Purpose Physical therapists play a crucial role in managing persistent pain and disability. Since psychosocial factors are important predictors of poor patient outcomes, it is essential that clinicians understand how to utilize validated instruments to assess psychosocial profile in the clinical setting. The following article reviews the psychometric properties and clinical application of the Keele Subgroups for Targeted Treatment Back Screening Tool (SBT), Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO‐YF), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Pain Self‐Efficacy Questionnaire (PSEQ), and Patient Health Questionnaire (PHQ). Results Multidimensional screening tools, such as the SBT and OSPRO‐YF, are useful prognostic indicators of long‐term disability and the presence of yellow flags that may be contributing to patient presentation, respectively. This can guide both the treatment and administration of specific, unidimensional psychosocial assessment tools. The following cutoffs are identified as moderate elevation of psychosocial profile which can be used to inform clinical practice: PCS ≥20, TSK >37, PSEQ ≥40, and PHQ‐9 ≥10. Conclusion Valid and reliable unidimensional and multidimensional psychosocial assessment tools provide important prognostic information to inform a patient's psychosocial profile and subsequently improve clinical efficiency and patient outcomes.

BackgroundAchieving adequate follow-up in clinical trials is essential to establish the validity of the findings. Achieving adequate response rates reduces bias and increases probability that the findings can be generalized to the population of interest. Therefore, the purpose of this study was to determine the influence of attention, demographic, psychological, and health status factors on web-based response rates in the ongoing Prevention of Low Back Pain in the Military (POLM) trial.MethodsTwenty companies of Soldiers (n = 4,325) were cluster randomized to complete a traditional exercise program including sit-ups (TEP) with or without a psychosocial educational program (PSEP) or a core stabilization exercise program (CSEP) with or without PSEP. A subgroup of Soldiers (n = 371) was randomized to receive an additional physical and ultrasound imaging (USI) examination of key trunk musculature. As part of the surveillance program, all Soldiers were encouraged to complete monthly surveys via email during the first year. Descriptive statistics of the predictor variables were obtained and compared between responders and non-responders using two sample t-tests or chi-square test, as appropriate. Generalized linear mixed models were subsequently fitted for the dichotomous outcomes to estimate the effects of the predictor variables. The significance level was set at .05 a priori.ResultsThe overall response rate was 18.9% (811 subjects) for the first year. Responders were more likely to be older, Caucasian, have higher levels of education and income, reservist military status, non smoker, lower BMI, and have received individualized attention via the physical/USI examination (p < .05). Age, race/ethnicity, education, military status, smoking history, BMI, and whether a Soldier received the physical/USI examination remained statistically significant (p < .05) when considered in a full multivariate model.ConclusionThe overall web based response rate during the first year of the POLM trial was consistent with studies that used similar methodology, but lower when compared to rates expected for standard clinical trials. One year response rate was significantly associated with demographic characteristics, health status, and individualized attention via additional testing. These data may assist for planning of future trials that use web based response systems.Trial RegistrationThis study has been registered at reports at http://clinicaltrials.gov (NCT00373009).

Background: Many patients live with long-term deficits in knee function after an anterior cruciate ligament reconstruction (ACLR). However, research is inconclusive as to which physical performance measure is most strongly related to long-term patient-reported outcomes after ACLR. Hypothesis: Quadriceps strength would be most strongly associated with patient-reported long-term outcomes after ACLR. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 40 patients (29 female) consented and participated an average of 10.9 years post-ACLR (range, 5-20 years). Patients completed the Lower Extremity Functional Scale (LEFS), the International Knee Documentation Committee (IKDC) Scale, Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QoL) and Sport (KOOS Sport) subscales, and the Tampa Scale of Kinesiophobia (TSK-17). Each patient subsequently performed maximal isometric quadriceps contraction, a 60-second single-leg step-down test, and the single-leg single hop and triple hop for distance tests. Multivariate linear and logistic regression models determined how performance testing was associated with each patient-reported outcome when controlling for time since surgery, age, and TSK-17. Results: When controlling for time since surgery, age at the time of consent, and TSK-17 score, maximal isometric quadriceps strength normalized to body weight was the sole physical performance measure associated with IKDC ( P < 0.001), KOOS Sport ( P = 0.006), KOOS QoL ( P = 0.001), and LEFS scores ( P < 0.001). Single-leg step-down, single hop, and triple hop did not enter any of the linear regression models ( P > 0.20). Additionally, TSK-17 was associated with all patient-reported outcomes ( P ≤ 0.01) while time since surgery was not associated with any outcomes ( P > 0.05). Conclusion: Isometric quadriceps strength and kinesiophobia are significantly associated with long-term patient-reported outcomes after ACLR. Clinical Relevance: These results suggest that training to improve quadriceps strength and addressing kinesiophobia in the late stages of recovery from ACLR may improve long-term self-reported function.

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BackgroundPsychosocial variables are known to play an important role in musculoskeletal pain. Recent efforts incorporating psychological theory into rehabilitative medicine, as part of patient‐centred care or psychologically informed physical therapy, have gained broader acceptance. The fear‐avoidance model is the dominant psychosocial model and has introduced a variety of phenomena which assess psychological distress (i.e., yellow flags). Yellow flags, such as fear, anxiety and catastrophizing, are useful concepts for musculoskeletal providers but reflect a narrow range of psychological responses to pain.ObjectiveClinicians lack a more comprehensive framework to understand psychological profiles of each patient and provide individualised care. This narrative review presents the case for applying personality psychology and the Big‐Five trait model (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience) to musculoskeletal medicine. These traits have strong associations with various health outcomes and provide a robust framework to understand patient emotion, motivation, cognition and behaviour.Key ResultsHigh conscientiousness is associated with positive health outcomes and health promoting behaviours. High neuroticism with low conscientiousness increases the odds of negative health outcomes. Extraversion, agreeableness and openness have less direct effects but have positive correlations with important health behaviours, including active coping, positive affect, rehabilitation compliance, social connection and education level.Clinical ApplicationThe Big‐Five model offers an evidence‐based way for MSK providers to better understand the personality of their patients and how it relates to health. These traits offer the potential for additional prognostic factors, tailored treatments and psychological intervention.