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Erekdag A, Sener IN, Zengin Alpozgen A, Gunduz T, Eraksoy M, Kurtuncu M. The agreement between face-to-face and tele-assessment of balance tests in patients with multiple sclerosis. Mult Scler Relat Disord 2024; 90:105766. [PMID: 39094448 DOI: 10.1016/j.msard.2024.105766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/26/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND To investigate the reliability of balance tests administered using a tele-assessment method in patients with multiple sclerosis (MS). METHODS The participants were assessed both online and face-to-face. The assessments were performed synchronously by two physiotherapists. The first method to used to evaluate the participants was determined through randomization. The Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Timed Up and Go (TUG) were used in the evaluations. Three days were left between the assessment methods. Online platforms were used for tele-assessment. The agreement between and correlation of face-to-face and tele-assessments was analyzed by applying intra-class correlation coefficients (ICC), limits of agreement, and Pearson's correlation coefficient. RESULTS This study included 39 individuals with MS with an EDSS score of 3.03 ± 1.41. Intra-rater reliability of the tele-assessment was excellent (ICCBBS = 0.96; ICCDGI = 0.97; ICCTUG = 0.97). Very high correlations were observed in all BBS, DGI, and TUG measurements between face-to-face and tele-assessment methods according to the first and second assessors (rBBS1 = 0.92; rBBS2 = 0.93; rDGI1 = 0.94; rDGI2 = 0.95; rTUG1 = 0.94; rTUG2 = 0.95, respectively). The inter-rater reliability of tele-assessments (ICCBBS = 0.97; ICCDGI = 0.97; ICCTUG = 1.00) achieved excellent reliability. CONCLUSION BBS, DGI, and TUG are reliable and agreed tests that can be used with tele-assessments, offering similar data to face-to-face methods.
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Affiliation(s)
- Aysenur Erekdag
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye; Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Türkiye
| | - Irem Nur Sener
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye; Istanbul Aydin University, Vocational School of Health Services, Physiotherapy Program, Istanbul, Türkiye
| | - Ayse Zengin Alpozgen
- Istanbul University-Cerrahpasa, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Türkiye.
| | - Tuncay Gunduz
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
| | - Mefkure Eraksoy
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
| | - Murat Kurtuncu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Türkiye
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Thomson A, Horne R, Chapman C, Bharadia T, Burke P, Colwell E, Harrington M, Boskovic B, Stennett A, Baker D, Giovannoni G, Schmierer K. Engaging a community to focus on upper limb function in people with multiple sclerosis: the ThinkHand campaign case study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:62. [PMID: 38886857 PMCID: PMC11184845 DOI: 10.1186/s40900-024-00586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Solving complex research challenges requires innovative thinking and alternative approaches to traditional methods. One such example is the problem of arm and hand, or upper limb function in multiple sclerosis (MS), a neurological condition affecting approximately 2.9 million people worldwide and more than 150,000 in the United Kingdom. Historically, clinical trials and research have focused on mobility and walking ability. This excludes a large number of patients who are wheelchair users, limiting their quality of life and restricting access to possibly helpful medications. To address this issue, the ThinkHand campaign was launched in 2016, aiming to raise awareness about the importance of upper limb function in MS and develop alternative ways to measure, record, and account for hand and arm function changes. MAIN BODY The campaign utilised innovative strategies at scientific conferences and online surveys to engage people affected by MS, healthcare professionals, charities, and researchers in discussing the importance of preserving upper limb function. Through co-design and interdisciplinary collaboration, the campaign developed new tools like the low-cost cardboard version of the Nine-Hole Peg Test, facilitating remote monitoring of hand function. Additionally, the campaign co-created the "Under & Over" rehabilitation tool, allowing individuals with advanced MS to participate in a remote rehabilitation program.The impact of the ThinkHand campaign has been significant, helping to shift the focus of both academic and industry-supported trials, including the O'HAND and ChariotMS trials, both using upper limb function as their primary end point. The campaign's patient-centred approach highlighted the importance of recognising patients' perspectives in research and challenged established assumptions and practices. It demonstrated the effectiveness of interdisciplinary collaboration, systems thinking, and co-creation with stakeholders in tackling complex problems. CONCLUSION The ThinkHand campaign provides valuable insights for health research practices. By involving patients at all stages, researchers can gain a deeper understanding of the impact of disease on their lives, identify gaps and focus research on their needs. Experimentation and iteration can lead to innovative solutions, and openness to unconventional methods can drive widespread change. The ThinkHand campaign exemplifies the potential of patient-centred approaches to address complex research challenges and revolutionise the field of MS research and management. Embracing such approaches will contribute to more inclusive and impactful research in the future.
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Affiliation(s)
- Alison Thomson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Rachel Horne
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Christine Chapman
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Trishna Bharadia
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Patrick Burke
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Elizabeth Colwell
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Mark Harrington
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Bonnie Boskovic
- Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK
| | - Andrea Stennett
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - David Baker
- The Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- The Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Klaus Schmierer
- The Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), Barts Health NHS Trust, The Royal London Hospital, London, UK
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Lerede A, Rodgers J, Middleton RM, Hampshire A, Nicholas R. Patient-reported outcomes in multiple sclerosis: a prospective registry cohort study. Brain Commun 2023; 5:fcad199. [PMID: 37605775 PMCID: PMC10440194 DOI: 10.1093/braincomms/fcad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
Registries have the potential to tackle some of the current limitations in determining the long-term impact of multiple sclerosis. Online assessments using patient-reported outcomes can streamline follow-up enabling large-scale, long-term, cost-effective, home-based, and patient-focused data collection. However, registry data are sparsely sampled and the sensitivity of patient-reported outcomes relative to clinician-reported scales is unknown, making it hard to fully leverage their unique scope and scale to derive insights. This retrospective and prospective cohort study over 11 years involved 15 976 patients with multiple sclerosis from the United Kingdom Multiples Sclerosis Register. Primary outcomes were changes in two patient-reported outcomes: Multiple Sclerosis Impact Scale motor component, and Multiple Sclerosis Walking Scale. First, we investigated their validity in measuring the impact of physical disability in multiple sclerosis, by looking at their sensitivity to disease subtype and duration. We grouped the available records (91 351 for Multiple Sclerosis Impact Scale motor and 68 092 for Multiple Sclerosis Walking Scale) by these two factors, and statistically compared the resulting groups using a novel approach based on Monte Carlo permutation analysis that was designed to cope with the intrinsic sparsity of registry data. Next, we used the patient-reported outcomes to draw novel insights into the developmental time course of subtypes; in particular, the period preceding the transition from relapsing to progressive forms. We report a robust main effect of disease subtype on the patient-reported outcomes and interactions of disease subtype with duration (all P < 0.0001). Specifically, patient-reported outcomes worsen with disease duration for all subtypes (all P < 0.0001) apart from benign multiple sclerosis (Multiple Sclerosis Impact Scale motor: P = 0.796; Multiple Sclerosis Walking Scale: P = 0.983). Furthermore, the patient-reported outcomes of each subtype are statistically different from those of the other subtypes at all time bins (Multiple Sclerosis Impact Scale motor: all P < 0.05; Multiple Sclerosis Walking Scale: all P < 0.01) except when comparing relapsing-remitting multiple sclerosis with benign multiple sclerosis and primary progressive multiple sclerosis with secondary progressive multiple sclerosis. Notably, there were statistically significant differences between relapsing-remitting and progressive subtypes at disease onset. Critically, the patient-reported outcomes are sensitive to future transitions to progressive subtypes, with individuals who transition presenting with higher patient-reported outcomes in their relapsing-remitting phase compared to individuals who don't transition since onset (all P < 0.0001). Patient-reported outcomes capture different patterns of physical worsening over disease length and across subtypes; therefore, they are a valid tool to measure the physical impact of multiple sclerosis over the long-term and cost-effectively. Furthermore, more advanced physical disability manifests years before clinical detection of progressive subtypes, adding evidence to the presence of a multiple sclerosis prodrome.
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Affiliation(s)
- Annalaura Lerede
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
| | - Jeff Rodgers
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Rod M Middleton
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
| | - Richard Nicholas
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
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English C, Ceravolo MG, Dorsch S, Drummond A, Gandhi DB, Halliday Green J, Schelfaut B, Verschure P, Urimubenshi G, Savitz S. Telehealth for rehabilitation and recovery after stroke: State of the evidence and future directions. Int J Stroke 2022; 17:487-493. [PMID: 34983266 DOI: 10.1177/17474930211062480] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS The aim of this rapid review and opinion paper is to present the state of the current evidence and present future directions for telehealth research and clinical service delivery for stroke rehabilitation. METHODS We conducted a rapid review of published trials in the field. We searched Medline using key terms related to stroke rehabilitation and telehealth or virtual care. We also searched clinical trial registers to identify key ongoing trials. RESULTS The evidence for telehealth to deliver stroke rehabilitation interventions is not strong and is predominantly based on small trials prone to Type 2 error. To move the field forward, we need to progress to trials of implementation that include measures of adoption and reach, as well as effectiveness. We also need to understand which outcome measures can be reliably measured remotely, and/or develop new ones. We present tools to assist with the deployment of telehealth for rehabilitation after stroke. CONCLUSION The current, and likely long-term, pandemic means that we cannot wait for stronger evidence before implementing telehealth. As a research and clinical community, we owe it to people living with stroke internationally to investigate the best possible telehealth solutions for providing the highest quality rehabilitation.
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Affiliation(s)
- Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Hunter Medical Research Institute, Heidelberg, VIC, Australia
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Università Politecnica delle March, Ancona, Italy
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia.,The StrokeEd Collaboration, Ashfield, NSW, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dorcas Bc Gandhi
- College of Physiotherapy and Department of Neurology, Christian Medical College & Hospital, Ludhiana, India
| | | | | | - Paul Verschure
- SPECS-lab, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Institució Catalana de la Recerca i Estudis Avançats, Barcelona, Spain
| | - Gerard Urimubenshi
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sean Savitz
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, TX, USA
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