Expanded access to multiple sclerosis teleneurology care following the COVID-19 pandemic.

BACKGROUND: Teleneurology for multiple sclerosis (MS) care was considered feasible, but utilization was limited. OBJECTIVE: To describe how the existing teleneurology populations at two academic MS Centers changed during the COVID-19 pandemic. METHODS: In this cross-sectional study, we captured all in-person and teleneurology visits at two academic MS Centers between January 2019 and April 2020. We compared group differences between the Centers, and COVID-related changes using T-, chi-squared Kruskal-Wallis and Fisher exact tests. RESULTS: 2268 patients completed 2579 teleneurology visits (mean age 48.3 ± 13.3 years, 72.9% female). Pre-COVID, the Centers' teleneurology populations were similar for age, sex, MS type, and disability level (all p > 0.1), but differed for race (96.5% vs 80.7% white, p ≤ 0.001), MS treatment (49.1% vs 32.1% infusible, p ≤ 0.001), and median distance from Center (72 vs 186 miles, p ≤ 0.001). Post-COVID, both Centers' teleneurology populations had more black (12.7% vs 4.37%, p ≤ 0.001) and local (median 34.5 vs 102 miles, p ≤ 0.001) patients. CONCLUSION: Teleneurology visits in 2019 reflected the organizational and local teleneurology reimbursement patterns of our Centers. Our post-COVID-19 changes illustrate the potential for payors and policy to change disparities in access to, or utilization of, remote care. Patients' perception of care quality and value following this shift warrants study.

Technology-enabled assessments to enhance multiple sclerosis clinical care and research.

BACKGROUND: Comprehensive and efficient assessments are necessary for clinical care and research in chronic diseases. Our objective was to assess the implementation of a technology-enabled tool in MS practice. METHOD: We analyzed prospectively collected longitudinal data from routine multiple sclerosis (MS) visits between September 2015 and May 2018. The MS Performance Test, comprising patient-reported outcome measures (PROMs) and neuroperformance tests (NPTs) self-administered using a tablet, was integrated into routine care. Descriptive statistics, Spearman correlations, and linear mixed-effect models were used to examine the implementation process and relationship between patient characteristics and completion of assessments. RESULTS: A total of 8022 follow-up visits from 4199 patients (median age 49.9 [40.2-58.8] years, 32.1% progressive course, and median disease duration 13.6 [5.9-22.3] years) were analyzed. By the end of integration, the tablet version of the Timed 25-Foot Walk was obtained in 89.0% of patients and the 9-Hole Peg Test in 94.8% compared with 74.2% and 64.3%, respectively before implementation. The greatest increase in data capture occurred in processing speed and low-contrast acuity assessments (0% prior vs 78.4% and 36.7%, respectively, following implementation). Four PROMs were administered in 41%-98% of patients compared with a single depression questionnaire with a previous capture rate of 70.6%. Completion rates and time required to complete each NPT improved with subsequent visits. Younger age and lower disability scores were associated with shorter completion time and higher completion rates. CONCLUSIONS: Integration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research.

Factors Associated with Sexual Dysfunction in Individuals with Multiple Sclerosis: Implications for Assessment and Treatment.

BACKGROUND: Sexual dysfunction is a common symptom of multiple sclerosis (MS) that often goes unreported by both the patient and the clinician. Sexual dysfunction can affect a person's mood, relationships, daily functioning, and quality of life. Gaining a better understanding of the prevalence and nature of sexual dysfunction in individuals with MS would not only help identify patients with this problem but also determine contributing factors, which can inform treatment alternatives available to the patient. METHODS: Patients with a diagnosis of MS (n = 162) completed the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 during their neurology appointments at the Mellen Center for Multiple Sclerosis at Cleveland Clinic. These data were merged with Knowledge Program data collected as part of standard practice and included measures of mood, disability, and quality of life. RESULTS: Sexual dysfunction was present in 64.2% of the clinic sample. Patients with sexual dysfunction had significantly worse average MS-related disability and depressive symptom scores. CONCLUSIONS: Sexual dysfunction is highly prevalent in the MS clinic sample. Assessment and treatment of depression may serve as a starting point for intervention in patients with MS who experience sexual dysfunction. Identifying individuals who are at risk for sexual dysfunction concerns may help with clinician and patient burden in terms of routine assessment of this symptom.