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

## TL;DR

A telephone triage system helped determine which low back pain patients needed in-person spine surgery consultations, reducing unnecessary visits.

## Contribution

This study demonstrates the effectiveness of telephone triage in managing low back pain referrals during restricted healthcare access.

## Key findings

- 59% of patients did not need an in-person visit after a virtual assessment.
- Leg dominant pain with imaging findings was the most common reason for surgical referral.
- Leg symptoms due to disc herniation or claudication were significantly associated with surgical candidacy.

## Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s12891-025-09416-y.