None listed
Conditions
Brief summary
Many people improve following discharge from conservative hospital treatment for low back pain (LBP), however some experience worsening LBP and seek additional care. The lack of support for patients after treatment discharge has been identified as a key driver for this clinical pattern. Introducing a discharge support system, incorporating referral to the NSW Health Get Healthy Service®, which delivers telephone and telehealth-based health coaching programs, has strong potential to bridge this clinical gap. Health coaching can improve physical activity levels in people with LBP. We will conduct a randomised controlled trial investigating the effectiveness and cost-effectiveness of a discharge support system (incorporating referral to the Get Healthy Service®) for improving pain, disability, and physical activity levels, in people recently discharged from hospital outpatient physiotherapy treatment, or from public or private physiotherapy, chiropractic or general practitioner care for chronic LBP. In-depth interviews will be conducted to identify factors contributing to intervention success, which will be used to inform the development of an implementation plan for upscaling the discharge support system across NSW LHDs.
Interventions
The project will involve a randomised, clinical, single-blind, parallel, superiority study with 1:1 allocation ratio to either a discharge support system (incorporating referral to the Get Healthy Service® health coaching intervention) or usual care group. The total sample will include 346 participants.
Discharge support system (Intervention group):
Participants in the intervention group will receive the usual care provided at discharge from hospital outpatient physiotherapy treatment, or from
The project will involve a randomised, clinical, single-blind, parallel, superiority study with 1:1 allocation ratio to either a discharge support system (incorporating referral to the Get Healthy Service® health coaching intervention) or usual care group. The total sample will include 346 participants. Discharge support system (Intervention group): Participants in the intervention group will receive the usual care provided at discharge from hospital outpatient physiotherapy treatment, or from public or private physiotherapy, chiropractic or general practitioner care for chronic non-specific LBP. Participants will be allowed to seek other forms of care. In addition, participants will be enrolled into a discharge support system which incorporates referral to the Get Healthy Service. The Get Healthy Service is a free, well-establish service funded and managed by the NSW Ministry of Health that delivers telephone-based health coaching programs. Participants will be offered up to 10 health coaching sessions, delivered over 6 months, from the standard coaching module. The participant will decide on the frequency of the telephone or telehealth-based health coaching sessions. The participant will also decide the number of sessions they wish to attend. The health coaching sessions will be delivered by university-qualified health care professionals (e.g. exercise physiologists, dietitians) who have undergone training procedures to comply with the standards of NSW Health. During the health coaching sessions, health coaches will motivate and support participants to remain physically active and sustainably achieve personal health-related goals. For example, this may include the provision or revision of a tailored exercise plan, recommendations for local community opportunities to increase physical activity participation (e.g. local recreational centers or community exercise programs), or a personalised diet plan, depending on the participant's goals. In accordance with Get Healthy Service®'s standard operations, each session will be up to 17 minutes in duration. Adherence will be monitored by the number of health coaching sessions attended, recorded by the Get Healthy Service®. In accordance with the current specifications of the Get Healthy Service® coaching program, after completing their program of health coaching sessions, participants will be given the option to: (1) ‘graduate’ from the health coaching program, (2) re-enrol for further health coaching sessions, or (3) opt-in to a free SMS program for a further 6 months called the Get Healthy Stay Healthy SMS program. For participants who opt-in for the Get Healthy Stay Healthy SMS program, they will receive automatic, standardised motivational SMS reminders tailored towards 3 distinct goal categories: (1) physical activity, (2) diet or (3) weight maintenance. A health coach will first phone the participant to confirm their preference for 1-2 goal categories. The health coach will also establish the participant’s preference for the frequency of receiving SMS reminders (i.e. specific day(s) and time(s) of the week), and the number of SMS reminders they wish to receive per goal category. There will be no minimum frequency for receiving SMS reminders (i.e. the frequency of receiving SMS reminders will be decided entirely by the participant). An example of a motivational SMS reminder is: Hi {Participant Name}, remember your goal to {Goal} this week. Long term change takes time, but you can get there by moving forward one step at a time. {GHSH_Coach}.” At 3 months after joining the Get Healthy Stay Healthy SMS program, the health coach will phone the participant to monitor their progress and adjust goals or SMS reminder preferences as needed. At 6 months after joining the Get Healthy Stay Healthy SMS program, the health coach will phone the participant to confirm completion (‘graduation’) from the SMS program, and encourage participants to continue ongoing self-maintenance of positive health behaviours.
Sponsors
University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
To be included, participants will need to meet all the following inclusion criteria: 1. be 18 years of age or older; 2. present with a diagnosis of non-specific LBP of at least 12-week duration, with or without leg pain but without radicular (e.g., reflex changes, motor loss) symptoms. Non-specific LBP will be diagnosed after screening for serious spinal pathology and indicators of potentially serious conditions using ‘red’ flags; 3. have been recently discharged (<4 weeks post-treatment) from physiotherapy treatment from outpatient physiotherapy departments at the participating hospital sites; OR have been recently discharged (<6 months post-regular treatment) from a course of treatment by their physiotherapist, chiropractor, or general practitioner in either private or public practices (including hospitals). For participants recruited from the general community, the definition of a course of treatment will be at least one attendance to a physiotherapist, chiropractor, or general practitioner, which may include a clinical examination, provision of manual therapy, a home exercise program, back care education or medication. Discharge from regular treatment describes people who are no longer receiving weekly treatment from their health care professional for their LBP. 4. have adequate hearing and eyesight to participate safely in physical activity; 5. independent ambulatory status, with or without gait aid.
Exclusion criteria
Potential participants will be excluded if they have any of the following: - known or suspected serious spinal pathology (e.g., fracture, inflammatory disorder); diagnosis of specific LBP (e.g., sciatica, spinal stenosis grade 3 to 4); - co-morbid health condition(s) diagnosed by a medical practitioner that would prevent participation in physical activity or exercise programs; - fibromyalgia or systemic/inflammatory condition; currently pregnant or planning to become pregnant over the study duration; - inadequate English to complete outcome measures or participate in the health coaching intervention; - spinal surgery in the past 12 months; - LBP caused by involvement in a road traffic crash in the last 12 months or ongoing compensation.
Outcome results
None listed