Abstract
BackgroundAlthough many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge.MethodsThree hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making.DiscussionThis study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes.ConclusionInnovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia.Trial RegistrationProspectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/09/2020.
Highlights
Many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again
Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia
After a series of consultations with senior musculoskeletal clinicians and consumer groups representing patients with LBP in Sydney, Australia, we identified that the lack of a coordinated support system at discharge is considered a strong factor driving the pattern of patients returning to hospital for further treatment
Summary
Many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. In Australia, local hospital networks are responsible for managing and linking public hospitals, health institutions, and health services across defined geographical areas [12] This includes the provision of hospital-based outpatient physiotherapy services for people with LBP. In the Western Sydney Local Health District, an ethnically and culturally diverse metropolitan region, the rate of re-presentation to hospital services (i.e., physiotherapy clinics, emergency departments, pain clinics, neurosurgical clinics) within 1 year after discharge from outpatient physiotherapy treatment for LBP is 21% (unpublished New South Wales hospital data). The high rate of re-presentation constitutes a financial burden of $AUD744,000 yearly in direct costs in this local health district alone Extrapolating these estimates across all local health districts within New South Wales, the cumulative financial and resource burden of representations following discharge from hospital outpatient physiotherapy treatment is undoubtedly substantial
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