Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial.
Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
2 · The registry
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
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5 · Who and what money
Authors and funding
20 authors.
Gemma AltingerInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.ORCID 0009-0008-7638-5783
Sweekriti SharmaInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.ORCID 0000-0002-0919-8813
Chris G MaherInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.ORCID 0000-0002-1628-7857
Louise CullenEmergency and Trauma Centre, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia.ORCID 0000-0001-6611-8229
Kirsten McCafferySydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0003-2696-5006
Jeffrey A LinderDivision of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.ORCID 0000-0003-2217-184X
Rachelle BuchbinderSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.ORCID 0000-0002-0597-0933
Ian A HarrisInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.ORCID 0000-0003-0887-7627
Enrico CoieraCentre for Health Informatics, Macquarie University, Sydney, New South Wales, Australia.ORCID 0000-0002-6444-6584
Qiang LiGeorge Institute for Global Health, Sydney, New South Wales, Australia.
Kirsten HowardMenzies Centre for Health Policy and Economics, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-0918-7540
Andrew CogginsDiscipline of Emergency Medicine, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.ORCID 0000-0002-5652-6920
Paul M MiddletonSouth Western Emergency Research Institute, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales, Australia.ORCID 0000-0003-0760-1098
Naren GunjaDiscipline of Emergency Medicine, The University of Sydney School of Medicine, Sydney, New South Wales, Australia.ORCID 0000-0002-8323-9388
Ian FergusonSouth West Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0001-5915-6315
Trevor ChanEmergency Care Institute, The Agency for Clinical Innovation, St Leonards Sydney, City of Willoughby, Australia.
Karen TambreeConsumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
Ajay VarshneyConsumer Advisor, The University of Sydney Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
Adrian C TraegerInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia adrian.traeger@sydney.edu.au.ORCID 0000-0002-1646-1907
NUDG-ED Study Group
Funding
USC-Yale Roybal Center for Behavioral Interventions in AgingP30AG024968 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI JASON N. DOCTOR, Daniella Meeker · 2004 to 2026
$14.7M
The Claude D. Pepper Older Americans Independence Center (OAIC) at Northwestern UniversityP30AG059988 · NIA · NORTHWESTERN UNIVERSITY AT CHICAGO · PI ACKERMANN, RONALD T. · 2020 to 2024
$7.1M
ToolBox Detect: Low Cost Detection of Cognitive Decline in Primary Care SettingsR01AG069762 · NIA · NORTHWESTERN UNIVERSITY AT CHICAGO · PI GERSHON, RICHARD, NOWINSKI, CINDY J. · 2020 to 2025
$6.4M
Development and Validation of a Telehealth Strategy for Routine Detection of Cognitive Impairment in Primary Care: The MyCog Mobile AssessmentR01AG074245 · NIA · NORTHWESTERN UNIVERSITY AT CHICAGO · PI NOWINSKI, CINDY J., WOLF, MICHAEL S · 2021 to 2025
$3.8M
Use of Behavioral Economics in Repeat SARS-CoV-2 Antibody Testing in Disadvantaged CommunitiesR33AG057395 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI DOCTOR, JASON N., SULLIVAN, MARK D · 2019 to 2021
$3.3M
Study in Outpatient Medicine using Nudges to improve Sleep: The SOMNUS TrialR01HL167023 · NHLBI · UNIVERSITY OF SOUTHERN CALIFORNIA · PI JASON N. DOCTOR · 2023 to 2026
$2.6M
Improving Safe Antibiotic Prescribing in Telehealth: A Randomized TrialR01HS026506 · AHRQ · YALE UNIVERSITY · PI MEEKER, DANIELLA · 2018 to 2022
$2.1M
Reducing High Risk Polypharmacy Using Behavioral Economics through Electronic Health RecordsR01AG070054 · NIA · NORTHWESTERN UNIVERSITY AT CHICAGO · PI PERSELL, STEPHEN · 2022 to 2025
$1.9M
The Role of Telehealth in COVID-19 ResponseR01HS028127 · AHRQ · UNIVERSITY OF SOUTHERN CALIFORNIA · PI MEEKER, DANIELLA · 2021 to 2022
introductionOpioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural 'nudge' interventions on low-value care for ED patients with low back pain. METHODS AND ANALYSIS: NUDG-ED is a 2×2 factorial, open-label, before-after, cluster randomised controlled trial. The trial includes 8 ED sites in Sydney, Australia. Participants will be ED clinicians who manage back pain, and patients who are 18 years or over presenting to ED with musculoskeletal back pain. EDs will be randomly assigned to receive (i) patient nudges, (ii) clinician nudges, (iii) both interventions or (iv) no nudge control. The primary outcome will be the proportion of encounters in ED for musculoskeletal back pain where a person received a non-indicated lumbar imaging test, an opioid at discharge or both. We will require 2416 encounters over a 9-month study period (3-month before period and 6-month after period) to detect an absolute difference of 10% in use of low-value care due to either nudge, with 80% power, alpha set at 0.05 and assuming an intra-class correlation coefficient of 0.10, and an intraperiod correlation of 0.09. Patient-reported outcome measures will be collected in a subsample of patients (n≥456) 1 week after their initial ED visit. To estimate effects, we will use a multilevel regression model, with a random effect for cluster and patient, a fixed effect indicating the group assignment of each cluster and a fixed effect of time. ETHICS AND DISSEMINATION: This study has ethical approval from Southwestern Sydney Local Health District Human Research Ethics Committee (2023/ETH00472). We will disseminate the results of this trial via media, presenting at conferences and scientific publications. TRIAL REGISTRATION NUMBER: ACTRN12623001000695.
Indexed as
Low Back PainMusculoskeletal PainAdultAnalgesics, OpioidAustraliaEmergency Service, HospitalHumansLow-Value CareRandomized Controlled Trials as TopicYoung AdultAnalgesics, Opioidaccident & emergency medicinebehaviorclinical decision-makingdecision makingpatientsquality in health care
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.
Behavioural 'nudging' interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial. · full record | Socratic