Saunders, B ORCID: https://orcid.org/0000-0002-0856-1596, Konstantinou, K ORCID: https://orcid.org/0000-0003-4228-9386, Artus, M, Foster, NE ORCID: https://orcid.org/0000-0003-4429-9756 and Bartlam, B ORCID: https://orcid.org/0000-0002-8557-6222 (2020) Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial. BMC Musculoskeletal Disorders, 21 (1).

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Abstract

Background
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.

Methods
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.

Results
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.

Conclusion
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.

Item Type: Article
Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Uncontrolled Keywords: Sciatica, Stratified care, ‘Fast-track’ pathway, Qualitative, Interviews
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC346 Neurology. Diseases of the nervous system, including speech disorders
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 30 Jul 2020 12:15
Last Modified: 06 Aug 2020 08:49
URI: https://eprints.keele.ac.uk/id/eprint/8450

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