Telerehabilitation May Be Effective in MS

Erik Greb

June 01, 2020

Telerehabilitation is safe and may offer functional benefits comparable to those of outpatient rehabilitation for patients with multiple sclerosis (MS) and impaired mobility. Telerehabilitation also saves time and travel cost, compared with outpatient rehabilitation.

"This model of home-based telerehabilitation offers a safe and cost-effective method for improving function and quality of life for MS patients with mobility deficits," said Heather Barksdale, DPT, a neurological clinical specialist at UF Health Jacksonville (Florida).

The study was presented at the virtual meeting of the Consortium of Multiple Sclerosis Centers (CMSC).

The Centers for Medicare & Medicaid Services do not reimburse for telerehabilitation services. Patients with MS have difficulty accessing rehabilitation specialists because of impaired mobility and lack of access to transportation. "We are based in Jacksonville, Fla., and often have patients who have to travel from Tallahassee, Panama City, Daytona Beach, and Brunswick, Ga., to receive specialty services," said Dr. Barksdale. "Telerehabilitation would allow these patients to get access to high-quality rehab services with clinicians that specialize in MS."

Dr. Barksdale and colleagues conducted a pilot study to evaluate the feasibility of a physical therapy–guided telerehabilitation program for people with mobility impairments resulting from confirmed MS. The investigators enrolled patients at the MS Center of Excellence at University of Florida Health Jacksonville into a telerehabilitation group. A board-certified neurologist and a physical therapist specializing in MS examined participants in person at baseline. The latter underwent an 8-week program of physical therapy–guided telerehabilitation that used the Jintronix software platform and a kinetic tracking system.

By reviewing charts during January 2018–September 2019, Dr. Barksdale and colleagues selected patients with MS who were seen on an outpatient basis by the same physical therapists who were administering telerehabilitation. This outpatient comparison group was matched to the telerehabilitation group on duration of treatment and outcome measures completed. Dr. Barksdale and colleagues reviewed the data for the effects of the two interventions on mobility and travel.

Eight patients completed the telerehabilitation program, and all had improvements in fatigue, quality of life, or mobility measures. The investigators did not observe any adverse events during or after the intervention. The total savings in projected travel costs for all eight participants was $8,487.23, compared with the outpatient group. Participants in the telerehabilitation and outpatient groups achieved minimal detectable changes in the outcome measures examined at equivalent rates.

"The game-based model with virtual visits by a physical therapist can be modified to include exercises specific for other motor, coordination, spasticity, and movement dysfunctions and may be useful for other chronic and progressive dysfunction seen in Parkinson's disease, stroke, and other movement and neuromuscular disorders," said Dr. Barksdale.

"Future studies are needed to further establish guidelines for patient selection and mode of delivery, as well as design of future telerehabilitation programs," she added. "Duration of treatment and types of exercises to be included should also be examined. Further research into use of telerehabilitation for the treatment of upper-extremity, cognitive, speech, and swallowing dysfunction should also be examined."

The investigators conducted their study without outside funding and reported no disclosures.

Consortium of Multiple Sclerosis Centers (CMSC): Abstract REH11. Published online May 25, 2020.

Erik Greb can be reached at egreb@mdedge.com. This article originally appeared on MDedge.

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