Abstract
Serious spinal pathology cases are difficult to recognise in the early stages of the
disease process and have become notorious amongst physiotherapists and
those from the wider medical professions. Delayed diagnosis can lead to
catastrophic patient consequences and create needless anxiety for the clinician.
In an evolving health economy, physiotherapists have expanding roles in the field
of musculoskeletal medicine, and are commonly the first practitioner to examine
a back pain sufferer. These clinicians are increasingly likely to encounter complex
patients presenting with previously undiagnosed serious pathology of the spine.
Using a range of evidence, this thesis summarises three main areas in which my
work has made a significant contribution to physiotherapy knowledge and
practice: 1. Enhancing practitioners’ awareness of clinical indicators and their
recognition of patterns within serious spinal cases presenting for physiotherapy
treatment. 2. Strengthening the clinical physiotherapy and musculoskeletal
evidence-base, specifically relating to improved diagnostic effectiveness in
responses to serious pathology of the spine. 3. Identifying demonstrable benefits
to both patients and funders from the systematic application of specific,
identifiable indicators to the logic of clinical management and pathways. In presenting the chronology of my work, the thesis refers to a variety of researchbased evidence that I have used to equip clinicians with the skills and knowledge
necessary to identify and manage this complex group of patients. My approaches
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include innovations such as the development of a weighting system for indicators
of serious spinal pathology to inform physiotherapists’ clinical reasoning, and a
qualitative study in Palliative Care which explored clinicians’ knowledge of vital,
identifiable indicators for serous pathology of the spine. I will present the
underpinning development process for the first ever alert system for Metastatic
Spinal Cord Compression. Aligned with this, I will also provide evidence of how
dissemination of this new knowledge resulted in improved patient outcomes both
nationally and internationally. In summary, this thesis outlines the contribution to physiotherapy and wider
medical practice that my work has made in informing clinical reasoning to
effectively consider the possibility of something serious causing the presenting
back problem.