Background. The physiotherapy profession has experienced a paradigm shift in recent years where mounting research evidence, indicating better patient outcomes, has led to an increase in popularity of a biopsychosocial model of care. In turn physiotherapists have begun to address psychosocial ‘obstacles’ to recovery, as means of improving outcomes for patients. To date, research has not examined how this change has affected the perceptions of physiotherapists about delivering care. The aim of this study was to explore these perceptions through exploratory interviews with physiotherapists in the UK. Methods. A qualitative interview study using a purposive sample of physiotherapists (n=12), nested within a larger study, exploring the attitudes and behaviours of UK general practitioners and physiotherapists about managing patients with low back pain. Interview transcripts were coded by the lead researcher and independently validated by a further team member. Transcripts were coded thematically using the constant comparative method to identify similarities and differences between the data and to determine fit and relevance. Results. The findings demonstrate that a combination of traditional physical therapy with a biopsychosocial approach presented significant challenges for professionals during the consultation. Physiotherapists perceived a number of ‘obstacles to recovery’ and responded to these through adoption of ‘health corrective’ strategies and by imposing limits around the management of these concerns with patients. Conclusion. A model of care combining a biopsychosocial approach with traditional physiotherapy can increase pressure on physiotherapists to use consultation strategies which appear to be patient-centred but may fail to shift from a professional-led agenda. Conflicts of interest. None. Sources of funding. Arthritis Research UK and the North Staffordshire Primary Care Research Consortium. We confirm that this abstract has not been previously published in whole or part nor has it been presented at a national meeting

Background

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered.

Background

In 2009, the National Institute for Health and Clinical Excellence (NICE) produced the guidance: Low back pain: early management of persistent non-specific low back pain aimed at general practitioners (GPs), consultants, and manual therapists in order to ensure all involved in the care of this complex and often debilitating condition are aware of the options most likely to yield a positive outcome.

Two years since the publication of the clinical guidance, services have had ample time to adapt and overcome early teething issues in order to deliver these guidelines.

Abstract. Objective. Meta-analysis of clinical trials highlights that non-operative management of degenerative knee meniscal tears is as effective as surgical management. Surgical guidelines though support arthroscopic partial meniscectomy which remains common in NHS practice. Physiotherapists are playing an increasing role in triage of such patients though it is unclear how this influences clinical management and patient outcomes. Methods. A 1-year cohort (July 2019–June 2020) of patients presenting with MRI confirmed degenerative meniscal tears to a regional orthopaedic referral centre (3× ESP physiotherapists) was identified. Initial clinical management was obtained from medical records alongside subsequent secondary care management and routinely collected outcome scores in the following 2-years. Management options included referral for surgery, conservative (steroid injection and rehabilitation), and no active treatment. Outcome scores collected at 1- and 2-years included the Forgotten Joint Score-12 (FJS-12) questionnaire and 0–10 numerical rating scales for worst and average pain. Treatment allocation is presented as absolute and proportional figures. Change in outcomes across the cohort was evaluated with repeated measures ANOVA, with Bonferroni correction for multiple testing, and post-hoc Tukey pair-wise comparisons. As treatment decision is discrete, no direct contrast is made between outcomes of differing interventions but additional explorative outcome change over time evaluated by group. Significance was accepted at p=0.05 and effect size as per Cohen's values. Results. 81 patients, 50 (61.7%) male, mean age 46.5 years (SD13.13) presented in the study timeframe. 32 (40.3%) received conservative management and 49 (59.7%) were listed for surgery. Six (18.8%) of the 32 underwent subsequent surgery and nine of the 49 (18.4%) patients switched from planned surgery to receiving non-operative care. Two post-operative complications were noted, one cerebrovascular accident and one deep vein thrombosis. The cohort improved over the course of 2-years in all outcome measures with improved mean FJS-12 (34.36 points), mean worst pain (3.74 points) average pain (2.42 points) scores. Overall change (all patients) was statistically significant for all outcomes (p<0.001), with sequential year-on-year change also significant (p<0.001). Effect size of these changes were large with all Cohen-d values over 1. Controlling for age and BMI, males reported superior change in FJS-12 (p=0.04) but worse pain outcomes (p<0.03). Further explorative analysis highlighted positive outcomes across all surgical, conservative and no active treatment groups (p<0.05). The 15 (18%) patients that switched between surgical and non-surgical management also reported positive outcome scores (p<0.05). Conclusion(s). In a regional specialist physiotherapy-led soft tissue knee clinic around 60% of degenerative meniscal tears assessed were referred for surgery. Over 2-years, surgical, non-operative and no treatment management approaches in this cohort all resulted in clinical improvement suggesting that no single strategy is effective in directly treating the meniscal pathology, and that perhaps none do. Clinical intervention rather is directed at individual symptom management based on clinical preferences. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Purpose and background. Private musculoskeletal practitioners treat a large section of people with back pain, and could play an important role in returning and maintaining patients to work. We aimed to examine practitioners perception of their role quantitatively. methods and results. A postal questionnaire was sent to 300 chiropractors, osteopaths and physiotherapists (n=900). Responses were received from 352 out of 900 (39%). Physiotherapists visited the work place more frequently than either of the other groups, osteopaths were more likely to give out sick leave certificates than chiropractors, who in turn are more likely to give out sick leave certificates than physiotherapists. Physiotherapists had a significantly higher belief in the psychological benefits of work, and in the importance of contacting work than either chiropractors or osteopaths. In addition, physiotherapists held the strongest belief that returning their patients to work was within their remit. There were no differences between the groups in their beliefs that employers could be an obstacle to return to work, that work could be detrimental to recovery, or in their belief that rest from work was necessary for recovery. Almost all practitioners recommended a short break from work sometimes, and more than 10% recommended a break often or always. Conclusion. Overall, practitioners perceived their role in returning patients to work as limited, and believed that direct contact with employers was beyond their remit. Physiotherapists appear to be better placed to liaise with work in terms of both their beliefs and activities. Conflicts of interest. None. Sources of funding. None