‘I thought they would do it on the spot’: why do people with non-traumatic musculoskeletal pain present to emergency departments?
Grace French
A D * , Karen Richards A B , Robert Waller A and Ivan Lin C
+ Author Affiliations
- Author Affiliations
A Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
B Physiotherapy Department, St John of God Midland Public Hospital, Perth, WA, Australia.
C Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia.
D Present address: Katanning Physiotherapy Centre, Katanning, WA, Australia.
* Correspondence to: gracefrench99@gmail.com
Australian Health Review 47(3) 274-281 https://doi.org/10.1071/AH22274
Submitted: 18 November 2022 Accepted: 3 March 2023 Published: 27 March 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To investigate the reasons patients with non-traumatic musculoskeletal pain (NTMSP) present to an emergency department (ED), their experience of care and perceptions about managing their condition in the future.
Methods A qualitative study using semi-structured interviews with patients with NTMSP presenting to a suburban ED. A purposive sampling strategy included participants with different pain characteristics, demographics and psychological factors.
Results Eleven patients with NTMSP who presented to an ED were interviewed, reaching saturation of major themes. Seven reasons for ED presentation were identified: (1) desire for pain relief, (2) inability to access other healthcare, (3) expecting comprehensive care at the ED, (4) fear of serious pathology/outcome, (5) influence of a third party, (6) desire/expecting radiological imaging for diagnosis and (7) desire for ‘ED specific’ interventions. Participants were influenced by a unique combination of these reasons. Some expectations were underpinned by misconceptions about health services and care. While most participants were satisfied with their ED care, they would prefer to self-manage and seek care elsewhere in the future.
Conclusions The reasons for ED presentation in patients with NTMSP are varied and often influenced by misconceptions about ED care. Most participants reported that, in future, they were satisfied to access care elsewhere. Clinicians should assess patient expectations so misconceptions about ED care can be addressed.
Keywords: back pain, emergency department, health perceptions, musculoskeletal pain, non-traumatic, pain management, patient perspective, qualitative research.
References
[1] James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392 1789–1858.| Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Crossref | GoogleScholarGoogle Scholar |
[2] Baker B, Kessler K, Kaiser B, et al. Non‐traumatic musculoskeletal pain in Western Australian hospital Emergency Departments: a clinical audit of the prevalence, management practices and evidence‐to‐practice gaps. Emerg Med Australas 2019; 31 1037–1044.
| Non‐traumatic musculoskeletal pain in Western Australian hospital Emergency Departments: a clinical audit of the prevalence, management practices and evidence‐to‐practice gaps.Crossref | GoogleScholarGoogle Scholar |
[3] Bellan M, Molinari R, Castello L, et al. Profiling the patients visiting the emergency room for musculoskeletal complaints: characteristics and outcomes. Clin Rheumatol 2016; 35 2835–2839.
| Profiling the patients visiting the emergency room for musculoskeletal complaints: characteristics and outcomes.Crossref | GoogleScholarGoogle Scholar |
[4] Australian Institute of Health and Welfare. Emergency Department care 2021–22: Australian hospital statistics. Australian Institute of Health and Welfare; 2022. Available at https://www.aihw.gov.au/getmedia/02c6e120-99e5-4a3c-b1d8-cbd1da785486/Emergency-Department-Care-2021-22.xlsx.aspx
[5] Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020; 54 79–86.
| What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review.Crossref | GoogleScholarGoogle Scholar |
[6] Coombs DM, Machado GC, Richards B, et al. Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia. Lancet Reg Health West Pac 2021; 7 100089
| Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar |
[7] Kawchuk GN, Aaskov J, Mohler M, et al. A prospective study of patients with low back pain attending a Canadian emergency department: why they came and what happened? PLoS One 2022; 17 e0268123
| A prospective study of patients with low back pain attending a Canadian emergency department: why they came and what happened?Crossref | GoogleScholarGoogle Scholar |
[8] Saggers A, Wand BM, Bulsara C, Truter P. ‘I’m not in GP pain, I’m in hospital pain’: qualitative study regarding patient decision-making factors in seeking care in the emergency department with non-specific low back pain. Emerg Med Australas 2021; 33 1013–1020.
| ‘I’m not in GP pain, I’m in hospital pain’: qualitative study regarding patient decision-making factors in seeking care in the emergency department with non-specific low back pain.Crossref | GoogleScholarGoogle Scholar |
[9] St John of God Health Care. St John of God Midland Public Hospital. St John of God, 2021. Available at https://www.sjog.org.au/our-locations/st-john-of-god-midland-public-hospital [cited 6 November 2021].
[10] Perrot S, Cohen M, Barke A, et al. The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain 2019; 160 77–82.
| The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain.Crossref | GoogleScholarGoogle Scholar |
[11] Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003; 60 184–189.
| Screening for serious mental illness in the general population.Crossref | GoogleScholarGoogle Scholar |
[12] Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995; 7 524–532.
| The Pain Catastrophizing Scale: development and validation.Crossref | GoogleScholarGoogle Scholar |
[13] Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 2007; 11 153–163.
| The pain self-efficacy questionnaire: taking pain into account.Crossref | GoogleScholarGoogle Scholar |
[14] O’Reilly M, Parker N. ‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research. Qual Res 2013; 13 190–197.
| ‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research.Crossref | GoogleScholarGoogle Scholar |
[15] Thorne S, Kirkham SR, O’Flynn-Magee K. The analytic challenge in interpretive description. Int J Qual Methods 2004; 3 1–11.
| The analytic challenge in interpretive description.Crossref | GoogleScholarGoogle Scholar |
[16] Australian Government Department of Health. Healthdirect. Healthdirect; 2021. Available at https://www.healthdirect.gov.au/ [cited 4 September 2021].
[17] Stafford V, Greenhalgh S, Davidson I. Why do patients with simple mechanical back pain seek urgent care? Physiotherapy 2014; 100 66–72.
| Why do patients with simple mechanical back pain seek urgent care?Crossref | GoogleScholarGoogle Scholar |
[18] Davidson SR, Bolsewicz K, Kamper SJ, et al. Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: a qualitative study. Emerg Med Australas 2022; 34 199–208.
| Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[19] Machado GC, Richards B, Needs C, et al. Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial. BMJ Open 2018; 8 e019052
| Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial.Crossref | GoogleScholarGoogle Scholar |
[20] Downie A, Hancock M, Jenkins H, et al. How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med 2020; 54 642–651.
| How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years.Crossref | GoogleScholarGoogle Scholar |
[21] Logan GS, Pike A, Copsey B, et al. What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews. PLoS One 2019; 14 e0225414
| What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews.Crossref | GoogleScholarGoogle Scholar |
[22] Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. Lancet 2018; 391 2384–2388.
| Low back pain: a call for action.Crossref | GoogleScholarGoogle Scholar |
[23] Rabey M, Smith A, Kent P, et al. Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses. Scand J Pain 2019; 19 743–753.
| Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses.Crossref | GoogleScholarGoogle Scholar |
[24] Lin I, Wiles L, Waller R, et al. Patient-centred care: the cornerstone for high-value musculoskeletal pain management. Br J Sports Med 2020; 54 1240–1242.
| Patient-centred care: the cornerstone for high-value musculoskeletal pain management.Crossref | GoogleScholarGoogle Scholar |
[25] WA Primary Health Alliance. GP Urgent Care. Perth: WA Primary Health Alliance; 2021. Available at https://www.wapha.org.au/health-professionals/gp-urgent-care/
[26] Brasseur E, Gilbert A, Servotte J-C, et al. Emergency department crowding: why do patients walk-in? Acta Clin Belg 2021; 76 217–223.
| Emergency department crowding: why do patients walk-in?Crossref | GoogleScholarGoogle Scholar |
[27] Burns TR. Contributing factors of frequent use of the emergency department: a synthesis. Int Emerg Nurs 2017; 35 51–55.
| Contributing factors of frequent use of the emergency department: a synthesis.Crossref | GoogleScholarGoogle Scholar |
[28] Chen A, Ospina M, McRae A, et al. Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study. CJEM 2021; 23 206–213.
| Characteristics of frequent users of emergency departments in Alberta and Ontario, Canada: an administrative data study.Crossref | GoogleScholarGoogle Scholar |
[29] Singer A, Kosowan L, Katz A, et al. Characterizing patients with high use of the primary and tertiary care systems: a retrospective cohort study. Health Policy 2020; 124 291–297.
| Characterizing patients with high use of the primary and tertiary care systems: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar |
