EXTENDED SCOPE PRACTITIONERS’ MANAGEMENT OF LUMBAR SPINAL STENOSIS

Abstract

Background: Lumbar spinal stenosis (LSS) involves narrowing of the spinal, nerve root or intervertebral canals, producing compression of the intraspinal vascular and nervous structures. With an ageing population and advances in diagnostic accuracy, LSS is increasingly encountered and has become a major health care management issue.

Extended Scope Practitioners (ESPs) often assess and manage patients with LSS in orthopaedic and rheumatology clinics. Little is reported about how these patients are managed, variations in practice and the rationale for the clinical decision-making that occurs.

Methods: This quantitative, cross-sectional study used a questionnaire and vignettes to determine the factors affecting clinical decision-making in ESPs when managing patients with suspected LSS. The target population comprised all ESPs in the national Occupational Group of ‘Chartered Physiotherapists working as ESPs’ (n=288).

Results: The response rate to the questionnaire was 78.5% (n=226). The main factors affecting clinical decision-making (when deciding on referral to conservative or surgical management) were: accessibility of resources, including further investigations (MRI), consultants and surgery; severity of symptoms; and patient choice.

Discussion: The majority of participants reportedly considered patient choice an important factor in decision-making. When this principle was presented in the form of a real patient scenario (in the vignette) however, the trend in data showed that patient choice became less important in decision-making than the severity of signs and symptoms.

Conclusion: There are currently no national protocols or pathways to guide ESPs and facilitate standardisation of managing patients with LSS and wide variations in practice exist. Furthermore, whilst recognising the importance of respecting patients’ choice, in practice this remains a challenge to deliver.