COMMONLY UTILIZED PHYSIOTHERAPY TREATMENT APPROACHES IN THE MANAGEMENT OF SUB-ACUTE SCIATICA: A PILOT STUDY USING THE DELPHI PROCESS

摘要

There is limited evidence for the utilization of physiotherapy in the management of sub-acute sciatica. The aim of this pilot study was to explore the Delphi method to attempt to reach consensus on physiotherapeutic approaches to the management of sub-acute sciatica amongst a panel of clinicians experienced in this field. The panel included senior physiotherapists (ft = 10) working within an outpatient setting at a specialized orthopedic trust. Iteration 1 consisted of the open-ended question 'List the treatment approaches/ techniques/modalities you employ when treating a patient with sub-acute sciatica and provide justifications'. Themes reaching 70% consensus progressed to the second iteration which followed up with the question 'Please indicate how frequently you would employ the following treatments in the management of sub-acute sciatica' using a 5-point likert scale ranging from 1 (never) to 5 (always). The mean score was calculated for each treatment and those themes achieving a mean of 3.5 or greater progressed to iteration 3 'Please rank in order of preference which of the following treatments you would employ in the treatment of sub-acute sciatica'. The response rate at iteration 3 was 60%. This pilot study achieved consensus on five treatment approaches to be employed in the management of sub-acute sciatica. In order of preference these treatments were advice (regarding staying active, staying at work, reassurance, analgesia), advice (time scale of recovery, natural course of sciatica, self-limiting condition, hurt does not equal harm), lumbar joint mobilizations (rotations, PA's, ilial mobs [distractions], transverse glides), direction specific stretches and nerve mobilizations. This pilot study provides preliminary evidence of commonly used treatment approaches for sub acute sciatica amongst physiotherapists.