How to manage with telemedicine people with neuromuscular diseases?

E-Health & Innovation to Overcome Barriers in Neuromuscular Diseases. Report from the 3rd eNMD Congress: Pisa, Italy, 29-30 October 2021

Neuromuscular diseases (NMDs), in their phenotypic heterogeneity, share quite invariably common issues that involve several clinical and socio-economical aspects, needing a deep critical analysis to develop better management strategies. From diagnosis to treatment and follow-up, the development of technological solutions can improve the detection of several critical aspects related to the diseases, addressing both the met and unmet needs of clinicians and patients. Among several aspects of the digital transformation of health and care, this congress expands what has been learned from previous congresses editions on applicability and usefulness of technological solutions in NMDs. In particular the focus on new solutions for remote monitoring provide valuable insights to increase disease-specific knowledge and trigger prompt decision-making. In doing that, several perspectives from different areas of expertise were shared and discussed, pointing out strengths and weaknesses on the current state of the art on topic, suggesting new research lines to advance technology in this specific clinical field.

Efficacy of Teleconsultation-Based Rehabilitation in Children with Landry-Guillain-Barré Syndrome: An Open Label Randomized Controlled Trial (Tele Rehab-LGBS Trial)

OBJECTIVES

To evaluate the feasibility and efficacy of teleconsultation-based rehabilitation in children with Landry-Guillain-Barré syndrome (LGBS), measured with Medical Research Council (MRC) sum score and Hughes score.

METHODS

A pragmatic, prospective, parallel open label randomized controlled trial was conducted among a total of 50 children with LGBS. The children were randomized using computer generated block randomization into 2 groups (25 in each group): Standard of care (Group A) and teleconsultation-based rehabilitation (Group B). Primary and secondary outcomes were measured with MRC sum score and Hughes score at 12- and 24-wk follow-up.

RESULTS

The mean age was 6.4 ± 3.3 y; 29 (58%) were boys. Baseline MRC sum score (median, IQR), and Hughes score (median, IQR) in group A was 24 (7-31) and 5 (4-5) respectively; and in group B was 18 (9-24) and 4 (4-5) respectively. At discharge, median (IQR) MRC sum score in group A and B was 34 (28-41), and 30 (25-43) (p value = 0.31) respectively. Tele-rehabilitation was provided to group B for 24 wk with 96% compliance. At 12 wk, median MRC sum score in group A and group B were similar [48 (IQR 44-54) vs. 52 (IQR 46-60), p value = 0.08]. At 12 wk and 24 wk, median Hughes score in group A and B were similar. At 24 wk, 15 out of 23 subjects of group A and 18 out of 25 subjects of group B were ambulatory (p value = 0.61).

CONCLUSIONS

Teleconsultation-based rehabilitation was feasible with a high compliance rate. The functional outcomes measured with MRC sum score and Hughes score were similar in both the groups at 12 and 24 wk follow-up. Teleconsultation-based rehabilitation has similar efficacy as physical rehabilitation.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

INTRODUCTION

The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.

AIM

The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.

METHODS

To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

RESULTS

The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.

CONCLUSIONS

It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

Digital measures of respiratory and upper limb function in spinal muscular atrophy: design, feasibility, reliability, and preliminary validity of a smartphone sensor-based assessment suite

Spinal muscular atrophy (SMA) is characterized by progressive muscle weakness and paralysis. Motor function is monitored in the clinical setting using assessments including the 32-item Motor Function Measure (MFM-32), but changes in disease severity between clinical visits may be missed. Digital health technologies may assist evaluation of disease severity by bridging gaps between clinical visits. We developed a smartphone sensor-based assessment suite, comprising nine tasks, to assess motor and muscle function in people with SMA. We used data from the risdiplam phase 2 JEWELFISH trial to assess the test-retest reliability and convergent validity of each task. In the first 6 weeks, 116 eligible participants completed assessments on a median of 6.3 days per week. Eight of the nine tasks demonstrated good or excellent test-retest reliability (intraclass correlation coefficients >0.75 and >0.9, respectively). Seven tasks showed a significant association (P < 0.05) with related clinical measures of motor function (individual items from the MFM-32 or Revised Upper Limb Module scales) and seven showed significant association (P < 0.05) with disease severity measured using the MFM-32 total score. This cross-sectional study supports the feasibility, reliability, and validity of using smartphone-based digital assessments to measure function in people living with SMA.

A pilot study of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders

INTRODUCTION

Telerehabilitation provides physical training to patients through telecommunication networks. We examined the feasibility, safety, and efficacy of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders (NMDs).

METHODS

Stable pediatric patients were recruited for a 16-week home training program with personalized pulmonary, upper and lower limb exercises. Patients reviewed instructional videos at home and attended bi-weekly follow-ups through video or audio calls, text messages, or emails. The primary outcomes were respiratory function, Medical Research Council (MRC) grading, hand/pinch strength, 6-minute walk test, and Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey. The secondary outcomes were study compliance and user feedback.

RESULTS

Patients with spinal muscular atrophy (n = 4), congenital myasthenic syndrome (n = 2), and Duchenne muscular dystrophy (n = 2) completed the program. The median weekly exercise time was 101.3 min (range: 30.0-266.9). No extra face-to-face physiotherapy sessions were requested by the patients. No adverse events were reported. After the study, patients showed improvements in maximal expiratory pressure (35.0 vs. 47.5 cm H2O, p = .028) and maintained their MRC grade, hand/pinch strength, and walking distance. Patients also reported improvements in the Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey score (74.5 vs. 87.0, p = .036). Patients rated the overall program highly (mean: 4.00/5.00) and recommended it as a standard of care (mean: 4.38/5.00).

DISCUSSION

Our telerehabilitation program was feasible, safe, and possibly effective for this pilot cohort of stable pediatric patients with hereditary NMDs. Larger-scale studies for longer periods are warranted to confirm the results.

Children oral health and parents education status: a cross sectional study

INTRODUCTION

Oral diseases are common and affect millions of people worldwide. They can range from mild and easily treatable conditions to more severe and serious diseases. Proper oral hygiene and regular dental monitoring are essential for maintaining good oral health. When it comes to children's health and well-being, parents' education level plays a critical role. Research has shown that parents' higher educational attainment is associated with better health outcomes for their children. Our aim is to evaluate whether parents' education level and employment influence children oral health and its impact on the family.

METHODS

We enrolled consecutively healthy subjects aged between 0-16 and their parents at the Dental Clinic of the University of Campania "L. Vanvitelli". The Italian version of the ECOHIS (I-ECOHIS) was administered to parents of the enrolled subjects referred to the Dental Clinic of the University of Campania "L. Vanvitelli". Linear regression models, adjusted for age and sex, were used to explore the association between parents' employment or education level and the ECOHIS scores. Statistical significance was accepted when p value < 0.05.

RESULTS

We found a significative association of a higher I-ECOHIS total score (coeff. 4.04244; CI 95%: 1.530855-6.554026; p = 0,002) and higher I-ECOHIS children section score (coeff. 3.2794; CI 95%: 1.29002-5.268; P = 0,002) and the father unemployed status. We also found that a higher education level of the father was associated with a lower ECOHIS total score (coeff. -1.388; IC 95%: -2.562115--0.214 p = 0.021) and a higher education level of the mother was associated with a lower ECOHIS in children section (coeff. -0.972; IC95%: -1.909356-0.034; p = 0.042).

CONCLUSIONS

Father unemployed status and a lower educational level for both parents may negatively affect oral health status.

Agreement between tele-assessment and face-to-face assessment of 30-s sit-to-stand test in patients with type 2 diabetes mellitus

BACKGROUND

The globalization of healthcare systems, and the aim to lower healthcare costs have all contributed to the growth of telehealth technology in recent years. However, before these systems are put into use, their efficacy should be verified. To the best of our knowledge, this is the first study focusing on the evaluation of functional exercise capacity using the 30-s sit-to-stand (30-s STS) test as a tele-assessment method in patients with type 2 diabetes mellitus (T2DM).

AIMS

The purpose of the study is to investigate the level of agreement between tele-assessment and face-to-face assessment of 30-s STS test in patients with T2DM.

METHODS

Fifty participants performed two times 30-s STS tests separated by 1 h: a face-to-face and an Internet-connected video call examination (tele-assessment). Two physiotherapists conduct these evaluations; each was blinded to the other. The order of the evaluations was designated at random for each participant and physiotherapist.

RESULTS

There was a good level of agreement between tele-assessment and face-to-face assessment of the 30-s STS test (mean differences = 0.20 ± 0.88, limits of agreement = 1.93 to - 1.53). Excellent interrater reliability was found for scores of the 30-s STS test [ICC = 0.93 (95% CI: 0.88; 0.96)]. In addition, all before and after test parameters show that there was a very good interrater reliability (ρ ≥ 0.75).

CONCLUSIONS

This study shows a good level of agreement between tele-assessment and face-to-face assessment of the 30-s STS test. Our study's findings indicate that tele-assessment is a potential application to determine the level of physical capacity remotely in patients with T2DM.

Eye Segmentation Method for Telehealth: Application to the Myasthenia Gravis Physical Examination

Due to the precautions put in place during the COVID-19 pandemic, utilization of telemedicine has increased quickly for patient care and clinical trials. Unfortunately, teleconsultation is closer to a video conference than a medical consultation, with the current solutions setting the patient and doctor into an evaluation that relies entirely on a two-dimensional view of each other. We are developing a patented telehealth platform that assists with diagnostic testing of ocular manifestations of myasthenia gravis. We present a hybrid algorithm combining deep learning with computer vision to give quantitative metrics of ptosis and ocular muscle fatigue leading to eyelid droop and diplopia. The method works both on a fixed image and frame by frame of the video in real-time, allowing capture of dynamic muscular weakness during the examination. We then use signal processing and filtering to derive robust metrics of ptosis and l ocular misalignment. In our construction, we have prioritized the robustness of the method versus accuracy obtained in controlled conditions in order to provide a method that can operate in standard telehealth conditions. The approach is general and can be applied to many disorders of ocular motility and ptosis.

A store-and-forward cloud-based telemonitoring system for automatic assessing dysarthria evolution in neurological diseases from video-recording analysis

BACKGROUND AND OBJECTIVES

Patients suffering from neurological diseases may develop dysarthria, a motor speech disorder affecting the execution of speech. Close and quantitative monitoring of dysarthria evolution is crucial for enabling clinicians to promptly implement patients' management strategies and maximizing effectiveness and efficiency of communication functions in term of restoring, compensating or adjusting. In the clinical assessment of orofacial structures and functions, at rest condition or during speech and non-speech movements, a qualitative evaluation is usually performed, throughout visual observation.

METHODS

To overcome limitations posed by qualitative assessments, this work presents a store-and-forward self-service telemonitoring system that integrates, within its cloud architecture, a convolutional neural network (CNN) for analyzing video recordings acquired by individuals with dysarthria. This architecture - called facial landmark Mask RCNN - aims at locating facial landmarks as a prior for assessing the orofacial functions related to speech and examining dysarthria evolution in neurological diseases.

RESULTS

When tested on the Toronto NeuroFace dataset, a publicly available annotated dataset of video recordings from patients with amyotrophic lateral sclerosis (ALS) and stroke, the proposed CNN achieved a normalized mean error equal to 1.79 on localizing the facial landmarks. We also tested our system in a real-life scenario on 11 bulbar-onset ALS subjects, obtaining promising outcomes in terms of facial landmark position estimation.

DISCUSSION AND CONCLUSIONS

This preliminary study represents a relevant step towards the use of remote tools to support clinicians in monitoring the evolution of dysarthria.

A Digital Telehealth System to Compute the Myasthenia Gravis Core Examination Metrics

Background

Telemedicine practice for neurological diseases has grown significantly during the COVID-19 pandemic.Telemedicine offers an opportunity to assess digitalization of examinations and enhances access to modern computer vision and artificial intelligence processing to annotate and quantify examinations in a consistent and reproducible manner. The Myasthenia Gravis Core Examination (MG-CE) has been recommended for the telemedicine evaluation of patients with myasthenia gravis.

Objective

We aimed to assess the ability to take accurate and robust measurements during the examination, which would allow improvement in workflow efficiency by making the data acquisition and analytics fully automatic and thereby limit the potential for observation bias.

Methods

We used Zoom (Zoom Video Communications) videos of patients with myasthenia gravis undergoing the MG-CE. The core examination tests required 2 broad categories of processing. First, computer vision algorithms were used to analyze videos with a focus on eye or body motions. Second, for the assessment of examinations involving vocalization, a different category of signal processing methods was required. In this way, we provide an algorithm toolbox to assist clinicians with the MG-CE. We used a data set of 6 patients recorded during 2 sessions.

Results

Digitalization and control of quality of the core examination are advantageous and let the medical examiner concentrate on the patient instead of managing the logistics of the test. This approach showed the possibility of standardized data acquisition during telehealth sessions and provided real-time feedback on the quality of the metrics the medical doctor is assessing. Overall, our new telehealth platform showed submillimeter accuracy for ptosis and eye motion. In addition, the method showed good results in monitoring muscle weakness, demonstrating that continuous analysis is likely superior to pre-exercise and post-exercise subjective assessment.

Conclusions

We demonstrated the ability to objectively quantitate the MG-CE. Our results indicate that the MG-CE should be revisited to consider some of the new metrics that our algorithm identified. We provide a proof of concept involving the MG-CE, but the method and tools developed can be applied to many neurological disorders and have great potential to improve clinical care.

Patient satisfaction with televisit in chronic neurologic disorders during Covid-19 pandemic

BACKGROUND

Covid-19 pandemic has boosted telemedicine in medical clinical practice. Experience in the management of chronic neurological disorders is limited as well as patient opinion. During Covid-19 pandemic, we evaluated patients' satisfaction and opinion about televisits in a large group of patients with chronic neurological disorders.

METHODS

All patients with chronic neurological disorders who had a virtual visit during the first phase of pandemic were invited to fill an online anonymous questionnaire about their global satisfaction and satisfaction regarding continuity of care, possibility to stay at home, doctor-patient relationship, the future of teleconsultation after pandemic and the possibility of understanding medical information and instructions.

RESULTS

We received 123 questionnaires among 232 e-mail (response rate 53%). Almost all (120 out of 121 patients, 99%) were satisfied with the overall experience with video-consultation. Comprehension of medical information was the same for 113 out of 122 patients (93%) and also the doctor-patient relationship was the same for 107 out of 122 respondents (88%) or better for 10 (8%). Ninety-three percent of patients (112 out of 120) were keen to integrate televisits with the traditional modality and only 11 out of 121 patients (9%) judged televisits as an option to discard. As a whole, 114 out of 122 respondents (93%) would suggest this modality to other patients.

CONCLUSIONS

Our large cohort of patients with chronic neurologic disorders rated experience with televisits satisfactory. Comprehension of medical information and doctor-patient interaction was considered good. Eventually, patients are keen to integrate this modality with traditional follow-up visits.

Current care practices for patients with Duchenne muscular dystrophy in China

BACKGROUND

The coronavirus disease (COVID-19) pandemic has presented challenges in the care of patients with chronic diseases. We identified the challenges faced by Chinese patients with Duchenne muscular dystrophy (DMD) during the pandemic.

METHODS

An online cross-sectional survey was conducted between March 27 and June 30, 2021.

RESULTS

Of the 2105 valid questionnaire responses, 2,056 patients were from non-lockdown areas. In these areas, 42.8% reduced outside daily activities, 49.4% reduced rehabilitation service use, 39.7% postponed regular follow-ups, and 40.8% reported accelerated motor function decline. These figures generally increased for patients from lockdown areas-67.3% reduced outside daily activities, 44.9% reduced rehabilitation service use, 79.6% postponed regular follow-ups, and 55.1% reported accelerated motor function decline. Ambulation loss was most commonly reported in September and March before 2020; however, this trend was absent in 2020. Regarding the informed prices of disease-modifying drugs in Europe and the United States, 86.7% could afford a maximum of one-twentieth of the prices, 8.0% could afford one-tenth of the prices, and only 0.6% of the patients could afford the full prices.

CONCLUSIONS

Implementation of standardized care for DMD in China is consistent with global practices, and the COVID-19 pandemic has affected the care of patients with chronic diseases worldwide, particularly in lockdown areas. Telemedicine is an effective model for providing healthcare to such patients. Healthcare workers should assist patients and establish more robust chronic disease management systems. Collaboration between governmental and non-governmental entities could address the cost of disease-modifying drugs in China and other developing countries.

Tele-assessment of core performance and functional capacity: Reliability, validity, and feasibility in healthy individuals

INTRODUCTION

Many assessment methods are used in physiotherapy to analyze the fitness level and injury risk in athletes, and to determine the general health status and the effectiveness of the treatment applied in patients. Considering the need for telehealth use, it is essential to determine the usability of tests performed as tele-assessment. This study aimed to examine the intra-rater reliability, validity, and feasibility of the tele-assessment version of core strength and endurance and functional capacity assessments in healthy individuals.

METHODS

"Curl-up," "Modified Push-up," "Plank," and "Lateral Bridge" tests were used for core strength and endurance performance assessment, and "Timed Up and Go," "30 second Sit to Stand," and "Functional Reach Test" tests were used for functional capacity assessment in healthy individuals. Participants were evaluated first by tele-assessment, then one hour later on the same day, all assessments were repeated face-to-face procedures by the researchers thus the validity of the tele-assessment method was determined. All tests were applied as tele-assessment one week later to determine the intra-rater reliability of the tele-assessment method. The system usability scale was applied to evaluate the usability of our tele-assessment method.

RESULTS

Eighty healthy people were enrolled. Intraclass correlation coefficients ranged between 0.91 and 0.97 for core performance tests and between 0.95 and 0.97 for functional tests. All tele-assessment versions of the core performance and functional tests were highly correlated with the face-to-face versions.

DISCUSSION

Core strength-endurance and functional tests performed via tele-assessment were reliable, valid, and feasible for practically measuring the performance of healthy young adults. This study supports the tele-assessment versions of these tests.

TRIAL REGISTRATION NUMBER AND TRIAL REGISTER

Clinicaltrials.gov: NCT04899804.

Telemedicine application to headache: a critical review

BACKGROUND

Migraine affects more than a billion people all over the world and requires critical employment of healthcare resources. Telemedicine could be a reasonable tool to manage people suffering from headaches, and it received a big push from the COVID-19 pandemic.

OBJECTIVE

This review aims to propose a practical approach for the virtual management of these patients.

METHODS

To do this, we conducted a literature search, including 32 articles relevant to the topic treated in this review.

RESULTS

The most challenging step in telemedicine applied to practical neurology remains the clinical assessment, but through a careful headache history and a recently proposed entirely virtual neurological assessment, this hitch can be easily overcome. Electronic diary compilations and virtual administration of disability-measuring scales, conversely, are the key features of effective long-term follow-up although we do not have apps that met the criteria of scientific reliability. Furthermore, tele-rehabilitation seems to be effective and has demonstrated to be a solution to alternatively treat chronic patients at home, and can be considered part of the remote management of headache patients. Moreover, virtual management of headaches finds an application in specific communities of patients, as pediatric patients and for rural communities of low- and middle-income countries suffer from health disparities, with inadequate resources and knowledge gaps.

CONCLUSION

Telemedicine could be promising for patients with no regular or convenient access to headache specialists and seems to be a priority in managing migraine patients to avoid non-urgent hospitalizations.

Nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication

Sweden as many other countries uses video consultation to increase patients’ access to primary healthcare services particularly during the COVID-19 pandemic. Working in digital care settings and using new technologies, in this case video consultations, require learning new skills and adoption to new workflow. The aim of this study is to explore nurses’ experience of using video consultation in a digital care setting and its impact on their workflow and communication. Fifteen semi-structured interviews were carried out with registered nurses recruited from a private digital healthcare provider. Interviews were recorded, transcribed, and analysed using an abductive approach. Nurses’ workflow was modeled, and several categories and subcategories were identified: nurses’ workflow (efficiency, flexibility, and information accessibility); communication (interaction with patients and interprofessional communication); user experience (change and development of the platform, challenges, and combining digital and physical care). Even though providing online care has its limitations, the nurses were positive towards using video consultations.

Low online search interest in teleneurology before and during COVID-19 pandemic: an infodemiological study

Background

The conduct of patient consults greatly changed during the time of the COVID-19 pandemic. There was a decrease in face-to-face patient consults and enhanced utilization of virtual consults. Infodemiological studies, using Google Trends, focus on internet search trends that may reflect public interest and awareness in diseases and as a proxy of public health risk perception.

Objectives

We aimed to investigate the online behavior of internet users on teleneurology, telehealth, and telemedicine during the time of the pandemic, as reflected in search volume indices (SVI) projected in Google Trends.

Methods

We used the data from Google Trends to quantify the interest of internet users in teleneurology, telehealth, and telemedicine. These keywords were entered in Google Trends as search terms. Data included were searches conducted from 2016 to 2020 to depict the transition into the pandemic.

Results

The SVI of teleneurology was unchanged during the 5-year period search relative to the SVIs of telehealth and telemedicine. Contrary to the noted worldwide increase in the SVI of telehealth and telemedicine during the year of pandemic, teleneurology’s SVI remained stable despite the increase of its utilization. Focusing on teleneurology, the highest SVI was observed in 2018.

Conclusion

There was an increase in the SVI of telehealth and telemedicine, possibly implying an increase in the general awareness of these virtual methods of health care, as catalyzed by the pandemic. However, the stable SVI of teleneurology may signify that the public awareness regarding it remained unchanged despite the increase in application in clinics and hospitals.

Frailties and critical issues in neuromuscular diseases highlighted by SARS-CoV-2 pandemic: how many patients are still "invisible"?

Almost 90% of neuromuscular diseases (NMDs) are classified as rare diseases, defined as conditions affecting less than 5 individuals in 10.000 (0.05%). Their rarity and diversity pose specific challenges for healthcare and research. Epidemiological data on NMDs are often lacking and incomplete. The COVID-19 pandemic has further highlighted the management difficulties of NMDs patients and the necessity to continue the program of implementation of standard of care. This article summarizes the Italian experience during pandemic.

Phenylketonuria Patients' and Their Caregivers' Perception of the Pandemic Lockdown: The Results of a National Online Survey

The first pandemic lockdown dramatically impacted many aspects of everyday life, including healthcare systems. The purpose of this study was to identify problems of patients with phenylketonuria (PKU) and their parents/caregivers during that time. We aimed to analyse potential differences in the self-reported compliance and characteristics of contacts with a doctor/dietitian before and during the pandemic lockdown and the perception of access to special food and opinions on remote contacts between a particular group of respondents. All participants (n = 614) were asked to complete an online questionnaire that consisted of 31 questions on pandemic-related events and circumstances which may have directly or indirectly impacted health and treatment. The people who completed the survey were divided into three groups: parents of PKU children (n = 403), parents of PKU adults (n = 58) and PKU patients older than 16 years (n = 153). The differences among the three analysed groups were found in the number of contacts, the way of contacting a doctor/dietitian during the pandemic and satisfaction with remote contact. Caregivers of children with PKU reported better therapy compliance, more frequent contacts with specialists and more satisfaction with remote visits than adult patients. We also observed a relationship between satisfaction from remote contact and self-reported frequency of contacts with a doctor/dietitian, as well as a relationship between satisfaction from remote contact and recommended blood Phe levels reported by both patients and caregivers. Travel time exceeding three hours from the respondents’ location to their doctor was associated with higher odds of their recognition of remote contact as a method of PKU treatment only in the group of caregivers. In the caregiver groups, the reported worse access to low-Phe products during the lockdown was linked to the perceived difficulty of maintaining the diet. However, such a relationship was not found among patients. In conclusion, significant differences in the perception of the pandemic lockdown and its impact on health and treatment-related issues were found.

Physician centricity in the deployment of digital solutions for neurological conditions

The widespread deployment of telemedical approaches to managed care during the CoV2 pandemic has provided an opportunity for clinicians to engage in the development and refinement of this mode of delivery. This also represents a pivotal moment to help effect a paradigm shift in how new and more sophisticated digital health services are designed and delivered with the caregiver playing a guiding role. Building on momentum this way can allow the fuller potential of digital health to be realized by focusing on “end user pull” which balances the omnipresent “technology push” of the consumer product and medical device industries. Perhaps nowhere is this more critical than in the care of neurological illnesses where patient–provider interactions must be managed frequently and rely on a complex battery of data measures. The emergent role of the physician-entrepreneur can be envisioned, complimenting established physician-scientist career paths and represents a timely and opportune moment to refine medical education curricula.

The practice of teleneurology in the Philippines during the COVID-19 pandemic

Background and objectives

The practice of teleneurology provided an accessible and safe method of consultation during the COVID-19 pandemic. We aimed to describe the practice of teleneurology among Filipino neurologists and determine the factors affecting its adoption using the unified theory of acceptance and use of technology (UTAUT) model and its constructs, namely performance expectancy, effort expectancy, social influence, and facilitating conditions.

Methods

This was a cross-sectional survey conducted online last October 2020 involving adult and pediatric neurologists in the Philippines. The internal consistency of the questionnaire adapted from UTAUT model was determined using Cronbach’s alpha. We performed logistic regression analysis to determine which constructs of the UTAUT model were significant factors on the intent to practice teleneurology.

Results

The study yielded a 28.8% response rate. Among the respondents (n₁ = 147), 95.2% (n₂ = 140) practiced teleneurology during the pandemic, and 77.6% (n₁ = 147) planned to continue it after the pandemic. Teleneurology was mostly done on an outpatient basis on social media platforms via videoconferencing due to easier access for both end-users. The UTAUT model explained 80.9% (95% CI 0.76, 0.86a) of the total variation. Performance expectancy and facilitating conditions affect the intent to use teleneurology.

Conclusions

Due to the limited resources and knowledge of its practice, infrastructural support and benefit awareness campaigns would be beneficial to increase its adoption, especially in developing countries.

Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution

BACKGROUND

Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients.

OBJECTIVE

In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits.

METHODS

A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow.

RESULTS

Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems.

CONCLUSIONS

The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.

Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review

The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy, we found a small but significant effect of the use of mHealth for cognitive training (Standardized Mean Difference (SMD) = 0.28 [0.12; 0.45]) and moderate effect for fatigue (SMD = 0.61 [0.47; 0.76]). mHealth is a promising tool in pwMS but more studies are needed to validate these solutions in the other ICF categories. More replications studies are also needed as most of the mHealth have only been assessed in one single study.