Impact of teleneurology care on multiple sclerosis outcomes

ABSTRACT

Background: Utilization of teleneurology rapidly expanded during the COVID-19 pandemic for multiple sclerosis (MS) care to maintain healthcare access. Feasibility and high patient satisfaction with virtual care has been studied, but there are no data regarding the impact of teleneurology on clinical outcomes. Objectives/Aims: To examine the impact of teleneurology care on MS outcomes at a single academic MS center (Cleveland Clinic). Methods: MS patients who completed ≥2 in-person visits 12 months apart (+/- 6 months) from 1/2019 to 12/2020 were studied. Patients with fully in-person care were compared to patients with a combination of teleneurology and in-person care during this timeframe. Multiple linear regression models were created to assess differences in clinical outcomes between groups, adjusting for age, sex, race, employment status, disease duration, education, MS course (relapsing remitting (RRMS), progressive), disability level measured by Patient Determined Disease Steps (PDDS), number of visits, and time from baseline. Significance was set at p<0.05. Results: For 2131 patients meeting the inclusion criteria median time between the first and last in-person visits 366 days, mean age 49.5±12.6 years, 72.4% female, 81.4% white, 55.3% employed, disease duration 15.9±11.5, RRMS 58.5%, and 71.2% PDDS <=4, distance from center 65.3 [22.9, 409] ). 1905 (89.4%) had only in-person visits and 226 (10.6%) had both teleneurology and in-person visits. The teleneurology group had shorter disease duration (14.4±10.3 vs 16.1±11.6 years), higher disability score (32.3% vs 25.1% PDDS >4), greater interval between first and last visit (412 [367, 497] vs 363 [253, 424] days), lived closer to the center (34.8 [17.3, 83.0] vs 68.9 [23.3, 2081] miles), and higher total number of visits (4 [3, 4] vs 3 [2, 3] visits) (p<0.05 for all). The groups did not differ for age, sex, race, employment status, education, or MS course (p>0.05). Patients with teleneurology care had no significant difference in manual dexterity, processing speed, or walking speed compared to patients with only in-person care after adjustment for demographic and disease characteristics (p>0.05 for all). Conclusions: This study demonstrates that teleneurology care did not appear to have an effect on clinical outcomes in MS. These data support the continued use of teleneurology in MS care. Future studies are needed to elucidate the optimal combination of teleneurology and in-person visit types for MS patients.