II. Screening and assessment tools

Commonly used tools are included below, though this list is not exhaustive.

Örebro Musculoskeletal Pain Screening Questionnaire - Short Form (ÖMPSQ-SF)

The ÖMPSQ-SF consists of 10 items, with questions related to pain intensity, fear-avoidance beliefs, mood, the impact of pain on daily activities, concerns about and expectations for return to work. Each item is scored on a scale, with the total score ranging from 0 to 100. A higher score indicates a higher risk of chronicity and delayed return to work.

The questions asked are:

1.How long have you had your current pain problem?

2.How would you rate the pain that you have had during the past week?

3.I can do light work (or home duties) for an hour.

4.I can sleep at night.

5.How tense or anxious have you felt in the past week?

6.How much have you been bothered by feeling depressed in the past week?

7.In your view, how large is the risk that your current pain may become persistent?

8.In your estimation, what are the chances you will be working your normal duties (at home or work) in 3 months?

9.An increase in pain is an indication that I should stop what I'm doing until the pain decreases.

10.I should not do my normal work (at work or home duties) with my present pain.

The ÖMPSQ-SF score significantly predicts the number of days to return to pre-injury duties, such that for every 1-point increase in the total ÖMPSQ-SF score, the predicted chance of returning to work reduced by 4% (hazard ratio = 0.96, p < 0.001). Another way of viewing the data is that those triaged via the tool as having elevated work loss risk have three times the number of days off work than those at low risk.

The ÖMPSQ-SF is concise, making it acceptable and feasible for use in busy settings. It has broad application for use in all musculoskeletal conditions.

As the most commonly used and best validated tool, the ÖMPSQ-SF is the current 'gold standard' for psychosocial triage.

A cut-off score of 50 out of 100 has been suggested to identify individuals at higher risk of poor outcomes. However, the optimal cut-off may vary depending on the specific population and context. Some research suggests that a slightly lower cut-off of 48 might be more appropriate in certain settings.

AB-5 Triage Tool

Developed from a comprehensive psychosocial assessment questionnaire (ARI.MSI), the AB-5 tool is designed to predict psychosocial risk with high sensitivity. It comprises five questions, which are drawn from the cluster of questions used to evaluate domain ratings within the full assessment questionnaire. A single question is not adequate to rate a psychosocial domain.

1.Function: I can do ordinary household chores

2.Emotions: I am unable to relax

3.Coping: I can cope with my pain without medication

4.Confidence: I have found everything getting on top of me

5.Work perceptions: I can do some form of work, despite the pain

Answers are given on a Likert scale from 0 to 4, with the total score being used to triage into low, medium and high-risk categories. Statistical testing measured the AB-5 capacity to predict if a respondent's Initial Abilita Assessment (ARI.MSI) rating would exceed the threshold that indicates that psychosocial factors are contributing to delayed recovery and RTW (sensitivity 94%, specificity 46%).

The STarT Back Screening Tool (SBST)

This is a validated tool specifically designed for, and limited to, people with low back pain. This tool categorises people into three risk levels of having poor outcomes: low, medium, and high risk. The tools limitation is it limited in use to those with back complaints, versus all musculoskeletal conditions.

Yellow Flag Questionnaire (mYFQ)

This suite of questions was designed as a conversational tool to identify psychosocial barriers. A small study in clinical practice suggests the results are comparable to the ÖMPSQ-SF.

One point is allocated for every 'yes' answer, to a maximum of ten points.

1.Do you believe that your pain must be reduced to nil before you can attempt to return to work?

2.Do you expect your pain will increase if you return to any form of work now?

3.Have you had disciplinary or other problems in your workplace before now?

4.Do you feel poorly supported by your workplace in any way?

5.Do you believe that you having pain is doing you harm?

6.Do you expect there is a single treatment that will cure your pain?

7.Do you lack support at home to talk about this problem?

8.Do you believe that movement is bad and should not form part of treatment?

9.Have you previously experienced depression, anxiety or other psychological illnesses?

10.Is there any other reason you believe you shouldn't be at work at present?

FactorWEB

The FactorWEB Assessment System has been adopted by the State Insurance Regulatory Authority (SIRA) in NSW as a standardised assessment tool. This system assesses key psychosocial barriers including:

Pain and Symptoms

•Pain intensity and interference with function

•Nature and pattern of symptoms

•Impact on daily activities

Recovery Expectations

•Beliefs about recovery timeline

•Return to work expectations

•Confidence in managing condition

Work-Related Factors

•Job satisfaction

•Workplace relationships

•Physical job demands

•Work modifications needed

Psychosocial Factors

•Mood and emotional state

•Sleep patterns

•Stress levels

•Social support

•Coping strategies

Lifestyle Impact

•Impact on family life

•Changes to daily routine

•Effects on recreational activities

•Financial concerns

Screening tools

Screening tools