349: Effectiveness of a virtual hospital for back pain in emergency departments (Back@Home)

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute musculoskeletal pain, Non-pharmacological treatments, Physiotherapy, Digital Health Technologies

Background and Aims: Back pain imposes an enormous burden on emergency departments (EDs) and inpatient services. In the United States, it accounts for 13% of hospital admissions [1]. In England, back pain was responsible for 365,327 ED presentations and 140,392 hospital admissions in 2023–24 [2]. In Australia, back pain was the 5th most common reason for ED visits in 2023–2024, with one third of the patients subsequently admitted to hospital [3]. Another concern is that 10% of the patients with back pain re-present to the ED within 12 months in Australia [4] and 14% in the United States [5]. Virtual care models, including home-based and outpatient services, have been proposed to reduce avoidable ED presentations and hospitalisations. This study evaluated the effectiveness of a virtual hospital model of care for back pain (Back@Home) in reducing hospital admissions and re-presentations to the ED.

Methods: We conducted an observational study across three Sydney Local Health District emergency departments (EDs) (>179,000 annual presentations) and a virtual hospital, following the STROBE Statement with a published protocol. We included patients aged ≥16 years discharged with non-serious (non-specific or radicular) back pain, identified using SNOMED CT-AU codes. The Back@Home model, a hybrid of virtual care and home visits, was introduced on 13 February 2023 at the first site, with rollouts on 15 and 29 May 2023. The primary outcome was admission to ED short stay or inpatient units following ED presentation. Secondary outcomes included 30-day ED re-presentations, and length of stay. Patient-reported outcomes (pain, function, satisfaction) were prospectively collected via REDCap in a sub-sample pre-implementation (Dec 2021–May 2023) and post-implementation (Feb 2023–Jan 2025). We used logistic and linear mixed-effects models with random intercepts for the primary analysis, adjusting for exposure, secular trends, seasonality, and COVID-19 restrictions.

Results: From January 2017 to January 2025, 18,851 patients presented to the ED with non-serious back pain (14,554 pre-implementation and 4,297 post-implementation of the model of care). The characteristics of the back pain presentations were similar before and after we introduced the model. The Back@Home model of care did not significantly affect admissions to inpatient or short-stay units (OR: 1.19, 95%CI: 0.46 to 3.06). However, it significantly reduced ED re-presentations within 30 days (OR: 0.59, 95% CI: 0.42 to 0.84), indicating a 41% reduction in the likelihood of returning to the ED following Back@Home implementation. Patients who received virtual hospital care through the Back@Home model of care reported less pain (β: -1.26,95%CI: -2.22 to -0.30), better physical function (β: 4.81, 95% CI: 2.36 to 7.27) and similar satisfaction with care received (β: 0.14; 95% CI: -0.72 to 1.01) compared with those receiving usual hospital care.

Conclusions: The Back@Home model of care did not lead to significant reductions in overall hospital admissions, but it was associated with a meaningful reduction in ED re-presentations – a key national health priority in Australia. Patients receiving Back@Home care reported outcomes that were comparable to, and sometimes better than, those receiving usual hospital care. Although causality cannot be inferred, these preliminary findings suggest that virtual care can be delivered effectively outside the hospital. Our findings position Back@Home as a promising and scalable approach to improve service delivery and patient outcomes for people with back pain presenting to EDs.

References: 1. Yelin, E., Weinstein, S. & King, T. The burden of musculoskeletal diseases in the United States. Semin. Arthritis Rheumat. 46, 259–260, https://doi.org/10.1016/j.semarthrit.2016.07.013 (2016).
2. National Health Service England. Hospital Admitted Patient Care Activity, 2023–2024, https://digital.nhs.uk/data-and-information/publications/
statistical/hospital-admitted-patient-care-activity/2023-24 (2024).
3. Australian Institute of Health and Welfare. Back problems. https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems (2023).
4. Xu, X.,Chen, Q.,Oliveira, C. B.,Maher,C.G.&Machado, G. C. Emergency department length of stay and re-presentation rates in patientswith lowbackpain: amedical record review study.Am.J.Emerg.Med. 84, 33–38, https://doi.org/10.1016/j.ajem.2024.07.035 (2024).
5. Megalla, M. et al. Factors associated with repeat emergency department visits for low back pain. Cureus 14, e21906, https://doi.org/10.7759/cureus.21906 (2022).

Presenting Author: Gustavo C. Machado
Submitting Author: Gustavo Machado

Senior Author: Gustavo C. Machado

IASP 2026 Global Year theme of Neuropathic Pain: No

• Chathurani Sigera: PhD - University of Sydney
• CrystianB.Oliveira: PhD - University of Sydney
• Alla Melman: PhD - University of Sydney
• Min Jiat Teng: BPhty - Sydney Virtual Hospital
• Danielle M. Coombs: PhD - University of Sydney
• Owen Hutchings: MBBS - Sydney Virtual Hospital
• Chris G. Maher: PhD - University of Sydney
• Back@Home Investigators: NA - University of Sydney