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Chen L, Sun Q, Chou R, Anderson DB, Shi B, Chen Y, Liu X, Feng S, Zhou H, Ferreira ML. Low back pain-driven inpatient stays in the United States: a nationwide repeated cross-sectional analysis. Int J Surg 2024; 110:1411-1419. [PMID: 38085809 PMCID: PMC10942240 DOI: 10.1097/js9.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/21/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Low back pain (LBP)-driven inpatient stays are resource-intensive and costly, yet data on contemporary national trends are limited. MATERIALS AND METHODS This study used repeated cross-sectional analyses through a nationally representative sample (US National Inpatient Sample, 2016-2019). Outcomes included the rate of LBP-driven inpatient stays; the resource utilization (the proportion of receiving surgical treatments and hospital costs) and prognosis (hospital length of stay and the proportion of nonroutine discharge) among LBP-driven inpatient stays. LBP was classified as overall, nonspecific, and specific (i.e. cancer, cauda equina syndrome, vertebral infection, vertebral compression fracture, axial spondyloarthritis, radicular pain, and spinal canal stenosis). Analyses were further stratified by age, sex, and race/ethnicity. RESULTS 292 987 LBP-driven inpatient stays (weighted number: 1 464 690) were included, with 269 080 (91.8%) of these for specific LBP and 23 907 (8.2%) for nonspecific LBP. The rate of LBP-driven inpatient stays varied a lot across demographic groups and LBP subtypes (e.g. for overall LBP, highest for non-Hispanic White 180.4 vs. lowest for non-Hispanic Asian/Pacific Islander 42.0 per 100 000 population). Between 2016 and 2019, the rate of nonspecific LBP-driven inpatient stays significantly decreased (relative change: 46.9%); however, substantial variations were found within subcategories of specific LBP-significant increases were found for vertebral infection (relative change: 17.2%), vertebral compression fracture (relative change: 13.4%), and spinal canal stenosis (relative change: 19.9%), while a significant decrease was found for radicular pain (relative change: 12.6%). The proportion of receiving surgical treatments also varied a lot (e.g. for overall LBP, highest for non-Hispanic White 74.4% vs. lowest for non-Hispanic Asian/Pacific Islander 62.8%), and significantly decreased between 2016 and 2019 (e.g. for nonspecific LBP, relative change: 28.6%). Variations were also observed for other outcomes. CONCLUSIONS In the US, the burden of LBP-driven inpatient stays (i.e. rates of LBP-driven inpatient stays, resource utilization, and prognosis among LBP-driven inpatient stays) is enormous. More research is needed to understand why the burden varies considerably according to the LBP subtype (i.e. nonspecific and specific LBP as well as subcategories of specific LBP) and the subpopulation concerned (i.e. stratified by age, sex, and race/ethnicity).
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Affiliation(s)
- Lingxiao Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute
- Department of Biostatistics, School of Public Health
- Sydney Musculoskeletal Health, Patyegarang Precinct, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Qingyu Sun
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - David B. Anderson
- Sydney Musculoskeletal Health, Patyegarang Precinct, Faculty of Medicine and Health, The University of Sydney, Sydney
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
| | - Baoyi Shi
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, United States
| | - Yujie Chen
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute
| | - Shiqing Feng
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University
| | - Hengxing Zhou
- Department of Orthopedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopedics, Advanced Medical Research Institute
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Manuela L. Ferreira
- Sydney Musculoskeletal Health, Patyegarang Precinct, Faculty of Medicine and Health, The University of Sydney, Sydney
- The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
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Melman A, Teng MJ, Coombs DM, Li Q, Billot L, Lung T, Rogan E, Marabani M, Hutchings O, Maher CG, Machado GC. A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study. JMIR Res Protoc 2024; 13:e50146. [PMID: 38386370 PMCID: PMC10921332 DOI: 10.2196/50146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. OBJECTIVE The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. METHODS This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an "audit and feedback" process. The implementation of "Back@Home" will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. RESULTS As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). CONCLUSIONS This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50146.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eileen Rogan
- Department of Medicine, Canterbury Hospital, Sydney Local Health District, Sydney, Australia
| | - Mona Marabani
- Department of Medicine, Canterbury Hospital, Sydney Local Health District, Sydney, Australia
| | - Owen Hutchings
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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Ellem R, Pickering R, Marks D, Todd J, Brown J, Roberts S, Michaleff ZA. Emergency presentations for older persons with low back pain: An increasing clinical and economic challenge. Australas J Ageing 2023; 42:742-750. [PMID: 37799007 DOI: 10.1111/ajag.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To determine whether differences exist for older persons presenting to Emergency Departments (EDs) with lower back pain (LBP) in terms of management, health service resource use and cost when compared to younger patients with LBP. METHODS Retrospective analysis of routinely collected electronic medical record data from January 2015 to July 2021. Data from 11,098 adults presenting with LBP to two large regional Australian EDs were analysed over a 5-year period. Rates of presentation, investigation, medication use, spinal surgery and cost were assessed for all participants with respect to age groups (over or under 65 years of age), diagnosis and time. Multivariable logistic regression analysis was employed to assess the contribution of presentation characteristics to the risk of inpatient admission and to investigate the variable effect of patient age. RESULTS Older people represented 23% (n = 2565) of all LBP presentations, with a growing proportion of presentations over time. More than 1 in 4 patients over 65 were admitted (n = 703, 27%), with CT imaging being proportionately three times more prevalent (24% vs. 6%), and average cost double (AU$3973 vs. $1671) that of the younger population. Consultation by an ED physiotherapist was associated with lower admission risk across all adult presentations (OR 0.52, 95% CI [0.40 to 0.67]). CONCLUSIONS Older persons are over-represented amongst gradually increasing rates of LBP presentations to EDs and associated with escalating cost of care and hospital resource use. Older patients present a different clinical and economic profile to younger patients, supporting the provision of individualised management recommendations.
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Affiliation(s)
- Rod Ellem
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rowan Pickering
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Darryn Marks
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - James Todd
- Bond Institute of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Jarryd Brown
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Shelley Roberts
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Health Science and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Zoe A Michaleff
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- New South Wales Health, St. Leonards, New South Wales, Australia
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Melman A, Vella SP, Dodd RH, Coombs DM, Richards B, Rogan E, Teng MJ, Maher CG, Ghinea N, Machado GC. Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study. JMIR Rehabil Assist Technol 2023; 10:e47227. [PMID: 37988140 DOI: 10.2196/47227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Simon P Vella
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Rachael H Dodd
- The Daffodil Centre, Faculty of Medicine and Health, a joint venture between The University of Sydney and Cancer Council New South Wales, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bethan Richards
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Narcyz Ghinea
- Department of Philosophy, Macquarie University, Sydney, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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de Melo Santana B, Raffin Moura J, Martins de Toledo A, Burke TN, Fernandes Probst L, Pasinato F, Luiz Carregaro R. Efficacy of mHealth Interventions for Improving the Pain and Disability of Individuals With Chronic Low Back Pain: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e48204. [PMID: 37962085 PMCID: PMC10662677 DOI: 10.2196/48204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 11/15/2023] Open
Abstract
Background Low back pain is one of the main causes of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (mHealth) has become popular, mostly due to the widespread use of smartphones. Despite the considerable number of apps for low back pain available in app stores, the effectiveness of these technologies is not established, and there is a lack of evidence regarding the effectiveness of the isolated use of mobile apps in the self-management of low back pain. Objective We summarized the evidence on the effectiveness of mHealth interventions on pain and disability for individuals with chronic low back pain. Methods We conducted a systematic review and meta-analysis comparing mHealth to usual care or no intervention. The search terms used were related to low back pain and mHealth. Only randomized controlled trials were included. The primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), the Cochrane Library, and OpenGrey, in addition to article references. The risk of bias was analyzed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain intensity and disability). In the meta-analysis, eligible studies were combined while considering clinical and methodological homogeneity. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. Results A total of 5 randomized controlled trials were included, totaling 894 participants (447 allocated to the mHealth group and 445 to the usual care group), and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain intensity (mean difference -0.86, 95% CI -2.29 to 0.58; P=.15) and disability (standardized mean difference -0.24, 95% CI -0.69 to 0.20; P=.14) when comparing mHealth and usual care. All studies showed biases, with emphasis on nonconcealed allocation and nonblinding of the outcome evaluator. The certainty of evidence was rated as low for the analyzed outcomes. Conclusions mHealth alone was no more effective than usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of evidence, the evidence remains inconclusive, and future quality clinical trials are needed.
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Affiliation(s)
- Bruna de Melo Santana
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Julia Raffin Moura
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Aline Martins de Toledo
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Thomaz Nogueira Burke
- School of Physical Therapy, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil
| | - Livia Fernandes Probst
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Fernanda Pasinato
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
| | - Rodrigo Luiz Carregaro
- Graduate Program in Rehabilitation Sciences, School of Physical Therapy, University of Brasilia, Campus UnB Ceilândia, Brasilia, Brazil
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Xia T, Picco L, Lalic S, Buchbinder R, Bell JS, Andrew NE, Lubman DI, Pearce C, Nielsen S. Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Res Protoc 2023; 12:e51825. [PMID: 37847553 PMCID: PMC10618880 DOI: 10.2196/51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Increasing harms related to prescription opioids over the past decade have led to the introduction of a range of key national and state policy initiatives across Australia. These include introducing a mandatory real-time prescription drug-monitoring program in the state of Victoria from April 2020 and a series of changes to subsidies for opioids on the Pharmaceutical Benefit Scheme from June 2020. Together, these changes aim to influence opioid supply and reduce harms related to prescription opioids, yet few studies have specifically explored how these policies have influenced opioid prescribing and related harms in Australia. OBJECTIVE The aim of this study is to examine the impact of a range of opioid-related policies on hospital admissions and emergency department (ED) presentations in Victoria, Australia. In particular, the study aims to understand the effect of various opioid policies and opioid-prescribing changes on (1) the number and rates of ED presentations and hospital admissions attributed to substance use (ie, opioid and nonopioid related) or mental ill-health (eg, suicide, self-harm, anxiety, and depression), (2) the association between differing opioid dose trajectories and the likelihood of ED presentations and hospital admissions related to substance use and mental ill-health, and (3) whether changes in an individual's opioid prescribing change the risk related to ED presentations and hospital admissions related to substance use and mental ill-health. METHODS We will conduct a population-level linked data study. General practice health records obtained from the Population Level Analysis and Reporting platform are linked with person-level data from 3 large hospital networks in Victoria, Australia. Interrupted time series analysis will be used to examine the impact of opioid policies on a range of harms, including the rates of presentations related to substance use (opioid and nonopioid) and mental ill-health among the primary care cohort. Group-based trajectory modeling and a case-crossover design will be used to further explore the impact of changes in opioid dosage and other covariates on opioid and nonopioid poisonings and mental ill-health-related presentations at the patient level. RESULTS Given that this paper serves as a protocol, there are currently no results available. The deidentified primary health data were sourced from electronic medical records of approximately 4,717,000 patients from 542 consenting general practices over a 6-year period (2017-2022). The submission of results for publication is planned for early 2024. CONCLUSIONS This study will add to the limited evidence base to help understand the impact of opioid policies in Australia, including whether intended or unintended outcomes are occurring as a result. TRIAL REGISTRATION EU PAS Register EUPAS104005; https://www.encepp.eu/encepp/viewResource.htm?id=104006. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51825.
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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Monash Health, Clayton, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, St Kilda, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
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Orlando JF, Beard M, Guerin M, Kumar S. Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain. PLoS One 2023; 18:e0292648. [PMID: 37816006 PMCID: PMC10564130 DOI: 10.1371/journal.pone.0292648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.
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Affiliation(s)
- Joseph F. Orlando
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Matthew Beard
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Michelle Guerin
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Saravana Kumar
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Jermini-Gianinazzi I, Blum M, Trachsel M, Trippolini MA, Tochtermann N, Rimensberger C, Liechti FD, Wertli MM. Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey. BMJ Open 2023; 13:e071893. [PMID: 37541755 PMCID: PMC10407374 DOI: 10.1136/bmjopen-2023-071893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES Clinical guidelines for acute non-specific low back pain (LBP) recommend avoiding imaging studies or invasive treatments and to advise patients to stay active. The aim of this study was to evaluate the management of acute non-specific LBP in the emergency departments (ED). SETTING We invited all department chiefs of Swiss EDs and their physician staff to participate in a web-based survey using two clinical case vignettes of patients with acute non-specific LBP presenting to an ED. In both cases, no neurological deficits or red flags were present. Guideline adherence and low-value care was defined based on current guideline recommendations. RESULTS In total, 263 ED physicians completed at least one vignette, while 212 completed both vignettes (43% residents, 32% senior/attending physicians and 24% chief physicians). MRI was considered in 31% in vignette 1 and 65% in vignette 2. For pain management, non-steroidal anti-inflammatory drugs, paracetamol and metamizole were mostly used. A substantial proportion of ED physicians considered treatments with questionable benefit and/or increased risk for adverse events such as oral steroids (vignette 1, 12% and vignette 2, 19%), muscle relaxants (33% and 38%), long-acting strong opioids (25% and 33%) and spinal injections (22% and 43%). Although guidelines recommend staying active, 72% and 67% of ED physicians recommended activity restrictions. CONCLUSION Management of acute non-specific LBP in the ED was not in agreement with current guideline recommendations in a substantial proportion of ED physicians. Overuse of imaging studies, the use of long-acting opioids and muscle relaxants, as well as recommendations for activity and work restrictions were prevalent and may potentially be harmful.
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Affiliation(s)
- Ilaria Jermini-Gianinazzi
- Emergency Department, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Ticino, Switzerland
| | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Trachsel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Alen Trippolini
- School of Health Professions, Berne University of Applied Sciences, Bern, Switzerland
- Evidence-based Insurance Medicine (EbIM), Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicole Tochtermann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Dominik Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, Kantonsspital Baden AG, Baden, Aargau, Switzerland
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Melman A, Lord HJ, Coombs D, Zadro J, Maher CG, Machado GC. Global prevalence of hospital admissions for low back pain: a systematic review with meta-analysis. BMJ Open 2023; 13:e069517. [PMID: 37085316 PMCID: PMC10124269 DOI: 10.1136/bmjopen-2022-069517] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To determine the proportion of low back pain presentations that are admitted to hospital from the emergency department (ED), the proportion of hospital admissions due to a primary diagnosis of low back pain and the mean hospital length of stay (LOS), globally. METHODS We searched MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO and LILACS from inception to July 2022. Secondary data were retrieved from publicly available government agency publications and international databases. Studies investigating admitted patients aged >18 years with a primary diagnosis of musculoskeletal low back pain and/or lumbosacral radicular pain were included. RESULTS There was high heterogeneity in admission rates for low back pain from the ED, with a median of 9.6% (IQR 3.3-25.2; 9 countries). The median percentage of all hospital admissions that were due to low back pain was 0.9% (IQR 0.6-1.5; 30 countries). The median hospital LOS across 39 countries was 6.2 days for 'dorsalgia' (IQR 4.4-8.6) and 5.4 days for 'intervertebral disc disorders' (IQR 4.1-8.4). Low back pain admissions per 100 000 population had a median of 159.1 (IQR 82.6-313.8). The overall quality of the evidence was moderate. CONCLUSION This is the first systematic review with meta-analysis summarising the global prevalence of hospital admissions and hospital LOS for low back pain. There was relatively sparse data from rural and regional regions and low-income countries, as well as high heterogeneity in the results.
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Affiliation(s)
- Alla Melman
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Harrison J Lord
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Danielle Coombs
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Joshua Zadro
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Christopher G Maher
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
| | - Gustavo C Machado
- The University of Sydney, Sydney Musculoskeletal Health, Camperdown, New South Wales, Australia
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10
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Wilson R, Pryymachenko Y, Abbott JH, Dean S, Stanley J, Garrett S, Mathieson F, Dowell A, Darlow B. A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: A Difference-in-Difference-in-Differences Analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:253-262. [PMID: 36471226 PMCID: PMC9734860 DOI: 10.1007/s40258-022-00776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Real-world adherence to clinical practice guidelines is often poor, resulting in sub-standard patient care and unnecessary healthcare costs. This study evaluates the effect of a guideline-implementation intervention for the management of low back pain (LBP) in general practice-the Fear Reduction Exercised Early (FREE) approach-on LBP-related injury insurance claims, healthcare utilisation, and costs of treatment. DESIGN Data were extracted from comprehensive nationwide New Zealand injury insurance claims records. Data were analysed using a 'triple-difference' (difference-in-difference-in-differences) method to isolate the causal effect of FREE training on LBP claims activity, comparing the difference in general practitioner (GP) LBP claims and associated activity before and after training with their non-musculoskeletal injury claims for the same periods (assumed to be unaffected by training), relative to the same comparisons for GPs not trained in the FREE approach. RESULTS Training GPs in the FREE approach resulted in significant reductions in the number of LBP injury claims lodged (- 19%, 95% CI -34 to -5), the use of physiotherapy (-30%, 95% CI - 42 to - 18) and imaging (- 27%, 95% CI - 46 to - 8%), and the healthcare costs (- 21%, 95% CI - 41 to - 1) of LBP injury. Changes in claims for earnings' compensation (- 10%, 95% CI - 34 to 13) were not significant. CONCLUSIONS A brief guideline-implementation intervention following best-practice LBP management and guideline-implementation strategies achieved significant reductions, persisting over at least 6 to18 months, in healthcare utilisation consistent with improved delivery of guideline-concordant care.
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Affiliation(s)
- Ross Wilson
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand.
| | - Yana Pryymachenko
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Sarah Dean
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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11
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Li X, Yin X, Feng H, Liao W, Zhao J, Su W, Fan Z, Wu S. Acupoint catgut embedding for chronic non-specific low back pain: A protocol of randomized controlled trial. Front Neurosci 2023; 17:1106051. [PMID: 36816104 PMCID: PMC9929453 DOI: 10.3389/fnins.2023.1106051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Chronic non-specific low back pain (CNLBP) is one of the leading causes of disability worldwide. Acupoint embedding (ACE) is widely used in China for the treatment of chronic non-specific low back pain, but there are no rigorous randomized controlled trials (RCTs) to confirm the effectiveness and safety of ACE for chronic non-specific low back pain. In this study, we design a single-center, single-blind, prospective RCT, with the aim of evaluating the efficacy and safety of ACE for CNLBP. 82 participants with CNLBP will be randomized in a 1:1 ratio into an ACE group and a sham ACE group. Participants will receive either ACE treatment or sham ACE treatment at once every 2 weeks, for an 8-week period, and followed by 6 months of follow-up. The primary outcome will be the change in visual analog scale (VAS) scores before and after treatment. Secondary outcomes will include the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ) and the Short Form 36-Health Survey (SF-36). Adverse events that occur during the course of the trial will be recorded. Data will be analyzed according to a predefined statistical analysis plan. This study was approved by the medical ethics committee of Guangzhou Panyu Hospital of Chinese Medicine (202230). Written informed consent from patients is required. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2200059245). Trial results will be published in a peer-reviewed academic journal. Clinical trial registration https://www.chictr.org.cn, identifier ChiCTR2200059245.
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Affiliation(s)
- Xiaohui Li
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiuju Yin
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,The Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Haiyan Feng
- The Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wangbin Liao
- The Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiayou Zhao
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wu Su
- Guangzhou Panyu Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhiyong Fan
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Zhiyong Fan,
| | - Shan Wu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Shan Wu, ; orcid.org/0000-0002-7155-9464
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12
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Melman A, Maher CG, Needs C, Richards B, Rogan E, Teng MJ, Machado GC. Management of patients with low back pain admitted to hospital: An observational study of usual care. Int J Rheum Dis 2023; 26:60-68. [PMID: 36206350 PMCID: PMC10092628 DOI: 10.1111/1756-185x.14449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Knowledge gaps exist around diagnostic and treatment approaches for patients admitted to hospital with low back pain. METHODS Medical record review of patients admitted to three Sydney teaching hospitals with a provisional emergency department diagnosis of non-serious low back pain, from 2016 to 2020. Data on demographic variables, hospital costs, length of stay (LOS), diagnostic imaging and analgesic administration were extracted. Logistic regression was used to identify predictors of longer hospital stay, advanced imaging, and concomitant use of sedating medicines. RESULTS Median inpatient LOS for non-specific low back pain was 4 days (interquartile range [IQR] 2-7), and for radicular low back pain was 4 days (IQR 3-10). Older patients with non-serious low back pain were more likely to stay longer, as were arrivals by ambulance. Plain lumbar radiography was used in 8.3% of admissions, whereas 37.6% of patients received advanced lumbar imaging (computed tomography or magnetic resonance imaging). Opioids were administered in ~80% of admissions; 49% of patients with radicular low back pain were given an antiepileptic in addition to an opioid. In all, 18.4% of admissions resulted in at least one hospital-acquired complication, such as an accidental fall (3.1%) or a medication-related adverse effect (13.3%). Physiotherapists saw 82.6% of low back pain admissions. Costs of inpatient care were estimated at a mean of AU$ 14 000 per admission. CONCLUSIONS We noted relatively high rates of concomitant use of sedating pain medicines and referrals for advanced lumbar imaging and laboratory tests. Strategies to address these issues in inpatient care of low back pain are needed.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
| | - Chris Needs
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bethan Richards
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Department of Emergency Medicine, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Min Jiat Teng
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia.,RPA Virtual Hospital, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
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13
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Ferreira G, Lobo M, Richards B, Dinh M, Maher C. Hospital variation in admissions for low back pain following an emergency department presentation: a retrospective study. BMC Health Serv Res 2022; 22:835. [PMID: 35818074 PMCID: PMC9275239 DOI: 10.1186/s12913-022-08134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background One in 6 patients with low back pain (LBP) presenting to emergency departments (EDs) are subsequently admitted to hospital each year, making LBP the ninth most common reason for hospital admission in Australia. No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP. Methods We used routinely collected ED data from public hospitals within the state of New South Wales, Australia, to identify presentations of patients aged between 18 and 111 with a discharge diagnosis of LBP. We fitted a series of random effects multilevel logistic regression models adjusted by case-mix and hospital variables. The main outcome was the hospital-adjusted admission rate (HAAR). Data were presented as funnel plots with 95% and 99.8% confidence limits. Hospitals with a HAAR outside the 95% confidence limit were considered to have a HAAR significantly different to the state average. Results We identified 176,729 LBP presentations across 177 public hospital EDs and 44,549 hospital admissions (25.2%). The mean (SD) age was 51.8 (19.5) and 52% were female. Hospital factors explained 10% of the variation (ICC = 0.10), and the median odds ratio (MOR) was 2.03. We identified marked variation across hospitals, with HAAR ranging from 6.9 to 65.9%. After adjusting for hospital variables, there was still marked variation between hospitals with similar characteristics. Conclusion We found substantial variation in hospital admissions following a presentation to the ED due to LBP even after controlling by case-mix and hospital characteristics. Given the substantial costs associated with these admissions, our findings indicate the need to investigate sources of variation and to determine instances where the observed variation is warranted or unwarranted. Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08134-8.
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Affiliation(s)
- Giovanni Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia. .,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,, Camperdown, Australia.
| | - Marina Lobo
- Center for Health Technology and Services Research (CINTESIS), Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bethan Richards
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | - Michael Dinh
- The RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Chris Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Kawchuk GN, Aaskov J, Mohler M, Lowes J, Kruhlak M, Couperthwaite S, Yang EH, Villa-Roel C, Rowe BH. A prospective study of patients with low back pain attending a Canadian emergency department: Why they came and what happened? PLoS One 2022; 17:e0268123. [PMID: 35536825 PMCID: PMC9089857 DOI: 10.1371/journal.pone.0268123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Low back pain is a common presentation to emergency departments, but the reasons why people choose to attend the emergency department have not been explored. We aimed to fill this gap with this study to understand why persons with low back pain choose to attend the emergency department. Between July 4, 2017 and October 1, 2018, consecutive patients with a complaint of low back pain presenting to the University of Alberta Hospital emergency department were screened. Those enrolled completed a 13-item questionnaire to assess reasons and expectations related to their presentation. Demographics, acuity and disposition were obtained electronically. Factors associated with admission were examined in a logistic regression model. After screening 812 patients, 209 participants met the study criteria. The most common Canadian Triage and Acuity Scale score was 3 (73.2%). Overall, 37 (17.7%) received at least one consultation, 89.0% of participants were discharged home, 9.6% were admitted and 1.4% were transferred. Participants had a median pain intensity of 8/10 and a median daily functioning of 3/10. When asked, 64.6% attended for pain control while 44.5% stated ease of access. Most participants expected to obtain pain medication (67%) and advice (56%). Few attended because of cost savings (3.8%). After adjustment, only advanced age and ambulance arrival were significantly associated with admission. In conclusion, most low back pain patients came to the emergency department for pain control yet few were admitted and the majority did not receive a consultation. Timely alternatives for management of low back pain in the emergency department appear needed, yet are lacking.
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Affiliation(s)
- Gregory N. Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Jacob Aaskov
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Matthew Mohler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Justin Lowes
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Maureen Kruhlak
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Stephanie Couperthwaite
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Esther H. Yang
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
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15
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Davidson SRE, Kamper SJ, Haskins R, O'Flynn M, Coss K, Smiles JP, Tutty A, Linton J, Bryant J, Buchanan M, Williams CM. Low back pain presentations to rural, regional, and metropolitan emergency departments. Aust J Rural Health 2022; 30:458-467. [PMID: 35229394 PMCID: PMC9545685 DOI: 10.1111/ajr.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the context of low back pain (LBP) presentations to emergency departments (EDs) by remoteness areas, hospital delineation level and staffing portfolios. Design A retrospective observational study using routinely captured ED and admission data over a 5‐year period (July 2014–June 2019). Settings Thirty seven EDs across a large health district in NSW, Australia, covering major cities, inner regional areas and outer regional areas. Participants Emergency department (ED) presentations with a principal or secondary diagnosis of LBP based on ICD‐10 code (M54.5). Main outcome measures ED presentation and associated admission measures, including presentation rate, referral source, time in ED, re‐presentation rate, admission details and cost to the health system. Results There were 26 509 ED presentations for LBP across the 5 years. Time spent in ED was 206 min for EDs in major cities, 146 min for inner regional EDs and 89 min for outer regional EDs. Re‐presentation rates were 6% in major cities, 8.8% in inner regional EDs and 11.8% in outer regional EDs. Admission rates were 20.4%, 15.8% and 18.8%, respectively. Conclusions This study describes LBP presentations across 37 EDs, highlighting the potential burden these presentations place on hospitals. LBP presentations appear to follow different pathways depending on the ED remoteness area, delineation level and staff portfolio.
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Affiliation(s)
- Simon R E Davidson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Robin Haskins
- John Hunter Hospital Outpatient Services, New Lambton Heights, New South Wales, Australia
| | - Michael O'Flynn
- John Hunter Hospital Emergency Department, New Lambton Heights, New South Wales, Australia
| | - Karen Coss
- Tamworth Hospital Emergency Department, Tamworth, New South Wales, Australia
| | - John Paul Smiles
- John Hunter Hospital Emergency Department, New Lambton Heights, New South Wales, Australia
| | - Amanda Tutty
- Clarence Health Services Physiotherapy Department, Northern New South Wales Local Health District, Grafton, New South Wales, Australia
| | - Jane Linton
- Clarence Health Services Physiotherapy Department, Northern New South Wales Local Health District, Grafton, New South Wales, Australia
| | - Joe Bryant
- Aboriginal Health Strategy Unit, Coffs Harbour, New South Wales, Australia
| | - Maree Buchanan
- Health Analytics and Business Support Unit, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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16
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Anderson DB, Chen L, Eyles JP, Ferreira ML. Emergency department presentations and associated hospital admissions for low back pain in Australia. Emerg Med Australas 2022; 34:559-568. [PMID: 35233970 PMCID: PMC9540465 DOI: 10.1111/1742-6723.13941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Objective To determine factors associated with hospital admissions from ED presentations for low back pain (LBP). Methods This was a retrospective analysis of 147 ED centres in New South Wales (NSW), Australia, between 2005 and 2014. Data were accessed from the NSW Emergency Department Data Collection to determine patients who attended ED and whether or not they were admitted to hospital. Results There were 1 388 078 ED visits for LBP across 147 different ED centres between 2005 and 2014. Between 2005 and 2013, hospital admission rates from ED visits for LBP increased annually by 5.1% (95% confidence interval [CI] 3.9–6.4) from 477 per 100 000 in 2005 to 730 per 100 000 in 2013. Patients who were under injured workers' insurance (i.e. workers compensation insurance) had significantly lower odds (odds ratio [OR] 0.42, 95% CI 0.40–0.43) of being admitted to hospital for LBP compared with those not on injured workers' insurance. Patients living in the highest socioeconomic areas were also more likely to be admitted to hospital from an ED visit, compared with those from the lowest socioeconomic areas (OR 1.26, 95% CI 1.24–1.29). Conclusion Rates of hospitalisation following attendance to ED for LBP increased annually by 5% between 2005 and 2013. Hospital admission rates were lower among patients from the lowest socioeconomic areas or under injured workers' compensation insurance.
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Affiliation(s)
- David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lingxiao Chen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jillian P Eyles
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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17
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Melman A, Maher CG, Needs C, Machado GC. Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause. Clin Rheumatol 2022; 41:1867-1871. [PMID: 35015190 PMCID: PMC9119888 DOI: 10.1007/s10067-022-06054-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
To determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future 'virtual hospital' admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain. Key Points • Among admitted patients provisionally diagnosed in ED with non-serious back pain, 38.1% were found to have 'serious spinal pathologies' or 'serious pathologies beyond the lumbar spine' at discharge. • Spinal fractures were the most common serious spinal pathology, accounting for 9% of all provisional 'non-serious back pain' admissions from ED. • 57% of back pain admissions were confirmed to be non-serious back pain and may be suitable to virtual hospital care; the challenge is discriminating these patients from those with serious pathology.
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Affiliation(s)
- Alla Melman
- Institute for Musculoskeletal Health, Sydney Local Health District and University of Sydney, Level 10N, King George V Building, Royal Prince Alfred Hospital PO Box M179, Missenden Road Camperdown, NSW, 2050, Sydney, Australia.
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and University of Sydney, Level 10N, King George V Building, Royal Prince Alfred Hospital PO Box M179, Missenden Road Camperdown, NSW, 2050, Sydney, Australia
| | - Chris Needs
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District and University of Sydney, Level 10N, King George V Building, Royal Prince Alfred Hospital PO Box M179, Missenden Road Camperdown, NSW, 2050, Sydney, Australia
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18
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Ultrasonographic Changes of Abdominal Muscles in Subjects with and without Chronic Low Back Pain. Healthcare (Basel) 2022; 10:healthcare10010123. [PMID: 35052287 PMCID: PMC8775819 DOI: 10.3390/healthcare10010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Chronic low back pain (CLBP) is a prevalent disfunction in the spine, affecting both women and men. The implication of the abdominal muscles in this disfunction has been studied, including wrong breathing patterns or inactivity of this area. However, there is a lack of studies examining changes in thickness of abdominal with ultrasonography. Thus, the aim of this study is to analyze the differences in the thickness of abdominal muscles at rest and during breathing between subjects with and without CLBP. A total of 72 subjects were divided in two groups: participants with CLBP (n = 36) and participants without CLBP (n = 36). In both groups, the thickness of the four abdominal muscles was measured and compared at rest and during breathing with ultrasonography. In TrA and IO there were no significant differences between groups, but those subjects with CLBP increased the muscle thickness more than participants without pain during breathing. In EO there were no differences in muscle thickness between groups and between rest and breathing. In RA, subjects with CLBP showed less muscle thickness than subjects without pain during breathing, but no changes were found at rest. In conclusion, the deepest abdominal muscles, TrA and IO, appear to increase their thickness and RA appear to decrease more in subjects with CLBP, in comparison with healthy participants.
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19
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Melman A, Maher CG, Machado GC. Virtual hospitals: why we need them, how they work and what might come next. J Physiother 2021; 67:156-157. [PMID: 34148815 DOI: 10.1016/j.jphys.2021.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alla Melman
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia.
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
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Carregaro RL. Management of non-serious low back pain in the context of emergency care. Is it worth the cost? LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 7:100105. [PMID: 34327422 PMCID: PMC8315429 DOI: 10.1016/j.lanwpc.2021.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Rodrigo Luiz Carregaro
- School of Physical Therapy and Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil.,Núcleo de Evidências e Tecnologias em Saúde (NETeCS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil
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