMSEA confidence interval (p-close>0.05, reject null hypothesis of poor fit).