Aims
To assess the effectiveness of implementation of a virtual hospital model of care for low back pain (Back@Home) to reduce hospital admissions, re-presentations to the emergency department (ED) and length of stay, as well as improve patient-reported outcomes.
Methods
This is a pre- and post-implementation study conducted across three EDs within the Sydney Local Health District. Patients aged ≥16 years presenting to the ED with a primary diagnosis of non-specific or radicular (non-serious) low back pain were included. Patients diagnosed with serious spinal pathology were excluded. Eligible patients with non-serious low back pain were referred to the Back@Home service, which provided virtual medical and physiotherapy care via telephone and/or video consultations, heat wraps, and access to a mobile application for exercise programs. The primary outcome was hospital admission to ED short-stay or inpatient units.
Results
From January 2017 to January 2025, there were 18,851 ED presentations for patients with non-serious low back pain. After implementation of Back@Home, there were no differences in admissions to inpatient or short-stay units (OR: 1.19, 95% CI: 0.46 to 3.06) or inpatient units only (OR: 1.03, 95% CI: 0.80 to 1.33). However, ED re-presentations within 30 days significantly reduced by 41% after implementation (OR: 0.59, 95% CI: 0.42 to 0.84). No difference was found in the remaining health service outcomes. Patients receiving virtual hospital care reported less pain (β: -1.26, 95% CI: -2.22 to -0.30), better physical function (β: 4.81, 95% CI: 2.36 to 7.27) and similar satisfaction with care (β: 0.14; 95% CI: -0.72 to 1.01) compared to those receiving inpatient care.
Conclusions
The proportion of patients with non-serious low back pain admitted to inpatient or short-stay units did not reduce after implementing the Back@Home service, but ED re-presentation rates reduced. Virtual care provided similar or better health outcomes than traditional care.