Fellowship training: a collateral damage of Covid-19 pandemic

Introduction. The COVID-19 pandemic has affected the delivery of healthcare to people with chronic diseases such as movement disorders. Movement disorders specialists were compelled to adapt to this unprecedented situation. The objective of this study is to assess this impact in terms of the reduction in the number of in-office consultations of a high-specialty fellowship program as a result of the pandemic restrictions, and to evaluate the overall satisfaction with the fellowship. Methods. Out-patient records of the Movement Disorders clinic from March 1st, 2020, to February 28th, 2021, were collected. Data from this period was compared to that from the previous eight years. A satisfaction survey along with a visual analog scale was applied to both the patients and the specialty fellows. Results. During the study period a total of 1,742 consultations were given, which represent a 60% drop in comparison to the previous year. Moreover, 38% of those consultations were carried out by telemedicine. Both fellows’ self-reported satisfaction and patient satisfaction with teleconsultation was high (90% and 96%, respectively. Conclusions. Despite the decrease of in-office visits, fellows reported an acceptable satisfaction regarding the learning objectives of the program and patient satisfaction was not compromised.

Telemedicine satisfaction in patients with movement disorders

Objective: The objective of this study was to assess the satisfaction after a telemedicine consultation in comparison to previous experiences in face-to-face visits in persons with a movement disorder. Background: SARS-COV2 virus pandemic has established the need to quickly change the way of providing medical care. Telemedicine has shown promise for management of chronic disorders, included neurological conditions, get in particular importance in movement disorders (MD), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. Design/Methods: A cross-sectional study, including subjects from three different private outpatient and a public tertiary referral center in Mexico. April 2020 and May 2020. After a successful connection written informed consent form and satisfaction survey was sent via email (Google Forms) for the subject to fill out anonymously. The questionnaire has been previously used by Hanson et al. and consist of 20 items assessing the satisfaction and ease of use-related items, setup-related items, and quality-of-service-related items. Results: A total of 175 teleconsultations were successfully performed. Age range, 60% were ≥60 years, 24% were 45 to 59 years old, and the remaining <45 years. 50% had a college or post grade degree, 7.4% advanced technician degree, 13.7% bachelor degree. The mean time used to prepare the teleconsultation was 14.3 ± 14.2 minutes (range 0 to 90 minutes). A total of 94 (53.8%) considered that the teleconsultation visit involved much less time in comparison to face-to-face visits. 92% were satisfied or very satisfied with neurologist ability to communicate recommendations 164 (93.7%) of the subjects indicated that the teleconsultation was valuable, and 90.9% considered that they would recommend teleconsultation to another patient with similar health conditions. Conclusions: Results indicate that patients with movement disorders see telemedicine as a convenient and potential tool;this study found satisfaction of the patients towards the telemedicine.

Inter-rater agreement of the modified motor United Parkinson's Disease Rating Scale (mUPDRS-III) for tele-health evaluation in Mexican Parkinson's disease (PD) patients during the COVID19 era

Objective: To evaluate the inter-rater reliability of the mUPDRS-III in Mexican PD patients evaluated during the COVID19 pandemic through telemedicine. Background: A modified version of the MDS-UPDRS part III for virtual administration has been previously validated, and has been proposed as a useful alternative to face-to-face follow-up of patients with PD. Limitations of it's use include the lack of evaluation of rigidity and postural impairment and technological barriers such as low-speed connection and poor access to webyielding devices in remote areas (e.g. rural Mexico). Design/Methods: 46 PD patients (mean age 65.34 ± 11.87 years, 58.7% male) were evaluated through web-based consultation (Cisco Webex). A brief follow-up questionnaire of symptoms, medications and current status was performed. Motor evaluation with the mUPDRS-III scale was applied independently by three movement disorders specialists. Agreement and reliability were evaluated using inter-rater correlation coefficient (ICC) and Kendall's concordance coefficient accordingly. Results: Total mUPDRS-III score (ICC 0.96, 95%CI 0.94-0.97;Kendall's W 0.038, p<0.005) and four motor domain sub-scores-Language and Facial Expression (ICC 0.85, 95%CI 0.76-0.91;Kendall's W 0.18, p<0.005), Bradykinesia (ICC 0.93, 95%CI 0.88-0.96;Kendall's W 0.25, p 0.005), Tremor (ICC 0.86, 95%CI 0.78-0.92;Kendall's W 0.233, p<0.005), Gait and Posture (ICC 0.97, 95%CI 0.95-0.98;Kendall's W 0.018, p 0.434)-showed good to excellent agreement but slight to poor concordance. Conclusions: We observed good agreement for motor domain sub-scores, as well as for the total scale score. This might confirm that the mUPDRS-III, albeit its intrinsic limitations, is a reproducible tool for the clinical follow-up of patients when face-to-face visits are not available. Nonetheless, the concordance values were poor which could be attributed to differences in rater perception of individual items due to technological barriers and to the sample's homogeneity. Further analysis and test-retest might be useful to elucidate this phenomenon.