Journal Article

Efficiency of telephone triage in the assessment of low back pain at a tertiary spine clinic

Robarts, Susan, Dickson, Patricia, Wainwright, Amy, Razmjou, Helen, Yee, Albert, Rachevitz, Maria, Finkelstein, Joel

2025

Overview

Purpose In response to COVID-19 related health care access restrictions, telemedicine was introduced to continue to provide necessary health care access in Ontario, Canada. This study examined the role of a telephone assessment (triage) in streamlining referral consultation in patients with low back pain who were referred to a spine specialty surgical clinic. Methods This was an observational study of patients presenting with low back pain with or without leg pain. The virtual interview was conducted by an experienced Advanced Practice Physiotherapist (APP) via telephone. The clinician documented the current symptoms, reviewed referral information including diagnostic imaging and made decisions regarding surgical appropriateness. Patients with cauda equina syndrome, metastatic spinal cord compression lesions, infection and fractures were excluded. Descriptive analysis and general linear modeling were conducted. Results A consecutive sample of 100 patients, 50 females (average age = 58, SD: 16, range 20–87 years) participated in the virtual assessment. Of 100 participants, 41 (41%) were deemed appropriate to proceed for an in-person assessment, with 36% being considered as potential surgical candidates (33 patients were seen by a spine surgeon and 3 were referred to a hip surgeon for hip arthritis). Fifty-nine (59%) patients did not require an in-person visit to the clinic. The most prominent reason for subsequent surgical assessment was leg dominant pain (neurogenic claudication/radiculopathy) with concordant imaging findings (27, 75%). There was a statistically significant association between surgical candidacy and presence of leg symptoms secondary to disc herniation or claudication ( p  = 0.0002) with no association with the scores of the PROMs or isolated imaging ( P  > 0.05). Conclusion A structured virtual telephone interview was an effective means of triaging patients with LBP with and without leg pain with a potential of reducing the number of unnecessary visits to a spine surgeon. Radicular pain to the lower extremity was the most common symptom among participants who were directed to the surgeon.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Back pain / Backache / Care and treatment / Clinical outcomes / Communication / COVID-19 / COVID-19 - epidemiology / Diagnosis / Epidemiology / Evaluation / Female / Fractures / Health care / Hip / Humans / Internal Medicine / Intervertebral discs / Leg / Low back pain / Low Back Pain - diagnosis / Low Back Pain - therapy / Magnetic resonance imaging / Male / Medical care / Medical prognosis / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Metastases / Methods / Middle Aged / Musculoskeletal disorders management / Ontario - epidemiology / Orthopedics / Pain / Pandemics / Patient compliance / Patient satisfaction / Patients / Physical therapy / Primary care / Quality management / Questionnaires / Rapid access clinic / Referral and Consultation / Rehabilitation / Rheumatology / Spinal cord / Spinal stenosis / Spine / Sports Medicine / Statistical analysis / Surgeons / Surgery / Surgical clinics / Telemedicine / Telephone / Telephone services / Tertiary Care Centers / Triage (Medicine) / Triage - methods / Virtual / Young Adult