Alla Melman

Background: Musculoskeletal (MSK) conditions are a leading cause of disability worldwide, yet MSK research often underrepresents diverse populations and inadequately reports considerations related to diversity, inclusion, culture, and equity. Inconsistent reporting limits the interpretability, transferability, and real-world impact of research findings, particularly for priority populations. Currently, there is no MSK-specific reporting guidance that systematically integrates equity-focused principles.Objective: To develop a DICE (Diversity, Inclusion, Culture, and Equity) Checklist, a reporting guideline designed to strengthen transparency, reflexivity, and equity considerations across all stages of musculoskeletal health research.Methods: The DICE Checklist was developed using a multi-phase, modified Delphi approach. This included (1) a short report describing existing equity-focused reporting frameworks, methods, and guidelines. (2) synthesis of key domains relevant to MSK research, and (3) iterative refinement through expert consultation (in-person workshops followed by individual follow up) involving clinicians, researchers, methodologists, and lived-experience contributors.Results: The final DICE Checklist comprises 25 recommendations across four key reporting domains spanning the research lifecycle: (1) community partnerships, leadership, and governance; (2) inclusive research design and ethical practice; (3) equity-driven data collection, analysis, and interpretation; and (4) communication and knowledge sharing. The checklist prompts authors to explicitly reflect on diversity, inclusion, culture, and equity considerations, justify methodological or practical limitations where relevant, and consider implications for generalisability, implementation, and translation. DICE is designed to complement, rather than replace, existing reporting guidelines.Conclusion: The DICE Checklist provides a practical, MSK-specific reporting tool to enhance equity-focused transparency in research. Its adoption may improve the quality, relevance, and inclusivity of musculoskeletal research, supporting more equitable evidence generation and translation into practice and policy.

Background: Osteoarthritis (OA) affects over 700,000 individuals in NSW, with projections estimating an increase to 1 million by 2030. This has led to a significant rise in joint replacement surgeries and associated healthcare costs. Despite guidelines recommending non‐surgical care as first line treatment, many patients remain on surgical waiting lists without accessing these treatments.Aim: The aims of this study were to describe the characteristics and clinical outcomes of people with hip and knee OA attending two Sydney Local Health District (SLHD) Osteoarthritis Chronic Care Program (OACCP) clinics, and to identify whether baseline measures are associated with achieving Minimal Clinically Important (MCI) difference in outcomes.Methods: This retrospective study (n = 1402) evaluated the OACCP's implementation within two SLHD hospitals between Oct 2018 and Sept 2023, describing patient characteristics, patient reported outcomes, physical performance measures, and allied health access. Changes in clinical outcomes in the short‐term (3 months) and long‐term (12 months) assessment as well as associations of patient's baseline measures with MCI improvements in clinical outcomes were analysed.Results: Most self‐reported outcomes and physical performance measures improved at both 3 and 12 months. 38.6% of patients reached the MCI threshold for KOOS total score at 3 months, which rose to 52.1% at 12 months. None of the baseline characteristics predicted outcomes.Conclusion: Following multidisciplinary non‐surgical care, people with hip and/or knee OA experience improved quality of life and function that is sustained for up to 12 months. However, analysis was limited by low long‐term follow‐up rates and no control group.

Objectives: Low back pain was the sixth most common reason for an ED visit in 2022–2023 in Australia, one‐third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes.Methods: Ethics approval was granted for protocols X21‐0278 & 2021/ETH10967 and X21‐0094 & 2021/ETH00591. We conducted a mixed‐method process evaluation, using the RE‐AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care.Results: This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724–AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function.Conclusions: Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non‐serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

[This corrects the article DOI: 10.2196/50146.].

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Background: Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. Objective: The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. Methods: This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an “audit and feedback” process. The implementation of “Back@Home” will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. Results: As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). Conclusions: This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. International Registered Report Identifier (IRRID): PRR1-10.2196/50146

Background: Alternate “hospital avoidance” models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called “Back@Home” and use qualitative interviews with stakeholders to develop and refine the model. Objective: We aim to explore clinicians’ perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. Methods: We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. Results: A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. Conclusions: The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians’ adoption of this model of care. Based on clinicians’ input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.

BACKGROUND Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. OBJECTIVE The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. METHODS This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an “audit and feedback” process. The implementation of “Back@Home” will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. RESULTS As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). CONCLUSIONS This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/50146

Objectives To determine the proportion of low back pain presentations that are admitted to hospital from the emergency department (ED), the proportion of hospital admissions due to a primary diagnosis of low back pain and the mean hospital length of stay (LOS), globally. Methods We searched MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO and LILACS from inception to July 2022. Secondary data were retrieved from publicly available government agency publications and international databases. Studies investigating admitted patients aged >18 years with a primary diagnosis of musculoskeletal low back pain and/or lumbosacral radicular pain were included. Results There was high heterogeneity in admission rates for low back pain from the ED, with a median of 9.6% (IQR 3.3–25.2; 9 countries). The median percentage of all hospital admissions that were due to low back pain was 0.9% (IQR 0.6–1.5; 30 countries). The median hospital LOS across 39 countries was 6.2 days for ‘dorsalgia’ (IQR 4.4–8.6) and 5.4 days for ‘intervertebral disc disorders’ (IQR 4.1–8.4). Low back pain admissions per 100 000 population had a median of 159.1 (IQR 82.6–313.8). The overall quality of the evidence was moderate. Conclusion This is the first systematic review with meta-analysis summarising the global prevalence of hospital admissions and hospital LOS for low back pain. There was relatively sparse data from rural and regional regions and low-income countries, as well as high heterogeneity in the results.

BACKGROUND Alternate “hospital avoidance” models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called “Back@Home” and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE We aim to explore clinicians’ perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians’ adoption of this model of care. Based on clinicians’ input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.