text: Opioids and diagnostic tests and imaging were the two 
  most common subsequent healthcare services utilized 
  following physical therapy. Of the individuals that com- 
  pleted follow up and had any subsequent healthcare 
  utilization, approximately 42% reported opioid use and 
  70% reported use of diagnostic tests and imaging. An 
  important health-related predictor of these services was 
  level of comorbidity burden. For those with high comor- 
  bidity burden and inadequate treatment response to 
  physical therapy, use of additional diagnostic tests and 
  imaging or low-dose opioids may be appropriate in some 
  cases. But given the growing public health concern over 
  opioid use and the desire to avoid unnecessary treat- 
  ment driven by imaging, our results suggest the import- 
  ance of considering disease burden when developing 
  treatment pathways and healthcare policy to mitigate 
  risk for avoidable use of these services. Interestingly, 
  neither 
  predicted 
  utilization outcomes even though it has been linked to 
  mental health, comorbidity, and persistent pain state in 
  other analyses [20, 21]. Systemic symptom burden is a 
  measure of patient complexity that is related to but dis- 
  tinct from comorbidity burden [36, 47]. In these ana- 
  lyses, the chronic condition measure (i.e. the CCI) was 
  a better predictor of utilization than symptom burden 
  (i.e. OSPRO-ROS). The reasons for this finding are un- 
  clear but may be related to providers and patients being 
  more likely to pursue follow-up medical care for mus- 
  culoskeletal pain when known co-existing conditions 
  are present as opposed to reporting of symptoms alone. 
  The distinction between symptom and disease burden 
  in defining musculoskeletal patient complexity, and its 
  influence on clinical decision-making and outcomes, 
  should be the subject of future research particularly re- 
  lated to aging populations [48]. 
  
  versions  of  the OSPRO-ROS 