Article Figures & Data
Figures
- Figure 1
Geographical origin of videos by surgery.
- Figure 2
Surgery for video category.
- Figure 3
Clinical score by category by surgery. Error bars represent the SEM; P = 0.02.
- Figure 4
JAMA score by category by surgery. Error bars represent the SEM; P = 0.004.
- Figure 5
Informative score by category by surgery. Error bars represent the SEM; P = 0.46.
- Figure 6
Clinical score by video duration (fusion). The shaded area indicates a 95% confidence interval.
- Figure 7
Clinical score by video duration (arthroplasty). The shaded area indicates a 95% confidence interval.
Tables
Score Assessment Criteria 5 Excellent Indication, outcome, complications, alternative, procedure description, or peer-reviewed literature 4 High Indication, outcome, complications, alternative, or procedure description 3 Moderate Indication, outcome, complications, or procedure description 2 Low Indication, outcome, or procedure description 1 Unacceptable Omission of indication, outcome, or procedure description Informative Score Marking Criteria. In order to achieve a score, all criteria for that score must bemet. For example, videos excluding the indication for surgery, expected outcome of surgery ordescription of the procedure scored 1, even if other factors (eg. alternative options, complications)were mentioned
Fusion Arthroplasty Description Scoring Description Scoring Indication Commonly performed in degenerative conditions such as: intervertebral disc disease degenerative scoliosis spinal canal stenosis20,21 Mentions one degenerative condition Indication Primary indication: isolated discogenic low back pain without instability in a skeletally mature patient, and no more than a grade I spondylolisthesis12,22 Broadened indications: patients with prior surgery, such as microdiscectomy, prior fusion with ASD, and disc replacement below a previous long-segment fusion for scoliosis23,24 Mentions the primary indication. May mention broadened indications but must not mention inappropriate indications Sometimes performed in lumbar fusion is used for spondylolisthesis, traumatic conditions (fractures and dislocations), tumors (most commonly metastases)21 Mentions one Other indications23,24 Mentions that other indications are unproven Alternatives Nonoperative management21 Mentions at least two nonoperative options Alternatives Nonoperative management21 Same as fusion marking Other operative management21 Mentions one other operative management Operative management13,21,25 Mentions other operative managements (eg, fusion) Procedure Approaches to the lumbar spine21 Mentions the existence of other approaches Procedure Approach21 Mentions anterior approach Types of fusion26 Mentions the existence of other types of fusion Implant21,27 Describes the basic structure or function of any implant Complications Major complications 28,29: mortality, neurological deficit, DVT/PE, vascular injury, stroke, deep wound infection Mentions four major complications, including mortality and neurological deficit Complications Major complications (see fusion)13,28,29 Same as fusion marking Minor complications: 28,29 dural tear, misplaced screw causing radicular pain, UTI, superficial wound infection, postoperative anemia, ileus hematoma/seroma, pseudarthrosis, postoperative pain, adjacent segment disease Mentions any 4 Minor complications (see fusion)13,28,29 Same as fusion marking Outcomes Hospital stay: 2–6 d25 Mentions an accurate hospital stay Outcomes Hospital stay: 2–4 d25 Mentions appropriate hospital stay Satisfaction rates: 21,30,31 "clinical success" 41%, satisfied—80 % unless on "workers comp" then closer to 50 % Mentions an accurate figure Satisfaction rates:21,27 53 % clinical success per FDA criteria for pro-disc L, otherwise as per fusion success rates Mentions appropriate satisfaction rates Recovery: 32 4–6 wk to return to an office or sedentary job, 3 mo or longer to return to activities that are more physical Mentions accurate recovery times Recovery: around 3 mo33 Mentions appropriate recovery times, same as fusion accepted Clinical score marking rubric. Marking criteria based on clinical evidence (references provided) and set at the standard expected for a patient’s informed consent.
ASD, adjacent segment disease; DVT, deep vein thrombosis; FDA, Food and Drug Administration; PE, pulmonary embolism; UTI, urinary tract infection.
Tool Fusion Arthroplasty P Mean (SD) Range Mean (SD) Range JAMA score 1.57 (0.633) 1–3 1.70 (0.587) 1–3 0.32 Informative score 1.57 (0.792) 1–4 1.23 (0.666) 1–5 0.02 Clinical score 0.218 (0.137) 0-0.583 0.159 (0.118) 0-0.417 0.06 Overview of scores in each video category. Fusion videos had a significantly higher informative score (P = 0.02) and had higher clinical score which neared statistical significance (P = 0.06)
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