Evidence map›Paper›PMID 34218612›Full record

ArticleNeurospine2021

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

Alexander F Haddad, John F Burke, Praveen V Mummaneni, Andrew K Chan, Michael M Safaee, John J Knightly, Rory R Mayer, Brenton H Pennicooke, Anthony M Digiorgio, Philip R Weinstein and 3 more

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurospine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 12 citations in OpenAlex.

  1. Article
  2. The role of advocacy and policy in advancing global neurosurgery.Annals of medicine and surgery (2012) · 2025
    Review
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

Alexander F HaddadDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
John F BurkeDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Praveen V MummaneniDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Andrew K ChanDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Michael M SafaeeDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
John J KnightlyAtlantic Neurosurgical Specialists, Morristown, NJ, USA.
Rory R MayerDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Brenton H PennicookeDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Anthony M DigiorgioDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Philip R WeinsteinDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Aaron J ClarkDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Dean ChouDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
Sanjay S DhallDepartment of Neurological Surgery, University of California, San Francisco, CA, USA.
University of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe 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.

methodsWe 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.

resultsAfter 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.

conclusionThe 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.

Indexed as

Delphi methodNeurologic examNeurosurgeryTelehealthTelemedicine

Identifiers

PMID34218612
PMCPMC8255762
OpenAlexW3173679999

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.