Reliability of televisits for patients with mild relapsing–remitting multiple sclerosis in the COVID-19 era

Abstract

Background Evidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely. Objectives This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits. Methods In total, 76 patients with relapsing–remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants. Results The inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70–0.91; p < 0.001). Conclusions Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.

Remote visits for people with multiple sclerosis during the COVID-19 pandemic in Austria: The TELE MS randomized controlled trial

“… 10 , 11 , 25 This development is facilitated by the availability of validated tools that can remotely monitor MS-related disability, for instance via a structured virtual neurological exam, the assessment of health-related quality of life or cognitive functions 26 . 27 There is emerging evidence that pwMS appreciate attempts in remote monitoring as they foster adherence and save time. Our present investigation emphasizes the importance of promoting telehealth concepts in pwMS as we provide evidence from a randomized controlled trial illustrating non-inferior satisfaction with remote visits over the phone or via videochat compared to conventional visits for both pwMS and their treating neurologists.…”

The Viewpoint of Informal Carers of People with Multiple Sclerosis in Digital Health Research: A Scoping Review

“…One article was published in 2014 [15], two in 2016 [16,17], one in 2018 [18], three in 2020 [19][20][21], four in 2021 [22][23][24][25] and three in 2022 [26][27][28]. Six of the included studies were conducted in the United States [18-21, 24, 27], two in Australia with international participants (the educational intervention was in English) [23,26], two in Italy [25,28], one in Spain [16], one in Germany [22], one in Belgium [15] and one in the United Kingdom [17].…”

“…Represents in what part of the research article informal carers were mentioned. [16,18,20,21,24,25,27,28] 6studies [15,17,19,22,23,26] F&F appeared in the results or discussion section of the research 11 studies [16][17][18][19][21][22][23][24][25][26][27][28] 2 studies [15,20]…”

“…Six out of 14 included studies were about telemedicine, meaning they arranged video appointments instead or in addition to in-person appointments at the clinic [18,19,24,25,27,28]. Video appointment was organized with Zoom [18], VSee [19], Express Care Online telemedicine platform [24], or Skype [25,28]. In one study software that was used in telemedicine was not mentioned [27].…”

Virtual Management of Multiple Sclerosis: Providing Access or Just Phoning it in?

“…8 Telemedicine may be effective for some evaluations of neurological disability but has been shown to be less useful in assessing brainstem, cerebellar, bowel/bladder, and sensory functional systems. 9,10 As many of these changes are associated with a worse prognosis, telemedicine may overlook findings that could have a significant impact on long-term outcomes if not promptly managed.…”