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Still Hurting: Low Back Pain Presentations in the Emergency Department: A Retrospective Observational Study With a
James Hendrie1,2, Jahar Bhowmik3, Hafiz Salih1
1Emergency Department, Austin Health, Heidelberg, Melbourne, Victoria, Australia, austin.org.au.
Background:
Nontraumatic low back pain is highly prevalent in Australia, affecting 79.2% of adults and accounting for up to 4% of emergency department (ED) presentations. This study examines the postdischarge outcomes of ED patients admitted to a short stay unit (SSU) for low back pain management.
Method:
A cross-sectional observational study design was employed, comprising retrospective observational data and a follow-up cross-sectional survey. Data were collected between June 2023 and February 2024. Functional status was measured with the Modified Oswestry Low Back Pain Disability Questionnaire.
Results:
Of the 422 participants invited, 21% (n = 89) completed questionnaires. Respondents were 58% female and 42% male, aged 20.3-96.1 years (mean 63.4, SD 19.4). Most respondents (71.2%) reported moderate-to-severe disability, with 19.1% reporting complete disability. Over 50% were still taking opioid analgesics at the time of survey completion. In the multivariable regression model, pharmacological treatments were significantly associated with disability scores (F (4, 84) = 5.34, p < 0.001). Use of short-acting opioids was associated with an average increase of 7.5 units in disability score and use of long-acting opioids with an average increase of 8.1 units, reflecting ongoing pain or greater disability among participants receiving opioid medications. Time spent in the SSU was associated with the severity of disability. Patients who later developed moderate or severe disability spent a mean of 31 h in SSU, compared to 17.5 h among those with no or mild disability (p = 0.012). Only 45% of patients sought ongoing physiotherapy care in the month following discharge.
Conclusion:
At one month postdischarge, most participants reported considerable ongoing disability and pain. A substantial proportion continued to use opioids, while physiotherapy services remained underutilised. Findings from this study informed a local business case to establish physiotherapy 'virtual hot clinics' for patients within 1 week of discharge.
