Telemedicine in Neurosurgery: Standardizing the Spinal Physical Examination Using A Modified Delphi Method

被引:9
作者
Haddad, Alexander F. [1 ]
Burke, John F. [1 ]
Mummaneni, Praveen, V [1 ]
Chan, Andrew K. [1 ]
Safaee, Michael M. [1 ]
Knightly, John J. [2 ]
Mayer, Rory R. [1 ]
Pennicooke, Brenton H. [1 ]
Digiorgio, Anthony M. [1 ]
Weinstein, Philip R. [1 ]
Clark, Aaron J. [1 ]
Chou, Dean [1 ]
Dhall, Sanjay S. [1 ]
机构
[1] Univ Calif San Francisco, Dept Neurol Surg, 505 Parnassus Ave,M-779, San Francisco, CA 94143 USA
[2] Atlantic Neurosurg Specialists, Morristown, NJ USA
关键词
Telemedicine; Neurosurgery; Telehealth; Neurologic exam; Delphi method; RANDOMIZED CONTROLLED-TRIAL; LOW-BACK-PAIN; FOLLOW-UP; MALPRACTICE LITIGATION; MEDICAL MALPRACTICE; CARE; PILOT; FEASIBILITY; TELEREHABILITATION; EXPERIENCE;
D O I
10.14245/ns.2040684.342
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: The use of telemedicine has dramatically increased due to the coronavirus disease 2019 pandemic. Many neurosurgeons are now using telemedicine technologies for preoperative evaluations and routine outpatient visits. Our goal was to standardize the telemedicine motor neurologic examination, summarize the evidence surrounding clinical use of telehealth technologies, and discuss financial and legal considerations. Methods: We identified a 12-member panel composed of spine surgeons, fellows, and senior residents at a single institution. We created an initial telehealth strength examination protocol based on published data and developed 10 agree/disagree statements summarizing the protocol. A blinded Delphi method was utilized to build consensus for each statement, defined as > 80% agreement and no significant disagreement using a 2-way binomial test (significance threshold of p<0.05). Any statement that did not meet consensus was edited and iteratively resubmitted to the panel until consensus was achieved. In the final round, the panel was unblinded and the protocol was finalized. Results: After the first round, 4/10 statements failed to meet consensus (< 80% agreement, and p=0.031, p=0.031, p=0.003, and p=0.031 statistical disagreement, respectively). The disagreement pertained to grading of strength of the upper (3/10 statements) and lower extremities (1/10 statement). The amended statements clarified strength grading, achieved consensus (> 80% agreement, p>0.05 disagreement), and were used to create the final telehealth strength examination protocol. Conclusion: The resulting protocol was used in our clinic to standardize the telehealth strength examination. This protocol, as well as our summary of telehealth clinical practice, should aid neurosurgical clinics in integrating telemedicine modalities into their practice.
引用
收藏
页码:292 / 302
页数:11
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