Development of a toolkit for early identification of cauda equina syndrome.

Aim To develop a simple cauda equina syndrome (CES) toolkit to facilitate the subjective examination of low back pain patients potentially at risk of CES. To undertake preliminary validation of the content of the toolkit. BACKGROUND: CES is a rare condition which can be very challenging to identify in a generalist medical setting. METHOD: A three phase iterative design with two stake holder groups; extended scope practitioners experienced in managing CES patients and CES sufferers. Toolkit development Synthesis of existing CES literature with CES patient data generated from in depth interviews. Toolkit validation Content validation of the draft toolkit with CES patients. Toolkit validation Content validation of the draft toolkit with extended scope physiotherapists. Findings A three arm toolkit has been developed for use with patients considered by the clinician as at risk of developing CES (eg, worsening low back pain with symptoms/signs of progressive sensory-motor deficit in the lower limbs); patient expertise, clinical expertise, research and pathways. Uniquely, the toolkit drew upon the lived experiences of patients suffering from CES to inform the content.

Defining, agreeing on, and testing an international physical therapy core data set: results of a feasibility study involving seven countries.

BACKGROUND: To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims. OBJECTIVES: The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations. DESIGN: A mixed, prospective design was used in the study. METHOD: Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations. RESULTS: Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally. LIMITATIONS: Although a true international collaboration, the limited sample size should be recognized. CONCLUSIONS: It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought.

A Delphi study investigating consensus among expert physiotherapists in relation to the management of low back pain.

OBJECTIVES: Low back pain (LBP) affects a large proportion of the adult population, with over 90% of people expected to experience symptoms associated with it. LBP is one of the most common conditions managed by primary health care practitioners, and physiotherapists are the largest professional group responsible for its management. Clinical guidelines exist for the management of LBP and are based on the best available evidence. However, there is currently no consensus on the actual physiotherapy management of this condition. METHODS: A three-round Delphi study was conducted among expert physiotherapists (n = 34). A focus group was initially convened to review the key questions, developed following a review of the literature. An expert panel then produced their responses, which were ranked in subsequent rounds, using a five-point Likert scale, until a predetermined point of consensus was reached. RESULTS: The results of this study indicated that it is possible to establish consensus among expert clinicians in relation to the management of LBP, with consensus reached on 64 (67.3%) of the 95 responses identified. The results also showed that, in general, physiotherapy management within the location studied conformed to current LBP evidence-based clinical guidelines. In addition, the expert panel identified the importance of a biopsychosocial approach to LBP management. CONCLUSIONS: 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.