Telephone consultation for myasthenia gravis care during the COVID‐19 pandemic: Assessment of a novel virtual myasthenia gravis index

Abstract

Introduction/Aims: The aim of the study was to determine the association between the virtual Myasthenia Gravis Impairment Index (vMGII) with other patient-reported outcomes (PROs) of myasthenia gravis (MG) and its usefulness in telephone consultations with MG patients.Methods: This was a retrospective case series in which vMGII score along with virtual Single Simple Question (vSSQ), virtual Patient-Acceptable Symptom State PASS (vPASS) response, and patient disease status based on Myathenia Gravis Foundation of America postintervention status were collected during telephone consultation along with the MGII, SSQ, and PASS responses during the preceding in-person clinic visits.Results: In 214 patients, the mean difference of vMGII between the vPASS "Yes" and "No" groups was −14.2 ± 1.4 (95% confidence interval, −16.9 to −11.3; P < .001) with mean vMGII for vPASS "Yes" group being 6.4 ± 7.7 and vPASS "No" being 20.5 ± 11.5. A vMGII of 11.5 or higher predicted vPASS "yes" response with a sensitivity of 78.7% and specificity of 81.4%. A strong negative correlation was found between the vMGII and vSSQ (r = −.667; P < .001). The mean vMGII was 0.48 ± 1.42 for patients in remission, and 9.31 ± 10.93 for improved, 9.32 ± 8.79 for stable, and 22.58 ± 14.04 for worsened groups (P < .001). These associations were the same as those obtained during the preceding in-person clinic visit and the direction of change in MGII scores also indicated change in disease status. Discussion: vMGII is an effective measure to assess an MG patient's disease status in telephone consultations and relates well with other PRO measures. The vMGII remains reliable for assessing MG disease status even with removal of the physical examination component.

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort

“…NMD patients were afraid of COVID-19—this was a limiting factor for clinical assessments and follow-up. However, taken together, fear and social restrictions seem to have also contributed to reducing the risk of infection in MG patients [ 5 , 8 ]; indeed, many centres and neurologists adopted telemedicine and telephone consultations in their clinics [ 42 , 43 ]. As a consequence, only about 10% of patients in our population were affected by COVID-19.…”

Retrospective study on the safety of COVID‐19 vaccination in myasthenia gravis

“…When the questionnaire section is obtained during a telephone consultation, foregoing the physical examination item scores, we use the adapted version of the MGII; the virtual MGII (vMGII), which has an excellent correlation with patient disease status. 18 The SSQ asks the patient the question: “what percentage of normal do you feel regarding your MG? In this score 100% is normal, and this question reflects the patient's perception of their overall disease status.…”

Development and validation of the Myasthenia Gravis TeleScore (MGTS)

“…Recently in MG, Menon et al evaluate a virtual MG Impairment Index through telephone consultation and compare it with other patients reported outcomes. They showed that virtual MG Impairment Index was an effective measure of disease status in telephone consultations [ 11 ]. However, the study was not addressed to evaluate clinically MG patients in an out-patient setting.…”

“…Ricciardi et al made some suggestions for MG patients’ evaluation [ 10 ] while Menon et al evaluate a virtual MG Impairment Index through telephone consultation [ 11 ]; however, there is a lack of specific disease tools to evaluate clinically patients in an homogenous and objective way, especially for neuromuscular diseases. Some suggestions on how to evaluate MG patients in telemedicine have been given and a score proposed [ 12 ].…”