1
|
Cotter R, Burns J, Kaufman K, Kudla A, Ehrlich-Jones L, Wafford QE, Heinemann AW. Effectiveness of Behavioral and Pharmacologic Interventions for Depressive Symptoms After Spinal Cord Injury: Findings From a Systematic Review. Arch Phys Med Rehabil 2024; 105:1733-1755. [PMID: 38266762 DOI: 10.1016/j.apmr.2024.01.004] [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: 08/29/2023] [Revised: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To summarize and evaluate evidence regarding the efficacy of interventions for depressive symptoms in adults living with spinal cord injury (SCI) and comorbid major depressive disorder or significant depressive symptoms to inform the development of clinical practice guidelines. DATA SOURCES Articles published since 2013 and available in Medline, The Cochrane Library, Embase, Scopus, CINAHL, or PsycINFO. Databases were searched in June 2022 and updated November 2023. STUDY SELECTION Inclusion criteria: age 18 years or older, traumatic SCI, and clinically significant depression (Population), mental health interventions including behavioral, pharmacologic, and complementary and alternative medicine (Intervention), inclusion of a control group (Comparator), with a primary outcome of depression symptom reduction (Outcome). Criteria were applied by multiple reviewers and disagreements were reconciled via unanimous decision among the entire research team. Eight articles of 2780 screened met the selection criteria. DATA EXTRACTION Data were extracted independently by multiple reviewers. Two reviewers independently assigned a quality score using the guidelines described by Hawker and associates and independently evaluated the risk of bias of each article using version 2 of the Cochrane risk-of-bias tool. DATA SYNTHESIS All studies assessed depressive symptoms during participant recruitment, screening, and/or at a baseline assessment stage. Pharmacotherapy with venlafaxine XR and several behavioral interventions appear promising, including an online mindfulness course and eye movement desensitization and reprocessing therapy. Remote interventions may be effective in reaching individuals who are unable to travel to in-person therapy sessions. CONCLUSIONS This systematic review provides valuable information for clinicians who treat individuals with SCI and comorbid major depressive disorder or significant depressive symptoms. It highlights the importance of considering a variety of interventions and individualizing treatment to meet individuals' needs and preferences. Future research should aim to identify effective interventions for treating depressive symptoms in individuals with SCI and optimal delivery methods for these interventions.
Collapse
Affiliation(s)
- Robert Cotter
- Shirley Ryan AbilityLab, Chicago, IL; Yale University School of Medicine, New Haven, CT.
| | | | | | | | - Linda Ehrlich-Jones
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Q Eileen Wafford
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
2
|
Leong D, Ng A, Chang P, Zheng J, Wilson R, Chen ME, Vargo M. Telemedicine impact on patient disparities and physician practice patterns in cancer rehabilitation: A multicenter retrospective study. PM R 2024. [PMID: 38864328 DOI: 10.1002/pmrj.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To examine the impact of telemedicine on demographic and practice patterns between outpatients receiving virtual versus in-person cancer rehabilitation physiatry care. DESIGN Multicenter retrospective study. SETTING Outpatient cancer rehabilitation physiatry clinics at four academic medical centers in the United States. PATIENTS Patients with cancer diagnoses or history of cancer diagnosis. INTERVENTIONS Cancer rehabilitation physiatry encounters. MAIN OUTCOME MEASURES Visit mode (in-person, telemedicine); disparities variables (age, race, and gender) by visit mode, and practice interventions (imaging, medications, procedures, other orders, and orders of any type) by visit mode. RESULTS Among a total of 7004 encounters, 2687 unique patients were found. In-person participants were significantly older than the average telemedicine participant (mean 62.9 vs. 60.7 years; p < .001). A race effect was seen (p = .037) with individuals reporting as Asian or other being more likely to have telemedicine encounters. No gender disparities were seen. Using a random visit analysis model to compare populations receiving in-person versus telemedicine care, a slight majority (53%) of follow-up visits were via telemedicine, versus 40% of new patient visits (p < .001). No significant differences were seen in medication prescribing frequency (38.9% telemedicine vs. 36.7% in-person, adjusted relative risk [RR]: 0.988, confidence interval [CI]: 0.73-1.34; p = .988) or imaging frequency (2.4% telemedicine vs. 7.6%; adjusted RR: 0.784, CI: 0.44-1.39; p = .408) between telemedicine versus in-person visit types. Other orders were significantly less likely to be placed during telemedicine than in-person visits (19.9% telemedicine vs. 28.6% in-person; adjusted RR: 0.623, CI: 0.45-0.86, p = .004). Order(s) of any type were placed in 54% of visits (52% telemedicine vs. 56% in-person; adjusted RR: 0.92 for telemedicine, CI: 0.83-1.01, p = .082). CONCLUSIONS Telemedicine has been integrated into cancer rehabilitation physiatry practices and appears to be conducive for placing many types of orders, especially medications. Age was found to be the only major demographic difference between in-person and telehealth patients.
Collapse
Affiliation(s)
- David Leong
- Department of PM&R, Case Western Reserve University/MetroHealth Rehabilitation Institute, Cleveland, Ohio, USA
| | - Amy Ng
- Department of Palliative Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip Chang
- Department of PM&R, Cedars-Sinai, Los Angeles, California, USA
| | - Jasmine Zheng
- Department of PM&R, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard Wilson
- Department of PM&R, Case Western Reserve University/MetroHealth Rehabilitation Institute, Cleveland, Ohio, USA
| | - Matthew Edwin Chen
- Department of PM&R, Case Western Reserve University/MetroHealth Rehabilitation Institute, Cleveland, Ohio, USA
| | - Mary Vargo
- Department of PM&R, Case Western Reserve University/MetroHealth Rehabilitation Institute, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Dean NA, Marwaha A, Grasdal M, Leong S, Mesa A, Krassioukov AV, Bundon A. Perspectives from the spinal cord injury community with teleSCI services during the COVID-19 pandemic: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:446-453. [PMID: 35797988 DOI: 10.1080/17483107.2022.2096932] [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: 06/11/2021] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To explore individuals with spinal cord injury (SCI) experiences with and perceptions towards teleSCI services during the COVID-19 global pandemic in British Columbia, Canada. METHOD Using maximum variation sampling, we invited selected individuals from a larger quantitative dataset (n = 71) to partake in an interview. In total, 12 individuals participated in the study. Interviews were recorded and transcribed verbatim. Interview transcripts were then coded and analysed by team members using qualitative descriptive analysis. RESULTS Individuals with an SCI perceived teleSCI services to be convenient, accessible, affordable, and an effective way to access some healthcare services during the COVID-19 pandemic. However, in-person healthcare was still needed by many participants to effectively manage and treat their SCI-associated secondary conditions. CONCLUSION Our findings suggest that, in a post-pandemic world, the SCI community would benefit from blended models of healthcare delivery that leverage telecommunication technologies to increase accessibility to healthcare while still providing in-person care for assessments and treatments.Implications for RehabilitationIndividuals with an SCI perceived teleSCI services to be convenient, accessible, affordable, and an effective way to access some healthcare services during the COVID-19 pandemic. However, in-person healthcare was still needed and desired by those with an SCI to effectively manage and treat their SCI-associated secondary conditions.In a post-pandemic world, individuals with an SCI would benefit from blended models of healthcare delivery that leverage telecommunication technologies to increase accessibility to healthcare, while still providing in-person care for those requiring ongoing treatment and management of secondary conditions associated with the patient's SCI.TeleSCI services offer the potential to allow healthcare professionals and SCI specialists to collaborate (digitally) with patients at the same time. This patient-centered approach could not only help healthcare professionals strategize effective remedies to better manage secondary conditions associated with SCI but could result in overall better-quality care received by those within the SCI community.
Collapse
Affiliation(s)
- Nikolaus A Dean
- School of Kinesiology, Faculty of Education, The University of British Columbia, Vancouver, Canada
| | - Arshdeep Marwaha
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark Grasdal
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sarah Leong
- Neuromotion Physiotherapy + Rehabilitation, Kitsilano Physiotherapy Clinic, Treloar Physiotherapy Clinic, Vancouver, Canada
| | - Adam Mesa
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Andrea Bundon
- School of Kinesiology, Faculty of Education, The University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
4
|
Argentinean consensus recommendations for the use of telemedicine in clinical practice in adult people with multiple sclerosis. Neurol Sci 2023; 44:667-676. [PMID: 36319902 PMCID: PMC9628297 DOI: 10.1007/s10072-022-06471-4] [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: 09/09/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of telemedicine has quickly increased during of the COVID-19 pandemic. Given that unmet needs and barriers to multiple sclerosis (MS) care have been reported, telemedicine has become an interesting option to the care of these patients. The objective of these consensus recommendations was to elaborate a guideline for the management of people with MS using telemedicine in order to contribute to an effective and high-quality healthcare. METHODS A panel of Argentinean neurologist's experts in neuroimmunological diseases and dedicated to the diagnosis, management,and care of MS patients gathered virtually during 2021 and 2022 to conduct a consensus recommendation on the use of telemedicine in clinical practice in adult people with MS. To reach consensus, the methodology of "formal consensus RAND/UCLA Appropriateness method" was used. RESULTS Recommendations were established based on relevant published evidence and expert opinion focusing on definitions, general characteristics and ethical standards, diagnosis of MS, follow-up (evaluation of disability and relapses of MS), identification and treatment of relapses, and finally disease-modifying treatments using telemedicine. CONCLUSION The recommendations of this consensus would provide a useful guide for the proper use of telemedicine for the assessment, follow-up, management, and treatment of people with MS. We suggest the use of these guidelines to all the Argentine neurologists committed to the care of people with MS.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Cloosterman S, Wijnands I, Huygens S, Wester V, Lam KH, Strijbis E, den Teuling B, Versteegh M. The Potential Impact of Digital Biomarkers in Multiple Sclerosis in The Netherlands: An Early Health Technology Assessment of MS Sherpa. Brain Sci 2021; 11:1305. [PMID: 34679370 PMCID: PMC8534078 DOI: 10.3390/brainsci11101305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Monitoring of Multiple Sclerosis (MS) with eHealth interventions or digital biomarkers provides added value to the current care path. Evidence in the literature is currently scarce. MS sherpa is an eHealth intervention with digital biomarkers, aimed at monitoring symptom progression and disease activity. To show the added value of digital biomarker-based eHealth interventions to the MS care path, an early Health Technology Assessment (eHTA) was performed, with MS sherpa as an example, to assess the potential impact on treatment switches. (2) Methods: The eHTA was performed according to the Dutch guidelines for health economic evaluations. A decision analytic MS model was used to estimate the costs and benefits of MS standard care with and without use of MS sherpa, expressed in incremental cost-effectiveness ratios (ICERs) from both societal and health care perspectives. The efficacy of MS sherpa on early detection of active disease and the initiation of a treatment switch were modeled for a range of assumed efficacy (5%, 10%, 15%, 20%). (3) Results: From a societal perspective, for the efficacy of 15% or 20%, MS sherpa became dominant, which means cost-saving compared to the standard of care. MS sherpa is cost-effective in the 5% and 10% scenarios (ICERs EUR 14,535 and EUR 4069, respectively). From the health care perspective, all scenarios were cost-effective. Sensitivity analysis showed that increasing the efficacy of MS sherpa in detecting active disease early leading to treatment switches be the most impactful factor in the MS model. (4) Conclusions: The results indicate the potential of eHealth interventions to be cost-effective or even cost-saving in the MS care path. As such, digital biomarker-based eHealth interventions, like MS sherpa, are promising cost-effective solutions in optimizing MS disease management for people with MS, by detecting active disease early and helping neurologists in decisions on treatment switch.
Collapse
Affiliation(s)
- Sonja Cloosterman
- Orikami Digital Health Products, Ridderstraat 29, 6511 TM Nijmegen, The Netherlands; (I.W.); (B.d.T.)
| | - Inez Wijnands
- Orikami Digital Health Products, Ridderstraat 29, 6511 TM Nijmegen, The Netherlands; (I.W.); (B.d.T.)
| | - Simone Huygens
- Institute for Medical Technology Assessment (iMTA), Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands; (S.H.); (V.W.); (M.V.)
| | - Valérie Wester
- Institute for Medical Technology Assessment (iMTA), Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands; (S.H.); (V.W.); (M.V.)
- Erasmus School for Health Policy & Management, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - Ka-Hoo Lam
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Location VUmc, De Boelelaan, 1117 HV Amsterdam, The Netherlands; (K.-H.L.); (E.S.)
| | - Eva Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Location VUmc, De Boelelaan, 1117 HV Amsterdam, The Netherlands; (K.-H.L.); (E.S.)
| | - Bram den Teuling
- Orikami Digital Health Products, Ridderstraat 29, 6511 TM Nijmegen, The Netherlands; (I.W.); (B.d.T.)
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment (iMTA), Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands; (S.H.); (V.W.); (M.V.)
| |
Collapse
|
7
|
Electronic Health Interventions in the Case of Multiple Sclerosis: From Theory to Practice. Brain Sci 2021; 11:brainsci11020180. [PMID: 33540640 PMCID: PMC7913051 DOI: 10.3390/brainsci11020180] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: eHealth interventions play a growing role in shaping the future healthcare system. The integration of eHealth interventions can enhance the efficiency and quality of patient management and optimize the course of treatment for chronically ill patients. In this integrative review, we discuss different types of interventions, standards and advantages of quality eHealth approaches especially for people with multiple sclerosis (pwMS). (2) Methods: The electronic databases PubMed, Cochrane and Web of Science were searched to identify potential articles for eHealth interventions in pwMS; based on 62 articles, we consider different ways of implementing health information technology with various designs. (3) Results: There already exist some eHealth interventions for single users with a single-use case, interventions with a social setting, as well as eHealth interventions that integrate various single and social interventions and even those that may be used additionally for complex use cases. A key determinant of consumer acceptance is a high-quality user-centric design for healthcare practitioners and pwMS. In pwMS, the different neurological disabilities should be considered, and particular attention must be paid to the course of the treatment and the safety processes of each treatment option. (4) Conclusion: Depending on the field of application and the respective users, interventions are designed for single, social, integrated or complex use. In order to be accepted by their target group, interventions must be beneficial and easy to use.
Collapse
|
8
|
Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
9
|
Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Domingues RB, Mantese CE, Aquino EDS, Fantini FGMM, Prado GFD, Nitrini R. Telemedicine in neurology: current evidence. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:818-826. [PMID: 33295422 DOI: 10.1590/0004-282x20200131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. OBJECTIVE This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. METHODS A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. RESULTS Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. CONCLUSION Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.
Collapse
Affiliation(s)
- Renan Barros Domingues
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Santa Casa de Misericórdia de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Eduardo Mantese
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Hospital Mãe de Deus, Porto Alegre RS, Brazil
| | - Emanuelle da Silva Aquino
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Gilmar Fernandes do Prado
- Diretoria Executiva, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Diretoria Científica, Academia Brasileira de Neurologia, São Paulo SP, Brazil
| |
Collapse
|
11
|
D'Haeseleer M, Eelen P, Sadeghi N, D'Hooghe MB, Van Schependom J, Nagels G. Feasibility of Real Time Internet-Based Teleconsultation in Patients With Multiple Sclerosis: Interventional Pilot Study. J Med Internet Res 2020; 22:e18178. [PMID: 32447274 PMCID: PMC7453329 DOI: 10.2196/18178] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Telemedicine (TM) is currently flourishing in rural and emergency settings, but its implementation in the routine management of chronic neurological disorders has developed with more hesitation. Limited access to specialized care facilities and expanding patient populations, combined with unprecedented mobility restrictions imposed by the coronavirus disease pandemic, are currently stressing the need for remote solutions in this field. Studies in patients with multiple sclerosis (MS) have been heterogeneous in objectives and methodology but generally support the concept that TM interventions produce clinical benefits, cost-effectiveness, and user satisfaction. Nonetheless, data on live interaction between patients and health care providers for MS teleconsultation purposes remain scarce. OBJECTIVE The aim of this study is to demonstrate the feasibility of planned real time audiovisual teleconsultation over the internet for patients with MS. METHODS A total of 20 patients with MS presenting at a specialized MS center in Belgium were recruited for this study. One teleconsultation was scheduled for each participant. Patients were provided a unique hyperlink by mail in advance, leading them automatically and directly to the virtual waiting room, where they could accept or decline our incoming call. All teleconsultations were performed by a trained medical student with the intention to keep the conversation similar to what is usually discussed during a classic face-to-face MS consultation; no remote physical exams were performed. The approach was considered feasible if at least 80% of the planned TM visits could be successfully completed at the foreseen moment. Patient satisfaction (technical quality, convenience, and overall quality of care) was evaluated at the end of each teleconsultation by means of 5-point Likert scales containing the categories very unsatisfied, unsatisfied, neutral, satisfied, and highly satisfied. RESULTS Out of 20 consultations, 17 were successfully completed (85%). Failures were due to patients not responding (n=2) and technical issues (n=1). Out of the 17 consultations, 17 patients declared themselves satisfied or highly satisfied for technical quality, 15 patients for convenience, and 16 patients for overall quality of care. CONCLUSIONS Planned real time audiovisual teleconsultation over the internet is feasible and highly appreciated in patients with MS. Incorporation of such services in routine clinical MS practice is expected to improve access to specialized care facilities for affected patients.
Collapse
Affiliation(s)
- Miguel D'Haeseleer
- Universitair Ziekenhuis Brussel, Brussels, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Piet Eelen
- Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium
| | - Nima Sadeghi
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marie B D'Hooghe
- Universitair Ziekenhuis Brussel, Brussels, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jeroen Van Schependom
- Universitair Ziekenhuis Brussel, Brussels, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Nagels
- Universitair Ziekenhuis Brussel, Brussels, Belgium.,Nationaal Multiple Sclerose Centrum, Melsbroek, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Zebra Academy, Brussels, Belgium
| |
Collapse
|
12
|
Yeroushalmi S, Maloni H, Costello K, Wallin MT. Telemedicine and multiple sclerosis: A comprehensive literature review. J Telemed Telecare 2019; 26:400-413. [PMID: 31042118 DOI: 10.1177/1357633x19840097] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with multiple sclerosis (pwMS) face barriers accessing specialty care for evaluation and treatment. Telemedicine, the practice of clinical care at a distance with the aid of technology, may be a potential bridge to close the access gap for pwMS separated by distance or disability. The objective of this review was to investigate the types of telemedicine being utilized and overall outcomes for pwMS and their providers. METHODS A Boolean search of the medical literature was conducted between January 2000 and January 31, 2018. PubMed, EMBASE, PsycINFO and the Cochrane databases, were used to identify all relevant citations. Two reviewers independently appraised the articles for meeting study criteria and for study quality using the CASP system. Financial costs of the telemedicine applications were assessed. RESULTS A total of 28 studies involving 3252 participants met criteria for inclusion. Telemedicine interventions were classified, and outcomes were assessed systematically by the following categories: general MS care; rehabilitation and exercise; and neuropsychology/mental health. Studies showed a range of outcomes with variable quality. Overall, remote clinical examinations, long-term telemedicine management interventions and telerehabilitation were shown to be beneficial, cost-effective and satisfactory for patients and providers. DISCUSSION Telemedicine is a viable platform for delivering specialty MS care. Remote neurological assessments and several forms of therapy have been shown to be technically feasible. Optimal implementation and barriers to the use of telemedicine in the current healthcare system should be explored.
Collapse
Affiliation(s)
- Samuel Yeroushalmi
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence-East, Washington, DC, USA
| | - Heidi Maloni
- Department of Veterans Affairs Multiple Sclerosis Center of Excellence-East, Washington, DC, USA
| | | | - Mitchell T Wallin
- Neurology Department, Johns Hopkins University, USA.,Neurology Department, George Washington University School of Medicine, USA
| |
Collapse
|
13
|
Telemedicine using an iPad in the spinal cord injury population: a utility and patient satisfaction study. Spinal Cord Ser Cases 2018; 4:71. [PMID: 30131874 PMCID: PMC6082908 DOI: 10.1038/s41394-018-0105-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 01/06/2023] Open
Abstract
Study design Prospective observational. Objectives To explore participants' experience, satisfaction, and utility of telemedicine. Setting Spinal cord injury (SCI) rehabilitation clinic at a county hospital. Methods Participants in this study received telemedicine appointments for routine scheduled care and/or urgent consults with a spinal cord injury specialist via iPad on FaceTime. Demographic changes, health care utilization, and medical complications were assessed. A Program Satisfaction Survey (PSS) was completed after a 6-month enrollment. Results Telemedicine visits included general follow-ups (51.25%), "multiple issues" (24.38%), skin (6.88%), bowel and bladder (5.63%), spasms (3.13%), and pain (3.13%). The PSS was collected (n = 45) and revealed positive results in perceived health, satisfaction with equipment/ease of use, and satisfaction with the program. Analysis of anecdotal comments revealed themes such as efficiency, convenience, and reduced barriers provided by telemedicine visits. Conclusions This study shows the feasibility and acceptance of a telemedicine intervention via iPad for individuals with SCI through positive PSS ratings and the wide variety of clinical topics addressed. Sponsorship Craig H. Neilsen Foundation.
Collapse
|
14
|
Self-management interventions for skin care in people with a spinal cord injury: part 2-a systematic review of use of theory and quality of intervention reporting. Spinal Cord 2018; 56:837-846. [PMID: 29795415 PMCID: PMC6128816 DOI: 10.1038/s41393-018-0136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To examine use of theory and quality of reporting in skin care self-management interventions for people with SCI. SETTING International. METHODS The Theory Coding Scheme (TCS) and the Template for Intervention Description and Replication (TIDieR) checklist were applied by two independent researchers to 17 interventions identified in a systematic review of self-management interventions for skin care in people with SCI. RESULTS Six (35%) of the 17 interventions reviewed were reported to have a theoretical basis. Theories used included three of the most commonly featured in health behavior research (the Health Belief Model, Social Cognitive Theory, and the Transtheoretical Model). In these six interventions, theory was used to design content but not to select participants or tailor strategies. None of the interventions were used to test theories in the SCI population, or to propose theoretical refinements. Reporting quality was found to vary by TIDieR item, with 6-100% of interventions including recommended information. Information on two intervention fidelity items was missing in 53 and 82% of descriptions. CONCLUSIONS Use of theory and reporting quality in SCI self-management research remains suboptimal, potentially slowing down advancements in this area of research. Rehabilitation researchers should direct their efforts toward improving these practices to help build a science of SCI self-management that is cumulative and reproducible by clinicians, scientists, and policy makers. SPONSORSHIP This work was funded through a postdoctoral fellowship awarded to the first author by the Rick Hansen Institute.
Collapse
|
15
|
Baron JS, Sullivan KJ, Swaine JM, Aspinall A, Jaglal S, Presseau J, White B, Wolfe D, Grimshaw JM. Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness. Spinal Cord 2018; 56:823-836. [PMID: 29802393 PMCID: PMC6128818 DOI: 10.1038/s41393-018-0138-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
Study design Systematic review. Objectives To review the content and effectiveness of skin care self-management interventions for people with SCI. Setting International. Methods We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied. Results In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting. Conclusions There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.
Collapse
Affiliation(s)
- Justine S Baron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Katrina J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jillian M Swaine
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Arlene Aspinall
- Rick Hansen Institute, Vancouver, BC, Canada.,Vancouver General Hospital, Vancouver, BC, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Barry White
- Rick Hansen Institute, Vancouver, BC, Canada
| | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada.,University of Western Ontario, London, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
16
|
Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System. Arch Phys Med Rehabil 2016; 97:1969-1978. [PMID: 27311718 DOI: 10.1016/j.apmr.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability. DESIGN Nonrandomized, noncontrolled cohort study; 2 years of enrollment. SETTING Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system. PARTICIPANTS Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention. INTERVENTIONS Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives. MAIN OUTCOME MEASURES Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost. RESULTS Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment. CONCLUSIONS Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.
Collapse
|