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Leavell Y, Meyers E, Mendelson A, Penna S, Brizzi K, Mehta AK. Outcomes and Issues Addressed by Palliative Care in the Neurology Clinic. Semin Neurol 2024. [PMID: 39084611 DOI: 10.1055/s-0044-1788770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Patients with neurological illnesses have many palliative care needs that need to be addressed in the outpatient clinical setting. This review discusses existing models of care delivery, including services delivered by neurology teams, palliative care specialists, telehealth, and home-based programs. We review the existing literature that supports these services and ongoing limitations that continue to create barriers to necessary clinical care for this vulnerable patient population.
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Affiliation(s)
- Yaowaree Leavell
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Neurology, Portland VA Healthcare System, Portland, Oregon
| | - Emma Meyers
- Department of Medicine, Section of Palliative Care, Beth Israel Deaconess Medical Center, Boston, Massachusettes
| | - Ali Mendelson
- Kaiser Permanente Medical Group, Seattle, Washington
| | - Sarah Penna
- Emory ALS Center, Emory Healthcare, Atlanta, Georgia
| | - Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusettes
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusettes
| | - Ambereen K Mehta
- Palliative Care Program, Division of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Gwathmey K, Heiman-Patterson TD. Multidisciplinary Clinics in Neuromuscular Medicine. Continuum (Minneap Minn) 2023; 29:1585-1594. [PMID: 37851044 DOI: 10.1212/con.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Multidisciplinary care is comprehensive, coordinated clinical care across medical disciplines and allied health professions. Neuromuscular disorders, such as amyotrophic lateral sclerosis and muscular dystrophies, are often associated with disabling weakness and extramuscular symptoms and may benefit from care in a model that consolidates numerous clinic visits into a single more efficient multidisciplinary clinic visit. The goal of the neuromuscular multidisciplinary care model is to improve patient outcomes, patient satisfaction, quality of life, access to medications and equipment, and survival. Although the costs of running a multidisciplinary clinic are high, they are likely associated with cost savings from the patient's perspective. Several barriers to acceptance of multidisciplinary clinics include the distance needed to travel to the clinic and the duration of the clinic visit. Telehealth multidisciplinary clinic visits may address some of these concerns. Further study is needed to understand the value of multidisciplinary clinics and is a necessary step toward creating a sustainable model.
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3
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Grogan J, Walsh S, Haulman A, Yazgi H, Geronimo A, Mamarabadi M, Simmons Z. Rapid Conversion to a Completely Virtual Multidisciplinary ALS Clinic in Response to the COVID-19 Pandemic: Implications for Future Care Delivery. J Clin Neuromuscul Dis 2023; 24:207-213. [PMID: 37219864 DOI: 10.1097/cnd.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The goals of this study were to assess the feasibility of maintaining multidisciplinary remote care, patient preferences, and outcomes of this transition because of COVID-19. METHODS From March 18, 2020 to June 3, 2020, 127 patients with amyotrophic lateral sclerosis (ALS) who were scheduled to be seen in our ALS clinic were contacted and scheduled according their preference for a telemedicine visit, telephone visit, or postponement until the next available in-person visit. Age, time from disease onset, ALS Functional Rating Scale-Revised, patient choices, and outcomes were recorded. RESULTS Patient visit preferences were 69% telemedicine, 21% telephone, and 10% postpone for a later in-clinic visit. Patients with higher ALS Functional Rating Scale-Revised were more likely to choose the next in-person opening (P = 0.04). Age and time from disease onset were not related to visit type preference. There were 118 virtual encounters, of which 91 (77%) began as telemedicine and 27 (23%) as telephone visits. Most telemedicine visits were conducted successfully, but 10 were converted to a telephone visit. The clinic maintained 88.6% of patient volume compared with the prior year, during which most visits were in-person. CONCLUSIONS Telemedicine care using synchronous videoconferencing is preferable and feasible for most patients on short notice, with telephone as back-up. Clinic volumes can be maintained. These findings support the conversion of a multidisciplinary ALS clinic to 1 with exclusively virtual visits when future events again disrupt in-person care.
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Affiliation(s)
- James Grogan
- Department of Neurology, Penn State University, Hershey, PA
| | - Susan Walsh
- ALS Association, Greater Philadelphia Chapter, Ambler, PA
| | - Anne Haulman
- Department of Neurology, Penn State University, Hershey, PA
| | - Habib Yazgi
- College of Medicine, Penn State University, Hershey, PA; and
| | - Andrew Geronimo
- Department of Neurosurgery, Penn State University, Hershey, PA
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Sharbafshaaer M, Buonanno D, Passaniti C, De Stefano M, Esposito S, Canale F, D'Alvano G, Silvestro M, Russo A, Tedeschi G, Siciliano M, Trojsi F. Psychological Support for Family Caregivers of Patients With Amyotrophic Lateral Sclerosis at the Time of the Coronavirus Disease 2019 Pandemic: A Pilot Study Using a Telemedicine Approach. Front Psychiatry 2022; 13:904841. [PMID: 35782440 PMCID: PMC9243390 DOI: 10.3389/fpsyt.2022.904841] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic confined most of the population to homes worldwide, and then, a lot of amyotrophic lateral sclerosis (ALS) centers moved to telemedicine services to continue to assist both patients with ALS and their caregivers. This pilot, randomized, controlled study aimed to explore the potential role of psychological support interventions for family caregivers of patients with ALS through resilience-oriented sessions of group therapy during the COVID-19 pandemic. In total, 12 caregivers agreed to be remotely monitored by our center since March 2020 and underwent scales for global burden (i.e., Caregiver Burden Inventory, CBI), resilience (i.e., Connor Davidson Resilience Scale, CD-RISC), and perceived stress (i.e., Perceived Stress Scale, PSS) at two-time points (i.e., at pre-treatment assessment and after 9 months or at post-treatment assessment). They were randomized into two groups: the former group underwent resilience-oriented sessions of group therapy two times a month for 3 months, while the latter one was only remotely monitored. No significant differences were found in CBI, CD-RISC, and PSS during the 9-month observation period in the treated group compared with the control group, suggesting a trend toward stability of caregiver burden together with resilience and perceived stress scores in all the subjects monitored. The lack of differences in caregivers' burden, resilience, and perceived stress scores by comparing the two groups monitored during 9 months could be due to the co-occurrence of the COVID-19 pandemic with the stressful events related to caring for patients with ALS that might have hindered the detection of significant benefits from short-lasting psychological support.
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Affiliation(s)
- Minoo Sharbafshaaer
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Daniela Buonanno
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Manuela De Stefano
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sabrina Esposito
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabrizio Canale
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia D'Alvano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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5
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Talal AH, Markatou M, Sofikitou EM, Brown LS, Perumalswami P, Dinani A, Tobin JN. Patient-centered HCV care via telemedicine for individuals on medication for opioid use disorder: Telemedicine for Evaluation, Adherence and Medication for Hepatitis C (TEAM-C). Contemp Clin Trials 2021; 112:106632. [PMID: 34813962 DOI: 10.1016/j.cct.2021.106632] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Telemedicine has the potential to increase healthcare access especially for vulnerable populations. Telemedicine for Evaluation, Adherence, and Medication for Hepatitis C (TEAM-C) is comparing telemedicine access to specialty medical care to usual care for management of hepatitis C virus (HCV) infection among persons with opioid use disorder (PWOUD). PWOUD have the highest hepatitis C virus (HCV) prevalence and incidence, yet they infrequently receive HCV care. The study objectives are to compare access to specialty care via telemedicine to offsite specialty referral (usual care) on 1) treatment initiation, completion, and sustained virological response, 2) patient satisfaction with health care delivery, and 3) HCV reinfection after successful HCV cure. METHODS TEAM-C is a multi-site, non-blinded, randomized pragmatic clinical trial conducted at 12 opioid treatment programs (OTP) throughout New York State that utilizes the stepped-wedge design. The unit of randomization is the OTP with a total sample size of 624 participants. HCV-infected PWOUD were treated via telemedicine or referral. Telemedicine encounters are conducted onsite in the OTP with co-administration of direct acting antivirals for HCV with medications for opioid use disorder. The primary outcome is undetectable HCV RNA obtained 12 weeks post-treatment cessation. We also follow participants for two years to assess for reinfection. CONCLUSIONS The study utilizes a rigorous study design to evaluate the effectiveness and implementation of virtual treatment for HCV integrated into behavioral treatment. We demonstrate the feasibility, engagement principles and lessons learned from the initial prospective randomized trial of telemedicine targeted to a vulnerable population.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicot Street, Suite 6090, Buffalo, NY 14203, USA.
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Elisavet M Sofikitou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Lawrence S Brown
- START Treatment & Recovery Centers, 22 Chapel Street, Brooklyn, NY 11201, USA.
| | - Ponni Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA; The Rockefeller University, 5 West 37th Street, 10(th) floor, New York, NY 10018, USA.
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6
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Villegas MA, Okenfuss E, Savarirayan R, White K, Hoover-Fong J, Bober MB, Duker A, Legare JM. Multidisciplinary Care of Neurosurgical Patients with Genetic Syndromes. Neurosurg Clin N Am 2021; 33:7-15. [PMID: 34801144 DOI: 10.1016/j.nec.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurosurgical patients with genetic syndromes often receive care from multidisciplinary teams. Successful models range from multiple providers in one clinic space seeing a patient together to specialists located at different institutions working together. Collaboration and bidirectional communication are key. Multidisciplinary care improves outcomes and patient satisfaction. Choosing the goal of the clinic, using ancillary staff, and obtaining institutional buy-in are important initial first steps to establishing a multidisciplinary team clinic. Multidisciplinary teams can leverage technology to expand care via telehealth in multidisciplinary clinics and more vitally communication between providers on the team.
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Affiliation(s)
- Melissa A Villegas
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Ericka Okenfuss
- Department of Genetics, Kaiser Permanente of Northern California, 1650 Response Road Kaiser, Sacramento, CA 95815, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria 3052, Australia
| | - Klane White
- Seattle Children's, 4800 Sand Point Way, OA.9.120, Seattle, WA 98105, USA
| | - Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, 600 N. Wolfe Street, Blalock 1008, Baltimore, MD 21287, USA
| | - Michael B Bober
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Angela Duker
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Janet M Legare
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA.
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Rashed HR. How COVID-19 pandemic changed our management strategies for amyotrophic lateral sclerosis (ALS) patients: Egyptian study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:80. [PMID: 34629844 PMCID: PMC8487708 DOI: 10.1186/s41983-021-00331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are several studies that have discussed the efficacy of telemedicine with amyotrophic lateral sclerosis (ALS) patients; however, this approach is still preliminary in Egypt and in North Africa. The objective of the current study is to discuss current experience with telemedicine in monitoring patients in the specialized ALS clinic in Egypt. Efficacy of Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) in monitoring disease progression remotely will be discussed. RESULTS This is a prospective study. Forty-three ALS patients were included in this study in the period between July 1, 2020, and February 6, 2021. Fifty-three telemedicine encounters and 13 post-telemedicine office visits were available. None of the participating patients had COVID-19 infection. Eight patients showed decline in ALSFRS score. ALSFRS-R score reported during telemedicine encounters was confirmed during office visits. Three bulbar onset ALS patients had gastrostomy, and 2 bulbar onset ALS patients had Botox injection for drooling. All eight patients with declining ALSFRS-R were maintained on non-invasive ventilation (NIV) based on their symptoms. CONCLUSION This is the first study discussing telemedicine in the field of ALS in Egypt and North Africa. ALSFRS-R showed feasibility and reliability in detecting disease progression remotely.
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Affiliation(s)
- Hebatallah R. Rashed
- Ain Shams University Hospital, Neurology department, Cairo, Egypt
- International Medical Center (IMC), New Heliopolis City, Egypt
- Faculty of Medicine, Ain Shams University, Ramsis St., Abbasseya, Cairo, Egypt
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8
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Murray D, Rooney J, Al-Chalabi A, Bunte T, Chiwera T, Choudhury M, Chio A, Fenton L, Fortune J, Maidment L, Manera U, Mcdermott C, Meldrum D, Meyjes M, Tattersall R, Torrieri MC, Van Damme P, Vanderlinden E, Wood C, Van Den Berg LH, Hardiman O. Correlations between measures of ALS respiratory function: is there an alternative to FVC? Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:495-504. [PMID: 34590504 DOI: 10.1080/21678421.2021.1908362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: An ongoing longitudinal study in six European sites includes a 3-monthly assessment of forced vital capacity (FVC), slow vital capacity (SVC), peak cough flow (PCF), and Sniff nasal inspiratory pressure (SNIP). The aim of this interim analysis was to assess the potential for SNIP to be a surrogate for aerosol generating procedures given COVID-19 related restrictions. Methods: This was a prospective observational study. Patients attending six study sites with King's Stage 2 or 3 ALS completed baseline FVC/SVC/SNIP/PCF and repeated assessments 3 monthly. Data were collected from March 2018 to March 2020, after which a COVID-19 related study suspension was imposed. Correlations between the measures were calculated. A Bayesian multiple outcomes random-effects model was constructed to investigate rates of decline across measures. Results: In total, 270 cases and 828 assessments were included (Mean age 65.2 ± 15.4 years; 32.6% Female; 60% Kings stage 2; 81.1% spinal onset). FVC and SVC were the most closely correlated outcomes (0.95). SNIP showed the least correlation with other metrics 0.53 (FVC), 0.54 (SVC), 0.60 (PCF). All four measures significantly declined over time. SNIP in the bulbar onset group showed the fastest rate of decline. Discussion: SNIP was not well correlated with FVC and SVC, probably because it examines a different aspect of respiratory function. Respiratory measures declined over time, but differentially according to the site of onset. SNIP is not a surrogate for FVC and SVC, but is a complementary measure, declining linearly and differentiating spinal and bulbar onset patients.
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Affiliation(s)
- Deirdre Murray
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
| | - James Rooney
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Amar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Tommy Bunte
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theresa Chiwera
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Mutahhara Choudhury
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Adriano Chio
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology 1, Azienda Ospedale Università Città della Salute e della Scienza, Turin, Italy
| | - Lauren Fenton
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Jennifer Fortune
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Lindsay Maidment
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Umberto Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Chris Mcdermott
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Dara Meldrum
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Myrte Meyjes
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel Tattersall
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
| | - Maria Claudia Torrieri
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Philip Van Damme
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and.,KU Leuven, Department of Neuroscience, Leuven Brain Institute and VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Elien Vanderlinden
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and
| | - Claire Wood
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Neurocent Directorate, Beaumont Hospital, Dublin, Ireland
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Costamagna G, Abati E, Bresolin N, Comi GP, Corti S. Management of patients with neuromuscular disorders at the time of the SARS-CoV-2 pandemic. J Neurol 2021; 268:1580-1591. [PMID: 32804279 PMCID: PMC7429942 DOI: 10.1007/s00415-020-10149-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
The novel Coronavirus disease-19 (COVID-19) pandemic has posed several challenges for neuromuscular disorder (NMD) patients. The risk of a severe course of SARS-CoV-2 infection is increased in all but the mildest forms of NMDs. High-risk conditions include reduced airway clearance due to oropharyngeal weakness and risk of worsening with fever, fasting or infection Isolation requirements may have an impact on treatment regimens administered in hospital settings, such as nusinersen, glucosidase alfa, intravenous immunoglobulin, and rituximab infusions. In addition, specific drugs for SARS-CoV2 infection under investigation impair neuromuscular function significantly; chloroquine and azithromycin are not recommended in myasthenia gravis without available ventilatory support and prolonged prone positioning may influence options for treatment. Other therapeutics may affect specific NMDs (metabolic, mitochondrial, myotonic diseases) and experimental approaches for Coronavirus disease 2019 may be offered "compassionately" only after consulting the patient's NMD specialist. In parallel, the reorganization of hospital and outpatient services may change the management of non-infected NMD patients and their caregivers, favouring at-distance approaches. However, the literature on the validation of telehealth in this subgroup of patients is scant. Thus, as the first wave of the pandemic is progressing, clinicians and researchers should address these crucial open issues to ensure adequate caring for NMD patients. This manuscript summarizes available evidence so far and provides guidance for both general neurologists and NMD specialists dealing with NMD patients in the time of COVID-19.
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Affiliation(s)
- Gianluca Costamagna
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Elena Abati
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Nereo Bresolin
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giacomo Pietro Comi
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Neuromuscular and Rare Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Stefania Corti
- Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
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10
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De Marchi F, Sarnelli MF, Serioli M, De Marchi I, Zani E, Bottone N, Ambrosini S, Garone R, Cantello R, Mazzini L, Solara V, Biroli G, Riso S, Vercelli R, Massara M, .. Telehealth approach for amyotrophic lateral sclerosis patients: the experience during COVID-19 pandemic. Acta Neurol Scand 2021; 143:489-496. [PMID: 33185886 DOI: 10.1111/ane.13373] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Specialized multidisciplinary ALS care has been shown to extend survival and improve patient's and caregiver's quality of life. During the COVID-19 pandemic, the management of patients suddenly changed and telemedicine has been proven to be as effective as outpatient care. We elaborate the experience with Telemedicine of a Tertiary ALS Center from an Italian geographical area with high infectious risk during the COVID-19 pandemic. METHODS 19 patients were evaluated in telemedicine by a multidisciplinary team including a neurologist (clinical evaluation, intercurrent events, and drug prescriptions); a dietician (diet and weight monitoring); a psychologist (psychological assessment and support); and a physiotherapist (physiotherapy treatment and device prescription). Telemedicine was performed using the online platform "IoMT Connected Care Platform (Ticuro Reply)." RESULTS All patients reported a positive perception of talking face to face with healthcare professionals and were satisfied with how the team understood their problems. During video televisits, there was a change in the patient's medication regimen in 11/19; 2/19 required pneumological evaluation and started NIV; and 9/16 patients required prescription of devices. The mean monthly decline of ALSFRS-R before televisit was 0.88 (SD 1.17) and during televisit of 0.49 (SD 0.75). Bodyweight and daily caloric content remain stable. Reduction in HADS scores and stability in ALSAQ-40 were observed. DISCUSSION Our study positively reproduced the multidisciplinary approach currently used with ALS patients, trying to stabilize the functional and metabolic status and improving the psychological one. Future directions include a personalized telemedicine program according to the patient's needs.
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Affiliation(s)
- Fabiola De Marchi
- Department of Neurology and ALS Centre University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
| | - Maria Francesca Sarnelli
- Department of Neurology and ALS Centre University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
| | - Marcella Serioli
- Department Dietetic and Clinical Nutrition University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
| | - Ilaria De Marchi
- Department of Neurology and ALS Centre University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
| | - Ermes Zani
- Healthy Reply, Business Unit Santer Reply S.p.A Torino Italy
| | - Nicola Bottone
- Healthy Reply, Business Unit Santer Reply S.p.A Torino Italy
| | | | | | - Roberto Cantello
- Department of Neurology and ALS Centre University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
| | - Letizia Mazzini
- Department of Neurology and ALS Centre University of Piemonte OrientaleMaggiore della Carità Hospital Novara Italy
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11
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Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci 2021; 11:brainsci11020237. [PMID: 33668641 PMCID: PMC7917616 DOI: 10.3390/brainsci11020237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Telehealth, by definition, is distributing health-related services while using electronic technologies. This narrative Review describes the technological health services (telemedicine and telemonitoring) for delivering care in neurodegenerative diseases, Alzheimer's disease, Parkinson's Disease, and amyotrophic lateral Sclerosis, among others. This paper aims to illustrate this approach's primary experience and application, highlighting the strengths and weaknesses, with the goal of understanding which could be the most useful application for each one, in order to facilitate telehealth improvement and use in standard clinical practice. We also described the potential role of the COVID-19 pandemic to speed up this service's use, avoiding a sudden interruption of medical care.
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12
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Abstract
Amyotrophic lateral sclerosis and multiple sclerosis are neurodegenerative diseases requiring interdisciplinary rehabilitation services to maximize function, manage symptoms, prevent complications, and promote higher quality of life. Distance and disability may pose barriers to access of subspecialized care. Telehealth is one solution to facilitate access and was rapidly expanded during the COVID-19 pandemic. This article details the utility of telehealth services across the disease spectrum-including to establish a diagnosis, monitor progression for ongoing management, and identify and manage symptoms and provide therapy interventions. The challenges and promise of telehealth services for clinical care and research will be explored.
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13
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Li Y, Emmett CD, Cobbaert M, Sanders DB, Juel VC, Hobson-Webb LD, Massey JM, Gable KL, Raja SM, Gonzalez NL, Guptill JT. Knowledge and perceptions of the COVID-19 pandemic among patients with myasthenia gravis. Muscle Nerve 2020; 63:357-364. [PMID: 33280141 DOI: 10.1002/mus.27130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with myasthenia gravis (MG) may be particularly vulnerable during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic due to risk of worsening disease during infection, potential adverse impacts of coronavirus disease 2019 (COVID-19) treatments on neuromuscular transmission, and a limited ability to fight off infection related to immunosuppressive treatments. Our goal is to understand how patients are experiencing the COVID-19 pandemic, including where they receive relevant information, how it has affected medical care, and what measures they use to protect themselves. METHODS This is a prospective online survey study at large academic practice. All patients with a neuromuscular junction disorder diagnosis code in the Duke Health System were invited to participate. RESULTS One thousand eight hundred and forty eight patients were approached to participate and 75 completed the survey between 16 April 2020 and 28 May 2020. The most frequently used information sources were non-presidential federal government (75%), state government (57%), local healthcare provider (37%), and television news (36%). Non-presidential federal government (80%), local healthcare providers (55%), state government (33%), and patient support organizations (29%) were considered the most trusted information sources. Thirty-three (44%) of survey responders had attended a telemedicine visit. Patients were taking recommended precautions during the pandemic and remained very concerned (69%) about COVID-19. Generalized Anxiety Disorder-7 scores were moderate-severe in 20% of responders. CONCLUSIONS Healthcare providers, the government, and patient organizations play a critical role in communicating with the MG patient community. Use of targeted messaging strategies by these groups to convey accurate information may increase effectiveness and lead to more informed patients with reduced anxiety.
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Affiliation(s)
- Yingkai Li
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - C Douglas Emmett
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marjan Cobbaert
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Donald B Sanders
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vern C Juel
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa D Hobson-Webb
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Janice M Massey
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Karissa L Gable
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shruti M Raja
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Natalia L Gonzalez
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey T Guptill
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
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14
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Pinto S, Quintarelli S, Silani V. New technologies and Amyotrophic Lateral Sclerosis - Which step forward rushed by the COVID-19 pandemic? J Neurol Sci 2020; 418:117081. [PMID: 32882437 PMCID: PMC7403097 DOI: 10.1016/j.jns.2020.117081] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a fast-progressive neurodegenerative disease leading to progressive physical immobility with usually normal or mild cognitive and/or behavioural involvement. Many patients are relatively young, instructed, sensitive to new technologies, and professionally active when developing the first symptoms. Older patients usually require more time, encouragement, reinforcement and a closer support but, nevertheless, selecting user-friendly devices, provided earlier in the course of the disease, and engaging motivated carers may overcome many technological barriers. ALS may be considered a model for neurodegenerative diseases to further develop and test new technologies. From multidisciplinary teleconsults to telemonitoring of the respiratory function, telemedicine has the potentiality to embrace other fields, including nutrition, physical mobility, and the interaction with the environment. Brain-computer interfaces and eye tracking expanded the field of augmentative and alternative communication in ALS but their potentialities go beyond communication, to cognition and robotics. Virtual reality and different forms of artificial intelligence present further interesting possibilities that deserve to be investigated. COVID-19 pandemic is an unprecedented opportunity to speed up the development and implementation of new technologies in clinical practice, improving the daily living of both ALS patients and carers. The present work reviews the current technologies for ALS patients already in place or being under evaluation with published publications, prompted by the COVID-19 pandemic.
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Affiliation(s)
- Susana Pinto
- Translational and Clinical Physiology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
| | - Stefano Quintarelli
- AgID - Italian digital agency and Clusit - Italian Computer Security Association, Italy
| | - Vincenzo Silani
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS - Department of Pathophysiology and Transplantation, “Dino Ferrari” Center and Center for Neurotechnology and Brain Therapeutics, Università degli Studi di Milano, Milan, Italy
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15
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Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail. Neurol Sci 2020; 42:9-13. [PMID: 33025327 PMCID: PMC7538170 DOI: 10.1007/s10072-020-04783-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.
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16
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Saporta MA, Granit V, Lewis R, Benatar M. Yes, we can: Neuromuscular examination by telemedicine. Muscle Nerve 2020; 62:E83-E85. [PMID: 32875561 DOI: 10.1002/mus.27056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Mario A Saporta
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Volkan Granit
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard Lewis
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Benatar
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Vasta R, Moglia C, D’Ovidio F, Di Pede F, De Mattei F, Cabras S, Peotta L, Iazzolino B, Giusiano S, Manera U, Palumbo F, Bombaci A, Torrieri MC, Ilardi A, Mastro E, Arcari M, Solero L, Grassano M, Daviddi M, Matteoni E, Salamone P, Fuda G, Canosa A, Chiò A, Calvo A. Telemedicine for patients with amyotrophic lateral sclerosis during COVID-19 pandemic: an Italian ALS referral center experience. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:308-311. [DOI: 10.1080/21678421.2020.1820043] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosario Vasta
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Cristina Moglia
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D’Ovidio
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Francesca Di Pede
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Filippo De Mattei
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Sara Cabras
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Laura Peotta
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Barbara Iazzolino
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Silvia Giusiano
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Umberto Manera
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Francesca Palumbo
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Alessandro Bombaci
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Maria Claudia Torrieri
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Antonio Ilardi
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Enza Mastro
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Martina Arcari
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Luca Solero
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Maurizio Grassano
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Margherita Daviddi
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Enrico Matteoni
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Paolina Salamone
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Fuda
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
| | - Antonio Canosa
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Adriano Chiò
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Andrea Calvo
- ALS Center, ‘Rita Levi Montalcini’ Department of Neuroscience, University of Turin, Turin, Italy and
- Neurology 1, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
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18
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Capozzo R, Zoccolella S, Musio M, Barone R, Accogli M, Logroscino G. Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: results from Southern Italy. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:542-548. [DOI: 10.1080/21678421.2020.1773502] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rosa Capozzo
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | | | - Marco Musio
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Roberta Barone
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Miriam Accogli
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari, Italy
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19
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Govindarajan R, Berry JD, Paganoni S, Pulley MT, Simmons Z. Optimizing telemedicine to facilitate amyotrophic lateral sclerosis clinical trials. Muscle Nerve 2020; 62:321-326. [DOI: 10.1002/mus.26921] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - James D. Berry
- Department of Neurology and Neurology Clinical Trials UnitMassachusetts General Hospital Boston Massachusetts
| | - Sabrina Paganoni
- Healey Center for ALS at Mass General Hospital, Massachusetts General Hospital, BostonMassachusetts and Spaulding Rehabilitation Hospital, Department of PM&R, Harvard Medical School Boston Massachusetts
| | | | - Zachary Simmons
- Department of NeurologyPenn State Health M.S. Hershey Medical Center Hershey Pennsylvania
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20
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Andrews JA, Berry JD, Baloh RH, Carberry N, Cudkowicz ME, Dedi B, Glass J, Maragakis NJ, Miller TM, Paganoni S, Rothstein JD, Shefner JM, Simmons Z, Weiss MD, Bedlack RS. Amyotrophic lateral sclerosis care and research in the United States during the COVID-19 pandemic: Challenges and opportunities. Muscle Nerve 2020; 62:182-186. [PMID: 32445195 PMCID: PMC7283687 DOI: 10.1002/mus.26989] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 has created unprecedented challenges for amyotrophic lateral sclerosis (ALS) clinical care and research in the United States. Traditional evaluations for making an ALS diagnosis, measuring progression, and planning interventions rely on in‐person visits that may now be unsafe or impossible. Evidence‐ and experience‐based treatment options, such as multidisciplinary team care, feeding tubes, wheelchairs, home health, and hospice, have become more difficult to obtain and in some places are unavailable. In addition, the pandemic has impacted ALS clinical trials by impairing the ability to obtain measurements for trial eligibility, to monitor safety and efficacy outcomes, and to dispense study drug, as these also often rely on in‐person visits. We review opportunities for overcoming some of these challenges through telemedicine and novel measurements. These can reoptimize ALS care and research in the current setting and during future events that may limit travel and face‐to‐face interactions.
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Affiliation(s)
- Jinsy A Andrews
- The Neurological Institute, Columbia University, New York, New York
| | - James D Berry
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert H Baloh
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nathan Carberry
- The Neurological Institute, Columbia University, New York, New York
| | - Merit E Cudkowicz
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brixhilda Dedi
- The Neurological Institute, Columbia University, New York, New York
| | - Jonathan Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Nicholas J Maragakis
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Miller
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Sabrina Paganoni
- Healey Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey D Rothstein
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Zachary Simmons
- Neurology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Michael D Weiss
- Department of Neurology, University of Washington, Seattle, Washington
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21
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Haulman A, Geronimo A, Chahwala A, Simmons Z. The Use of Telehealth to Enhance Care in ALS and other Neuromuscular Disorders. Muscle Nerve 2020; 61:682-691. [PMID: 32297678 PMCID: PMC10797583 DOI: 10.1002/mus.26838] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
Telehealth has the potential to improve the efficiency of healthcare while reducing the burden on patients and caregivers. Encounters can be synchronous or asynchronous. When used for care of those with amyotrophic lateral sclerosis (ALS) by individual health care providers or by a multidisciplinary team, synchronous telehealth is feasible, acceptable, may produce outcomes comparable to those of in-person care, and is cost effective. Individuals with ALS who use telehealth tend to have lower physical and respiratory function and to live farther from an ALS clinic than those who exclusively attend in-person clinic visits. Asynchronous telehealth can be used as a substitute full multidisciplinary visits, or for remote monitoring of pulmonary function, gait/falls, and speech. Barriers to implementing telehealth on a wider scale include disparities in access to technology and challenges surrounding medical licensure and billing, but these are being addressed.
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Affiliation(s)
- Anne Haulman
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew Geronimo
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Amit Chahwala
- Department of Virtual Health, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zachary Simmons
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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22
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23
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Helleman J, Kruitwagen ET, van den Berg LH, Visser-Meily JMA, Beelen A. The current use of telehealth in ALS care and the barriers to and facilitators of implementation: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:167-182. [PMID: 31878794 DOI: 10.1080/21678421.2019.1706581] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: We aimed to provide an overview of telehealth used in the care for patients with amyotrophic lateral sclerosis (ALS), and identify the barriers to and facilitators of its implementation. Methods: We searched Pubmed and Embase to identify relevant articles. Full-text articles with original research reporting on the use of telehealth in ALS care, were included. Data were synthesized using the Consolidation Framework for Implementation Research. Two authors independently screened articles based on the inclusion criteria. Results: Sixteen articles were included that investigated three types of telehealth: Videoconferencing, home-based self-monitoring and remote NIV monitoring. Telehealth was mainly used by patients with respiratory impairment and focused on monitoring respiratory function. Facilitators for telehealth implementation were a positive attitude of patients (and caregivers) toward telehealth and the provision of training and ongoing support. Healthcare professionals were more likely to have a negative attitude toward telehealth, due to the lack of personal evaluation/contact and technical issues; this was a known barrier. Other important barriers to telehealth were lack of reimbursement and cost-effectiveness analyses. Barriers and facilitators identified in this review correspond to known determinants found in other healthcare settings. Conclusions: Our findings show that telehealth in ALS care is well-received by patients and their caregivers. Healthcare professionals, however, show mixed experiences and perceive barriers to telehealth use. Challenges related to finance and legislation may hinder telehealth implementation in ALS care. Future research should report the barriers and facilitators of implementation and determine the cost-effectiveness of telehealth.
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Affiliation(s)
- Jochem Helleman
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands, and
| | - Esther T Kruitwagen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands, and
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands, and
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, the Netherlands.,Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands, and
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24
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Hobson E, Baird W, Bradburn M, Cooper C, Mawson S, Quinn A, Shaw PJ, Walsh T, McDermott CJ. Process evaluation and exploration of telehealth in motor neuron disease in a UK specialist centre. BMJ Open 2019; 9:e028526. [PMID: 31640994 PMCID: PMC6830641 DOI: 10.1136/bmjopen-2018-028526] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the processes involved in using a novel digitally enabled healthcare system (telehealth in motor neuron disease (TiM)) in people living with motor neuron disease (MND) and their informal carers. We examined TiM implementation, potential mechanisms of impact and contextual factors that might influence TiM implementation or impact. DESIGN An 18-month, single-centre process evaluation within a randomised, pilot and feasibility study. INTERVENTION TiM plus usual care versus usual care alone. SETTING A specialist UK MND care centre. PARTICIPANTS 40 patients with MND and 37 primary informal carers. PRIMARY AND SECONDARY OUTCOME MEASURES Patient, carer and staff outcomes and experiences using semistructured interviews. Descriptive data on implementation and use of TiM. RESULTS The TiM was acceptable and accessible to patients, carers and staff. Intervention uptake and adherence were good: 14 (70%) patients completed a TiM session at least fortnightly. Barriers to TiM use (such as technology experience and disability) were overcome with well-designed technology and face-to-face training. Reported potential benefits of TiM included improved communication and care coordination, reassurance, identification of complications and the potential for TiM to be an alternative or addition to clinic. Benefits depended on patients' current level of needs or disability. The main challenges were the large number of alerts that were generated by TiM, how the clinicians responded to these alerts and the mismatch between patient/carer expectations and nurses actions. This could be improved by better communication systems and adjusting the alerts algorithm. CONCLUSION TiM has the potential to facilitate access to specialist care, but further iterative developments to the intervention and process evaluations of the TiM in different services are required. TRIAL IDENTIFIER NUMBER ISRCTN26675465.
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Affiliation(s)
- Esther Hobson
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Department of Neurology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Wendy Baird
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Mawson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Quinn
- Sheffield Motor Neurone Disease Association Research Advisory Group, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Department of Neurology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Theresa Walsh
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Department of Neurology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Christopher J McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Department of Neurology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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25
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Paganoni S, van de Rijn M, Drake K, Burke K, Doyle M, Ellrodt AS, Nicholson K, Atassi N, de Marchi F, Babu S, Estrada J, Schwamm LH, Berry JD. Adjusted cost analysis of video televisits for the care of people with amyotrophic lateral sclerosis. Muscle Nerve 2019; 60:147-154. [PMID: 31136007 PMCID: PMC6772103 DOI: 10.1002/mus.26606] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We previously reported our amyotrophic lateral sclerosis (ALS) video televisit experience. Here we report on video televisit versus in-clinic costs, adjusting for perceived medical usefulness (MU). METHODS We take the patient-perspective and a focused institutional-perspective. Costs are adjusted for patient/caregiver and physician perceptions of visit MU. The base-case reflects our outpatient ALS practice. RESULTS In the base-case, from the patient perspective, in-clinic visits cost $1,116 and video televisits cost $89 ($119 after MU-adjustment). From the institutional perspective, clinic visits cost $799, and video televisits cost $354 ($472 after MU-adjustment). Adjusted cost-savings per televisit are $997 (patient) and $327 (institution). Sensitivity analyses on 5 variables accounted for uncertainty in base-case assumptions. CONCLUSIONS Video televisits provide marked adjusted cost-savings for patients and institutions. Adjusted costs are sensitive to perceived MU of video televisits. Future research should explore the ability of video televisits to reduce healthcare resource usage. Muscle Nerve 60: 147-154, 2019.
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Affiliation(s)
- Sabrina Paganoni
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Marc van de Rijn
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Kristin Drake
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Burke
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Doyle
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Swartz Ellrodt
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine Nicholson
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nazem Atassi
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fabiola de Marchi
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA
| | - Suma Babu
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juan Estrada
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Berry
- Harvard Medical School, Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge St, Suite 600, Boston, Massachusetts, 02114, USA.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Paganoni S, Simmons Z. Telemedicine to innovate amyotrophic lateral sclerosis multidisciplinary care: The time has come. Muscle Nerve 2018; 59:3-5. [DOI: 10.1002/mus.26311] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Sabrina Paganoni
- Neurological Clinical Research Institute; Massachusetts General Hospital; 165 Cambridge Street, Suite 600, Boston Massachusetts 02114 USA
- Department of Physical Medicine and Rehabilitation; Spaulding Rehabilitation Hospital; Boston Massachusetts USA
| | - Zachary Simmons
- Department of Neurology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Humanities; Penn State Hershey Medical Center; Hershey Pennsylvania USA
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