Research: Cauda Equina Syndrome (CES) and litigation

Research summary

• June 2020 to June 2022

Cauda Equina Syndrome (CES) is a rare neurological condition affecting the nerves in the lower back.

CES has devastating consequences. Approximately 20% of patients have a poor outcome due to misdiagnosis or delays in treatment, which has led to an increase in litigation cases.

Advanced practice physiotherapy roles are increasing, meaning physiotherapists are increasingly involved in CES litigation claims. This may negatively impact physiotherapists, patients, the profession and the NHS.

Aim

To explore the lived experiences of UK physiotherapists in relation to CES and litigation to:

• support them in their role
• understand their potential training needs
• ensure their health and wellbeing

Methodology

We are using a mixed-methods approach consisting of:

• Phase 1: Scoping literature review, freedom of information requests and correspondence with stakeholders.
• Phase 2: Interpretative qualitative design to explore the lived experiences of physiotherapists involved in CES litigation cases. Interviews will also be undertaken with CES stakeholders to gain a holistic understanding.
• Phase 3: A national survey to investigate the views from the wider physiotherapy profession

Research outputs

Academic papers

• Yeowell, G, Leech, R, Greenhalgh, S, Selfe, J et al (2023) The lived experiences of UK physiotherapists involved in Cauda Equina Syndrome litigation. A qualitative study. PLOS ONE

• Leech, RL, Ball, S, Greenhalgh, S, Hogan, G, Holway, J, Selfe, J, Willis, E and Yeowell, G (2021) A scoping review protocol: Investigating the extent and legal process of Cauda Equina Syndrome claims for UK physiotherapists. Musculoskeletal Care

• Leech, RL, Ball, S, Greenhalgh, S, Hogan, G, Holway, J, Selfe, J, Willis, E and Yeowell, G (2021) A scoping review: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists. Musculoskeletal Science and Practice

• Yeowell, G, Leech, R, Greenhalgh, S, Selfe, J et al (2022) Medico-legal litigation of UK physiotherapists in relation to cauda equina syndrome: a multimethods study The BMJ

Other publications

• Yeowell, G, Greenhalgh, S and Selfe, J (2022) NLR0010 - NHS litigation reform UK Parliament Committees
• Hunt,  J (2022) NHS litigation reform report House of Commons Health and Social Care Committee

Resources

• Yeowell G, Leech R, Greenhalgh S, Willis E, Selfe J. (2022) Keep calm and carry on: I have received a clinical negligence claim – what do I do?

Other cauda equina syndrome resources

• Cauda Equina information cards
• Finucane, L, Greenhalgh, S, Leech, R and Selfe, J et al (2020) International Framework for red flags for potential serious spinal pathologies JOSPT. 50(7):350-372
• Greenhalgh, S, Selfe, J and Yeowell, G Back pain costs the NHS nearly £5 billion, physiotherapists have an ever-increasing role to play in relieving strain on services, News story, Manchester Met

Cauda equina syndrome video resources