Abstract
BackgroundEvidence 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.ObjectivesThis study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits.MethodsIn 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.ResultsThe 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).ConclusionsDespite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.
Highlights
In recent years, the digital revolution and the near-universal spread of Internet have changed the doctor–patient communication and the way clinicians take care of patients
Patients who accepted to undergo TM visits exhibited a mean age at study entry of 38.4 ± 9.2 years, 31 (77.5%) were resident outside the municipality of Catania, and 21 (52.5%) graduated from high school (52.5%)
The unwillingness to undergo TM visits was the reason for refusal for 20 out of 36 patients (55.6%), while 5 (13.9%) were not inclined to undergo in-person visit due to COVID-19 pandemic, 3 (8.3%) had some difficulties in using technologies, and 2 (5.6%) did not succeed in initiating TM visit
Summary
The digital revolution and the near-universal spread of Internet have changed the doctor–patient communication and the way clinicians take care of patients. During the Coronavirus Disease 2019 (COVID19) pandemic, the need to find an alternative way to manage chronic diseases, despite travel restrictions and bans on gatherings, has emerged. In this context, TM has allowed clinicians and healthcare providers to share information with patients outside the hospital or the outpatient setting [4], to guide neurorehabilitation for disabled patients [5] and to perform visits through videoconferencing. 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. Conclusions Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability
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