Portal de Periódicos da CAPES

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

2018; SAGE Publishing; Volume: 25; Issue: 11 Linguagem: Inglês

10.1177/1352458518793527

1477-0970

Riley Bove, Carolyn Bevan, Elizabeth Crabtree, Chao Zhao, Refujia Gomez, Priya Garcha, John Morrissey, Jason Dierkhising, Ari Green, Stephen L. Hauser, Bruce Cree, Mitchell T. Wallin, Jeffrey M. Gelfand,

Systemic Sclerosis and Related Diseases

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.