E. Brunner1, D. Vancampfort2, M. Probst2
1OST - Eastern Switzerland University of Applied Sciences, Department of Health, St. Gallen, Switzerland, 2KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
Background: The management for patients with low back pain (LBP) how are hospitalised in acute care hospitals remains largely unstudied. In acute care hospitals, LBP management requires specialised and coordinated interdisciplinary management. Inpatient care at the weekend usually differs from other weekdays. Patients who are admitted on Friday of Saturday often need to wait until Monday before specialised LBP management starts. This initial delay may have negative effects on to following LBP management.
Purpose: The goals of this study were:
(1) to investigate the effect of the weekday of intake on length of stay (LOS) in patients with LBP hospitalised at acute care hospital under general medicine units, and
(2) explore whether the effect of contrast in weekday (Friday/Saturday vs. Sunday-Thursday) on LOS was moderated by patient-reported distress.
(1) to investigate the effect of the weekday of intake on length of stay (LOS) in patients with LBP hospitalised at acute care hospital under general medicine units, and
(2) explore whether the effect of contrast in weekday (Friday/Saturday vs. Sunday-Thursday) on LOS was moderated by patient-reported distress.
Methods: Patients with LBP admitted to general medicine units were screened during a 12-months period. The 4Dimensional Symptoms Questionnaire was used for measuring patient-reported distress. Specialised interdisciplinary LBP management included an assessment by a specialised physiotherapist and an interdisciplinary meeting, in which the diagnosis, treatment strategies and discharge management are discussed. The physiotherapy assessment focuses identification and management of psychological factors associated with LBP. Interdisciplinary meetings do not take place during weekends. Patients admitted on Friday or Saturday must wait until specialised interdisciplinary LBP management starts on Monday. A linear mixed model with planned contrasts was used to test the moderation effect of contrast in weekdays (Friday/Saturday vs. Sunday-Thursday) and patient-reported distress on LOS in patients with LBP. The study was approved by the local ethical committee.
Results: 177 patients with LBP were screened and 173 included in the analysis. Mean LOS in patients with LBP was 7.8 days. The difference in LOS between patients admitted to general medicine units on Saturday to those admitted on Sunday was 3.5 days. Based on the linear model for LOS, planned contrast revealed that the effect of distress on the LOS was significantly modified by dichotomic weekdays (Friday/Saturday vs. Sunday-Thursday), estimated contrast=0.09, t(df, 72)=2.51, p=0.014.
Conclusion(s): Patients with LBP who are admitted on Friday or Saturday stay longer in hospital than those admitted on other weeks. Patient distress may explain the effect of weekday of intake on LOS. High levels of distress are associated with longer hospitalisations, but only in patients who must wait for more than two days until specialised interdisciplinary management starts.
Implications: Physiotherapists and other healthcare professionals, including medical doctors and nurses, should be trained to identify and manage psychological factors associated with LBP. Interdisciplinary management targeted at psychological factors associated with LBP should be strengthened in general hospital settings.
Funding, acknowledgements: There are no funders to report.
Keywords: Low back pain, Primary Care, Mental Health
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Canton of Zurich
Committee: Kantonale Ethikkommission Zürich (KEK ZH)
Ethics number: EK-ZH: 2020-01465
All authors, affiliations and abstracts have been published as submitted.
