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Development of a toolkit for early identification of cauda equina syndrome

Aim To develop a simple cauda equina syndrome (CES) toolkit to facilitate the subjective examination of low back pain patients potentially at risk of CES. To undertake preliminary validation of the content of the toolkit. Background CES is a rare condition which can be very challenging to identify in a generalist medical setting. Method A three phase iterative design with two stake holder groups; extended scope practitioners experienced in managing CES patients and CES sufferers. Toolkit development Synthesis of existing CES literature with CES patient data generated from in depth interviews. Toolkit validation Content validation of the draft toolkit with CES patients. Toolkit validation Content validation of the draft toolkit with extended scope physiotherapists. Findings A three arm toolkit has been developed for use with patients considered by the clinician as at risk of developing CES (eg, worsening low back pain with symptoms/signs of progressive sensory-motor deficit in the lower limbs); patient expertise, clinical expertise, research and pathways. Uniquely, the toolkit drew upon the lived experiences of patients suffering from CES to inform the content.