Abstract
Background and purpose of the study
Uncertainty remains regarding the optimal method of diagnosing sciatica. Clinical guidelines currently recommend that investigations be used only when they are likely to change management. In clinical practice, considerable variation can occur between patient and clinician, regarding the perceived importance of investigations such as MRI scans. The aim of this study was to explore patients' experiences of investigations and to consider the impact of concordance between clinical presentation and investigation findings.
Methods and results
In this qualitative study, based on the principles of interpretative phenomenological analysis, 14 participants with a clinical presentation of sciatica of likely nerve root origin, who had recently undergone investigations, were purposively recruited from an NHS, Primary Care Musculoskeletal Service in the UK. Individual, semi-structured interviews were used to collect data, which were audio-recorded and transcribed verbatim. Data were managed using a framework approach and analysed thematically.
Although patients reported wanting investigations to understand the cause of symptoms and inform management, access to them was difficult and protracted. When investigations revealed potentially relevant findings, patients experienced relief, validation, empowerment and decisive decision-making. Disappointment emerged, however, regarding treatment waiting times and options, and long-term prognosis. When investigations failed to identify relevant findings, patients were unable to make sense of their symptoms, move forward in their management or relinquish their search to identify the cause.
Conclusion
This study provides the first reported in-depth interpretation of patients' experience of undergoing investigations for sciatica. Important policy and practice implications have been identified for investigation referral criteria; shared-decision-making; information sharing; aligning expectations and managing disappointment.
No conflicts of interest.
This study was funded by an NIHR Masters in Clinical Research Fellowship awarded to CR. LR is funded, in part, by an NIHR Senior Clinical Lecturer award (Round 3).
