Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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Yellow Flag Assessment Tool - About the Tool


  • The OSPRO-YF is a concise yellow flag assessment tool that allows for accurate estimates of individual, full-length psychological questionnaire scores for depressive symptoms, anxiety, anger, fear-avoidance beliefs, kinesiophobia, catastrophizing, self-efficacy, and pain acceptance.
  • It is designed for use by orthopedic physical therapists with an interest in estimating multiple individual psychological questionnaire scores without burdening the patient by completing each full instrument. 
  • In addition to providing full-length questionnaire score estimates, the OSPRO-YF identifies the presence of yellow flags. A yellow flag is operationally defined as scores that fall in the top quartile for negative psychological questionnaires (e.g. PCS, FABQ, PHQ-9) or bottom quartile for positive psychological questionnaires (e.g. PSEQ, CPAQ and SER).
  • The OSPRO-YF comes in 3 forms: 17-items, 10-items, and 7-items with a minimum 85%, 81%, and 75% accuracy, respectively, for identifying yellow flags.
  • The OSPRO-YF informs treatment decision-making and facilitates treatment monitoring for patients determined to be at high risk for poor outcomes by existing risk-assessment tools.

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