653: Clinician views of behavioural intervention to reduce low-value care for back pain in emergency care

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Non-pharmacological treatments

Background and Aims: Low back pain is one of the leading causes of emergency department (ED) presentations globally.1 Although guidelines recommend against opioids and routine imaging, about 70% of people with low back pain receive opioids, and ~25% receive imaging in Australian EDs.3 We recently completed a trial of behavioural interventions to reduce low-value care for back pain in the ED called NUDG-ED. The trial found clinician nudges (electronic alerts) did not reduce low-value care for low back pain. We aimed to explore the extent to which our findings can be explained by clinicians’ awareness and perceptions of the electronic alerts.

Methods: This is a qualitative process evaluation of the NUDG-ED trial. NUDG-ED trial is a 2x2 factorial, open label, before-after cluster randomised controlled trial designed to reduce low value care for patients with low back pain who presented to eight emergency departments in Sydney, Australia. Participants included 33 emergency department (ED) clinicians involved in the care of back pain (physicians, registered nurses and physiotherapists). ED clinicians were invited to participate in an interview after the nine-month intervention period. We conducted thematic analysis to identify the main themes.

Results: Three key themes emerged from the preliminary analysis: (i) alerts help manage patient expectations; (ii) written patient information materials are highly valued; and (iii) the timing of alerts influences patient pressure. Clinicians reported that alerts were helpful in informing decisions about whether to prescribe opioids. They also emphasised the importance of written patient education materials to reinforce verbal counselling. However, clinicians noted that alert timing was critical, as alerts often appeared after prescribing decisions had already been made. However, the effectiveness of alerts is strongly influenced by their timing, with late presentation limiting their impact on prescribing decisions.

Conclusions: The results highlight the potential of clinical alerts to support opioid prescribing by assisting clinicians in managing patient expectations and reinforcing evidence-based decision-making. The findings underscore the added value of written patient education materials in supporting clinician–patient communication and promoting shared understanding. Optimising the design and delivery of alerts, particularly ensuring they appear earlier in the clinical workflow, may enhance their usefulness and reduce patient pressure. Future interventions should integrate timely alerts with accessible educational resources to maximise clinical and patient-centred outcomes.

References: Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2017;18(1):143.
2. Xu X, Chen Q, Oliveira CB, Maher CG, Machado GC. Emergency department length of stay and re-presentation rates in patients with low back pain: A medical record review study. The American Journal of Emergency Medicine. 2024;84:33-8.
3. Ferreira GE, Machado GC, Christina Abdel S, Chung-Wei CL, Needs C, Edwards J, et al. Management of low back pain in Australian emergency departments. BMJ Quality & Safety. 2019;28(10):826.

Presenting Author: Sweekriti Sharma
Submitting Author: Sweekriti Sharma

Senior Author: Adrian Traeger

IASP 2026 Global Year theme of Neuropathic Pain: No

• Sweekriti Sharma: PhD - The University of Sydney
• Gemma Altinger: MBehEcon - The University of Sydney
• Kristen Pickles: PhD - The University of Sydney
• Chris G Maher: PhD - The University of Sydney
• Aidan van Wyk: BSC - The University of Sydney
• Adrian Traeger: PhD - The University of Sydney