Virtual Care May Help Multiple Sclerosis Patients Even After the Pandemic

People with multiple sclerosis (MS) who incorporated teleneurology into their care had similar clinical outcomes as MS patients who received only in-person care, a longitudinal study suggested.

Over a 1-year period, MS patients who received care both virtually and in person showed no significant differences in manual dexterity, processing speed, or walking speed over MS patients who had only in-person visits, after adjusting for demographic and disease characteristics (P>0.05 for all), reported Marisa McGinley, DO, of the Cleveland Clinic, in a presentation at the 2021 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress.

“The pandemic has taught us that telehealth is a viable and sustainable method to provide healthcare for a multitude of conditions,” McGinley told MedPage Today.

“Prior to the pandemic, most research regarding telehealth focused on feasibility and satisfaction, but there is limited data regarding its impact on clinical outcomes,” she said. “This study suggests that mixing telehealth and in-person visits for MS care provided similar outcomes to in-person care alone.”

“This is an important finding because one of the main concerns for patients and providers is that, if a patient does not come into the office, is it possible we could be causing harm?” McGinley added. “This study provides initial evidence that outcomes were similar to in-person care, which is reassuring.”

Survey data presented earlier this year showed that telemedicine use among MS specialists increased from 15% of practice encounters before the COVID-19 public health emergency to 73% of encounters during the pandemic. Nearly all MS clinicians said they were very or somewhat satisfied with their last telemedicine visit, and 94% said they wanted to continue to use telemedicine.

In her study, McGinley followed MS patients at the Cleveland Clinic who had completed two or more in-person visits about 12 months apart (plus or minus 6 months) from January 2019 to December 2020, comparing people who had fully in-person care with those who had a combination of virtual and in-clinic appointments. Clinical outcomes were assessed and differences were adjusted for age, sex, race, employment status, disease duration, MS course, disability level, number of visits, and time from baseline. Disability was measured by Patient Determined Disease Steps (PDDS), a scale that ranges from 0 (normal) to 8 (bedridden).

A total of 2,131 patients met inclusion criteria: 1,905 people had only in-person visits, and 226 people had both in-person and virtual visits (referred to as the teleneurology group). Overall, the mean age of the group was 49.5 and 72.4% were female. Disease duration averaged 15.9 years and 64.4% of patients had relapsing-remitting MS. Most patients (73.3%) had a PDDS score less than or equal to 4. Patients drove an average of 65 miles to the center for in-person visits.

The teleneurology group had shorter disease duration (14.4 vs 16.1 years), a higher disability score (34.0% vs 25.18% had a PDDS score greater than 4), a greater interval between the first and last visit (412 vs 363 days), a shorter commute to the center (35 vs 69 miles), and a higher number of total visits (4 vs 3) than the in-person group (P<0.05 for all). The two groups did not differ by age, sex, race, employment status, education, or MS course.

The findings support the continued use of teleneurology in MS care, McGinley noted. “One of the main questions in MS and many fields remains what is the appropriate dosing of telehealth care.”

“The pandemic highlighted that telehealth is here to stay, but now we need to determine the appropriate timing of virtual versus in-person care,” McGinley pointed out. “Additionally, we need to conduct longer studies to assess clinical outcomes and develop methods to monitor neurological function outside the office setting.”