Clinical Uncertainty Among Health Professionals Who Assess People With Sciatica and Leg Weakness: Results of an Online Survey

Conflicts of interest: No conflicts of interest. Sources of funding: Lucy Dove, Clinical Doctoral Research Fellow (NIHR303586) is funded by the NIHR for this research project. The views expressed are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care. A. B. Schmid is supported by a Wellcome Trust Clinical Career Development Fellowship (222101/Z/20/Z). Background Sciatica describes spinally referred leg pain of neural origin. Sciatica is a common problem, with upper estimates of lifetime prevalence at 43%. Studies show that 11–25% of people with sciatica report leg weakness two years following onset. Despite its prevalence, leg weakness in people with sciatica is poorly characterised using existing clinical measures. Purpose To identify the measures and pathways that health professionals use in their clinical consultations involving people with sciatica and leg weakness, and to understand how these factors guide clinical decision making. Methods An online survey was performed with health professionals who work with patients who have sciatica. The survey was shared at BritSpine 2024, by email and on X, and LinkedIn. Results 331 valid responses were collected. Most responses were from physiotherapists (76%) and spine surgeons (7%), in the UK (79%) working in NHS practice (61%). High proportions of respondents' report asking patients if they experience weakness (93%) and carry out a manual muscle test (88%). However, only 35% report an established clinical pathway for foot drop in their work setting and only 14% report awareness of clinical guidelines on foot drop. A higher proportion, 44%, use informal guidelines on diagnosing and managing foot drop, with high variation in current clinical practice. Conclusion Health professionals ask patients with sciatica about leg weakness and commonly carry out a manual muscle test. In the absence of clear clinical pathways for diagnosing and managing foot drop, heterogeneity in clinical practice poses real challenges to consistent patient care.