burden. The CCI has demonstrated good test-retest re-
liability (0.91) and positive but weak to modest correla-
tions with medication use, hospitalizations, length of
stay, total charges, and pharmacy and laboratory
charges for older adults in general medical care and
surgical care settings [ 35].
Assessment tools
OSPRO Review of Systems tool (OSPRO-ROS)
The OSPRO-ROS is a review-of-systems screening tool for
use in outpatient orthopedi c physical therapy settings [ 36].
The OSPRO-ROS has demonstrated good concurrent val-
idity with depression and a comprehensive 97-item battery
of non-musculoskeletal symptoms (i.e., red flags). [ 36]
Moderate to strong predictive capabilities of the
OSPRO-ROS have been reported for persistence of pain,
quality of life, and change in comorbidity 12 months fol-
lowing physical therapy in pat ients with musculoskeletal
pain [ 20, 21]. The OSPRO-ROS includes standard symp-
tom descriptors to aid with identification of systemic or
non-musculoskeletal origins of musculoskeletal pain. It
includes questions related to symptoms of the cardiovascu-
lar, gastrointestinal, endocrine, nervous, integumentary,
pulmonary, and musculoskeletal systems. The full-length
23-item version of the OSPRO-ROS is capable of identify-
ing 100% of positive red-flag r esponders (i.e. indicating
“yes” to at least one systemic symptom on a questionnaire)
in outpatient orthopedic ph ysical therapy settings. [ 36]A
shorter, 10-item version is also available that has been
Lentz et al. BMC Health Services Research  (2018) 18:648 Page 3 of 14