UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California, San Francisco, CA, USA.
VA MS Center of Excellence East, Washington, DC, USA.
Mult Scler. 2019 Oct;25(11):1526-1534. doi: 10.1177/1352458518793527. Epub 2018 Aug 24.
Remote assessment of neurological disability in people with multiple sclerosis (MS) could improve access to clinical care and efficiency of clinical research.
To develop and validate a telemedicine-based MS disability examination that does not require an in-home examiner.
Adults with MS were recruited after a standardized in-person Expanded Disability Status Scale (EDSS) evaluation, and within 1 week underwent a blinded televideo-enabled EDSS examination with a different clinician. EDSS and tele-EDSS scores were compared.
Overall, 41 adults participated (mean (standard deviation (SD)) age: 47.0 years (11.6); median EDSS: 2 (range: 0-7)); 37 required no in-home assistance for the tele-EDSS evaluation (e.g. help positioning camera). Mean difference between EDSS and tele-EDSS was 0.34 (95% confidence interval (CI): 0.07-0.61). For 88% of evaluations, tele-EDSS and EDSS scores were within 1 point (similar to reported in-person inter-rater differences). Unweighted kappa for agreement within 0.5 point was 0.72. Correlation for individual functional systems (FS) ranged from modest (vision: 0.37) to high (bowel/bladder: 0.79). Overall correlation between EDSS and tele-EDSS was 0.89 ( < 0.0001); and 0.98 ( < 0.0001) at EDSS range: 4-7.
In this proof of principle study, disability evaluation in mild to moderate MS is feasible using telemedicine without an aide at the patient's location.
远程评估多发性硬化症（MS）患者的神经功能障碍可以改善临床护理的可及性和临床研究的效率。
开发和验证一种基于远程医疗的 MS 残疾评估方法，该方法无需家访评估员。
在经过标准的扩展残疾状况量表（EDSS）评估后，招募成年 MS 患者，并在 1 周内由不同的临床医生进行盲法电视视频启用的 EDSS 检查。比较 EDSS 和远程 EDSS 评分。
共有 41 名成年人参与（平均（标准差（SD））年龄：47.0 岁（11.6）；中位数 EDSS：2（范围：0-7））；37 名患者无需在家中接受远程 EDSS 评估的帮助（例如，帮助定位摄像头）。EDSS 和远程 EDSS 之间的平均差异为 0.34（95%置信区间（CI）：0.07-0.61）。在 88%的评估中，远程 EDSS 和 EDSS 评分相差 1 分（与报告的面对面评估者之间的差异相似）。相差 0.5 分的一致性的未加权 Kappa 值为 0.72。个体功能系统（FS）的相关性从中等（视力：0.37）到高（肠道/膀胱：0.79）。EDSS 和远程 EDSS 之间的总体相关性为 0.89（<0.0001）；在 EDSS 范围：4-7 时，相关性为 0.98（<0.0001）。
在这项原理验证研究中，使用远程医疗在患者所在地无需助手的情况下，对轻度至中度 MS 的残疾评估是可行的。
