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Yakubu AO, Olalude O, Salami M, Amuta AC, Amusa A, Salaudeen HA, Awoyemi AJ. Telemedicine and Neurology: A Survey of Neurology Patients in a Nigerian Tertiary Hospital. Cureus 2024; 16:e57916. [PMID: 38725763 PMCID: PMC11081517 DOI: 10.7759/cureus.57916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background Telemedicine has been recognized as a viable solution for addressing the shortage of medical professionals in developing countries such as Nigeria. Tele-neurology has the potential to provide remote consultations and care for patients with neurological conditions, thereby reducing the burden of travel and improving access to medical care. Despite its growing popularity, there is a lack of research on patient's views on this mode of care delivery in Nigeria. This study was conducted to investigate patient's perspectives on the use of tele-neurology in Nigeria. Methodology A descriptive cross-sectional study was conducted among 398 neurology patients at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. The data obtained were analyzed using descriptive statistics and a chi-square test using p < 0.05. Results Only 3% of our respondents had previously used telemedicine, with 78.1% of the respondents open to using telemedicine as a means of consultation. The disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health conditions (84.4%), and lack of technical support (14.6%). The majority of respondents (96.5%) believed telemedicine will help in saving time. There was a statistically significant association between propensity to use telemedicine and time spent in the hospital (0.045) and time off work (<0.001). The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). Conclusion The findings suggested that there is a need for healthcare providers and policymakers to invest in developing telemedicine to improve access to care.
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Affiliation(s)
- Aliu O Yakubu
- Department of Old Age Psychiatry, University Hospital Wishaw NHS Trust, Wishaw, GBR
| | - Oluwakemi Olalude
- Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, NGA
| | - Mayowa Salami
- Department of Paediatrics, Princess Royal Maternity Hospital NHS Trust, Glasgow, GBR
| | - Augustine C Amuta
- Department of Health and Wellness, Prince George's County Health Department, Upper Marlboro, USA
| | - Abeedat Amusa
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Hasanat A Salaudeen
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
| | - Ayodeji J Awoyemi
- Department of Medicine and Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago Iwoye, NGA
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Vitturi BK, Rahmani A, Montecucco A, Dini G, Durando P. Occupational outcomes of people with multiple sclerosis during the COVID-19 pandemic: a systematic review with meta-analysis. Front Public Health 2023; 11:1217843. [PMID: 38089033 PMCID: PMC10711111 DOI: 10.3389/fpubh.2023.1217843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Background People with Multiple Sclerosis (PwMS) are vulnerable to unfavorable occupational outcomes and the COVID-19 pandemic brought major consequences on people's professional lives. In this view, we decided to investigate the occupational outcomes of PwMS during the COVID-19 pandemic. Methods We performed a systematic review with meta-analysis searching key terms in four databases. We initially included any peer-reviewed original article that enrolled adult patients with the diagnosis of MS and assessed any occupational variable during the COVID-19 pandemic. There were no time limits and no language restrictions. The primary outcomes were the prevalence of unemployment, retirement and employment status change among people with MS during the COVID-19 pandemic. Other outcomes included the modality and characteristics of work: type of work, full-time work, part-time work and remote work. We also searched for data from studies that addressed any change in the work status due to the COVID-19 outbreak. Results We identified 49 eligible articles comprising a total sample size of 17,364 individuals with MS. The pooled prevalence of unemployment and retirement was 0.47 (95% CI = 0.42-0.53). The pooled prevalence of PwMS who were unemployed or retired was positively associated with the progressive phenotype of the disease (p = 0.017) and the use of glatiramer acetate (p = 0.004), but negatively associated with hospitalization due to COVID-19 (p = 0.008) and the use of immunosuppressants (p = 0.032), siponimod (p < 0.001), and cladribine (p = 0.021). The pooled proportion of PwMS that reported any change of the employment status during the COVID-19 pandemic was 0.43 (95% CI = 0.36-0.50) while the pooled prevalence of PwMS who worked remotely during this period was 0.37 (95% CI = 0.15-0.58). The change in employment status was negatively associated with the duration of MS (p = 0.03) but positively associated with the progressive phenotype of the disease (p < 0.001). Conclusion Our seminal review may serve as an example of how patients with neurological diseases or disabilities in general may have their jobs impacted in a pandemic and foster the context of global socio-economic crisis.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino di Genova IRCCS, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino di Genova IRCCS, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino di Genova IRCCS, Genoa, Italy
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Altieri M, Capuano R, Bisecco A, d'Ambrosio A, Risi M, Cavalla P, Vercellino M, Annovazzi P, Zaffaroni M, De Stefano N, Stromillo ML, D'Amico E, Zanghì A, Buscarinu MC, Lanzillo R, De Luca G, Calabrese M, Lorefice L, Di Filippo M, Valentino P, Gajofatto A, Marfia GA, Fuiani A, Nociti V, Tedeschi G, Gallo A. Quality of care provided by Multiple Sclerosis Centers during Covid-19 pandemic: Results of an Italian multicenter patient-centered survey. Mult Scler Relat Disord 2023; 77:104870. [PMID: 37454568 DOI: 10.1016/j.msard.2023.104870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Covid-19 pandemic impacted on management of people with Multiple Sclerosis (pwMS). Level of satisfaction of pwMS regarding the care received by the staff of Multiple Sclerosis Centers (MSCs) during the pandemic was not fully investigated. In a large patient-centered multicenter study, the therapeutic adherence and quality of care of MSCs was assessed. METHODS In April-May 2021, an online survey was widespread by 16 Italian MSCs. Frequencies, percentages and/or means and standard deviations were calculated to describe the sample. ANOVAs were performed to evaluate the effect of sociodemographic and clinical variables on overall pwMS' rating of MSC assistance. RESULTS 1670 pwMS completed the survey (67.3% women). During the pandemic, 88% did not change their disease modifying therapy schedule, and 89.1% reached their MSCs with no or little difficulties. Even if only 1.3% of participants underwent a tele-health follow-up visit with their MSC staff, the 80.1% believed that tele-health services should be improved regardless of pandemic. 92% of participants were satisfied of how their MSC took charge of their needs; ANOVAs revealed an effect of disease duration on pwMS' level of satisfaction on MSCs management during the pandemic. CONCLUSIONS The results revealed an efficient MSCs response to Covid-19 pandemic and provided the basis for the implementing of tele-health services that would further improve the taking charge of patients, particularly those with longer disease, higher disability, and/or living far from their MSC.
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Affiliation(s)
- Manuela Altieri
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Capuano
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro d'Ambrosio
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Risi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Marco Vercellino
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Nicola De Stefano
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emanuele D'Amico
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Maria Chiara Buscarinu
- Dept. of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital-site, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Dept. of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, Policlinico SS. Annunziata, Chieti, Italy
| | - Massimiliano Calabrese
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Dept. of Medical Sciences and Public Health, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Paola Valentino
- Institute of Neurology, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alberto Gajofatto
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | | | - Aurora Fuiani
- Dept. of Neuroscience, Riuniti Hospital of Foggia, Foggia, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioacchino Tedeschi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Gallo
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Sumner L, Schmidt H, Minden S, Falkenberg N, Sun L, McBurney R, Loud S, Wallin M. Use of Telemedicine Among People with Multiple Sclerosis Before and During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1152-1163. [PMID: 36493358 DOI: 10.1089/tmj.2022.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is the most common progressive neurological condition with onset in young adulthood. Because people with MS (PwMS) are often separated from specialty care by distance or disability, telemedicine can help alleviate that burden by removing obstacles to accessing care. Methods: We surveyed 762 PwMS in the iConquerMS research network about their use of in-person and telemedicine services prepandemic (January-February 2020) and during the coronavirus disease 2019 (COVID-19) pandemic (September-November 2020). The survey asked PwMS about their use of in-person and telemedicine services, technology access, perceptions and preferences of telemedicine, their most recent telemedicine encounter, and reasons for not using telemedicine. Results: Prepandemic, the most cited reason for not using telemedicine was providers not offering remote visits. During the pandemic, there was a decrease in the use of in-person health care (100% to ∼78%) and an increase in telemedicine utilization (25% to ∼80%). Most participants had access to telemedicine-enabling technologies and a large portion indicated a preference for using telemedicine for some or most/all of their MS health care (41-57%). Before the pandemic, telemedicine utilization was highest for primary care, while during the pandemic, utilization of telemedicine was greatest for general MS care. Mental health telemedicine encounters increased during the pandemic. Discussion: The dramatic increase in telemedicine utilization during the COVID-19 pandemic has provided access for PwMS to multispecialty care. Maintaining the policy changes that enabled remote health care to expand during the pandemic will be critical for sustained access to MS specialty care for this vulnerable population.
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Affiliation(s)
| | | | | | | | - Landy Sun
- Gryphon Scientific, Takoma Park, Maryland, USA
| | | | - Sara Loud
- Accelerated Cure Project, Waltham, Massachusetts, USA
| | - Mitchell Wallin
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Capasso N, Virgilio E, Covelli A, Giovannini B, Foschi M, Montini F, Nasello M, Nilo A, Prestipino E, Schirò G, Sperandei S, Clerico M, Lanzillo R. Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review. Front Neurol 2023; 14:1207617. [PMID: 37332984 PMCID: PMC10272733 DOI: 10.3389/fneur.2023.1207617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.
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Affiliation(s)
- Nicola Capasso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Eleonora Virgilio
- Neurology Unit, Department of Translational Medicine, AOU Maggiore della Carità Novara, University of Eastern Piedmont, Novara, Italy
| | - Antonio Covelli
- Department of Neurology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Beatrice Giovannini
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Foschi
- Department of Neuroscience, MS Center, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Federico Montini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Nasello
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Head, Neck and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Elio Prestipino
- UOSC Neuro-Stroke Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Giuseppe Schirò
- Section of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Silvia Sperandei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marinella Clerico
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
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Thompson CM, Pulido MD, Babu S, Zenzola N, Chiu C. Communication between persons with multiple sclerosis and their health care providers: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3341-3368. [PMID: 35927111 DOI: 10.1016/j.pec.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study undertakes a scoping review of research about communication between persons with MS and their health care providers. DESIGN PubMed, PsycInfo, Communication Source, Socindex, Sociological Abstracts, Cinahl, and Proquest Dissertations and Theses were used to identify studies since each database's inception. Research team members engaged in study selection, coding for communication issues, and data extraction for descriptive information. RESULTS Of the 419 empirical articles identified, 175 were included. Codes represented all elements of ecological and pathway models, emphasizing emerging technologies for facilitating communication, uncertainty and anxiety for persons with MS, and communication issues surrounding diagnosis, information seeking, and decision making. CONCLUSION This review synthesizes and organizes influences on communication, communication processes, and health outcomes of communication for persons with MS and their providers. Findings extend the ecological model with illness context and the pathway model with communication breakdowns and provider outcomes. PRACTICE IMPLICATIONS Health care providers should consider the complexity of communication when interacting with persons with MS, including the larger context in which it occurs, communication processes and their purposes, and short-term and long-term consequences of interactions. Ecological and pathway models can be frameworks for developing educational materials, as they succinctly capture key communication issues and outcomes.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA.
| | - Manuel D Pulido
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Sara Babu
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Nicole Zenzola
- Department of Communication, University of Illinois, Urbana-Champaign, Urbana, USA
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Urbana, USA
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Ziemssen T, Vandercappellen J, Jordan Mondragon V, Giovannoni G. MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression. J Clin Med 2022; 11:jcm11154401. [PMID: 35956018 PMCID: PMC9369349 DOI: 10.3390/jcm11154401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 12/10/2022] Open
Abstract
This article describes the rationale for the development of the MSProDiscuss™ clinical decision support (CDS) tool, its development, and insights into how it can help neurologists improve care for patients with multiple sclerosis (MS). MS is a progressive disease characterized by heterogeneous symptoms and variable disease course. There is growing consensus that MS exists on a continuum, with overlap between relapsing–remitting and secondary progressive phenotypes. Evidence demonstrates that neuroaxonal loss occurs from the outset, that progression can occur independent of relapse activity, and that continuous underlying pathological processes may not be reflected by inflammatory activity indicative of the patient’s immune response. Early intervention can benefit patients, and there is a need for a tool that assists physicians in rapidly identifying subtle signs of MS progression. MSProDiscuss, developed with physicians and patients, facilitates a structured approach to patient consultations. It analyzes multidimensional data via an algorithm to estimate the likelihood of progression (the MSProDiscuss score), the contribution of various symptoms, and the impact of symptoms on daily living, enabling a more personalized approach to treatment and disease management. Data from CDS tools such as MSProDiscuss offer new insights into disease course and facilitate informed decision-making and a holistic approach to MS patient care.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Clinic, Fetscherstraße. 74, 01307 Dresden, Germany
- Correspondence:
| | | | | | - Gavin Giovannoni
- Blizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
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Marrie RA, Kosowan L, Cutter G, Fox R, Salter A. Disparities in Telehealth Care in Multiple Sclerosis. Neurol Clin Pract 2022; 12:223-233. [DOI: 10.1212/cpj.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives:The COVID-19 pandemic has dramatically increased telehealth use. We assessed access to and use of telehealth care including videoconferencing, and usability of videoconferencing among persons with multiple sclerosis (MS).Methods:In Fall 2020, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants reported availability and receipt of MS care or education through telehealth. Participants who completed ≥1 live videoconferencing visit completed the Telehealth Usability Questionnaire (TUQ). We tested factors associated with access to and receipt of telehealth care using logistic regression. We tested factors associated with TUQ scores using quantile regression.Results:Of the 8434 participants to whom the survey was distributed, 6043 responded (71.6%); 5403 were eligible for analysis. Of the respondents, 4337 (80.6%) were women, and they had a mean (SD) age of 63.2 (10.0) years. Overall, 2889 (53.5%) reported access to MS care via telehealth, 2110 (39.1%) reported receipt of MS care via telehealth including 1523 (28%) via videoconference. Among participants who reported telehealth was available, older age was associated with decreased odds of having a telehealth video visit; higher income and being physically active were associated with increased odds. Older age and moderate to very severe visual symptoms were associated with lower perceived usability of telehealth.Conclusion:Older age, lower socioeconomic status and disease-related impairments are associated with less access to and use of telehealth services in people with MS. Barriers to telehealth should be addressed to avoid aggravating health care disparities when using digital medicine.
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Gopal A, Bonanno V, Block VJ, Bove RM. Accessibility to Telerehabilitation Services for People With Multiple Sclerosis: Analysis of Barriers and Limitations. Int J MS Care 2022; 24:260-265. [PMID: 36545648 PMCID: PMC9749830 DOI: 10.7224/1537-2073.2022-002] [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: 12/24/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), telemedicine improves access to specialized medical care; however, barriers remain, including universal access and effective implementation. Focusing on telerehabilitation, ie, remotely delivered physical therapy, our goal was to identify barriers to telerehabilitation implementation and factors associated with patients completing telerehabilitation physical therapy treatment. METHODS Quantitative data included a review of electronic health records of patients with MS treated at the University of California San Francisco Physical Therapy Faculty Practice. We extracted demographic, clinical, and transit-related factors. For patients who scheduled an initial evaluation, we recorded the number of follow-ups, cancellations, completed physical therapy goals, and discharges. Qualitative data included interviews with 3 board-certified neurologic physical therapists and patients' perspectives recorded in the subjective portion of physical therapy notes. RESULTS We identified 111 patients with at least 1 visit (in-person or telerehabilitation) to physical therapy (82 women; mean ± SD age, 54.2 ± 12.7 years). Patients with no disability (Expanded Disability Status Scale [EDSS] score, 0) were 73% less likely to schedule a follow-up appointment (in-person or telerehabilitation) than those with some disability (EDSS score, >0) (odds ratio, 0.27; 95% CI, 0.09-0.75; P = .012). Neurologic physical therapists identified reduced travel burden and scheduling flexibility as benefits of telerehabilitation vs in-person visits. Barriers to telerehabilitation included low technological literacy, cognitive impairment, and fall risk. Patients described scheduling conflicts and pain/illness as barriers to telerehabilitation. CONCLUSIONS Patients with no disability were least likely to complete physical therapy treatment via telerehabilitation. Although both benefits and barriers to completing physical therapy via telerehabilitation are present, the neurologic physical therapists were supportive of a hybrid model for physical therapy.
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Affiliation(s)
- Arpita Gopal
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
| | - Valeria Bonanno
- The Multiple Sclerosis Center Sant’Andrea Hospital, University La Sapienza, Rome, Italy (VB)
| | - Valerie J. Block
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA,The Department of Physical Therapy and Rehabilitation Science (VJB), University of California San Francisco, San Francisco, CA, USA
| | - Riley M. Bove
- From the Department of Neurology, MS and Neuroinflammation Clinic, UCSF Weill Institute for Neurosciences (AG, VJB, RMB), University of California San Francisco, San Francisco, CA, USA
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