Low back pain and A&E: understanding need and improving care
Research type
Research Study
Full title
A qualitative interpretative study exploring why, from the patients’ perspective, people attend A&E for low back pain and how this need might be best or alternatively met.
IRAS ID
295242
Contact name
Clare Ryan
Contact email
Sponsor organisation
University of Southampton
Clinicaltrials.gov Identifier
ICA-CDRF-2018-04-ST2-040, NIHR CDRF reference number
Duration of Study in the UK
2 years, 7 months, 28 days
Research summary
Research Summary
Low back pain is the leading cause of disability, both globally and in the UK. This condition occurs at significant cost to those who experience it, to the healthcare system and the wider economy; it is therefore crucial to manage well. Clinical guidelines recommend that low back pain should, for most, be managed in primary care. However, in the UK, each month, more than 50,000 people attend the Emergency Department (A&E) for this condition. This is despite emergency care being clinically unnecessary for the vast majority. Both in the UK and internationally, demand for A&E is rising at an unsustainable rate and reducing this is a UK policy priority. This study aims to inform understanding about why people attend A&E for low back pain. The research questions are, from the patients’ perspective, why do some people attend A&E for low back pain and how might this need be best or alternatively met?
This qualitative study will be informed by interpretative phenomenology, narrative inquiry and critical theory. Data will be collected using semi-structured individual interviews either remotely (using telephone and video technology) or face-to-face. The sample will comprise 40-50 adults presenting to A&E in the UK National Health Service for low back pain (all types/durations). Using purposive sampling to achieve maximum variation, interviews will explore why, from the patients’ perspective, people attend A&E, what is required to meet patients’ needs and if and how this need could be best/alternatively met. Analysis will be thematic, managed using a framework approach and will be both inductive and theoretically informed. The end product will be a detailed account of patients’ perceptions supported by direct quotes. The anticipated impact is to inform policy makers, commissioners and providers about why people attend A&E for low back pain and potentially feasible strategies to best/alternatively manage this population.
Summary of Results
People experienced low back pain to be a threat (to their capacity to cope; activities of daily living; health; and future) and sought ‘urgent help’ to address this. People understood their options to be ‘the GP or A&E’. Issues arose with access to and confidence in primary care, and this resulted in people feeling helpless and lost. A&E became the only remaining option and, for many, the option that healthcare professionals advised. Attending A&E was therefore a deliberate action taken to mitigate the vulnerability that resulted from both the threat of low back pain and primary care’s inability to address this.
REC name
West of Scotland REC 3
REC reference
21/WS/0068
Date of REC Opinion
9 Jun 2021
REC opinion
Favourable Opinion