Telemedicine reaches MS patients living with disabilities: at-home telerehabilitation with remotely-supervised transcranial direct current stimulation (RS-tDCS)
ECTRIMS Online Library. Charvet L. 09/11/19; 279064; P704
Leigh Charvet
Leigh Charvet
Contributions
Abstract

Abstract: P704

Type: Poster Sessions

Abstract Category: RIMS - Multi-disciplinary rehabilitation

M. Shaw1, P. Best1, A. Frontario2, M. Lustberg1, K. Sherman1, L. Krupp1, L. Charvet1

1New York University Langone Medical Center, New York, NY, 2Lake Erie College of Osteopathic Medicine, Erie, PA, United States

Introduction: Travel to clinic can be difficult due to barriers of time and cost and becomes even more burdensome for MS patients living with disabilities. Telemedicine platforms present a solution by providing supervised treatment and rehabilitation at home. Without barriers to access, patients may be more compliant and adherent to daily rehabilitation exercises.
We have a large telerehabilitation research program in MS that pairs rehabilitation with transcranial direct current stimulation (tDCS), an emerging non-invasive brain stimulation technique used to improve outcomes. We provide real-time treatment administration and supervision via HIPAA compliant videoconference, termed remotely supervised tDCS or RS-tDCS.
Objectives: To characterize the advantages of telemedicine for patients with MS in an urban setting.
Aims: To measure barriers to access for participants in our RS-tDCS telerehabilitation program, as well as compliance and adherence to a remotely supervised intervention.
Methods: Participants with MS were recruited to complete a trial of cognitive remediation paired with RS-tDCS at-home. Participants were surveyed following completion of the intervention and asked to rate their difficulty in attending the clinic (on a 1-5 ordinal scale, 1 = no difficulty and 5 = nearly impossible difficulty) as well as the typical cost of attending clinic. Descriptive statistics and ordinal logistic regression models were used to evaluate the factors driving difficulty of travel.
Results: Participants (n=44) reported that round trip travel to the clinic requires an average of 2.3±2.3 hours of time and $27.04±38.13. Participants rated the difficulty associated with attending clinic as being moderate to significant (2.5±1.3). Regression analyses that included disease features produced better models and accounted for greater variance in difficulty attending the clinic, (p< 0.001, McFadden pseudo R2 = .515), as compared with socioeconomic variables alone (p< 0.001, McFadden pseudo R2 = .140).
The RS-tDCS protocol was successful in providing treatment (95% compliance to treatment) and 93% of participants reported satisfaction with the treatment and remote protocols.
Conclusions: Participants with MS face considerable difficulty reaching the clinic, largely due to increasing neurologic disability. Telemedicine techniques such as RS-tDCS can increase treatment access, reduce physical and financial burden of travel and maintain high rates of treatment adherence.
Disclosure: This pilot study was funded by the National Multiple Sclerosis Society.
Michael Shaw reports no conflicts of interest.
Pamela Best reports no conflicts of interest.
Ariana Frontario reports no conflicts of interest.
Matthew Lustberg reports no conflicts of interest.
Kai Sherman reports no conflicts of interest.
Lauren Krupp reports no conflicts of interest.
Leigh Charvet reports no conflicts of interest.

Abstract: P704

Type: Poster Sessions

Abstract Category: RIMS - Multi-disciplinary rehabilitation

M. Shaw1, P. Best1, A. Frontario2, M. Lustberg1, K. Sherman1, L. Krupp1, L. Charvet1

1New York University Langone Medical Center, New York, NY, 2Lake Erie College of Osteopathic Medicine, Erie, PA, United States

Introduction: Travel to clinic can be difficult due to barriers of time and cost and becomes even more burdensome for MS patients living with disabilities. Telemedicine platforms present a solution by providing supervised treatment and rehabilitation at home. Without barriers to access, patients may be more compliant and adherent to daily rehabilitation exercises.
We have a large telerehabilitation research program in MS that pairs rehabilitation with transcranial direct current stimulation (tDCS), an emerging non-invasive brain stimulation technique used to improve outcomes. We provide real-time treatment administration and supervision via HIPAA compliant videoconference, termed remotely supervised tDCS or RS-tDCS.
Objectives: To characterize the advantages of telemedicine for patients with MS in an urban setting.
Aims: To measure barriers to access for participants in our RS-tDCS telerehabilitation program, as well as compliance and adherence to a remotely supervised intervention.
Methods: Participants with MS were recruited to complete a trial of cognitive remediation paired with RS-tDCS at-home. Participants were surveyed following completion of the intervention and asked to rate their difficulty in attending the clinic (on a 1-5 ordinal scale, 1 = no difficulty and 5 = nearly impossible difficulty) as well as the typical cost of attending clinic. Descriptive statistics and ordinal logistic regression models were used to evaluate the factors driving difficulty of travel.
Results: Participants (n=44) reported that round trip travel to the clinic requires an average of 2.3±2.3 hours of time and $27.04±38.13. Participants rated the difficulty associated with attending clinic as being moderate to significant (2.5±1.3). Regression analyses that included disease features produced better models and accounted for greater variance in difficulty attending the clinic, (p< 0.001, McFadden pseudo R2 = .515), as compared with socioeconomic variables alone (p< 0.001, McFadden pseudo R2 = .140).
The RS-tDCS protocol was successful in providing treatment (95% compliance to treatment) and 93% of participants reported satisfaction with the treatment and remote protocols.
Conclusions: Participants with MS face considerable difficulty reaching the clinic, largely due to increasing neurologic disability. Telemedicine techniques such as RS-tDCS can increase treatment access, reduce physical and financial burden of travel and maintain high rates of treatment adherence.
Disclosure: This pilot study was funded by the National Multiple Sclerosis Society.
Michael Shaw reports no conflicts of interest.
Pamela Best reports no conflicts of interest.
Ariana Frontario reports no conflicts of interest.
Matthew Lustberg reports no conflicts of interest.
Kai Sherman reports no conflicts of interest.
Lauren Krupp reports no conflicts of interest.
Leigh Charvet reports no conflicts of interest.

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