{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T20:38:14Z","timestamp":1773779894950,"version":"3.50.1"},"reference-count":37,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011698","name":"Chartered Society of Physiotherapy Charitable Trust","doi-asserted-by":"crossref","award":["PRF\/19\/A18"],"award-info":[{"award-number":["PRF\/19\/A18"]}],"id":[{"id":"10.13039\/100011698","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,6,15]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim was to investigate the extent of cauda equina syndrome (CES) litigation and explore the process of medico-legal litigation in relation to physiotherapy in the UK.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A multimethods inquiry that followed on from a previously conducted scoping literature review was undertaken to address the aim. This included freedom of information requests and direct communication with relevant stakeholders and organisations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2496 CES claims were found in the UK between 2012 and 2020. 51 of these were attributed to physiotherapists. There was little information available to physiotherapists regarding the legal process of litigation and much of this information was not from a physiotherapist\u2019s perspective.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This is the first study that has investigated the extent and process of CES litigation in physiotherapy in the UK. The extent of CES litigation appears to be high considering CES is a rare spinal condition. Furthermore, the extent of CES litigation is suspected to be considerably higher than the data reported in this study due to the issues identified in how CES claims are recorded. Finally, there is no clearly articulated, easily accessible information describing the process and support available for physiotherapists in receipt of a legal claim.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-060023","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T13:18:35Z","timestamp":1657631915000},"page":"e060023","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Medico-legal litigation of UK physiotherapists in relation to cauda equina syndrome: a multimethods study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3872-9799","authenticated-orcid":false,"given":"Gillian","family":"Yeowell","sequence":"first","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Leech","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Greenhalgh","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, UK"},{"name":"Orthopaedic Interface Service, Bolton One, Bolton NHS Foundation Trust, Bolton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Selfe","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"2025101815112570000_12.7.e060023.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-025230"},{"key":"2025101815112570000_12.7.e060023.2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.physio.2021.03.004","article-title":"The prevalence of serious pathology in musculoskeletal physiotherapy patients - a nationwide register-based cohort study","volume":"112","author":"Budtz","year":"2021","journal-title":"Physiotherapy"},{"key":"2025101815112570000_12.7.e060023.3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.msksp.2018.06.002","article-title":"Assessment and management of cauda equina syndrome","volume":"37","author":"Greenhalgh","year":"2018","journal-title":"Musculoskelet Sci Pract"},{"key":"2025101815112570000_12.7.e060023.4","unstructured":"Finucane L , Mercer C , Greenhalgh S . Clinical update: cauda equina syndrome. The Chartered Society of physiotherapy. front Physiother MAG Csp members, 2017. Available: https:\/\/www.csp.org.uk\/frontline\/article\/clinical-update-cauda-equina-syndrome [Accessed 27 Apr 2020]."},{"key":"2025101815112570000_12.7.e060023.5","unstructured":"NHS Resolution . Did you know? cauda equina syndrome, 2020. Available: https:\/\/resolution.nhs.uk\/wp-content\/uploads\/2020\/07\/Did-you-know-Cauda-Equina.pdf [Accessed 24 Nov 2020]."},{"key":"2025101815112570000_12.7.e060023.6","unstructured":"Hutton M . Spinal services GIRFT programme national specialty report GIRFT is delivered in partnership with the Royal national orthopaedic Hospital NHS trust and NHS improvement Foreword from Professor TIM Briggs GIRFT programme chair GIRFT programme chair and Natio, 2019."},{"key":"2025101815112570000_12.7.e060023.7","unstructured":"Chacko D . Medical liability litigation: an historical look at the causes for its growth in the United Kingdom. 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Available: https:\/\/www.mlacp.org.uk\/what-we-do\/ [Accessed 24 May 2021]."},{"key":"2025101815112570000_12.7.e060023.21","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/1355297X.2004.11736237","article-title":"Cauda equina syndrome: diagnosis, delay and litigation risk","volume":"26","author":"Markham","year":"2004","journal-title":"J Orthop Med"},{"key":"2025101815112570000_12.7.e060023.22","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1668-3"},{"key":"2025101815112570000_12.7.e060023.23","unstructured":"White P . Professional liability insurance: are you adequately covered? | The Chartered Society of Physiotherapy [Internet], 2015. Available: https:\/\/www.csp.org.uk\/frontline\/article\/professional-liability-insurance-are-you-adequately-covered [Accessed 24 Nov 2020]."},{"key":"2025101815112570000_12.7.e060023.24","unstructured":"White P . Adviceline: avoiding litigation. Frontline: The physiotherapy magazine for CSP members [Internet], 2016. 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Learning from litigation claims the getting it right first time (GIRFT) and NHS resolution best practice guide for clinicians and managers clinical lead for spinal surgery for the GIRFT programme, 2021."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-060023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T22:11:35Z","timestamp":1760825495000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-060023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,12]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1136\/bmjopen-2021-060023"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-060023","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}