Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis

Author:

Bove Riley1,Bevan Carolyn1,Crabtree Elizabeth1,Zhao Chao1,Gomez Refujia1,Garcha Priya1,Morrissey John1,Dierkhising Jason1,Green Ari J1,Hauser Stephen L1,Cree Bruce AC1,Wallin Mitchell T23,Gelfand Jeffrey M1

Affiliation:

1. UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA

2. VA MS Center of Excellence East, Washington, DC, USA

3. Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA

Abstract

Background: Remote assessment of neurological disability in people with multiple sclerosis (MS) could improve access to clinical care and efficiency of clinical research. Objective: To develop and validate a telemedicine-based MS disability examination that does not require an in-home examiner. Methods: Adults with MS were recruited after a standardized in-person Expanded Disability Status Scale (EDSS) evaluation, and within 1 week underwent a blinded televideo-enabled EDSS examination with a different clinician. EDSS and tele-EDSS scores were compared. Results: Overall, 41 adults participated (mean (standard deviation (SD)) age: 47.0 years (11.6); median EDSS: 2 (range: 0–7)); 37 required no in-home assistance for the tele-EDSS evaluation (e.g. help positioning camera). Mean difference between EDSS and tele-EDSS was 0.34 (95% confidence interval (CI): 0.07–0.61). For 88% of evaluations, tele-EDSS and EDSS scores were within 1 point (similar to reported in-person inter-rater differences). Unweighted kappa for agreement within 0.5 point was 0.72. Correlation for individual functional systems (FS) ranged from modest (vision: 0.37) to high (bowel/bladder: 0.79). Overall correlation between EDSS and tele-EDSS was 0.89 ( p < 0.0001); and 0.98 ( p < 0.0001) at EDSS range: 4–7. Conclusion: In this proof of principle study, disability evaluation in mild to moderate MS is feasible using telemedicine without an aide at the patient’s location.

Funder

National Multiple Sclerosis Society

Publisher

SAGE Publications

Subject

Clinical Neurology,Neurology

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