Abstract General Information
Reliability of telemedicine evaluation for EDSS functional systems in multiple sclerosis.
Introduction: There was a significant increase in telemedicine during the COVID-19 pandemic to follow patients with multiple sclerosis (MS). However, there are scarce data if these online evaluations can cover details assessed during in-clinic appointments, especially those data that may indicate disease progression, as the Expanded Disability Status Score (EDSS). Telemedicine evaluations require the development of a reliable and standardized tool for the evaluation of functional systems. Objectives: To develop a remote evaluation tool for the EDSS functional systems and compare the performance with face-to-face evaluations. Methods: This single-center cross-sectional study included MS patients followed up at outpatient clinics of Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul. All patients evaluated in-clinic, between April and August 2022, were invited to participate. Initially, patients were routinely evaluated by one trained neurologist for EDSS. After scheduling the online evaluation, patients were evaluated remotely without any information about the in-clinic EDSS results. We used a standardized interview with an interactive video platform to evaluate EDSS functional systems by telemedicine. Results: Forty-nine participants completed the evaluations. Intra-class coefficient (ICC) was 0.97 (95% IC: 0.95-0.98), and concordance correlation coefficient (CCC) for EDSS below 4.0 was 0.87 (95% CI: 0.77 to 0.93), and 4.0 was 0.97 (95% IC: 0.89 to 0.99). There was perfect agreement in final EDSS in 71.4% of the online and in-clinic evaluations. In multivariate analysis, visual (beta = 0.453; p 0.003) and pyramidal (beta = 0.403; p 0.009) systems contributed significantly to the difference in final EDSS. Conclusion: The telemedicine tool created in this study can detect changes in functional systems with reliable results compared to in-clinic EDSS. Nevertheless, caution is required in the assessments of the visual and pyramidal systems. Telemedicine evaluations may reduce the number of in-clinic visits and the disease burden for MS patients.
Cássia Elisa Marin, Paula Oliveira Pinto, Giordani Rodrigues Dos Passos, Daissy Liliana Mora Cuervo, Mário Bernardes Wagner, Jefferson Becker, Douglas Kazutoshi Sato