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

Authors

Riley Bove, University of California, San Francisco
Carolyn Bevan, University of California, San Francisco
Elizabeth Crabtree, University of California, San Francisco
Chao Zhao, University of California, San Francisco
Refujia Gomez, University of California, San Francisco
Priya Garcha, University of California, San Francisco
John Morrissey, University of California, San Francisco
Jason Dierkhising, University of California, San Francisco
Ari J. Green, University of California, San Francisco
Stephen L. Hauser, University of California, San Francisco
Bruce A.C. Cree, University of California, San Francisco
Mitchell T. Wallin, VA MS Center of Excellence East
Jeffrey M. Gelfand, University of California, San Francisco

Document Type

Journal Article

Publication Date

10-1-2019

Journal

Multiple Sclerosis Journal

Volume

25

Issue

11

DOI

10.1177/1352458518793527

Keywords

digital health; disability; multiple sclerosis; remote trials; Telemedicine

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.

APA Citation

Bove, R., Bevan, C., Crabtree, E., Zhao, C., Gomez, R., Garcha, P., Morrissey, J., Dierkhising, J., Green, A., Hauser, S., Cree, B., Wallin, M., & Gelfand, J. (2019). Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis. Multiple Sclerosis Journal, 25 (11). http://dx.doi.org/10.1177/1352458518793527