Poster Presentation Sydney Spinal Symposium 2026

A pragmatic, two-arm, parallel randomised controlled trial comparing a virtual care referral pathway with usual paramedic care for back pain in ambulance service: the RAMBO trial protocol (#112)

Simon Vella 1 , Gustavo Machado 1 , Christopher Maher 1 , Paul Simpson 2 , Michael Swain 3 , Chris Smith 4 , Jeremy Fry 5
  1. Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
  2. School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
  3. Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
  4. Clinical Capability Safety and Quality, NSW Ambulance, Sydney
  5. VirtualADULTS service, Sydney Virtual Hospital, Sydney

Background

At present, 81% of people with non-traumatic back pain who call an ambulance are transferred to hospital. Once in the emergency department (ED) these people are likely to receive high-risk medicines, unnecessary investigations, and admission to hospital. There is a need for robust alternatives, like virtual care, to reduce unnecessary transport by ambulance to hospital.

 

Objectives

To evaluate the effectiveness of a new virtual care referral pathway as an alternative to usual paramedic care to manage people with back pain.

 

Methods

Design: A randomised controlled trial embedded within NSW Ambulance.

 

Participants: Adults who seek ambulance care for non-traumatic back pain, with no suspicion of serious underlying pathology, and who receive subsequent in-person paramedic care in NSW, Australia. Eligible participants will be randomised 1:1 to virtual care or to receive usual paramedic care.

 

Intervention:The intervention is a new virtual care referral pathway through Sydney Virtual’s VirtualADULTS service. Paramedics will perform routine clinical care including assessment and administration of pain medicines. Participants randomised to the virtual care pathway will be transferred by the paramedic to the virtualADULTS service where an emergency physician will conduct a virtual assessment (supported by the on-scene paramedic) and make a recommendation regarding care. Participants accepted for virtual care will be discharged by the paramedic/s and managed by the virtualADULTS service. 

Control: Usual paramedic care.

 

Outcomes

Primary outcome is proportion of people with back pain who are transported by ambulance to ED. Secondary outcomes will include re-contact with ambulance, (re)presentation to ED, hospital admission, healthcare costs, and patient outcomes; pain, function and satisfaction with care. Time measures: day 3, 7, 14 and 42.

 

Conclusion

This project will provide high-quality evidence to inform health service policy nationwide. This project has the potential to improve patient outcomes and health service/system efficiency by reducing unnecessary ED presentations for back pain.