Experience-Based Co-Design of the Virtual Physiotherapist-led Evaluation of Referrals for spine surgery (VIPER) model of care: study protocol

Background: Despite guidelines advising that most low back pain is best managed in primary care without surgery, many patients referred to spine surgeons have not tried effective non-surgical care. These patients can wait 1-2 years to see a surgeon and develop symptoms which become more complex and costly to manage. A promising solution is the Virtual Physiotherapist-led Evaluation of Referrals for spine surgery (VIPER) model of care which involves a physiotherapist triaging new patient referrals suitability for a course of non-surgical care. Participants will be discharged if they no longer need to see a surgeon or referred back to see the spine surgeon if they are not responding to physiotherapist-led treatment. Evaluation of similar models in Australia have shown 2 in 3 referrals for non-urgent musculoskeletal conditions could be appropriately managed by a physiotherapist without needing to see a surgeon. Aims: The aim of this study is to co-design the VIPER model of care so that it is user-centred and acceptable to patients, clinicians and key stakeholders. Methods: The co-design and evaluation of the new model of care will be conducted across three phases. The first phase involved qualitative interviews to explore stakeholders perceptions of the proposed model of care. The second phase will involve co-design of the model of care with patients, clinicians and key stakeholders. This co-design study will use an Experience-Based Co-Design methodological approach to develop a final model of care for evaluation (third phase) in a randomised controlled trial in Australian public hospital spine surgery clinics.