Reliability of televisits for patients withmild relapsing-remitting multiple sclerosis in the COVID-19 era, Neurological Science

Background 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. Objectives This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits. Methods 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. Results The inter-rater agreement attributed by two independent neurologists during TM visit was high (kappa > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (kappa = 0.57; p < 0.001), brainstem (kappa = 0.57; p < 0.001), bowel and bladder (kappa = 0.54; p < 0.001) and sensory (kappa = 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). Conclusions Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability