The experiences of UK physiotherapists in relation to Cauda Equina Syndrome and litigation

Leech, Rachel Louise ORCID: https://orcid.org/0000-0002-9266-2284 (2024) The experiences of UK physiotherapists in relation to Cauda Equina Syndrome and litigation. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Introduction Cauda equina syndrome (CES) is widely described as a rare condition which can be challenging to diagnose and can have life changing impacts on the patient. Cauda equina syndrome can lead to clinical negligence claims, and although the prevalence of this condition is low, CES is one of the most litigious spinal conditions in the UK. Legal claims are costing some NHS trusts over 40 million pounds each year and represent 2% of the NHS budget. This thesis aimed to explore the experiences of UK physiotherapists in relation to CES and litigation to help support them in their role and ensure their health and wellbeing. Methods Four key studies were conducted using a mixed methods design. These included a scoping literature review (chapter 2) which provided foundational knowledge for the following empirical phases. A multi-methods inquiry (chapter 3) which provided additional data relating to the extent of CES claims in physiotherapy in the UK and information on the legal process for physiotherapists. The qualitative study (chapter 4) generated data from physiotherapists with experience of CES litigation and other stakeholders on their experiences and views of CES litigation. The national survey study (chapter 5) aimed to validate the findings from the qualitative study (chapter 4) using a survey open to all physiotherapists in the UK. Results A total of N=2496 CES claims were recorded in the UK between 2009-2021. Of these, 51 CES claims were attributed to physiotherapy. Results found 10% of physiotherapists had been involved in litigation at some point in their career. A total of 23% of neuromusculoskeletal claims were related to CES, which was 9% of all claims captured. There are different legal processes for physiotherapists depending on their employment. However, there was no easily accessible, clear advice, to inform physiotherapists of these legal pathways. Physiotherapists described negative physical impacts of litigation claims, most commonly stress, anxiety and worry and defensive clinical practice. Many physiotherapists felt unsupported, often because they were unaware of where to find appropriate support. There should be opportunities for basic litigation 3 training for physiotherapy students at undergraduate level and further litigation training at postgraduate level, as physiotherapists’ progress through their clinical career. Conclusion The extent of CES litigation in UK physiotherapy is suspected to be much higher than the data reported due to the claims recording processes. There is no overarching, clearly articulated information describing the legal process and support available for physiotherapists, and this differs depending on who the physiotherapist is employed by. Litigation impacted physiotherapists’ physical health, mental wellbeing and clinical practice. Support should be improved for physiotherapists who become involved in litigation. The need for training was highlighted for both undergraduate and postgraduate levels.