Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK.
Haywood Hospital, Midlands Partnership Foundation NHS Trust, Staffordshire, UK.
BMC Musculoskelet Disord. 2020 Jul 17;21(1):469. doi: 10.1186/s12891-020-03483-z.
Sciatica is common and associated with significant impacts for the individual and society. The SCOPiC randomised controlled trial (RCT) (trial registration: ISRCTN75449581 ) tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were 'fast-tracked' for a magnetic resonance imaging (MRI) scan and spinal specialist opinion. This paper reports qualitative research exploring patients' and clinicians' perspectives on the acceptability of this 'fast-track' pathway.
Semi-structured interviews were conducted with 20 patients and 20 clinicians (general practitioners, spinal specialist physiotherapists, spinal surgeons). Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and 'boundary objects' concept.
Whilst the 'fast-track' pathway achieved a degree of 'coherence' (i.e. made sense) to both patients and clinicians, particularly in relation to providing early reassurance based on MRI scan findings, it was less 'meaningful' to some clinicians for managing patients with acute symptoms, reflecting a reluctance to move away from the usual 'stepped care' approach. Both groups felt a key limitation of the pathway was that it did not shorten patient waiting times between their spinal specialist consultation and further treatments.
Findings contribute new knowledge about patients' and clinicians' perspectives on the role of imaging and spinal specialist opinion in the management of sciatica, and provide important insights for understanding the 'fast-track' pathway, as part of the stratified care model tested in the RCT. Future research into the early referral of patients with sciatica for investigation and specialist opinion should include strategies to support clinician behaviour change; as well as take into account the role of imaging in providing reassurance to patients with severe symptoms in cases where imaging reveals a clear explanation for the patient's pain, and where this is accompanied by a thorough explanation from a trusted clinical expert.
坐骨神经痛很常见，会给个人和社会带来重大影响。SCOPiC 随机对照试验（RCT）（试验注册：ISRCTN75449581）通过根据预后和临床指标将患者分为三组对坐骨神经痛进行分层初级保健，测试了这种分组方法。其中一组患者被“快速通道”进行磁共振成像（MRI）扫描和脊柱专家意见。本文报告了一项定性研究，探讨了患者和临床医生对这种“快速通道”方法的可接受性的看法。
对 20 名患者和 20 名临床医生（全科医生、脊柱专科理疗师、脊柱外科医生）进行了半结构化访谈。使用主题分析法对数据进行分析，并使用规范化进程理论（NPT）和“边界对象”概念探索研究结果。
尽管“快速通道”方法在一定程度上对患者和临床医生来说具有“一致性”（即有意义），特别是在根据 MRI 扫描结果提供早期保证方面，但对于管理急性症状的患者，一些临床医生认为这种方法不太“有意义”，这反映了他们不愿意放弃通常的“阶梯式护理”方法。两组人员都认为该方法的一个主要局限性是，它并没有缩短患者从脊柱专家咨询到进一步治疗之间的等待时间。
研究结果提供了有关患者和临床医生对影像学和脊柱专家意见在坐骨神经痛管理中的作用的新见解，并为理解 RCT 中测试的分层护理模型中的“快速通道”方法提供了重要的见解。未来对坐骨神经痛患者进行早期转诊进行检查和专家意见的研究应包括支持临床医生行为改变的策略；同时还应考虑影像学在为症状严重的患者提供保证方面的作用，在这种情况下，如果影像学为患者的疼痛提供了明确的解释，并且有值得信赖的临床专家进行了详细的解释，那么影像学可以为患者提供保证。
