Abstract
Objective
This study sought to evaluate the adherence to guidelines for the management of mechanical
Low Back Pain within a single tertiary metropolitan Emergency Department setting.
Our objectives were:
- 1.To identify the proportion of patients presenting to a single Emergency Department with mechanical Low Back Pain who received management in line with the guidelines; and
- 2.To understand and describe factors that can influence clinicians’ (non-) adherence to the guidelines.
Methods
A two-stage multi-methods study design was undertaken. Stage 1 involved a retrospective
chart audit of patients presenting with a diagnosis of mechanical Low Back Pain to
establish documented adherence to clinical guidelines. Stage 2 explored clinicians’
perspectives towards factors influencing adherence to the guidelines via a study-specific
survey and follow up focus groups.
Results
The audit demonstrated low adherence to the following guidelines: (i) appropriate
prescription of analgesia, (ii) targeted education and advice, and (iii) attempts
to mobilise. Three major themes were identified as factors influencing adherence to
the guidelines: (1) clinician driven influences and factors, (2) workflow processes,
and (3) patient expectations and behaviours.
Conclusion
There was low adherence to some published guidelines and factors influencing adherence
to the guidelines were multi-factorial. Understanding the factors that influence care
decisions and developing strategies to address these can improve Emergency Department
management of mechanical Low Back Pain.
Keywords
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References
Australian Institute of Health and Welfare. Back problems Cat. no. PHE 231. Canberra: AIHW; 2019.
Australian Bureau of Statistics. National health survey: first results. 2017–18.
- A systematic review and meta-synthesis of the impact of low back pain on people’s lives.BMC Musculoskelet Disord. 2014; 15: 50
- The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: data from 43 low- and middle-income countries.Gen Hosp Psychiatry. 2016; 43: 63-70
Australian Institute of Health and Welfare. Emergency department care 2017-18: Ausralian Hospital Statistics. Canberra: AIHW; 2018.
- Prevalence of low back pain in emergency settings: a systematic review and meta-analysis.BMC Musculoskelet Disord. 2017; 18: 143
- Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia.Lancet Reg Health West Pac. 2021; 7100089
- Review article: best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series).Emerg Med Austral. 2018; 30: 18-35
- Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia.Emerg Med Austral. 2022; 34 (157-63)
- Managing non-serious low back pain in the emergency department: time for a change?.Emerg Med Austral. 2018; 30 (279-82)
- Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care.Spine (Philos Pa 1976). 2001; 26: 2615-2622
- Imaging for patients presenting to an emergency department with back pain: Impact on patient pathway.Emerg Med Austral. 2016; 28: 412-418
- Worsening trends in the management and treatment of back pain.JAMA Intern Med. 2013; 173: 1573-1581
Queensland Health Clinical Excellence Division. ED monthly performance and analysis report; 2022.
- Using mixed-methods sequential explanatory design: from theory to practice.Field Methods. 2006; 18: 3-20
- Achieving integration in mixed methods designs-principles and practices.Health Serv Res. 2013; 48: 2134-2156
- Comparison of convenience sampling and purposive sampling.Am J Theor Appl Stat. 2016; 5: 1-4
- Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inf. 2009; 42: 377-381
- The REDCap consortium: building an international community of software platform partners.J Biomed Inform. 2019; 95103208
QSR International Pty Ltd. NVivo; 2020.
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101
- Ensuring trustworthiness in qualitative research.Belitung Nurs J. 2015; 1: 10-11
- Management of low back pain in Australian emergency departments.BMJ Qual Saf. 2019; 28 (826-34)
- CDC guideline for prescribing opioids for chronic pain—United States, 2016.JAMA. 2016; 315: 1624-1645
- Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: a qualitative study.Emerg Med Austral. 2022; 34: 199-208
- How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years.Br J Sports Med. 2019; 54 (bjsports-2018)
- Clinical guidelines for low back pain: a critical review of consensus and inconsistencies across three major guidelines.Best Pract Res Clin Rheumatol. 2016; 30 (968-80)
- Current management practices for patients presenting with low back pain to a large emergency department in Canada.BMC Musculoskelet Disord. 2017; 18: 92
- General practitioner experiences using a low back pain management booklet aiming to decrease non-indicated imaging for low back pain.Implement Sci Commun. 2022; : 3
Article info
Publication history
Published online: May 14, 2023
Accepted:
April 28,
2023
Received in revised form:
April 11,
2023
Received:
December 17,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
