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Assessment of variability in motor grading and patient-reported outcome reporting: a multi-specialty, multi-national survey

  • Original Article Peripheral Nerves
  • Published:
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Abstract

Background

The goal of this survey-based study was to evaluate the current practice patterns of clinicians who assess patients with peripheral nerve pathologies and to assess variance in motor grading on the Medical Research Council (MRC) scale using example case vignettes.

Methods

An electronic survey was distributed to clinicians who regularly assess patients with peripheral nerve pathology. Survey sections included (1) demographic data, (2) vignettes where respondents were asked to assess on the MRC scale, and (3) assessment of practice patterns regarding the use of patient-reported outcome measures. Inter-rater reliability statistics were calculated for the application of the MRC scale on example vignettes.

Results

There were 109 respondents. There was significant dispersion in motor grading seen on the example vignettes. For the raw responses grading the example vignettes on the MRC scale, Krippendorff’s alpha was 0.788 (95% CI 0.604, 0.991); Gwet’s AC2 was 0.808 (95% CI 0.683, 0.932); Fleiss’ kappa was 0.416 (95% CI 0.413, 0.419). Most respondents reported not utilizing any patient-reported outcome measures across peripheral nerve pathologies.

Discussion

Our data show that there is significant disagreement among providers when applying the MRC scale. It is important for us to reassess our current tools for patient evaluation in order to improve upon both clinical evaluation and outcomes reporting. Consensus guidelines for outcomes reporting are needed, and domains outside of manual muscle testing should be included.

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Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Brandon W. Smith & Robert J. Spinner

  2. Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA

    Sarada Sakamuri

  3. Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA

    Kara E. Flavin

  4. Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA, 94305, USA

    Michael Jensen, David A. Purger & Thomas J. Wilson

  5. Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA

    Lynda J.-S. Yang

Authors
  1. Brandon W. Smith
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  2. Sarada Sakamuri
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  3. Kara E. Flavin
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  4. Michael Jensen
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  5. David A. Purger
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  6. Lynda J.-S. Yang
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  7. Robert J. Spinner
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  8. Thomas J. Wilson
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Corresponding author

Correspondence to Thomas J. Wilson.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Completing the voluntary survey was considered consent to participate.

Conflict of interest

The authors declare that they have no conflict of interest.

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This article is part of the Topical Collection on Peripheral Nerves

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Smith, B.W., Sakamuri, S., Flavin, K.E. et al. Assessment of variability in motor grading and patient-reported outcome reporting: a multi-specialty, multi-national survey. Acta Neurochir 163, 2077–2087 (2021). https://doi.org/10.1007/s00701-021-04861-9

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  • DOI: https://doi.org/10.1007/s00701-021-04861-9

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