Exploring physiotherapist's ability to identify cauda equina syndrome early

Abstract

OBJECTIVES: To explore the ability of physiotherapists in Saudi Arabia to identify cauda equina syndrome (CES) in a timely manner, and to identify the methods used by physiotherapists to manage patients with suspected CES. METHODS: This study utilized a cross-sectional research design and was conducted in the period May-October 2023. It included licensed physiotherapists working in Saudi Arabia. The data was collected using a survey that aimed to assess physiotherapists' ability to identify CES early, using 12 statements. Based on the participants response to these statements, all responders were categorized into the following groups based on their ability to identify and manage CES early: proficient (10-12 points); good ability (7-9); fair ability (5-6); and poor ability (<=4). Consensus to a statement was reached when more than 70% of participants agreed or disagreed with the statement. RESULTS: This study included 401 physiotherapists (mean age=29.51 (SD 5.54); 53.4% female). Most participants (63.6%) have a proficient-good ability to identify and manage CES early, while 36.4% were categorized as having fair-poor ability Consensus for the CES statements was achieved for 8 statements [1, 2, 3, 4, 5, 8, 9, 12] out of 12. Among these statements, most participants agreed that a patient should be suspected to have CES when they exhibited urinary difficulties of neurogenic origin (88.3%) and/or bilateral radiculopathy (85.5%); and 88.0% of them agreed that an MRI should be requested urgently when managing a patient with CES. Conversely, consensus was not achieved on statements, concerning communication with patients, patient instructions, and management decisions for suspected CES cases. CONCLUSION: Most physiotherapists had a proficient-good ability to identify and manage CES early. The study's findings can aid in the creation or improvement of clinical standards and protocols pertaining to physiotherapists' roles in the early identification of CES.