Investigating hospital admissions for low back pain for low back pain

Abstract

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 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.