Poster Presentation Sydney Spinal Symposium 2026

Stakeholder perceptions of the VIrtual Physiotherapist-led Evaluation of low back pain Referrals to spine surgeons (VIPER) model of care: a qualitative study (#108)

Tarcisio F de Campos 1 , Andrew R Gamble 1 , Giovanni E Ferreira 1 , Christopher G Maher 1 , Joshua M Hutton 1 , Sophie MacPherson 2 , Christopher S Han 1 , Mouna Sawan 3 , Ian Harris 4 , Leanne Hassett 1 , James Van Gelder 5 , Mark Halliday 5 , Rowena Charteris 1 , Laurent Billot 6 , Abby Haynes 1 , Jemma Moujalli 7 , Edith Wong 7 , Joshua R Zadro 1
  1. The University of Sydney - Institute for Musculoskeletal Health, Camperdown, NSW, Australia
  2. Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  3. School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  4. South West Sydney Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, University of New South Wales Sydney, Sydney, NSW, Australia
  5. Concord Repatriation General Hospital, Sydney Local Health District, Sydney, NSW, Australia
  6. The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
  7. Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia

Introduction Despite guidelines advising that non-serious low-back-pain(LBP) should be managed with self-management advice/exercise, referrals to spine surgeons are common. High referral rates to public hospital spine surgery clinics means many surgeons can’t assess new cases within 1-2 years. Patients referred to these clinics have not tried recommended non-surgical care, and while they wait for surgical review, they develop symptoms which are complex and costly to manage. We developed the VIrtual Physiotherapist-led Evaluation of low back pain Referrals to spine surgeons (VIPER) model of care to help clinics identify referrals who can be managed sooner by a physiotherapist and reduce wait-times for those needing surgical review. Aim Explore stakeholder perceptions of this model of care, to co-design VIPER and then evaluate it in a large, multi-site trial. Methods We conducted semi-structured interviews with people with LBP, clinicians (e.g., physiotherapists, spine surgeons), and other key stakeholders (e.g., department managers). Participants were recruited via advertisements, the authors’ networks, and snowball sampling. Interview transcripts were analysed using an inductive descriptive qualitative analysis. Results Interviews with 39 participants (6 people with LBP, 26 clinicians, and 7 other key stakeholders) highlighted four key themes: 1) current gaps in LBP care pathways and implementation considerations; 2) perceptions of the role of physiotherapy in LBP care and patient selection for VIPER; 3) support for VIPER as a means to improve patient outcomes and health system efficiency; and 4) views on virtual assessment and escalation, recognising the value of hybrid models and its limitations. Conclusion The proposed model of care appears feasible, acceptable, and well-suited to improve LBP care by promoting guideline-based non-surgical management and reducing wait-times for surgical review. The virtual component of the model offers flexible, patient-centred delivery with potential system-wide benefits, supporting further piloting and evaluation, and possibly wider applications in musculoskeletal care.