Although the study identified that consensus existed in relation to many aspects of physiotherapy management of LBP, it was also noted that confusion existed in relation to several key areas of practice, highlighting the need for further work.

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If only certain red flags are being assessed, this may put patients at risk of having serious spinal pathologies going undetected. Thus, strategies encouraging therapists to ask all red-flag questions may be needed. The importance of the more recently recognized red flags may need to be emphasized to clinicians. Finally, the inconsistent way in which the red-flag questions were asked highlights a potential practical barrier to translating red-flag knowledge into clinical practice. There is a need to build on this work, using in-depth qualitative interviews, to gain a deeper understanding of how therapists understand and apply the red flags commonly used in back pain assessment.

Cauda Equina Syndrome (CES) is a very rare condition in patients with low back pain (LBP), however, the discovery of CES is seen as a surgical emergency. With the rapid rolling out of patient self-referral to outpatient physiotherapy, there is an increased likelihood of physiotherapists being exposed to this condition. However, the literature to date has focused on CES from a medical perspective and clear physiotherapy guidelines have not been reviewed. To improve and standardize the citywide management of such patients a pathway of care was developed. Clinical specialist physiotherapists oversaw the development guided by orthopaedic and neurosurgery consultants. The results of a three-cycle audit suggest this evidence-based pathway of care is an effective tool in identifying patients with CES.