This study aims to compare health service and patient-reported outcomes of people presenting to ED with LBP before and after the implementation of a virtual hospital model of care for LBP (Back@Home).This study aims to compare health service and patient-reported outcomes of people presenting to ED with LBP before and after the implementation of a virtual hospital model of care for LBP.
This is a hybrid effectiveness-implementation type-I study linked with the virtual hospital (rpavirtual) launched by Sydney Local Health District. We have established a Low Back Pain Working Group within rpavirtual, involving ED physicians, physiotherapists, and rheumatologists. Patients diagnosed with non-serious LBP requiring admission and meeting eligibility criteria are referred to 'Back@Home' by the ED Medical Officer. Additionally, patients already admitted to the inpatient ward may be referred to 'Back@Home' to facilitate earlier discharge. This program utilised a mix of virtual care methods, including telephone calls, video calls, SMS, email, and applications such as Physitrack for providing exercise programs. It also included the delivery of heat packs and home visits by physiotherapists as needed.
The implementation strategy included educational meetings, local opinion leaders, and local consensus discussions. Outcomes will be compared before and after the implementation of the virtual hospital model of care. Patient reported outcomes include pain intensity, physical function and satisfaction with care at 2 weeks after admission. The health service outcomes included mean length of hospital stay, the proportion of ED presentations that result in a traditional hospital, monthly proportion of admitted patients representing to traditional hospital, including representations to the ED within 48 hours since discharge and readmissions to an inpatient unit within 28 days.
From December 2021 to July 2024, 107 inpatients (before implementation) and 198 virtual hospital patients (after implementation) were followed through Back@Home program. Fifty-three patients admitted to the traditional hospital and 102 patients admitted to the virtual hospital completed the 2-week follow-up assessment. The 2 weeks mean (SD) pain intensity, physical function and satisfaction of patients admitted to traditional and virtual hospitals were, respectively: 5.6 (2.6) vs 4.2 (2.5); 14.6 (8.9) vs 20.5 (6.6); and 7.6 (2.6) vs 7.8 (2.3). The complete results including the between-group differences of the service and patient-reported outcomes will be presented at the conference.
The virtual hospital has shown promising evidence it provides equivalent or better outcomes compared to the traditional hospital for LBP.
The findings of this study will contribute to expanding the scope of physiotherapy services and improving referrals through general practitioners, aged care facilities, neurosurgery, and ambulance services. This research will support the evaluation of a novel model of care, generating detailed data to inform healthcare service planning, update back pain guidelines, and quality improvement initiatives.
physiotherapy
virtual care
