Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;18(2):292-302.
doi: 10.14245/ns.2040684.342. Epub 2021 Jun 30.

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

Alexander F Haddad  1 , John F Burke  1 , Praveen V Mummaneni  1 , Andrew K Chan  1 , Michael M Safaee  1 , John J Knightly  2 , Rory R Mayer  1 , Brenton H Pennicooke  1 , Anthony M Digiorgio  1 , Philip R Weinstein  1 , Aaron J Clark  1 , Dean Chou  1 , Sanjay S Dhall  1
Affiliations

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

Alexander F Haddad et al. Neurospine. 2021 Jun.

Abstract

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.

Keywords: Delphi method; Neurologic exam; Neurosurgery; Telehealth; Telemedicine.

PubMed Disclaimer

Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Line graph of video visits at our spine surgery clinic in the weeks following the city-mandated shelter-in-place order. Daily video visits (thin black line) and the 3-day video visit moving average are shown (thick red line).
Fig. 2.
Fig. 2.
Percentage of agreement on Delphi consensus statements regarding spine physical exam maneuvers in round 1 (A) and round 2 (B). The consensus threshold was 80% (red dashed line); 95% consensus, used as an expected outcome in 2 tailed binomial testing of significant disagreement, is indicated by the green dashed line. The green asterisk indicates statements that had significant disagreement.
Fig. 3.
Fig. 3.
A consensus-based tele-strength examination as a result of our modified Delphi method. UCSF, University of California, San Francisco.
Fig. 4.
Fig. 4.
A simulated patient example of the spine telemedicine motor exam performed over an audio/visual communication modality.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377:1585–92. - PubMed
    1. Rockville (MD): Health Resources & Services Administration; Telehealth programs [Internet] [cited 2020 Apr 8]. Available from: https://www.hrsa.gov/about/contact/index.html.
    1. Kahn EN, La Marca F, Mazzola CA. Neurosurgery and telemedicine in the United States: assessment of the risks and opportunities. World Neurosurg. 2016;89:133–8. - PubMed
    1. United States Department of Health and Human Services . Secretary Azar announces historic expansion of telehealth access to combat COVID-19. Washington, DC: United States Department of Health and Human Services; 2020.
    1. Opening up America again. Washington, DC: The White House; 2020.