Interventions to improve the quality of low back pain care in emergency departments: a systematic review and meta-analysis
Abstract
Low back pain (LBP) is a common reason people visit Emergency Departments (ED). However, the care provided is often not aligned with guideline recommendations. Despite increasing research aiming to promote guideline-based care in EDs, interventions to best implement recommendations are unknown. This study aimed to identify ED LBP implementation interventions that have been trialed and evaluate their effects on ED-relevant outcomes. A systematic review and meta-analysis, including studies that evaluated interventions to improve the quality of care provided to adults presenting to ED with LBP. Databases searched until May 2023 were Cochrane Library, CINAHL, EMBASE (via OVID), and PEDro. Interventions were categorized according to whether they had a patient, clinician, health service, or multiple-level focus. Where possible, meta-analysis was undertaken. Certainty around the results was assessed using the GRADE criteria. Twenty-eight studies were included. Interventions were categorized as patient (n = 2), clinician (n = 8), health service (n = 12), or multiple-level (n = 6) targeted. Overall, interventions successfully reduced the likelihood of receiving an opioid in ED (OR 0.65; 95% CI 0.55–0.75). However, no significant effect on lumbar imaging was demonstrated (OR 0.85; 95% CI 0.64–1.12). Subgroup analyses showed that studies reporting high baseline imaging rates ≥ 36% and those that included systems-based changes significantly reduced imaging (OR 0.60; 95% CI 0.39–0.93;…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 12 participants or records.
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