The Orebro Musculoskeletal Pain Questionnaire (OMPQ) screens your patients for psychosocial “yellow flags”. It has been validated to identify those patients with acute musculoskeletal pain that are at risk of developing persistent symptoms or experience a delayed recovery. This is particularly relevant in the space of back pain, which contributes a huge social, physical and financial burden on the community as well as the individual.
The OMPQ was originally developed as a long form, however the correlation with a shorter 10 item form is 0.91, making it nearly as accurate, and more user-friendly. Validity studies consider outcomes such as pain, functional disability, sick leave due to injury and measures of global recovery as indicators of delayed recovery.
A practical cutoff for predicting delays in recovery is considered to be a score of 50 (short form). This cutoff will identify around 85% of your patients in an occupational or primary care sample that will go on to experience chronicity.
A score above 50 will identify 85% of your patients who will experience delayed recovery.
If you know that there is an increased risk of developing persistent symptoms, you can focus attention on –
- education around the nature of pain
- addressing psychosocial factors relating to pain eg depression
- reframing unhelpful beliefs about pain
- limiting the hands-on nature of treatment
- avoiding dependancy on strong analgesic medication
- encouraging early mobilisation
- addressing obstacles to recovery in the workplace or functioning in the home
- planning for a return to function, eg work, in some capacity as soon as possible.
Looking closely at the individual items within the OMPQ can help direct a discussion around topics that may otherwise feel awkward to raise early in the therapeutic relationship. For example, you can respond to questions 5 and 6 –
“How tense or anxious have you felt in the past week?”
“How much have you been bothered by feeling depressed in the past week?”
“What do you think is making you feel anxious or depressed? Is it your condition or other things happening in your life?”
You can then suggest specific interventions around these issues, or at least educate your patient around the impact of mental health on the experience of pain.
Likewise, question 7 –
“In your view, how large is the risk that your current pain may become persistent?”
….can lead to reassuring information about the expected natural history of the injury, that you have treated this many times before and expect good recovery.
When to use OMPQ?
In conditions where there is an increased risk of developing persisting symptoms such as back pain, work related injury, compensable injury or where there are concerns about psychosocial risks. Use OMPQ in conjunction with other condition or region specific PROMs such as the Quebec Back Pain Disability Scale, which can help you follow progress over time.
Whilst it can be repeated during the course of a condition, its value lies in the opportunity for early intervention and prevention of prolonged disability, therefore OMPQ is best used early after onset of pain or injury, as a baseline.
OMPQ is a short PROM to include in your toolkit for back injury, workplace injury and situations where you suspect recovery may be delayed. Its value lies well beyond simple measurement.