What this trial measures

• Changes in level of Depression (DASS-21)8 weeks

  Assessed using the Depression Anxiety Stress Scale (DASS-21) electronically administered patient reported outcome questionnaire * General adult population average total score: 9.43 (standard deviation (SD) 9.66), out of a total possible score of 63 points, * Indication of significant difference from normative data: Average score \>1 SD above the General adult population average total score * General adult population average depression sub scale score: 2.83 (SD 3.87) * Values above 9.03 points in the depression subsection score correlate with clinical depression and generalized anxiety disorders * A change of 3.86 or more points in the depression subscore reliably represents clinical improvement.

• Changes in level of Depression (PROMIS)8 weeks

  Assessed using the Patient Reported Outcome Measures Information (PROMIS): Depression. An electronically administered patient reported outcome questionnaire * Normative T-score generated from US adult population data: mean 50 (SD 10). * For this study, an average T-score \<40 would be considered significantly different compared to normative values. * The minimally important difference (MID) of 3.0-3.1 calculated from research in nonoperative treatment of knee osteoarthritis will be representative of clinical improvement at eight weeks.

• Changes in level of Anxiety (DASS-21)8 weeks

  Assessed using the Depression Anxiety Stress Scale (DASS-21) electronically administered patient reported outcome questionnaire * General adult population average total score: 9.43 (SD 9.66) * An average total score \>1 SD above the mean would be considered significantly different from normative data * General adult population average anxiety subscale scores: 1.88±2.95 * Average anxiety subsection score above 6.27 correlate with clinical depression and generalized anxiety disorders * A change of 3.85 or more points in the anxiety subscore reliably represents clinical improvement.

• Changes in level of Anxiety (PROMIS)8 weeks

  Assessed using the Patient Reported Outcome Measures Information (PROMIS): Anxiety. An electronically administered patient reported outcome questionnaire * Normative T-score generated from US adult population data: mean 50 (SD 10). * For this study, an average T-score \<40 would be considered significantly different compared to normative values. * The minimally important difference (MID) of 2.3 to 3.4 calculated from research in nonoperative treatment of knee osteoarthritis will be representative of clinical improvement at eight weeks.

• Changes in level of Stress (DAAS-21)8 Weeks

  Assessed using the Depression Anxiety Stress Scale (DASS-21) electronically administered patient reported outcome questionnaire * General adult population average total score: 9.43 (SD 9.66) * An average total score \>1 SD above the mean would be considered significantly different from normative data * General adult population average stress subscale scores: 4.73±4.20 * Average stress subsection score above 12.27 correlate with clinical depression and generalized anxiety disorders * A change of 4.90 or more points in the anxiety subscore reliably represents clinical improvement.

• Evaluating the presence and severity of Kinesiophobia8 weeks

  Assessed via the Shortened Tampa Scale for Kinesiophobia (TSK-11) electronically administered patient reported outcome questionnaire * The survey is a 11-question test scored from 11-44, where higher scores indicate increasing fear of movement. * A value of 11 is presumed in a nonpainful population. * Adults with chronic musculoskeletal pain undergoing outpatient chronic pain therapy report an average TSK score of 30.4 (+/- 6.6). * Successful evaluation of Kinesiophobia will be indicated if increases in TSK-11 scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents would also be considered a successful finding.

• Evaluation of Resiliency8 weeks

  Assessed via The Brief Resiliency Scale (BRS) electronically administered patient reported outcome questionnaire * An 8 question survey scored from 1-5 points * The average score for US adults age 24-34 is 3.2 (SD 0.7) * A statistically significant lower Grit score would be \>1SD below this average value. * Successful evaluation of Grit will be indicated if increases in GRIT-S scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents would also be considered a successful finding.

• Evaluation of Grit8 weeks

  Assessed via The Short Grit Scale (GRIT-S) electronically administered patient reported outcome questionnaire * A 6-question test with low resiliency defined as a score of \<3.00. * Prior descriptive studies indicate an average score of 3.57 (SD 0.76) for young adults age 19.8±3.0 years. * Statistically significant lower resilience would be \>1SD below this average value. * Successful evaluation of Resiliency will be indicated if increases in GRIT-S scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents (for those tests where this data exists) would also be considered a successful finding.

• Evaluating the presence and severity of Pain Catastrophizing8 weeks

  Assessed via Pain Catastrophizing Scale (PCS) electronically administered patient reported outcome questionnaire * Scored on a 13 point scale. * Normative average values from a population of adults adults age 42.2 (17-63 years) with low back pain: mean 20.90 (SD 12.5), * Successful evaluation of Pain Catastrophization will be indicated if increases in PCS scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents would also be considered a successful finding.

• Evaluating Self-Efficacy8 weeks

  Assessed via The General Self-Efficacy Scale (GSE) electronically administered patient reported outcome questionnaire * 10-question test, scored from 10-40, with lower scores representing low self efficacy. * Average US adult values: 29.48 (SD 5.13) * Successful evaluation of Self-Efficacy will be indicated if increases in GSE scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents would also be considered a successful finding.

• Evaluating the presence and severity of Alcohol Use Disorders8 weeks

  Assessed via Alcohol Use Disorders Identification Test (AUDIT) electronically administered patient reported outcome questionnaire * A 10-question test with a threshold score \>7 considered "AUDIT-positive", indicating risky or hazardous alcohol use behavior. * National data suggests 15-20% of US 14-18 year olds screen positive * Successful evaluation of Alcohol Use Disorders will be indicated if increases in AUDIT scores are found to be significantly associated with increased pain and decreased physical function (HOOS, PROMIS-PI, PROMIS-PB, PROMIS-PF) or increased self-reporting of opioid use. * The finding of no significant association, but increased presence of maladaptive features compared to normative data for US adolescents would also be considered a successful finding.

• Changes in Physical Function (PROMIS)8 weeks

  Measured via the following electronically administered patient reported outcome questionnaires. * PROMIS: Physical Function (PF) * Normative T-score generated from US adult population data: mean 50 (SD 10). * For this study, an average T-score \<40 would be considered significantly different compared to normative values. * The minimally important difference (MID) of 1.9 - 2.2 calculated from research in nonoperative treatment of knee osteoarthritis will be representative of clinical improvement at eight weeks.

• Changes in Physical Function (HOOS)8 weeks

  Measured via the following electronically administered patient reported outcome questionnaires. * The Hip disability and osteoarthritis outcome score (HOOS) * Scored from 0-100 * Increasing score represent better function. * Average scopres for hip preservation patients prior to surgery is well established

• Reduced Opioid Use8 weeks

  Measured via self reported opioid use after surgery