Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
Department of Economics and Business, University of Catania, 95129, Catania, Italy.
Neurol Sci. 2022 Apr;43(4):2253-2261. doi: 10.1007/s10072-022-05868-5. Epub 2022 Jan 11.
Evidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely.
This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits.
In total, 76 patients with relapsing-remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants.
The inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70-0.91; p < 0.001).
Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.
最近有证据表明远程医疗（TM）在多发性硬化症（MS）管理中的成本效益。然而，对于远程进行的神经检查的准确性仍存在一些疑问。
本研究旨在比较轻度 MS 患者通过 TM 进行的神经评估与标准面对面就诊的可靠性。
共招募了 76 例复发缓解型 MS 患者，扩展残疾状况量表（EDSS）≤3.5。其中，40 例患者（52.6%）接受了独立评估员在 48 小时内进行的面对面和 TM 评估。我们还要求患者在 TM 就诊时是否有照顾者在场。所有参与者都填写了一份满意度问卷。
两位独立神经科医生在 TM 就诊期间的评分具有很高的组内一致性（κ>0.80），适用于 EDSS 和功能系统（FS）评分。TM 和面对面评估之间存在中度一致性，适用于锥体束（κ=0.57；p<0.001）、脑干（κ=0.57；p<0.001）、肠和膀胱（κ=0.54；p<0.001）和感觉 FS 评分（κ=0.51；p<0.001），在有照顾者支持的患者中更高。在远程和面对面就诊期间计算的 EDSS 评分具有良好的可靠性（ICC=0.83；95%CI 0.70-0.91；p<0.001）。
尽管神经检查复杂，但 TM 可能对监测低残疾 MS 患者有用。
