The question of sexual dysfunction during cauda equina screening: A qualitative study exploring the views of advanced practice physiotherapists.

Cauda Equina Syndrome (CES) is a rare but serious spinal condition which can result in permanent impairment of bladder, bowel and sexual dysfunction. Screening for sexual dysfunction in suspected CES is inconsistent, with age, gender and embarrassment inferred as likely reasons for under reporting, limiting potential understanding of the prevalence and prognostic importance of sexual dysfunction pre CES diagnosis. Further training has been suggested to improve screening for sexual dysfunction in CES, but how this should be delivered has not been fully evaluated. This qualitative phenomenological study explores the views of Advanced Practice Physiotherapists (APPs) regarding their current screening practices for sexual dysfunction in suspected CES. Ten APPs were purposively sampled from two NHS Orthopaedic interface services in Northern Ireland. Semi-structured interviews were conducted on-line via MS Teams, video recorded with consent and then coded, transcribed and analysed using a system of reflexive thematic analysis. The following themes and subthemes were identified (1) 'I throw it in at the end' - the tension between knowing and doing. (1a) Understanding the impact of experience. (2) The influence of the clinician's own characteristics and beliefs. (2a) 'I really think the question is easier for a man to answer than a woman'. (3) An effective therapeutic alliance matters. (4) Further training - an interactive approach. These themes offer insight into the complex interplay between knowledge translation, clinicians' beliefs, clinical experience, the therapeutic alliance and reflexivity. Interactive training involving key stakeholders was recommended by participants and implementation should be considered for future research.