MSK Service, Birmingham Community Healthcare NHS Trust, 1 Priestley Wharf, Holt Street, Aston, Birmingham, B7 4BN, UK.
Trauma & Orthopaedics, University of Salford School of Health & Society, The Crescent, Salford, M5 4WT, UK.
Musculoskelet Sci Pract. 2023 Jun;65:102773. doi: 10.1016/j.msksp.2023.102773. Epub 2023 May 10.
Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be as thorough and effective as possible. This study explores whether Physiotherapists are asking the correct questions, in the correct way and investigates their experiences when screening for this serious condition. Thirty physiotherapists working in a community musculoskeletal service were purposively sampled and participated in semi-structured interviews. Data was transcribed and thematically analysed. All participants routinely asked bladder, bowel function and saddle anaesthesia screening questions although only 9 routinely asked about sexual function. Whether questions are asked in the correct way has never been studied. Sufficient depth of questioning, using lay terminology and explicit language was achieved by two-thirds of participants. Less than half of the participants framed the questions before asking them and only 5 participants combined all four dimensions. Whilst most clinicians felt comfortable asking general CES questions, half reported feeling uncomfortable when asking about sexual function. Issues around; gender, culture and language were also highlighted. Four main themes emerged from this study; i) Physiotherapists ask the right questions but frequently omit sexual function questions, ii) mostly, Physiotherapists ask CES questions in a way that patients understand however, there needs to be improvement in framing the context of the questions, iii) Physiotherapists generally feel comfortable with CES screening but there is some awkwardness surrounding discussion of sexual function and iv) Physiotherapists perceive there to be barriers to effective CES screening caused by culture and language.
马尾综合征（CES）是一种需要紧急手术的病症。随着物理治疗师越来越多地承担起第一线和脊柱分诊的角色，对 CES 的筛查必须尽可能全面和有效。本研究探讨了物理治疗师是否在以正确的方式提出正确的问题，并调查了他们在筛查这种严重疾病时的经验。30 名在社区肌肉骨骼服务机构工作的物理治疗师被有意抽样并参与了半结构化访谈。数据被转录并进行了主题分析。所有参与者都例行询问膀胱、肠道功能和鞍区感觉缺失的筛查问题，尽管只有 9 名参与者例行询问性功能。关于提问方式是否正确，还从未进行过研究。三分之二的参与者使用通俗易懂的语言和明确的语言进行了足够深入的提问。不到一半的参与者在提问前就提出了问题，只有 5 名参与者将这四个维度结合起来。虽然大多数临床医生在询问一般 CES 问题时感到自在，但有一半的人报告在询问性功能问题时感到不舒服。性别、文化和语言等问题也被强调。本研究得出了四个主要主题：i）物理治疗师提出了正确的问题，但经常省略性功能问题，ii）大多数物理治疗师以患者能理解的方式提出 CES 问题，但需要改进问题的框架，iii）物理治疗师普遍对 CES 筛查感到自在，但在讨论性功能时存在一些尴尬，iv）物理治疗师认为文化和语言是导致 CES 筛查效果不佳的障碍。
