Managing Sciatica in the Physiotherapy Consultation: A Qualitative Observation and Interview Study

Background: There is limited evidence on prognostic factors for low back-related leg pain including the group with nerve root pain. It is unclear at present whether the prognostic indicators relevant to outcome in patients with leg pain are similar to those for LBP alone. Clinical characteristics and indexes of risk however, are not the only variables affecting outcome. The effect of interaction style (level of patient participation, engagement of the clinician with patient concerns, elicitation of patient preferences, and reassurance) on patient health outcomes has received limited attention in the literature. However, research has shown that the approach adopted by clinicians in the consultation may affect health outcomes. Consequently, there is a need to understand the different dimensions of the physiotherapist-patient interaction, in order to identify the relationship between the specific approach to the consultation and outcomes. Methods: The observation and interview study is part of the larger ATLAS study investigating prognosis for LBP and leg pain in primary care. The study (currently ongoing) aimed to investigate the effect of physiotherapists' approach to clinical assessment and treatment negotiation with patients (with and without nerve root involvement) on outcomes such as a) perceived recovery from pain, b) disability and c) adherence to treatment advice. In total 56 consultations at two clinics in the UK were observed and digitally recorded, with supplementary field notes made immediately following each observed episode. Of these, 36 have been transcribed for analysis. These described the communication ‘style' of the physiotherapist, the language used to explain the clinical assessment findings to patients, and post-consultation ‘debrief' discussions between the researcher and physiotherapist. Subsequently, 21 interviews were conducted with patients attending the clinics (similar proportions diagnosed with and without ‘nerve root involvement'). The consultation and interview data have been coded and analysed thematically in search of common themes and differences. Results: Analyses of the observations and interviews are ongoing, but early indications suggest that physiotherapists' overall ‘approach' to the interaction, advice giving, and disclosure of the clinical findings, alongside the matching of treatments with prognostic profile, affected patients' self-management of their leg pain symptoms. The giving of reassurance and treatment advice appeared to increase patients' understanding of their leg pain, improved their adaptation to their symptoms, and reduced re-consultation to primary care services. Conclusions: The study highlights the importance of the specific approach to the consultation adopted by physiotherapists, alongside the matching of appropriate treatments with patients' prognostic profile, in order to fully understand the mediators of outcome