The NUDG-ED trial, led by Dr. Adrian Traeger, is an initiative aimed at reducing unnecessary medical care for low back pain in Australian emergency departments. In 2018, over 120,000 people visited emergency departments in Australia due to low back pain. Most of these cases involved 'simple' low back pain, where medical interventions such as diagnostic imaging (x-ray, CT, MRI) and strong opioid medications offer minimal benefit. Despite this, 3 out of every 4 patients still received such care. 

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Unnecessary medical care not only poses potential harm to patients but also diverts substantial resources from areas where they are most needed. The NUDG-ED trial tests a novel approach to address this issue by implementing 'nudging' interventions for both patients and clinicians. These behavioural nudges aim to reduce the use of low-value care, such as unnecessary imaging and opioid prescriptions, in emergency departments. 

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The trial is designed as a 2×2 factorial, open-label, before-after, cluster randomized controlled trial, involving eight emergency department sites in Sydney, Australia. Participants include ED clinicians who manage back pain and patients aged 18 years or older presenting with musculoskeletal back pain. The primary outcome measure is the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge, or both. 

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By evaluating the effectiveness of these behavioural nudges, the NUDG-ED trial aims to improve patient care, reduce unnecessary medical interventions, and optimize the use of healthcare resources in Australian hospitals. 

 

Funding: NHMRC Clinical Trials and Cohort Studies Scheme – $1.12 million funding (CIA Traeger) 

 

The team comprises academics, public health experts and health economists from a range of organisations. 

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Lead Investigator:  A/Prof Adrian Traeger 

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Investigator team: Gemma Altinger, Sweekriti Sharma, Chris G Maher, Louise Cullen, Kirsten McCaffery, Jeffrey A Linder, Rachelle Buchbinder, Ian A Harris, Enrico Coiera, Qiang Li, Kirsten Howard, Andrew Coggins, Paul M Middleton, Naren Gunja, Ian Ferguson, Trevor Chan, Karen Tambree, Ajay Varshney, Adrian C Traeger on behalf of NUDG-ED Study Group 

Trial Operations: Sweekriti Sharma (Project Manager), Aidan Van Wyk (Clinical Trials Assistant), Gemma Altinger (PhD Candidate) 

 

Contact or further information 

Associate Professor Adrian Traeger: adrian.traeger@sydney.edu.au

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Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial