cure study website for the informed consent process and
baseline self-report assessment. Eligibility criteria have
been thoroughly reported elsewhere [ 19] and were
intentionally broad to develop a cohort that was
generalizable to those seeking physical therapy for com-
mon musculoskeletal conditions in the US. Participants
completed follow-up self-reported assessments on the
study website at 4 weeks, 6 months and 12 months. Partic-
ipants were notified of a pending assessment by an email
that directed them back to the study website to complete
their follow-up assessment. For additional details of the
dataset and cohort, readers are directed to the published
cohort profile [ 19].
The primary aim of the OSPRO cohort study was to de-
velop and validate review of systems (i.e. evidence of sys-
temic involvement) and yellow flag (i.e. pain-related
psychological distress) screening tools for use in out-
patient orthopedic physical therapy settings. These screen-
ing tools, once validated and refined for clinical decision
making, may improve the value of care delivery by accur-
ately identifying individuals who 1) are appropriate for
referral to other providers for management of
non-musculoskeletal symptoms, and/or 2) would benefit
from enhanced, psychologically-informed physical ther-
apy. Early identification of individuals most appropriate
for these modified pathways of care has the potential to
reduce wasteful downstream health care utilization, limit
the risk of unwarranted and costly care escalation, and im-
prove clinical outcomes. Results of the primary analyses
examining the predictive ability of the OSPRO tools for
pain, disability, health status, and comorbidity outcomes
have been previously published [ 20]. Pre-planned second-
ary analyses included prediction of persistent pain state
[21] and this current analysis predicting future healthcare
utilization. All subjects consented to participation in the
study and ethics approval was granted by the University of
Florida Institutional Review Board.
Lentz et al. BMC Health Services Research  (2018) 18:648 Page 2 of 14