Clinical negligence and physiotherapy: UK survey of physiotherapists' experiences of litigation.

AIM: To investigate the extent and impact of litigation on the UK physiotherapy profession. DESIGN: An online cross-sectional questionnaire survey design was used. The survey was open to all qualified physiotherapists who have practiced in the UK, from any speciality, of any grade and from any setting including NHS, non-NHS, and private practice. RESULTS: 688 respondents completed the survey (96% CI). All UK nations were represented. 73% were female, 44% were qualified >20 Years. Most worked in the NHS (74%) and worked in a neuromusculoskeletal setting (62%). 10% of respondents had been involved in litigation. 128 claims were reported with some respondents being involved in more than 1 case. Litigation was a highly stressful experience for those who experienced it and was a source of concern for many others. The personal impact was stress (76%) and worry and anxiety (67%). The most common professional impact was defensive practice (68%). Most respondents incorrectly identified who should provide their legal support. 46% were not satisfied with the support received. Most (77%) reported that litigation training should be included in pre-registration, as well as postgraduate (68%) programs. CONCLUSION: This is the first UK survey that has investigated the experiences of litigation on the UK physiotherapy profession. Ten percent of physiotherapists in our survey had been involved in litigation. Litigation impacted physiotherapists' physical and mental wellbeing and their clinical practice. Improved support, both emotional and legal is required. Clinical negligence training should be included in pre-registration and postgraduate programs. CONTRIBUTION OF THE PAPER.

The lived experiences of UK physiotherapists involved in Cauda Equina Syndrome litigation. A qualitative study.

BACKGROUND: Cauda Equina Syndrome is a serious spinal pathology, which can have life changing physical and psychological consequences and is highly litigious. Litigation can have negative personal and professional effects on the healthcare professionals cited in a clinical negligence claim. There is an absence of research looking at the experience of the physiotherapist and as such, it is unknown the impact litigation is having on them. This study explored the lived experiences of UK physiotherapists in relation to Cauda Equina Syndrome litigation. METHODS: A qualitative design, informed by Gadamerian hermeneutic phenomenology, using semi-structured interviews was used to explore participants' lived experiences of litigation. Interviews were audio-recorded and transcribed verbatim. Findings were analysed using an inductive thematic analysis framework. Nvivo software was used to facilitate analysis. The study is reported in accordance with the consolidated criteria for reporting qualitative (COREQ) research. RESULTS: 40 interviews took place online or over the phone, with physiotherapists and stakeholders. Four themes were found; 'litigation effects', 'it feels personal', 'learning from litigation' and 'support and training'. CONCLUSION: This is the first study to investigate the lived experiences of litigation in UK physiotherapists. Involvement in clinical negligence affected physiotherapists' physical and mental wellbeing and impacted their clinical practice. Most physiotherapists felt litigation was a personal attack on them and their ability to do their job. Physiotherapists highlighted perceptions of a 'blame culture' and perceived stigma associated with the claim, which often led to a lack of sharing and learning from litigation. Physiotherapists emphasised the need for emotional support for those going through a legal claim and that training was needed to understand the process of litigation and range of potential outcomes.

Salmonella Biofilm Formation under Fluidic Shear Stress on Different Surface Materials.

This study characterized biofilm formation of various Salmonella strains on common processing plant surface materials (stainless steel, concrete, rubber, polyethylene) under static and fluidic shear stress conditions. Surface-coupons were immersed in well-plates containing 1 mL of Salmonella (6 log CFU/mL) and incubated aerobically for 48 h at 37 °C in static or shear stress conditions. Biofilm density was determined using crystal violet assay, and biofilm cells were enumerated by plating on tryptic soy agar plates. Biofilms were visualized using scanning electron microscopy. Data were analyzed by SAS 9.4 at a significance level of 0.05. A surface-incubation condition interaction was observed for biofilm density (p < 0.001). On stainless steel, the OD600 was higher under shear stress than static incubation; whereas, on polyethylene, the OD600 was higher under static condition. Enumeration revealed surface-incubation condition (p = 0.024) and surface-strain (p < 0.001) interactions. Among all surface-incubation condition combinations, the biofilm cells were highest on polyethylene under fluidic shear stress (6.4 log/coupon; p < 0.001). Biofilms of S. Kentucky on polyethylene had the highest number of cells (7.80 log/coupon) compared to all other strain-surface combinations (p < 0.001). Electron microscopy revealed morphological and extracellular matrix differences between surfaces. Results indicate that Salmonella biofilm formation is influenced by serotype, surface, and fluidic shear stress.

Speech-Language Pathology Interventions for Children With Executive Function Deficits: A Systematic Literature Review.

PURPOSE: The purpose of this synthesis was to systematically review the research and guidance for school-based speech-language pathologists (SLPs) who provide intervention to children with developmental executive function (EF) deficits, particularly those children with co-occurring developmental language disorder (DLD). METHOD: We conducted a structured search of four major electronic databases, as well as a manual review of references and journals, which yielded 4,571 nonduplicate articles. We screened first titles and abstracts and then full texts to identify peer-reviewed articles, dissertations, and theses containing research or guidance for SLPs' interventions for children with co-occurring DLD and EF deficits; this process yielded 27 articles for analysis. We categorized these studies by type of publication and synthesized their contents to assess the evidence base for EF interventions in children with DLD and to evaluate the guidance for SLP-implemented direct and indirect interventions. RESULTS: A small body of research explores the efficacy of SLPs' intervention for children with co-occurring DLD and EF deficits, generally finding modest but inconsistent effects of cognitive interventions and strategy training to improve language outcomes. Meanwhile, nonempirical articles (e.g., tutorials) offer guidance to SLPs to support students with EF deficits through direct and indirect services. CONCLUSIONS: A growing body of literature equips SLPs with the principles and strategies of EF intervention. Many of these articles are sourced from literature about children with EF deficits or attention-deficit/hyperactivity disorder, but few empirical studies measure the efficacy of these interventions for children with co-occurring DLD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21401901.

Medico-legal litigation of UK physiotherapists in relation to cauda equina syndrome: a multimethods study.

OBJECTIVE: The aim was to investigate the extent of cauda equina syndrome (CES) litigation and explore the process of medico-legal litigation in relation to physiotherapy in the UK. DESIGN: A multimethods inquiry that followed on from a previously conducted scoping literature review was undertaken to address the aim. This included freedom of information requests and direct communication with relevant stakeholders and organisations. RESULTS: A total of 2496 CES claims were found in the UK between 2012 and 2020. 51 of these were attributed to physiotherapists. There was little information available to physiotherapists regarding the legal process of litigation and much of this information was not from a physiotherapist's perspective. CONCLUSION: This is the first study that has investigated the extent and process of CES litigation in physiotherapy in the UK. The extent of CES litigation appears to be high considering CES is a rare spinal condition. Furthermore, the extent of CES litigation is suspected to be considerably higher than the data reported in this study due to the issues identified in how CES claims are recorded. Finally, there is no clearly articulated, easily accessible information describing the process and support available for physiotherapists in receipt of a legal claim.

A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists.

INTRODUCTION: Cauda equina syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially devastating effects. There is a high number of litigation cases linked with CES given it is a relatively rare condition. This scoping review protocol proposes to explore the extent and process of CES litigation in UK healthcare context cases amongst UK physiotherapists. METHODS AND ANALYSIS: The methodological framework recommended by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute will be used throughout this review to aid reporting and transparency. A patient and public involvement (PPI) group meeting was convened at the beginning of the review process in order to provide knowledge exchange to inform the search strategy and propose resources to be used during the scoping review. Two reviewers will independently review the literature in order to apply the inclusion and exclusion criteria. Once the studies to be included have been identified, the data from these studies will be extracted and charted. Results will show quantitative data of the studies included in the review and a narrative synthesis of the literature. DISSEMINATION: This scoping review will evaluate the existing knowledge relating to CES and litigation and will map the key concepts around this topic. Results will be disseminated to practitioners and policy-makers through peer-reviewed publications, conferences, reports and social media. This method may prove helpful to others who are investigating extent and processes relating to medicolegal cases involving healthcare practitioners. REGISTRATION: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/MP6Y3).

A scoping review: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists.

INTRODUCTION: Cauda Equina Syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially life changing devastating effects. This paper reviews the extent and process of CES litigation amongst UK physiotherapists. METHODS: A well-established framework by Arksey and O'Malley was followed when completing the current scoping review. Records were identified via a comprehensive search of three databases as well as website and grey literature searching. Data was extracted and a descriptive analysis and thematic summary were formed. RESULTS AND DISCUSSION: A total of N = 1639 records were identified, following removal of duplicates and screening of titles and abstracts N = 211 full text records were screened and N = 39 were included for full analysis. CONCLUSIONS: This study is the first to investigate the extent and process of CES litigation for physiotherapists in the UK. Our data suggest that between 2009 and 2021 there were 15 CES claims recorded against physiotherapists which is 0.7% of all CES claims recorded in the UK. In terms of the legal process for CES claims, there is currently limited information for physiotherapists and what steps they would need to take once they receive notification they are being sued. REGISTRATION: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/6FCXN).