Poster Presentation Sydney Spinal Symposium 2026

Effectiveness of the Virtual or In-person Physiotherapist-led Evaluation of Referrals to spine surgeons (VIPER) model of care: a protocol for a randomised controlled trial (#114)

Andrew R Gamble 1 2 , Giovanni Ferreira 1 2 , Christopher G Maher 1 2 , Tarcisio Folly de Campos 2 , Joshua Hutton 1 2 , Mouna Sawan 2 , Ian Harris 3 , Leanne Hassett 1 2 , James Van Gelder 4 5 , Mark Halliday 5 , Chris Williams 2 , Monika Boogs 2 , Deborah Fullwood 2 , Sam Adie 2 , Edd Riley-Gibson 2 , Emma Molineux 2 , Karen Tambree 2 , Rowena Charteris 1 2 , David B Anderson 2 , Laurent Billot 2 , Abby Haynes 1 2 , Saurab Sharma 2 , Adam de Gruchy 1 2 , Sophie Macpherson 2 , Edith Wong 2 , Bruce Donald 6 , Scott Collins 6 , Joshua R Zadro 1 2
  1. The Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
  2. The University of Sydney, Sydney, NSW, Australia
  3. The University of New South Wales, Sydney, New South Wales, Australia
  4. Discipline of Neurosurgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
  5. Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  6. John Hunter Hospital, Newcastle, NSW, Australia

INTRODUCTION

Many patients with lumbar spine conditions referred to see a spine surgeon in Australian public hospitals wait 1-2 years for an appointment and develop more complex symptoms to treat while they wait. To address this, we co-designed the Virtual or In-person Physiotherapist-led Evaluation of Referrals to spine surgeons (VIPER) model of care to help clinics prioritise which patients require non-surgical care before seeing a surgeon and which require a surgical appointment.

OBJECTIVES

To evaluate whether VIPER reduces disability at 6 months in patients with non-specific low back pain and/or lumbar spine-related leg pain who are referred to see a spine surgeon, compared to usual care.

METHODS

We will recruit 314 adults with non-specific low back pain and/or lumbar spine-related leg pain who newly referred to see a spine surgeon at public hospital spine surgery clinics in NSW, Australia. Eligible and consenting participants will be randomly allocated (ratio 1:1; 157 in each arm) to receive the VIPER model of care or usual care (i.e. joining the waiting list for an in-person appointment with a surgeon). An experienced physiotherapist will call participants in the VIPER group to book an appointment for their initial assessment which will [give some details about the initial assessment]. Following the initial assessment, the physiotherapist will triage participants as needing either non-surgical care (either physiotherapy treatment or referral to another health professional) or an appointment with a surgeon, discussing their decision with the surgeon as needed. The primary outcome is disability at 6 months post-randomisation, assessed via the Oswestry Disability Index (ODI). Secondary outcomes include other patient-reported outcomes (e.g. pain, quality of life, satisfaction with care, health service use, medication use, adverse events) assessed at 3-, 6- , and 12-months, process measures (e.g. waiting time) and costs for an economic evaluation.