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Telemedicine in rheumatology: high specificity and sensitivity of follow-up virtual video consultations during COVID-19 pandemic.
Piga, Matteo; Floris, Alberto; Congia, Mattia; Chessa, Elisabetta; Cangemi, Ignazio; Cauli, Alberto.
  • Piga M; Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA.
  • Floris A; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
  • Congia M; Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA.
  • Chessa E; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
  • Cangemi I; Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA.
  • Cauli A; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
Rheumatology (Oxford) ; 61(5): 1795-1801, 2022 05 05.
Article in English | MEDLINE | ID: covidwho-1343712
ABSTRACT

OBJECTIVE:

To evaluate the reliability of virtual video-assisted visits, added to the tight-control strategy for inflammatory rheumatic diseases (IRDs), in identifying patients who need treatment adjustment.

METHODS:

Tightly followed-up adult patients with RA, PsA, AS or SLE took part in a video consultation during COVID19 lockdown and repeated the same rheumatology evaluations through a face-to-face visit within 2 weeks. The sensitivity and specificity of the virtual visits for treatment decisions (categorized as unchanged, adjusted/escalated, tapered/discontinued, need for further examinations), and the intraclass correlation coefficient (ICC) for virtually measured disease activity and patient-reported outcomes (PROs) were calculated with 95% CIs using face-to-face visits as the reference method.

RESULTS:

In 89 out of 106 patients (84.0%), face-to-face visits confirmed the remotely delivered treatment decision. Video-visiting showed excellent sensitivity (94.1% with 95% CI 71.3%, 99.9%) and specificity (96.7%; 95% CI 90.8%, 99.3%) in identifying the need for treatment adjustment due to inadequate disease control. The major driver for the low sensitivity of virtual video consultation (55.6%; 95% CI 21.2%, 86.3%) in identifying the need for treatment tapering was SLE diagnosis [odds ratio (OR) 10.0; 95% CI 3.1, 32.3; P <0.001], mostly because of discordance with face-to-face consultation in glucocorticoid tapering. Remotely evaluated PROs showed high reliability (ICC range 0.80-0.95), while disease activity measures had less consistent data (ICC range 0.50-0.95), especially for those diseases requiring more extensive physical examination, such as in SLE and PsA.

CONCLUSION:

Video-visiting proved to have high reliability in identifying the need for treatment adjustment and might support the IRDs standard tight-control strategy.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatology / Telemedicine / COVID-19 / Lupus Erythematosus, Systemic Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male Language: English Journal: Rheumatology (Oxford) Journal subject: Rheumatology Year: 2022 Document Type: Article Affiliation country: Rheumatology

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatology / Telemedicine / COVID-19 / Lupus Erythematosus, Systemic Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male Language: English Journal: Rheumatology (Oxford) Journal subject: Rheumatology Year: 2022 Document Type: Article Affiliation country: Rheumatology