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Pilates is a commonly recommended exercise modality for the management of persistent low back pain. Whilst guidelines recommend the use of exercise for low back pain, research suggests that no one exercise is superior, creating a question over the mechanism of effect. The patient-practitioner relationship may be important in managing low back pain; however, the relationship between Pilates teachers and clients is not well understood. The purpose of this study was to identify the components of the relationship between Pilates teachers and clients with persistent low back pain, explore key influences on the relationship, and ascertain the nature of the relationship. We conducted a qualitative, ethnographically-informed study at eight sites in the South of England, observing 24 Pilates sessions and interviewing 9 Pilates teachers and 10 clients with persistent low back pain. Fieldnotes and interview transcripts were analysed thematically. The findings demonstrate a complex, multi-faceted interaction that occurs during Pilates sessions, grounded within certain health perceptions, and predicated on expectations of individuality, choice and expertise. A key finding reveals the perceived importance of mastery of prescribed movements with control and precision, in which clients particularly value the authority of the teacher in a directive learning environment. We contend that the role of the Pilates teacher in this study facilitated the alleviation of clients' distress through the application of ritual-like Pilates activity. We conclude that the relationship between Pilates teachers and clients with persistent low back pain may be considered a therapeutic relationship. • Pilates teachers may develop therapeutic relationships with clients with low back pain. • Clients value the Pilates teacher's authority in a directive relationship. • Activities within a Pilates encounter are ritual-like. • An ethnographically-informed methodology provides insight to therapeutic Pilates practice. [ABSTRACT FROM AUTHOR]

Background: Nursing science is heavily dependent on nurse scientists with adequate funding. Nurse scientists should be aware of organizations' research agendas and, to the extent possible, align research with stated research priorities. Current information on the demographics of nurse scientists, their projects, and the alignment to known priorities is illusive. Purpose: To describe areas of inquiry pursued by PhD-prepared nurses and congruence with the research agendas of nursing organizations. Methods: A descriptive, exploratory approach was undertaken with PhD-prepared nurse scientists to gather data about their PhD program, dissertation topic, current work status, productivity, and future recommendations. Results: Key findings were that dissertation topics were broad and aligned with research priorities. Elements influencing research productivity are described. Conclusions: Understanding current nursing science stewardship and intentionally strategizing for the future of research, academia, and clinical practice will enhance our ability to tailor PhD programs accordingly. [ABSTRACT FROM AUTHOR]

Integral to holistic "big picture" nursing care is an empathy that strives for social justice. Social empathy requires more than technical skills or even interpersonal empathy or other-focus; it also requires a perspective that appreciates the impact of social determinants and seeks action to address them. This study sought to measure social empathy and potentially associated demographic, personal, and work-related factors among nurses. This cross-sectional, observational study used online survey methods to collect data from 614 registered nurses employed in a faith-based health care system in the northwestern United States. Constructs measured included social empathy, social advocacy, self-compassion, emotional exhaustion, and trust/mistrust in God. Parametric statistical tests, including multiple logistic regression, allowed analyses. Findings indicated that social empathy was high in this sample. Younger nurses, those more inclined to advocate, those more self-compassionate, those less burned out, those working part-time (in contrast only with those working overtime), and those with at least a baccalaureate degree in nursing were more socially empathic. Findings highlight further rationale for creating healthy work environments that foster self-compassion and minimize burnout. [ABSTRACT FROM AUTHOR]

Background: Intestinal (i.e., "gut") permeability may be related to cardiovascular disease (CVD) risk, but biomarkers for gut permeability are limited and associations with CVD risk are unknown—particularly among older adults. Aims: This cross-sectional study aimed to determine if serum biomarkers related to gut permeability [intestinal fatty acid-binding protein (iFABP)] and bacterial toxin clearing [cluster of differentiation 14 (CD14), lipopolysaccharide binding protein (LBP)] are associated with CVD risk among older adults. Methods: Older adults (n = 74, 69.6 ± 6.5-years-old) were stratified by CVD risk category. One-way ANOVAs determined differences in each biomarker by risk category, and associations with risk score were evaluated with Pearson correlations. Results: LBP (p = 0.007), but not iFABP and CD14, was significantly different between CVD risk categories. Post-hoc tests indicated LBP was higher in moderate risk and high-moderate risk compared to the high risk category (p < 0.005). Evaluation of LBP and individual components in the risk score demonstrated a moderate, negative correlation of LBP with age and systolic blood pressure (r = − 0.335 and r = − 0.297) and a small positive correlation between LBP and total cholesterol and LDL cholesterol (r = 0.204 and r = 0.220). Discussion/Conclusion: Lower risk for CVD was associated with higher circulating concentrations of LBP, lower iFABP, and lower systemic inflammation in older adults. Further, there were small positive relationships between total and LDL cholesterol and circulating levels of LBP. These data suggest LBP may be a key component in reducing CVD risk in older adults. [ABSTRACT FROM AUTHOR]

Background: Caregiving and clinical care for people living with dementia (PLWD) is complex and complicated by communication challenges among caregivers and providers (Gaugler et al., 2022; Ruggiano et al. 2012; 2019). These challenges can constrain decision making about treatment options (Hinton et al., 2007; Miller et al., 2016; Wolff et al., 2020) and may contribute to negative mental health outcomes often reported by family caregivers (Gaugler et al., 2022), which disproportionately impact vulnerable caregivers (e.g., underserved racial/ethnic groups, rural caregivers (Abner et al., 2016; Fabius et al., 2020)). Health information technology (HIT) has been identified as a potential solution to communication challenges in dementia care (Ruggiano et al., 2019; Vedel et al., 2013). However, few studies have reported how to effectively integrate new HIT into practice to support provider‐caregiver communication. In this study, a four‐stage implementation science framework (Meyers et al., 2012) was used to integrate a newly developed web‐based application (app) technology, called CareHeroes (Brown et al., 2016), into clinical practice at two memory clinics to promote caregiver‐physician communication. CareHeroes is multi‐functional and allows secure sharing of patient‐related clinical information between caregivers and providers. It also provides education and support, including an educational chatbot that provides tailored, expert feedback to caregiver questions. Method: Early stages of implementation involved interviews with caregivers and focus groups with clinic providers to develop a clinical workflow integration plan for the new app. Then, the research team collected user data collected through the app during implementation as well as caregiver psychosocial outcome data (e.g., depression, burden) at baseline and 3‐month follow‐up to evaluate implementation. Result: Thirty‐six caregivers and eight clinic providers provided qualitative data that informed the clinical workflow integration plan. The same providers and 21 additional caregivers enrolled in the CareHeroes implementation demonstration study. While user data demonstrated that it was feasible for caregivers to share clinical information and engage in self‐support using CareHeroes, expected outcomes were confounded by complications during the COVID‐19 pandemic. Conclusion: Through using the implementation framework, several lessons were learned regarding potential success and challenges in integrating new HIT into clinical care to support dementia care and caregiving. [ABSTRACT FROM AUTHOR]

Background: Caregiving and clinical care for people living with dementia (PLWD) is complex and complicated by communication challenges among caregivers and providers (Gaugler et al., 2022; Ruggiano et al. 2012; 2019). These challenges can constrain decision making about treatment options (Hinton et al., 2007; Miller et al., 2016; Wolff et al., 2020) and may contribute to negative mental health outcomes often reported by family caregivers (Gaugler et al., 2022), which disproportionately impact vulnerable caregivers (e.g., underserved racial/ethnic groups, rural caregivers (Abner et al., 2016; Fabius et al., 2020)). Health information technology (HIT) has been identified as a potential solution to communication challenges in dementia care (Ruggiano et al., 2019; Vedel et al., 2013). However, few studies have reported how to effectively integrate new HIT into practice to support provider‐caregiver communication. In this study, a four‐stage implementation science framework (Meyers et al., 2012) was used to integrate a newly developed web‐based application (app) technology, called CareHeroes (Brown et al., 2016), into clinical practice at two memory clinics to promote caregiver‐physician communication. CareHeroes is multi‐functional and allows secure sharing of patient‐related clinical information between caregivers and providers. It also provides education and support, including an educational chatbot that provides tailored, expert feedback to caregiver questions. Method: Early stages of implementation involved interviews with caregivers and focus groups with clinic providers to develop a clinical workflow integration plan for the new app. Then, the research team collected user data collected through the app during implementation as well as caregiver psychosocial outcome data (e.g., depression, burden) at baseline and 3‐month follow‐up to evaluate implementation. Result: Thirty‐six caregivers and eight clinic providers provided qualitative data that informed the clinical workflow integration plan. The same providers and 21 additional caregivers enrolled in the CareHeroes implementation demonstration study. While user data demonstrated that it was feasible for caregivers to share clinical information and engage in self‐support using CareHeroes, expected outcomes were confounded by complications during the COVID‐19 pandemic. Conclusion: Through using the implementation framework, several lessons were learned regarding potential success and challenges in integrating new HIT into clinical care to support dementia care and caregiving. [ABSTRACT FROM AUTHOR]

Haitian nurses live in a precarious environment, with healthcare disparity and low wages. In the presence of significant politicosocial- economic disparities, adverse effects of natural disasters, deleterious infrastructure, challenged self-boundaries, and the burden of caring for high-need patients, the authors sought a better understanding of nurses' perspective of the situation. During qualitative interviews, Haitian nurses in two faith-based hospitals (N = 17) reported feeling powerless yet exhibited resilience and dedication to nursing as a calling. These conditions cry out for support of nurses' self-care needs. Future interventions may help nurses identify better resources to care for themselves and guide their practice. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care. Problem: Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD. Approach: This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions. Outcomes: Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD. Conclusion: The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly. [ABSTRACT FROM AUTHOR]

Background: Evaluating the impact of communication during clinical encounters is complex. One behaviour, largely ignored in clinical practice and training, is interruptions in verbal communication. Two types exist: an 'overlap' (an error projecting when a turn ends); and an 'interruption' (when an individual starts talking before the speaker's turn is complete). This paper reports the prevalence of these behaviours during initial consultations involving physiotherapists and patients with back pain. Method: 25 initial back pain consultations were observed, audio-recorded, transcribed verbatim, analysed thematically and managed using a Framework approach. Results: The data set comprised 15,489 turns: 7659 by patients; 7647 by clinicians; and 183 by others (patients' spouse or clinical colleagues). Clinicians were 7 times more likely to interrupt than patients (284 and 39 respectively), however overlaps were 1.5 times more prevalent among patients (n = 582) compared to clinicians (n = 385). The main functions for interruptions by clinicians and patients were to 'seek' or 'give' additional information respectively. A trend was noted that female physiotherapists were 3 times more likely to interrupt than male clinicians and overall, the prevalence of interruptions in same-sex consultations was twice as likely as in mixed-sex encounters, however the small sample size precluded secondary analyses. Conclusion: Alongside measuring the prevalence of interruptions in back pain consultations, this study identified differences in the nature of interruptions made by physiotherapists and patients. It highlights the complexity of clinical encounters and that being aware of interruptions is important to optimize rapport and clinician-patient relationships. [ABSTRACT FROM AUTHOR]

Empathy is considered essential to creating a positive clinician-patient relationship, along with improving patient experience and adherence to treatment. It is not clear how physiotherapists acquire their empathic skills. This study explored physiotherapists’ perceptions of empathy during musculoskeletal clinical encounters. Seventeen participants attended three focus groups separated by clinical employment grade. The definition of empathy, its acquisition and impact on a clinical encounter were discussed, audio-recorded, transcribed verbatim and analysed thematically. Six key themes and 48 sub-themes were identified. Empathy was defined similarly in all three focus groups. There was divergence on its acquisition and the extent to which it can be taught, however participants agreed that empathy is an innate characteristic. Senior physiotherapists placed greater emphasis on the importance of empathic communication than student physiotherapists, whilst student and junior physiotherapists considered limited clinical experience to be a barrier in delivering empathic communication, anticipating this to improve over time. This study identified a mismatch between the perceived importance of empathic communication in the literature and by clinicians, compared with the time spent acquiring and developing these skills. Clinicians need to place a greater emphasis on enhancing their empathic communication skills throughout their career to help create a positive patient experience and enhance clinician-patient relationships. [ABSTRACT FROM PUBLISHER]

Objective: To investigate the effects of ballroom and Latin American dancing classes on turning in people with Parkinson's.Design: This study employed a randomised, controlled, experimental design.Setting: Dance classes were performed in a community dance centre in Southern England and all assessments took place a gait laboratory.Participants: Twenty-seven people with mild-moderate Parkinson's participated.Intervention: Participants were randomly allocated to receive either 20, 1-h dancing classes over 10 weeks (n=15), or a 'usual care' control group (n=12).Main Outcome Measure: Twelve, 180° on-the-spot turns to the predicted/un-predicted and preferred/un-preferred direction were analysed for each participant, using 3-dimensional motion analysis before and after the intervention period, alongside clinical measures.Results: Movement of the head, pelvis, and feet during turning in people with Parkinson's are affected by dancing with tighter coupling of body segments. Significant 4-way interactions between the groups, over time and turn style, with longer latency of the head (p=0.008) and greater rotation in the pelvis (p=0.036), alongside a trend of slower movement of the first (p=0.063) and second (p=0.081) foot in controls were shown, with minimal change in dancers. All interactions were affected by the type of turn. No significant differences were found in the centre of mass displacement, turn time or clinical measures.Conclusion: Those who danced were better able to coordinate their axial and perpendicular segments and surprisingly became more 'en bloc' in their turning behaviour, suggesting this may be a beneficial adaptation, rather than a maladaptive result of Parkinson's, as previously suggested. [ABSTRACT FROM AUTHOR]

Background The ability of physiotherapists to make clinical decisions is a vital component of being an autonomous practitioner, yet this complex phenomenon has been under-researched in cardiorespiratory physiotherapy. The purpose of this study was to explore clinical decision-making (CDM) by experienced physiotherapists in a scenario of a simulated patient experiencing acute deterioration of their respiratory function. Objectives The main objective of this observational study was to identify the actions, thoughts, and behaviours used by experienced cardiorespiratory physiotherapists in their clinical decision-making processes. Design A mixed-methods (qualitative) design employing observation and think-aloud, was adopted using a computerised manikin in a simulated environment. Setting The participants clinically assessed the manikin programmed with the same clinical signs, under standardised conditions in the clinical skills practice suite, which was set up as a ward environment. Participants Experienced cardiorespiratory physiotherapists, recruited from clinical practice within a 50-mile radius of the University(*). Methods Participants were video-recorded throughout the assessment and treatment and asked to verbalise their thought processes using the 'think-aloud' method. The recordings were transcribed verbatim and managed using a Framework approach. Results Eight cardiorespiratory physiotherapists participated (mean 7 years clinical experience, range 3.5–16 years. CDM was similar to the collaborative hypothetico-deductive model, five-rights nursing model, reasoning strategies, inductive reasoning and pattern recognition. However, the CDM demonstrated by the physiotherapists was complex, interactive and iterative. Information processing occurred continuously throughout the whole interaction with the patient, and the specific cognitive skills of recognition, matching, discriminating, relating, inferring, synthesising and prediction were identified as being used sequentially. Conclusions The findings from this study were used to develop a new conceptual model of clinical decision-making for cardiorespiratory physiotherapy. This conceptual model can be used to inform future educational strategies to prepare physiotherapists and nurses for working in acute respiratory care. [ABSTRACT FROM AUTHOR]

Introduction This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. Discussion It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Conclusion Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. [ABSTRACT FROM AUTHOR]

In a US population of adult male and female Sikh immigrant participants (N = 350), we explored sociocultural factors related to depression, giving participants a choice between English or Punjabi surveys. Language preference pointed to a subgroup with higher levels of depression and lower satisfaction with life. Underreporting of depression suggests a general reluctance to discuss depression. While multiple sociocultural variables were associated with depression bivariably, multivariate analysis identified negative religious coping and anxiety as unique predictors of depression. Community interventions should tap into the protective close-knit social fabric of this community as an opportunity to change the stigma of mental health. [ABSTRACT FROM AUTHOR]

Introduction Employing allied health professionals in extended scope roles has developed relatively recently in health-care. Within physiotherapy, the extended role has provided clinicians with autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) and X-ray as part of the diagnostic process, a practice beyond the traditional scope of physiotherapy. In these advancing roles, little is written about the clinical reasoning processes that clinicians use in managing patients with musculoskeletal pain and knowledge of these processes would advance training for new recruits to this arena. Study This qualitative study has explored the processes by which extended scope physiotherapists (ESPs) clinically reason their decisions regarding patients reporting low back pain in a musculoskeletal outpatient setting. The study used a multiple case study design informed by grounded theory methodology, using focus groups (involving ESPs and non-ESPs/musculoskeletal physiotherapists) and semi-structured interviews with a think-aloud method (ESPs only) to investigate these processes. Conclusions The themes identified include: prior thinking; patient interaction; formal testing; time; safety and accountability; external and internal factors; and gut-feeling (which challenges current physiotherapy models of reasoning). Extended scope physiotherapists reported experiencing greater stress due to higher levels of perceived accountability, safety requirements and internal drivers for competence than non-ESPs. Further research is indicated to explore the role of gut-feeling in musculoskeletal physiotherapy clinical reasoning. [ABSTRACT FROM AUTHOR]

Abstract: Effective communication between healthcare professionals and their patients is crucial for successful consultations, and can profoundly affect patients' adherence to treatment. Despite this evidence, communication within the physiotherapy profession is still underexplored, in particular, how ‘best’ to open clinical encounters. This study explores the issue by seeking the preferences of physiotherapists for opening encounters in the adult musculoskeletal outpatient setting. Initially, 42 consultations and 17 first follow-up encounters were observed between qualified physiotherapists and patients with back pain. These encounters were audio-recorded, analysed and used to develop a questionnaire to determine clinicians' preferences for opening encounters. From these findings, a synopsis of the questionnaire was posted on the four most-relevant professional networks of the national, interactive Chartered Society of Physiotherapy (iCSP) website, to canvass opinion more widely. Among the 43 physiotherapists who responded, the preferred ‘key clinical question’ for an initial encounter was: “Do you want to just tell me a little bit about [your ‘problem presentation’] first of all?”; and for follow-up encounters: ‘How have you been since I last saw you?’ These results provide an important and novel contribution to the profession, as debate on this issue has not previously been published. Although the sample size in this study is small, the aim of this paper is to generate reflection and debate among clinicians on their preferences for opening patient encounters and optimising the non-specific treatment effects. [Copyright &y& Elsevier]

Staphylococcus pseudintermedius is a commensal and opportunistic pathogen of dogs. It is mainly implicated in canine pyoderma, as well as other suppurative conditions of dogs. Although bacterial culture is routinely used for clinical diagnosis, molecular methods are required to accurately identify and differentiate S. pseudintermedius from other members of the Staphylococcus intermedius group. These methods, owing largely to their cost, are not easy to implement in nonspecialized laboratories or veterinary practices. In the current study, loop-mediated isothermal amplification (LAMP), a novel isothermal nucleic acid amplification procedure, was employed to develop a rapid, specific, and sensitive S. pseudintermedius assay. Different detection strategies, including the use of a lateral flow device, were evaluated. The assay was evaluated for cross-reactivity against 30 different bacterial species and validated on a panel of 108 S. pseudintermedius isolates, originating from different dog breeds and locations within the United Kingdom. The assay was specific, showing no cross-reactivity during in silico and in vitro testing. When tested using DNA extracts prepared directly from 35 clinical surgical site swabs, the assay could detect S. pseudintermedius in less than 15 min, with a diagnostic sensitivity of 94.6%, superior to that of a polymerase chain reaction method. The LAMP assay also had an analytical sensitivity in the order of 101 gene copies, and the amplified products were readily detected using a lateral flow device. The LAMP assay described in the present study is simple and rapid, opening up the possibility of its use as a diagnostic tool within veterinary practices. [ABSTRACT FROM AUTHOR]

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Abstract: The purpose of this quality improvement initiative was to enhance service delivery and patient experience in a musculoskeletal out-patient setting. A cross-sectional survey, with 6 annual stages, evaluated the musculoskeletal outpatient physiotherapy service in a large National Health Service hospital in Southern England. The population comprised 1095 patients, referred by medical staff to the service from rheumatology, orthopaedics, pain clinic and occupational health departments. The individual clinician-initiated strategies for quality improvement included: cue cards; reminders; reflections and training. The systems-changes comprised revised documentation and booking systems. The primary outcome was patient experience, measured with the Chartered Society of Physiotherapy''s standardised ‘Patients feedback’ questionnaire. Attendance data was a secondary outcome. This initiative showed that strategies to motivate individual clinicians to change their behaviour were unsuccessful, whereas system-changes resulted in 32/37 improvements (8 statistically significant) in patient experience. Furthermore, the revised systems resulted in a 6% decrease in wasted appointments. It is essential that clinical services are evaluated through the eyes of their users. This initiative demonstrates the value of service evaluations (alongside research) and the importance of patient feedback to show how it can drive change and positively impact upon health-care experiences. Furthermore, this work has shown that active implementation strategies with systems-level changes produced greater improvements in service quality and patient experience, than simply encouraging and supporting clinicians to change their behaviour. [Copyright &y& Elsevier]

Abstract: This case study charts the progress of a 60-year-old angling coach presenting with a complex upper quadrant dysfunction. Following a brief summary of the history and physical examination, the main focus of the paper explores the mechanical and physiological rationale for adopting a neurodynamic approach for a proposed double crush condition. This case further highlights mismatches that arose between the clinical findings and traditional healing timescales, and the importance of considering pathomechanics of the whole quadrant in complex clinical circumstances. [Copyright &y& Elsevier]

The article evaluates the architectural design of Jane Addams' Hull-House Museum in founded by Jane Addams and Ellen Gates Starr.

Abstract: Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Objective: To review the current evidence for the signs and symptoms of cauda equina syndrome (CES). Data Sources: Relevant literature sourced through Medline, Embase, and CINAHL using the key search words “cauda equina syndrome” combined with “definition,” “clinical presentation,” “signs and symptoms,” “pathology,” and “etiology.” Study Selection: Not applicable. Data Extraction: Not applicable. Data Synthesis: Three reviewers independently extracted data on CES from the literature specific to its definition, clinical presentation, and etiology. Of 111 articles, 105 were included for review, and relevant information on CES was synthesized into a framework structured as per a clinical consultation. A content analysis was then conducted using the method adopted by the Chartered Society of Physiotherapy whereby the level of consensus for each sign and symptom of CES was determined by its percentage coverage within the literature: 100% coverage equals unanimity, 75% to 99% equals consensus, 51% to 74% equals majority view, and 0% to 50% equals no consensus. This enabled the frequency of each reported sign and symptom to be ranked. Articles that included specific definitions for CES were divided into 3 categories: those that (1) included generalized statements, (2) stated a pathomechanical basis, and (3) defined the syndrome by its clinical presentation. Throughout this review, the frequencies of specific etiologies and pathologies were noted. Together with details of clinical presentation, this enabled a comprehensive review of CES. No single aspect of CES within the literature achieved unanimity or consensus; however, a majority view indicated that there would be bladder and sensory disturbance (74% and 66% of all articles, respectively). The most commonly cited pathology resulting in CES was identified as the disk (45% of all articles reviewed). Conclusions: There are marked inconsistencies in the current evidence base surrounding the etiology and clinical presentation of CES, with 17 definitions identified. Subclassifications of the definition of CES are ambiguous and should be avoided. From reviewing 105 articles, a single definition of CES is proposed. For a diagnosis of CES, one or more of the following must be present: (1) bladder and/or bowel dysfunction, (2) reduced sensation in the saddle area, and (3) sexual dysfunction, with possible neurologic deficit in the lower limb (motor/sensory loss, reflex change). [Copyright &y& Elsevier]