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      Feasibility of Real Time Internet-Based Teleconsultation in Patients With Multiple Sclerosis: Interventional Pilot Study

      , MD, PhD , 1 , 2 , 3 , , RNCS 2 , , BMBS 3 , , MD, PhD 1 , 2 , 3 , , MEng, PhD 1 , 2 , 3 , , MD, MEng, PhD 1 , 2 , 3 , 4

      (Reviewer), (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications

      multiple sclerosis, teleconsultation, internet, feasibility, eHealth

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          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.

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          Most cited references 26

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          Teleneurology and mobile technologies: the future of neurological care

          Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.
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            COVID-19 is catalyzing the adoption of teleneurology

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              Telemedicine in neurology

              While there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                August 2020
                13 August 2020
                : 22
                : 8
                Affiliations
                [1 ] Universitair Ziekenhuis Brussel Brussels Belgium
                [2 ] Nationaal Multiple Sclerose Centrum Melsbroek Belgium
                [3 ] Center for Neurosciences Vrije Universiteit Brussel Brussels Belgium
                [4 ] Zebra Academy Brussels Belgium
                Author notes
                Corresponding Author: Miguel D'Haeseleer miguel.dhaeseleer@ 123456uzbrussel.be
                Article
                v22i8e18178
                10.2196/18178
                7453329
                32447274
                ©Miguel D'Haeseleer, Piet Eelen, Nima Sadeghi, Marie B D'Hooghe, Jeroen Van Schependom, Guy Nagels. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.08.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                Categories
                Original Paper
                Original Paper

                Medicine

                multiple sclerosis, teleconsultation, internet, feasibility, ehealth

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