Cauda Equina screening in physiotherapy : are we asking the right questions and are we asking the questions right?

Kimber, D; Pigott, TMC

Abstract

Purpose: Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be thorough, as effective as possible and easily understood by patients. Diagnosing CES however, can be challenging. Previous, patients’ lived experience studies have developed a ‘toolkit’ to aid early identification of CES recommending what questions to ask and how to ask them. Gaining insight into the experiences of physiotherapists asking these questions had not been studied prior to this. The aims of this study were to explore to what extent Physiotherapists ask the CES questions in accordance with the recommendations from prior evidence and to explore their own personal feelings when asking the questions

Methods: This phenomenological study purposively recruited, via invitation, thirty Physiotherapists working in a community musculoskeletal service to participate in individual, semi-structured interviews that were audio recorded, transcribed verbatim, member-checked for accuracy and evaluated using thematic analysis

Results: When questioning for CES, all participants routinely asked all bladder and bowel function and saddle anaesthesia screening questions however, only 9 routinely asked about sexual function. Whether questions are asked in the correct way, has never been studied. Sufficient depth of questioning was achieved by 63% of participants, 76% used lay terminology and 73% used explicit language. Only 43% of participants framed the context of CES screening questions before asking them and only 16% combined all four dimensions. Whilst most participants (n = 25) felt comfortable asking CES questions, 50% of participants reported feeling uncomfortable when asking about sexual function. Issues around; gender, age, culture and language were also reported

Conclusion(s): Four main themes emerged from this study:
(i)
physiotherapists do ask the right questions but frequently omit asking about sexual function,

(ii)
on the whole, Physiotherapists ask CES questions in a way that patients understand however, there needs to be improvement in framing the context of the questions,

(iii)
physiotherapists generally feel comfortable with CES screening but there is some awkwardness surrounding discussion of sexual function and

(iv)
physiotherapists perceive there to be barriers to effective CES screening caused by language and culture.


Impact: This study provides evidence of the depth and quality of CES screening by MSK Physiotherapists, highlighting areas requiring improvement and ongoing training. The study provides novel understanding into the personal feelings that CES assessment evokes in Physiotherapists and therefore highlights barriers to effective screening. The difficulties reported in this study, that Physiotherapists have talking about sexual function, align with other areas of healthcare (e.g. nursing, general practice, sexual & reproductive health) suggesting that these issues could be multi-professional rather than Physiotherapy specific. The conclusions of this study therefore, are thought to be transferable across all professions within healthcare and can have a positive impact, improving efficacy of CES screening, across medicine in general.

Citation

Kimber, D., & Pigott, T. (2022). Cauda Equina screening in physiotherapy : are we asking the right questions and are we asking the questions right?. Physiotherapy, 114(Sup. 1), e129. https://doi.org/10.1016/j.physio.2021.12.084

• Journal Article Type: Conference Paper
• Conference Name: Physiotherapy UK 2021 Conference
• Conference Location: Virtual
• End Date: Nov 6, 2021
• Publication Date: Feb 16, 2022
• Deposit Date: Feb 22, 2022
• Journal: Physiotherapy
• Publisher: De Gruyter
• Volume: 114
• Issue: Sup. 1
• Pages: e129
• DOI: https://doi.org/10.1016/j.physio.2021.12.084
• Publisher URL: https://doi.org/10.1016/j.physio.2021.12.084
• Related Public URLs: https://www.journals.elsevier.com/physiotherapy/
• Additional Information: Access Information : This is the published abstract of a poster presentation.; Event Type : Conference