Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial. Issue 4 (19th April 2018)

• Record Type: Journal Article
• Authors: Machado, Gustavo C; Richards, Bethan; Needs, Chris; Buchbinder, Rachelle; Harris, Ian A; Howard, Kirsten; McCaffery, Kirsten; Billot, Laurent; Edwards, James; Rogan, Eileen; Facer, Rochelle; Lord Cowell, David; Maher, Chris G
• Other Names: author non-byline.; Oliver Matthew author non-byline.; Coombs Danielle author non-byline.; Perrot Ruth author non-byline.; Chu Matthew author non-byline.; Marabani Mona author non-byline.; Harrison Daniel author non-byline.; Barnsley Leslie author non-byline.; Hatswell Kristy author non-byline.; Oliveira Mauricio author non-byline.; Baidya Noel author non-byline.; Storey Hannah author non-byline.; Knoblanche Rachael author non-byline.; Vukasovic Matthew author non-byline.; Manolios Nicholas author non-byline.; Maka Katherine author non-byline.; Day Rob author non-byline.; Laurent Rodger author non-byline.; Jennings Matthew author non-byline.; Speerin Robyn author non-byline.; Alcala Nobby author non-byline.; Moloney Niamh author non-byline.; Ferreira Manuela author non-byline.; Ferreira Paulo author non-byline.; Lin Chris author non-byline.
• Is Part Of: BMJ open. Volume 8:Issue 4(2018)
• Publication Date: 2018-04-19
• Subjects: low back pain -- clinical trials -- health policy; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-019052
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes. Methods and analysis: A stepped-wedge cluster randomised controlled trial will be conducted to implement and evaluate the use of the Agency for Clinical Innovation (ACI) model of care for acute low back pain at four emergency departments in New South Wales, Australia. Clinician participants will be emergency physicians, nurses and physiotherapists. Codes from the Systematised Nomenclature of Medicine—Clinical Terms—Australian version will be used to identify low back pain presentations. The intervention, targeting emergency clinicians, will comprise educational materials and seminars and an audit and feedback approach. Health service delivery outcomes are routinely collected measures of imaging (primary outcome), opioid use and inpatient admission. A random subsample of 200 patient participants from each trial period will be included to measure patient outcomes (pain intensity, physical function, quality of life and experience with emergency service). The effectiveness of the intervention will be assessed by comparing the postintervention period with the retrospective baseline control period. Ethics and dissemination: The study received ethical approval from the Sydney Local Health District (Royal Prince Alfred Hospital zone) Ethics Committee (X17-0043). The results of this study will be published in peer-reviewed journals and presented at international conferences. Trial registration number: Australia New Zealand Clinical Trials Registry: ACTRN 12617001160325.