As cases continue to grow, the condition is placing ED staff and resources under mounting pressure at a time when the COVID-19 pandemic has already brought many hospitals to a point of crisis.

We know, however, that most people presenting with low back pain in ED are triaged as non-serious/non-urgent and many could be managed by a physiotherapist.

There are opportunities to reduce the pressure low back pain places on EDs by rethinking the way healthcare is organised and delivered.

The APA and the Physiotherapy Research Foundation are increasing their work with universities and the research sector in this field and engaging in partnerships and support for trials and new models of care.

The University of Sydney, for example, seeks to bring together three strategies that have previously been shown to increase health efficiency.

Dr Gustavo De Carvalho Machado, a physiotherapist research fellow at the University of Sydney, and his multidisciplinary team, including four physiotherapists, were recently awarded $2.8 million for a project entitled Reshaping the management of low back pain in emergency departments.

The grant was given under the National Health and Medical Research Council’s Medical Research Future Fund 2022 Models of Care to Improve the Efficiency and Effectiveness of Acute Care Grant Opportunity.

Its goal is to validate a new model of care that increases health efficiency, reduces pressure on the ED and offers better health outcomes for ED patients with low back pain.

The model will provide a dedicated physiotherapist in the ED to manage the non-serious/ non-urgent cases of back pain, with the option of a virtual hospital admission to avoid the problem of access block and allow early supported discharge.

This model has elements that echo the APA’s advocacy for publicly funded first contact physiotherapy.

First, an experienced physiotherapist will triage patients presenting with low back pain in the ED. Patients assessed as non-serious or ‘non-urgent’ will be diverted to outpatient physiotherapy clinics for prompt management.

Second, patients with low back pain requiring care within the ED will be primarily managed by an experienced physiotherapist (under ED medical oversight), who will organise a timely follow-up consultation at the outpatient physiotherapy clinic.

Finally, patients with low back pain requiring admission to ED short-stay or inpatient units will be triaged by a physiotherapist in consultation with senior ED medical staff.

Suitable cases will be referred to virtual hospital care. This trial will be conducted in seven New South Wales public hospital EDs: three in Sydney and four in the Hunter and Mid North Coast regions.

We are also working with the University of Sydney and the University of Queensland on another grant application—Direct Access Physiotherapy for Low Back Pain in Primary Care.

This proposal is based on evaluating whether giving patients direct access to physiotherapy, in collaboration with their GP, leads to improved access to appropriate care while also reducing the musculoskeletal case load burden on GPs.

We know that this type of innovative care works in the UK and similar evaluations are being undertaken in the USA.

Research trials such as the one being proposed (and supported by the APA and the PRF) would provide us with clinical data on the effectiveness of a direct access physiotherapy model within primary care—reducing pressure on hospital emergency departments, which can only benefit us all.