Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Abstract

Introduction Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. Methods Semi‐structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. Ethical approval Ethical approval was obtained from a university Ethics committee and NHS Research and Development. Findings Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. Discussion The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. Conclusion Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s

The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care

“…The use of investigations is a common method to guide decision‐making when faced with uncertainty, but this can lead to an over‐cautious approach or ‘defensive medicine’ (Vento et al., 2018). The worry of missing serious pathology and concerns related to litigation has been proposed as a potential reason for over‐investigating in the MSK FCP role (Finucane et al., 2022; Paling & Hebron, 2021). The findings from this research offer some support to this with similar experiences noted by the participants, illustrating the potential for a defensive medicine culture amongst MSK FCP's.…”