An IMH led multidisciplinary team from the University of Sydney, Sydney Local Health District and Qlik have developed a clinical care dashboard known as the STARS Back Pain App. This dashboard captures routinely collected data of patients presenting with low back pain at three large public hospitals in Sydney, Australia using Qlik Sense, a business intelligence software. The app allows analysis of low back pain presentations to describe current care practices and explore factors associated with the quality of care. It also allows near real-time clinical feedback on clinical performance in the management on low back pain presentations. Investigators: Dr Gustavo Machado (IMH), Dr Bethan Richards (IMH), Dr Chris Needs (Royal Prince Alfred Hospital), Hannah Storey (Sydney Local Health District), Professor Chris Maher (IMH). This project has received funding from the National Health and Medical Research Council. For more information about this project please contact: Dr Gustavo Machado e: gustavo.machado@sydney.edu.au

In 2018 over 120 000 people went to an emergency department in Australia because of low back pain. Most had ‘simple’ low back pain, where medical care such as diagnostic imaging (x-Ray, CT, MRI) and strong opioid medicines offer little benefit. Yet 3 in every 4 patients still received this kind of care. Unnecessary care can harm patients and diverts substantial resources from where they are most needed. NUDGED tests a new way to reduce unnecessary care in Australian hospitals. Funding: NHMRC Clinical Trials and Cohort Studies Scheme – $1.12 million funding Principal Investigator: Adrian Traeger Chief Investigators: Prof Chris Maher (IMH),Prof Louise Cullen (University of Queensland),Prof Kirsten McCaffery (University of Sydney), Prof Jeffrey Linder (Northwestern Memorial Hospital), Prof Rachelle Buchbinder (Monash University), Prof Ian Harris (University of New South Wales), Prof Enrico Coiera (Macquarie University), Mr Qiang Li (The George Institute for Global Health), Prof Kirsten Howard (University of Sydney). Associate Investigators: Dr Andrew Coggins (Westmead Hospital), Ms Elise Tcharkhedian (Liverpool Hospital), Dr Gustavo Machado (IMH), Dr Ian Ferguson (Liverpool Hospital), Prof James McAuley (Neuroscience Research Australia), Janet Harrison, Dr Zoe Michaleff (Bond University Limited), Dr Trevor Chan (Emergency Care Institute), Dr Robyn Lindner (NPS MedicineWise).

This project aims to investigate the effects of oral glucocorticoids in people with acute sciatica. There is currently no simple, effective treatment to relieve the pain in acute sciatica. Acute sciatica is a prevalent, debilitating pain condition. Preliminary evidence suggests that taking oral glucocorticoids may relieve pain and improve function in acute sciatica. The OASIS clinical trial will evaluate whether oral glucocorticoids are effective and safe compared to placebo. The medication will be taken for up to 2 weeks. Participants will be followed up for one year to measure leg pain intensity and other important outcomes. We will also assess drug safety and evaluate cost-effectiveness. This trial is now recruiting. The research team is also looking for General Practitioners who are interested in research to be involved with the recruitment of patients with sciatica into the OASIS study. For more information, please contact: Giovanni Ferreira e: giovanni.ferreira@sydney.edu.au The sponsor of this trial is The University of Sydney. OASIS is funded by the National Health and Medical Research Council. Principal Investigator: Professor Christine Lin (IMH) Chief Investigators: Professor Andrew McLachlan (University of Sydney), Professor Jane Latimer (IMH), Dr Christina Abdel Shaheed (IMH), Qiang Li (The George Institute) Associate Investigators: Dr Bethan Richards (IMH), Professor Rachelle Buchbinder (Monash University), Professor Chris Maher (IMH), Professor Ric Day (University of NSW).

The intention of the trial is to prevent recurrences of low back pain through determining if a progressive individualised walking and education program is more effective when compared to usual care, in preventing recurrence of low back pain in people recently recovered from an episode of non-specific low back pain. Participants will be randomly allocated to one of two groups. One group will receive a walking and advice intervention delivered by a physiotherapist (3 face to face/video conferencing and 3 over the phone consultations, at no cost) and the other group will receive usual care which does not involve any intervention as part of the trial. This project is currently recruiting. You may be eligible to participate in this study if you live in Australia and have had an episode of low back pain in the last 6 months Principal Investigator: Professor Mark Hancock Institute for Musculoskeletal Health Investigators: Professor Jane Latimer, Professor Chris Lin, Professor Chris Maher, Associate Professor Anne Tiedemann. For more information on this Macquarie University Trial, please visit the WALKBACK website. This NHMRC funded project has received ethics approval from Macquarie University Human Research Ethics Committee. Trial registered on ANZCTR: ACTRN12619001134112

This project will provide the first robust evidence on the effectiveness of opioids in the treatment of acute low back pain and neck pain. The trial results will improve care for patients suffering acute spinal pain. Low back pain and neck pain place an enormous burden on patients and health services, both nationally and internationally. Despite the widespread use and recommendations in clinical guidelines, there are no randomised controlled trials that have assessed the effectiveness of opioids for acute low back and neck pain. OPAL is a clinical trial to find out whether opioid analgesics are effective in reducing low back or neck pain, compared to placebo. The opioid analgesic medication– oxycodone – will be taken for up to six weeks. During these six weeks, the participant will be reviewed weekly by a treating physician. This study is currently recruiting. You may be eligible to participate if you have experienced low back pain and/or neck pain of at least moderate severity within the last 12 weeks, and are considered by your treating doctor as appropriate for opioid analgesia. Principal Investigator: Professor Christine Lin Chief Investigators: Professor Chris Maher, Professor Jane Latimer, Associate Professor Laurent Billot, Professor Andrew McLachlan, Professor Ric Day and Professor Bart Koes. The sponsor of this trial is the George Institute. The study has received ethics approval from the University of Sydney Human Research Ethics Committee. For more information, please contact the OPAL team. e: sph.opal@sydney.edu.au Trial registered on ANZCTR: ACTRN12615000775516

Low back pain affects 1 in 4 Australians and is a leading cause for opioid analgesic prescriptions globally. The COMFORT trial aims to support general practitioners to provide opioid stewardship for patients with low back pain. The trial will compare two ways of prescribing an opioid analgesic. The first is the traditional way GPs carefully prescribe the medicine in usual care. The second offers patients other pain relief options in addition to the opioid analgesic. We are not sure which way works best. If successful, the COMFORT trial has the potential to transform care for people with low back pain globally. The project will be recruiting in 2023. Funding: National Health and Medical Research Council APP2000989 (2022-2026) Principal Investigator: Dr Christina Abdel Shaheed Chief Investigators: Prof Chris Maher, Prof Andrew McLachlan, A/Prof Rowena Ivers, Prof Louisa Degenhardt, A/Prof Patrick Kelly, A/Prof Fiona Blyth, Dr Thomas Lung, A/Prof Fiona Stanaway, Dr Rachel Thompson. Professional Staff: Lisa Vissa (Project Manager), Chantay Lenord (Clinical Trial Assistant), Sarah Diprose (Clinical Trial Assistant).

We hope that implementation of a new model of care for acute low back pain will make an enormous difference to the health outcomes of patients when visiting an emergency department (ED) and improve the quality of emergency services. The SHaPED trial aims to improve ED practices through implementing an evidence-based model of care for acute low back pain and evaluating the effects on healthcare services, patient outcomes, and cost compared with usual emergency care. Low back pain patients presenting to EDs often receive complex and unnecessary interventions (e.g. imaging and opioids) yet miss out on the basics of care such as advice on how to self-manage the condition. The Agency for Clinical Innovation (ACI) has recently published a model of care for acute low back pain. The key messages for practice are that non-serious acute low back pain does not require imaging, simple analgesics should be the first option for medicine, and patients should be managed as outpatients. Timely referral and scheduled follow-up reviews are also recommended. At present, active implementation of the ACI model of care and its effects have not been evaluated, and passive dissemination (i.e. publication on a website) is unlikely to change ED practices. This project is no longer recruiting. Principal Investigator: Professor Chris Maher Chief Investigators: Dr Gustavo Machado, Dr Bethan Richards, Dr Chris Needs, Dr James Edwards, Dr Eileen Rogan, Dr Rochelle Facer, Dr David Lord Cowell, Professor Ian Harris, Professor Rachelle Buchbinder, Ms Danielle Coombs, Associate Professor Laurent Billot, Professor Kirsten Howard and Professor Kirsten McCaffery. For more information about this project, please visit the SHaPED Trial Website or contact Dr Gustavo Machado,. The project has received ethics approval from Sydney Local Health District, is funded by Sydney Health Partners, and is endorsed by the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. ACTRN12617001160325

Patients with musculoskeletal conditions often seek care in emergency departments (ED). The problem is that the time required to manage these patients places a great deal of pressure on the ED medical and nursing staff, who are primarily trained and resourced to manage high acuity patients. Primary-contact physiotherapists could play a greater role in supporting the ED team in the management of patients presenting with musculoskeletal conditions. The RESHAP-ED trial is a multicentre, pragmatic, open-label, two-arm, parallel randomised controlled trial with nested process and economic evaluations. The trial will investigate whether a primary-contact physiotherapy service when compared to usual care (primary-contact by physicians or nurse practitioners) reduces the time patients spend in ED. A total of 1,370 patients with simple musculoskeletal conditions will be recruited from six EDs in New South Wales, Australia. The primary effectiveness outcome is the ED length of stay. Secondary outcomes include patient-reported outcomes, adverse events, and healthcare costs. The adjusted mean difference in ED length of stay and 95% confidence interval will be calculated using linear regression adjusted for hospital using a random effect model. This project is currently recruiting. Principal Investigator: Professor Chris Maher (CIA) Coordinating Principal Investigator: Dr Gustavo Machado Chief Investigators: Prof Chris Maher (CIA), A/P The SHaPED trial aims to improve ED practices through implementing an evidence-based model of care for acute low back pain and evaluating the effects on healthcare services, patient outcomes, and cost compared with usual emergency care. Low back pain patients presenting to EDs often receive complex and unnecessary interventions (e.g. imaging and opioids) yet miss out on the basics of care such as advice on how to self-manage the condition. The Agency for Clinical Innovation (ACI) has recently published a model of care for acute low back pain. The key messages for practice are that non-serious acute low back pain does not require imaging, simple analgesics should be the first option for medicine, and patients should be managed as outpatients. Timely referral and scheduled follow-up reviews are also recommended. At present, active implementation of the ACI model of care and its effects have not been evaluated, and passive dissemination (i.e. publication on a website) is unlikely to change ED practices. This project is no longer recruiting. Principal Investigator: Professor Chris Maher Chief Investigators: Dr Gustavo Machado, Dr Bethan Richards, Dr Chris Needs, Dr James Edwards, Dr Eileen Rogan, Dr Rochelle Facer, Dr David Lord Cowell, Professor Ian Harris, Professor Rachelle Buchbinder, Ms Danielle Coombs, Associate Professor Laurent Billot, Professor Kirsten Howard and Professor Kirsten McCaffery. For more information about this project, please visit the SHaPED Trial Website or contact Dr Gustavo Machado,. The project has received ethics approval from Sydney Local Health District, is funded by Sydney Health Partners, and is endorsed by the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. ACTRN12617001160325

ANZBACK is a network of world leading back pain researchers, working in partnership with leading researchers from health policy/systems, health economics, data linkage, health literacy/shared decision-making, and implementation science. Our interdisciplinary team aims to produce major improvements in health outcomes for people with low back pain. Lower back pain is the leading cause of disability burden in Australia, costing the Australian healthcare system $4.8bn annually. It is the most common health reason forcing middle-aged Australians to retire early, consequently reducing Australia’s GDP by more than $10.5bn annually. ​

ANZMUSC Clinical Trials Network has been established by research leaders with funding from the National Health and Medical Research Council (NHMRC) for five years (2018-2022) and is being led by Monash University. ANZMUSC Clinical Trials Network’s vision is to optimise musculoskeletal health through high quality, collaborative clinical research. They aim to do this through identifying key clinical research questions, improving the quality of research, increasing translation of research into policy and practice, fostering collaborations, endorsing clinical research, and advancing research through mentoring and education. Principal Investigator: Professor Rachelle Buchbinder – Monash University Institute for Musculoskeletal Health Investigators: Professor Chris Maher, Professor Ian Harris, Professor Jane Latimer and Professor Christine Lin. For more information, please visit: ANZMUSC Clinical Trials Network https://anzmusc.org/