An adaptive trial of emergency department interventions for back pain.

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

We hope the findings of this project reduce avoidable hospital admissions and length of stay for low back pain while ensuring high quality care and outcomes. The project aims to implement the ‘rpavirtual’ model of care to avoid unnecessary low back pain admissions to the hospital wards and reduce length of stay across Sydney Local Health District. The project will involve conducting an audit of inpatient management of low back pain and semi-structured interviews with clinicians and patients to understand current inpatient management practices. Then, we will adapt the existing ACI model of care for acute low back pain to a ‘virtual mode’ in partnership with ‘rpavirtual’ and use an interrupted time series design to test the ‘virtual hospital’ model as an alternative to inpatient admission for low back pain. Principal Investigator: Dr Gustavo Machado (IMH) Associate Investigators: Dr Bethan Richards (IMH), Professor Chris Maher (IMH), Dr Teresa Anderson (Sydney Local Health District), Miranda Shaw (Sydney Local Health District), Dr Owen Hutchings (Sydney Local Health District), Cassandra Dearing (Sydney Local Health District), Dr James Edwards (Royal Prince Alfred Hospital), Dr Eileen Rogan (Canterbury Hospital), Dr Chris Needs (Royal Prince Alfred Hospital), Dr Danielle Coombs (IMH), Dr Rachael Dodd (University of Sydney), Dr Narcyz Ghinea (University of Sydney), Min Jiat Teng (Concord Hospital), Alla Melman (IMH). This project has received funding from Lifespan Research Network, University of Sydney and HCF Research Foundation. For more information about this project please contact: Dr Gustavo Machado e: gustavo.machado@sydney.edu.au

Simple bone fractures, those that don’t require surgery or plaster casting, often require minimal care such as advice and monitoring by a physiotherapist. This care has traditionally been provided by in-person clinics at public hospitals, which often have long wait times. More recently, hospitals have begun to provide follow-up fracture care remotely by phone or video call. The Virtual Fracture Clinic Trial will determine whether the virtual clinic approach is as effective as an in-person fracture clinic in terms of patient function, recovery and other outcomes. Funding: Sydney Research PhD Scholarship (awarded to Min Jiat Teng) Principal Investigator: Adrian Traeger, Min Jiat Teng, Miranda Shaw (RPA Virtual) Associate Investigators: Dr Owen Hutchings, (RPA Virtual), A/Prof Mark Horsley (Deputy Director Neurosciences, Bone & Joint, RPA Hospital), Dr Jeffrey Petchell (Head of Orthopaedic Department & Director of Trauma RPA Hospital), Prof Chris Maher (Director, Institute for Musculoskeletal Health), Dr Tessa Copp, (The University of Sydney), Dr Kristen Pickles (The University of Sydney) & Ms Rong Liu (RPA Virtual Hospital).

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).

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).

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/

Opioid evidence-based deprescribing guidelines Read less Overprescribing of prescription opioid analgesics is acknowledged to be a major international public health problem. There is an increasing body of evidence on potentially inappropriate opioid use leading to clinically significant adverse events, and limited evidence regarding the efficacy of opioids in the longer term. Regular monitoring of chronic prescription opioid use and deprescribing (medication withdrawal) may be required to minimise the risk of harms. Deprescribing is defined as the act of reducing or ceasing medication that is no longer necessary or that may cause harm. Current prescribing guidelines provide advice regarding initiation of treatment and rarely address monitoring or medication discontinuation, or, where they do, provide inadequate cessation guidance and support. As such, novel opioid cessation approaches are needed to ensure appropriate opioid use. The objective of this project is to develop evidence-based opioid deprescribing guidelines to provide guidance on how and when to stop opioids. Australian Clinical Practice Guidelines Register: https://www.nhmrc.gov.au/guidelines Investigators: Associate Professor Danijela Gnjidic (University of Sydney), Dr Carl Schneider (University of Sydney), Ms Aili Langford (University of Sydney), Professor Christine Lin (IMH)

Investigators of the opioid evidence-based deprescribing guidelines project and a guideline development group have developed a resource titled: Communication Techniques for Opioid Tapering Conversations Guide. The Communication Techniques for Opioid Tapering Conversations Guide (provided in the link below) has been adapted using the ‘FRAME’ acronym for leading deprescribing conversations with permission by the authors of “Communication Techniques for Deprescribing Conversations”. This conversation guide aims to provide guidance on structuring opioid tapering conversations and can be used in conjunction with existing clinical and policy guidance. Guideline development group members: Professor Lisa Bero, Professor Fiona Blyth, Dr Jason Doctor, Dr Simon Holliday, Professor Yun-Hee Jeon, Dr Joanna Moullin, Associate Professor Bridin Murnion, Associate Professor Suzanne Nielsen, Ms Rawa Osman, Dr Jonathan Penm, Dr Emily Reeve, Dr Sharon Reid & Ms Janney Wale. Suggested Citation: Langford AV, Gnjidic D, Schneider CR. Communication techniques for opioid analgesic tapering conversations. Sydney: The University of Sydney; 2020.