text: Abstract 
  
  Background: In the United States, value-based purchasing has created the need for healthcare systems to prospectively 
  identify patients at risk for high healthcare utilization beyond a physical therapy episode for musculoskeletal pain. The 
  purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode 
  of physical therapy for musculoskeletal pain. 
  
  Methods: This study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) 
  longitudinal cohort study that recruited individuals with a primary complaint of neck, low back, knee or shoulder 
  pain in physical therapy (n = 440). Demographics, health-related information, review of systems, comorbidity and 
  pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in 
  pain intensity, disability, and pain-related psychological distress were measured as treatment response variables. 
  At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests 
  or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models 
  were developed for any subsequent care and service-specific utilization. 
  
  Results: Subsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed 
  the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors 
  of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain 
  intensity, disability and pain-related psychological distress predicted specific service utilization. 