How do physiotherapists use Cauda Equina Syndrome safety netting techniques and what influences their practice?

Cauda Equina Syndrome (CES) is a rare but serious neurological condition requiring urgent intervention to prevent permanent harm. Although safety netting practices are recommended to mitigate risks, they are inconsistently applied, with limited guidance or evidence to inform their use. Existing research has largely overlooked the specific challenges of CES safety netting, particularly in advanced physiotherapy roles like First Contact Practitioners (FCPs) and Extended Scope Practitioners (ESPs), who play a pivotal role in managing suspected cases.

This study aimed to address the research gap by exploring the experiences, beliefs, and practices of MSK physiotherapists regarding CES safety netting, focusing on its impacts on patients and healthcare systems.

A qualitative study was conducted using semi-structured interviews with eight MSK physiotherapists across various roles. Reflexive thematic analysis was employed to identify and interpret key themes.

Five themes emerged: (1) perceived anxiety and responsibility, emphasising fear of missed diagnoses; (2) challenges with communication and referral pathways, particularly with Trauma and Orthopaedics (T&O) and Accident and Emergency (A&E) departments; (3) variation in safety netting practices, influenced by individual and contextual factors; (4) the impact of ambiguous CES presentations on decision-making; and (5) systemic barriers, including poorly integrated referral pathways and limited diagnostic resources.

This study uniquely highlights the challenges of CES safety netting in advanced physiotherapy roles. Clearer guidance, interdisciplinary collaboration, and improved training are needed to support clinicians and enhance patient outcomes. Further research should investigate systemic impacts and patient perspectives.