Low back pain (LBP) is the leading cause of disability worldwide and one of the top five reasons people attend an Emergency Department in Australia. A team of researchers at Rosebud Hospital has launched a study to understand and improve the management of this condition.
The study’s core objectives are to assess the confidence of Rosebud Hospital Emergency Department staff in treating people with LBP and to explore the beliefs of these staff members about LBP and its treatment.
“When patients present to an Emergency Department with LBP, they are usually in a lot of pain, with high levels of distress and disability, often without a corresponding specific anatomical pathology,” explains Lead Investigator, Physiotherapist Emmett McKenna.
“There is an expectation by the consumer that imaging will be done to identify the source of their pain; however, in most cases imaging is rarely helpful or indicative, and can increase a patient’s distress and worry.”
Despite comprehensive guidelines including the Low Back Pain Clinical Care Standard (launched in 2022 by the Australian Commission on Safety and Quality in Health Care), managing acute LBP remains a clinical challenge. Health professionals often report low confidence and conflicting beliefs about the best treatment approaches for people presenting with LBP. This can lead to inconsistent and low-value patient care interventions.
In the Emergency Department setting, imaging and opioid prescriptions are common while high-value interventions – such as advice, education and exercise prescription are not always provided.
This initiative, part of the Monash University Research Partnership Program, aims to bridge the gap between existing clinical guidelines and actual practice in Emergency Departments.
The study methodology involves fourth-year physiotherapy students from Monash University designing a protocol to assess clinician confidence and beliefs using validated surveys. The data collected from Rosebud Hospital Emergency Department staff will identify areas for potential quality improvement projects, such as targeted education and training programs.
The significance of this research is far reaching. LBP not only impacts patient wellbeing but also poses a significant financial burden. Emergency care for non-serious LBP cost Australian hospitals approximately $392.9 million in 2019. In Australia, 23.6% of LBP emergency visits result in lumbar imaging and 69.6% involve opioid prescriptions, contrary to guideline recommendations.
Previous research has demonstrated that health professionals’ confidence in managing LBP and their beliefs about LBP, are moderating factors in the care they provide to patients; more helpful beliefs about back pain are associated with guideline-consistent care.
“By tackling these critical areas, Peninsula Health and Monash University hope to set new standards in LBP management, offering better outcomes for patients and paving the way for more effective emergency care practices,” says Mr McKenna.
“It’s so important for effective patient care that we spread more helpful messages to people about back pain and its management – everyone needs to get the best possible message from the very start.”
The study will utilise a Back Pain Attitudes Questionnaire and a five-point Likert scale to measure staff confidence.
Participants will be asked questions about their own back; about their thoughts on recovering from back pain; and then about their confidence in managing people with LBP in the Emergency Department.
The anonymous online survey will target all Rosebud Hospital Emergency Department clinicians, including doctors, nurses and allied health professionals, with a focus on those actively caring for people presenting with LBP.
The research aims to provide a clearer picture of Emergency Department clinicians’ confidence and beliefs about LBP management. The ultimate goal is to align clinical practice with established guidelines, enhancing patient care, reducing hospital stays and costs, and improving staff satisfaction.