Investigating hospital admissions for low back pain for low back pain
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USyd Access
Type
ThesisThesis type
Doctor of PhilosophyAuthor/s
Melman, AllaAbstract
Chapter 1 summarises the prevalence and burden of low back pain in Australia, with a focus on hospital admissions, and introduces virtual hospital care as an opportunity to reduce inpatient hospitalisation. Chapter 2 systematically reviews global rates of hospital admission and ...
See moreChapter 1 summarises the prevalence and burden of low back pain in Australia, with a focus on hospital admissions, and introduces virtual hospital care as an opportunity to reduce inpatient hospitalisation. Chapter 2 systematically reviews global rates of hospital admission and stays for LBP. Chapter 3 describes usual care for people admitted to hospital with LBP. The study found that opioids were administered in approximately 80% of admissions and 49% of patients with radicular low back pain were given an antiepileptic medication in addition to an opioid. Chapter 4 estimated what proportion of patients initially diagnosed with non-serious LBP in the ED were discharged following an inpatient admission with a similar diagnosis, and therefore potentially suitable for virtual hospital care as an alternative to traditional admission. The proportion of potentially avoidable admissions for non-serious LBP were found to be ~57%, with ~14% deemed a serious spinal pathology and ~24% other non-lumbar pathology, both likely requiring admission. Chapter 5 identified potential barriers to and facilitators of the world’s first ‘Back@Home’ virtual hospital model of care. The resulting model was co-designed with front line clinicians to mitigate concerns while optimising virtual care delivery. Chapter 6 presents the protocol for evaluating Back@Home, a hybrid effectiveness-implementation type-I feasibility study designed to evaluate the effectiveness of a virtual hospital model of care for LBP on health service outcomes, patient-reported outcomes, costs, acceptability, and appropriateness of the virtual hospital model of care, as well as the feasibility and fidelity of our multifaceted implementation strategy. Chapter 7 presents the preliminary evaluation of Back@Home, a mixed-methods study using the RE-AIM framework. Chapter 8 summarises the principal findings of this thesis, describes its clinical implications and suggests future programs of research related to Back@Home.
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See moreChapter 1 summarises the prevalence and burden of low back pain in Australia, with a focus on hospital admissions, and introduces virtual hospital care as an opportunity to reduce inpatient hospitalisation. Chapter 2 systematically reviews global rates of hospital admission and stays for LBP. Chapter 3 describes usual care for people admitted to hospital with LBP. The study found that opioids were administered in approximately 80% of admissions and 49% of patients with radicular low back pain were given an antiepileptic medication in addition to an opioid. Chapter 4 estimated what proportion of patients initially diagnosed with non-serious LBP in the ED were discharged following an inpatient admission with a similar diagnosis, and therefore potentially suitable for virtual hospital care as an alternative to traditional admission. The proportion of potentially avoidable admissions for non-serious LBP were found to be ~57%, with ~14% deemed a serious spinal pathology and ~24% other non-lumbar pathology, both likely requiring admission. Chapter 5 identified potential barriers to and facilitators of the world’s first ‘Back@Home’ virtual hospital model of care. The resulting model was co-designed with front line clinicians to mitigate concerns while optimising virtual care delivery. Chapter 6 presents the protocol for evaluating Back@Home, a hybrid effectiveness-implementation type-I feasibility study designed to evaluate the effectiveness of a virtual hospital model of care for LBP on health service outcomes, patient-reported outcomes, costs, acceptability, and appropriateness of the virtual hospital model of care, as well as the feasibility and fidelity of our multifaceted implementation strategy. Chapter 7 presents the preliminary evaluation of Back@Home, a mixed-methods study using the RE-AIM framework. Chapter 8 summarises the principal findings of this thesis, describes its clinical implications and suggests future programs of research related to Back@Home.
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Date
2024Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, The University of Sydney School of Public HealthAwarding institution
The University of SydneyShare