Our research in the

Improving Clinical Care theme

The Improving Clinical Care theme includes research staff, research students and professional staff from a variety of backgrounds including physiotherapy, chiropractic, rheumatology and emergency medicine.

Australia’s CareTrack study showed that Australians get the right care at only 60% of healthcare visits. In this theme, we work with clinicians, patients and policymakers to implement the latest research knowledge so that patients receive the very best healthcare – every time.

IMH-led projects

We hope that the 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 (IMH)

Chief Investigators: Dr Gustavo Machado (IMH), Dr Bethan Richards (IMH), Dr Chris Needs (SLHD), Dr James Edwards (SLHD), Dr Eileen Rogan (SLHD), Dr Rochelle Facer (SLHD), Dr David Lord Cowell (ISHLD), Professor Ian Harris (IMH), Professor Rachelle Buchbinder (Monash University), Ms Danielle Coombs (IMH), Associate Professor Laurent Billot (University of Sydney), Professor Kirsten Howard (University of Sydney) and Professor Kirsten McCaffery (University of Sydney).

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 Centre of Research Excellence funded by the National Health and Medical Research Council (NHMRC) for four years (2020-2023).

ANZBACK’s aim is to produce major improvements in health outcomes for people with low back pain. To achieve this, a network of world leading back pain researchers are working in partnership with leading researchers from health policy/systems, health economics, data linkage, health literacy/shared decision-making, and implementation science.

To learn more about ANZBACK and how you could be involved as a researcher, policy maker, health professional or consumer please visit the ANZBACK website.

Principal Investigator: Professor Chris Maher (IMH)

Chief Investigators: Professor Rachelle Buchbinder (Monash University), Professor Mark Hancock (Macquarie University), Professor Peter O’Sullivan (Curtin University), Professor James McAuley (University of New South Wales), Professor Fiona Blyth (University of Sydney), Professor Louisa Jorm (University of New South Wales), Professor Alex Collie (Monash University), Professor Kirsten McCaffery (University of Sydney), Professor Alison Hayes (University of Sydney).

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), Ms 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.

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), Ms Miranda Shaw (Sydney Local Health District), Dr Owen Hutchings (Sydney Local Health District), Ms 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), Ms Danielle Coombs (IMH), Dr Rachael Dodd (University of Sydney), Dr Narcyz Ghinea (University of Sydney), Mr Min Jiat Teng (Concord Hospital), Ms Alla Melman (IMH).

This project has received funding from Lifespan Research Network, University of Sydney.

For more information about this project please contact Dr Gustavo Machado.

We hope the findings of this retrospective observational study lead to a greater understanding of the use of analgesia in Australian Emergency Departments (ED).

This study aims to describe the analgesic medicines prescribed on discharge from the three EDs within the Sydney Local Health District for patients presenting with a musculoskeletal condition. This study will focus on the rate of opioid analgesics prescribed on discharge and the patient and clinician factors associated with their use. The analyses will be repeated with patients who presented with low back pain.

Principal Investigator: Dr Stephanie Mathieson (IMH)

Associate Investigators: Ms Martina Salib (IMH), Professor Asad Patanwala (University of Sydney), Professor Christopher Maher (IMH), Dr Tim Badgery-Parker (Macquarie University).

This study has received ethics approval from Sydney Local Health District Human Research Ethics Committee.

For more information about this study please contact Ms Martina Salib.

We hope the findings of this retrospective observational study lead to a greater understanding of the use of analgesia in the hospital setting.

This study aims to determine the patterns and characteristics associated with analgesia prescribing, particularly opioid analgesics, to patients on hospital discharge in the Sydney Local Health District over time. It also aims to determine the patient and clinician factors associated with the use of different analgesics.

Principal Investigator: Dr Stephanie Mathieson (IMH)

Associate Investigators: Ms Martina Salib (IMH), Professor Asad Patanwala (University of Sydney), Professor Christopher Maher (IMH), Dr Tim Badgery-Parker (Macquarie University).

This study has received ethics approval from Sydney Local Health District Human Research Ethics Committee.

For more information about this study please contact Ms Martina Salib.

Collaborative projects

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 (IMH), Professor Ian Harris (IMH), Professor Jane Latimer (IMH) and Professor Christine Lin (IMH).

For more information, please visit ANZMUSC Clinical Trials Network.

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

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 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.

Communication techniques for opioid analgesic tapering conversations

Theme leader: Professor Chris Maher

BAppSc(Phty), GradDipAppSc(ExSpSc), GradDipAppSc(ManipPhty), PhD, DMedSc, FACP, FAAHMS

Professor Chris Maher is an NHMRC Principal Research Fellow and Fellow of the Australian Academy of Health and Medical Sciences. His clinical training is in physiotherapy and he is a fellow of the Australian College of Physiotherapy. Chris is best known for his clinical research evaluating the management of low back pain which has been published in leading journals including New England Journal of Medicine, Lancet, Annals of Internal Medicine and British Medical Journal.