text: 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 
  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. 
  
  to  other  providers  for management 