Why managing sciatica is difficult: patients’ experiences of an NHS sciatica pathway. A qualitative, interpretative study
Why managing sciatica is difficult: patients’ experiences of an NHS sciatica pathway. A qualitative, interpretative study
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.
adult orthopaedics, back pain, musculoskeletal disorders, protocols & guidelines, qualitative research, quality in health care
Ryan, Clare
8be9d4a9-deb0-450b-8207-24f2190a2d92
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
11 June 2020
Ryan, Clare
8be9d4a9-deb0-450b-8207-24f2190a2d92
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
Ryan, Clare, Pope, Catherine and Roberts, Lisa
(2020)
Why managing sciatica is difficult: patients’ experiences of an NHS sciatica pathway. A qualitative, interpretative study.
BMJ Open, 10 (6), [037157].
(doi:10.1136/bmjopen-2020-037157).
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.
Text
Why managing sciatica is difficult patients' experiences of an NHS sciatica pathway. A qualitative interpretative study
- Accepted Manuscript
More information
Accepted/In Press date: 16 March 2020
e-pub ahead of print date: 11 June 2020
Published date: 11 June 2020
Additional Information:
Funding Information:
The authors gratefully acknowledge the support of study participants and the host NHS Trust.
Funding Information:
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).
Funding Information:
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.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords:
adult orthopaedics, back pain, musculoskeletal disorders, protocols & guidelines, qualitative research, quality in health care
Identifiers
Local EPrints ID: 441774
URI: http://eprints.soton.ac.uk/id/eprint/441774
ISSN: 2044-6055
PURE UUID: d23c0887-1834-477e-86cc-bd2eeb4f3602
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Date deposited: 26 Jun 2020 16:41
Last modified: 19 Jun 2025 02:20
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Author:
Clare Ryan
Author:
Catherine Pope
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