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Montañés‐Masias B, Bort‐Roig J, Pascual JC, Soler J, Briones‐Buixassa L. Online psychological interventions to improve symptoms in multiple sclerosis: A systematic review: Online psychological interventions in Multiple Sclerosis. Acta Neurol Scand 2022; 146:448-464. [PMID: 36121184 PMCID: PMC9825977 DOI: 10.1111/ane.13709] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review was to assess the effectiveness of Internet-based psychological interventions in the treatment of physical, socio-affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio-affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio-affective and cognitive symptoms as well as QoL in pwMS, overcoming the face-to-face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS.
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Affiliation(s)
- Brenda Montañés‐Masias
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Judit Bort‐Roig
- Sport and Physical Activity Research Group, Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Juan Carlos Pascual
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Joaquim Soler
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Laia Briones‐Buixassa
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
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Menzies RE, Sharpe L, Richmond B, Dudeney J, Todd J, Szabo M, Sesel AL, Dear B. Randomised controlled trial of cognitive behaviour therapy versus mindfulness for people with rheumatoid arthritis with and without a history of recurrent depression: study protocol and design. BMJ Open 2022; 12:e056504. [PMID: 35589354 PMCID: PMC9121498 DOI: 10.1136/bmjopen-2021-056504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Psychosocial treatments have been shown to benefit people with rheumatoid arthritis (RA) on various outcomes. Two evidence-based interventions are cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR). However, these interventions have been compared only once. Results showed that CBT outperformed MBSR on some outcomes, but MBSR was more effective for people with RA with a history of recurrent depression, with efficacy being moderated by history of depressive episodes. However, this was a post-hoc finding based on a small subsample. We aim to examine whether a history of recurrent depression will moderate the relative efficacy of these treatments when delivered online. METHODS AND ANALYSIS This study is a randomised controlled trial comparing CBT and MBSR delivered online with a waitlist control condition. History of recurrent depressive episodes will be assessed at baseline. The primary outcome will be pain interference. Secondary outcomes will include pain intensity, RA symptoms, depressive symptoms and anxiety symptoms. Outcome measures will be administered at baseline, post-treatment and at 6 months follow-up. We aim to recruit 300 participants, and an intention-to-treat analysis will be used. Linear mixed models will be used, with baseline levels of treatment outcomes as the covariate, and group and depressive status as fixed factors. The results will demonstrate whether online CBT and MBSR effectively improve outcomes among people with RA. Importantly, this trial will determine whether one intervention is more efficacious, and whether prior history of depression moderates this effect. ETHICS AND DISSEMINATION The trial has been approved by the Human Research Ethics Committee of the University of Sydney (2021/516). The findings will be subject to publication irrespective of the final results of the study, and based on the outcomes presented in this protocol. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000997853p).
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Affiliation(s)
- Rachel E Menzies
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Bethany Richmond
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Dudeney
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jemma Todd
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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3
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression. Mult Scler 2022; 28:1392-1401. [PMID: 35130768 DOI: 10.1177/13524585211068002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI). OBJECTIVES We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome. METHODS Participants (N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months. RESULTS The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist (p = 0.046, Cohen's d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without (p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history (p = 0.009, d = 0.5). Pain interference was less overall in the MBI group (p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue. CONCLUSION The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression. TRIAL REGISTRATION ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Sauder T, Hansen S, Bauswein C, Müller R, Jaruszowic S, Keune J, Schenk T, Oschmann P, Keune PM. Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression. BMC Neurol 2021; 21:390. [PMID: 34625058 PMCID: PMC8499486 DOI: 10.1186/s12883-021-02390-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention. METHODS A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training. RESULTS Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance. CONCLUSION Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.
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Affiliation(s)
- Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Carina Bauswein
- Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sonja Jaruszowic
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Thomas Schenk
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
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Özkeskin M, Özden F, Ekmekçi Ö, Yüceyar N. The reliability and validity of the Turkish version of the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) in individuals with multiple sclerosis. Neurol Sci 2021; 43:1921-1927. [PMID: 34342782 PMCID: PMC8328809 DOI: 10.1007/s10072-021-05519-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/25/2021] [Indexed: 12/03/2022]
Abstract
Objective The study was aimed to translate and adapt the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) into Turkish, thereafter to analyze the psychometric properties of both questionnaires. Methods A total of 149 multiple sclerosis (MS) patients were recruited in the study. For 4 years, all patients were supervised by a department clinician using telemedicine. Cronbach’s alpha coefficient was used to assess internal consistency. By evaluating the scores of 41 retested patients 1 week later, the test-retest reliability was determined using the intraclass correlation coefficient (ICC). Pearson’s correlation coefficient was used to assess the construct validity (r). Results A total of 149 patients (103 women, 46 men) with a mean age of 40.9±10.9 years were included in the study. MS duration of the patients was 9.15±6.24 years. Internal consistency of all items and the total score of the TSUQ were excellent (>0.80; ranged 0.971–0.974). On the other hand, the internal consistency of all items and total score of the TPQ was excellent, either (>0.80; ranged 0.878–0.890). The ICC of the TSUQ’s and TPQ’s total score was excellent (>0.80). The correlation between TSUQ and TPQ was strong (r=0.734, p<0.01). In addition, there was moderate relationship between the TSUQ and the Beck Depression Scale (BDS) (r=−0.363, p<0.01). On the other hand, there was low correlation between TPQ and BDS (r=−0.217, p<0.05). Conclusion The Turkish version of the TSUQ and the TPQ is valid and reliable in individuals with MS.
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Affiliation(s)
- Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Elderly Care, Muğla Sıtkı Koçman University, 48800, Köyceğiz, Muğla, Turkey.
| | - Özgül Ekmekçi
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
| | - Nur Yüceyar
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
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Newland P, Chen L, Sun P, Zempel J. Neurophysiological Correlates of Fatigue in Multiple Sclerosis. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pilot Study of Videos to Deliver Mindfulness-Based Art Therapy for Adults With Multiple Sclerosis. J Neurosci Nurs 2021; 52:E19-E23. [PMID: 33156593 DOI: 10.1097/jnn.0000000000000547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mindfulness-based art therapy (MBAT) has been shown to provide a strategy for adults with multiple sclerosis (MS) to self-manage their symptoms. There is a need for the use of an MBAT intervention that can be delivered in any setting for adults with MS. The purpose of this pilot feasibility study was to test the feasibility and acceptability of an MBAT intervention delivered via videoconference. METHODS We developed an MBAT intervention to be delivered by videoconference to adults with MS recruited from an academic center registry. We also conducted phone interviews to collect acceptability data. RESULTS Most of the participants (n = 5) were very positive about the MBAT video sessions and stated content as clear and easy to follow and understand. The time and delivering method were acceptable. CONCLUSION Mindfulness-based art therapy sessions delivered through videoconference are acceptable and feasible for adults with MS.
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study. J Med Internet Res 2021; 23:e19309. [PMID: 33650980 PMCID: PMC7967236 DOI: 10.2196/19309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Marianna Szabo
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Sydney, Australia
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Mullur RS, Kaur Cheema SP, Alano RE, Chang LE. Tele-Integrative Medicine to Support Rehabilitative Care. Phys Med Rehabil Clin N Am 2021; 32:393-403. [PMID: 33814064 DOI: 10.1016/j.pmr.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complementary and integrative health (CIH) modalities have therapeutic value in the multidisciplinary rehabilitation of chronic pain patients. Evidence of such has been seen with the Whole Health Model at the (Veterans Affairs) VA Healthcare system. CIH therapies, including yoga, tai chi, mindfulness meditation, hypnosis, self-massage, and acupressure, are significantly effective for managing chronic pain with little to no negative effects, and can be easily incorporated into telemedicine care with great potential benefit. The future of wellness in telemedicine is evolving with great potential, and needs further attention to addressing barriers of care.
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Affiliation(s)
- Rashmi S Mullur
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Mail Code 111-D, Los Angeles, CA 90073, USA.
| | - Seetal Preet Kaur Cheema
- Department of Anesthesia (212), VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Ryan Edward Alano
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Lynn Elizabeth Chang
- Department of Physical Medicine and Rehabilitation (1415), VA Greater Los Angeles Healthcare System, 1301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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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.
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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
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