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Why managing sciatica is difficult: patients’ experiences of an NHS sciatica pathway. A qualitative, interpretative study
  1. Clare Ryan1,2,
  2. Catherine J Pope3,
  3. Lisa Roberts2,4
  1. 1Physiotherapy Service, Solent NHS Trust, Portsmouth, Hampshire, UK
  2. 2School of Health Sciences, University of Southampton, Southampton, UK
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
  4. 4Therapy Services Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Clare Ryan; Clare.ryan1{at}nhs.net

Abstract

Objectives Amid a political agenda for integrated, high-value care, the UK is implementing its Low Back and Radicular Pain Pathway. To align care with need, it is imperative to understand the patients’ perspective. The purpose of this study was, therefore, to explore how people experience being managed for sciatica within an National Health Service (NHS) pathway.

Design Qualitative interpretative study.

Setting Musculoskeletal Service in an NHS, Primary Care Trust, UK.

Participants The sample comprised 14 people aged ≥18 years with a clinical presentation of sciatica, who were currently under the care of a specialist physiotherapist (the specialist spinal triage practitioner), had undergone investigations (MRI) and received the results within the past 6 weeks. People were excluded if they had previously undergone spinal surgery or if the suspected cause of symptoms was cauda equina syndrome or sinister pathology. Participants were sampled purposively for variation in age and gender. Data were collected using individual semi-structured interviews (duration: 38–117 min; median: 82.6 min), which were audio-recorded and transcribed verbatim. Data were analysed thematically.

Results A series of problems with the local pathway (insufficient transparency and information; clinician-led decisions; standardised management; restricted access to specialist care; and a lack of collaboration between services) made it difficult for patients to access the management they perceived necessary. Patients were therefore required to be independent and proactive or have agency. This was, however, difficult to achieve (due to the impact of sciatica and because patients lacked the necessary skills, funds and support) and together with the pathway issues, this negated patients’ capability to manage sciatica.

Conclusions This novel paper explores how patients experience the process of being managed within a sciatica pathway. While highlighting the need to align with recommended best practice, it shows the need to be more person-centred and to support and empower patient agency.

Trial registration number ClinicalTrials.gov reference (UOS-2307-CR); Pre-results.

  • back pain
  • musculoskeletal disorders
  • adult orthopaedics
  • qualitative research
  • quality in health care
  • protocols & guidelines
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Footnotes

  • Contributors All authors contributed to the conception of this paper. CR and LR contributed to the conception and design of the study. CR performed data collection. CR, CJP and LR contributed to material preparation and analysis. Each draft of the manuscript was written by CR and commented on by CJP and LR. All authors read and approved the final manuscript.

  • Funding This research and preparation of the manuscript was funded by Health Education England (HEE) and the National Institute of Health Research (NIHR) as part of a Master’s degree in Clinical Research and a Clinical Doctoral Research Fellowship (Round 4), awarded to CR, both undertaken at the University of Southampton. LR was funded, in part, by a NIHR Senior Clinical Lecturer award (Round 3).

  • Disclaimer This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was gained from the South-West Ethics Committee in September 2015 (15/SW/0247).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data sets generated during and/or analysed during the current study are not publicly available due to a restriction within the ethical agreement but are available from the corresponding author on reasonable request.

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