Remote visits for people with multiple sclerosis during the COVID-19 pandemic in Austria: The TELE MS randomized controlled trial

Abstract

Introduction: Continuous monitoring is the hallmark of managing chronic disease. Multiple sclerosis (MS), in particular, requires patients to visit their treating neurologists typically twice a year, at least. In that respect, the COVID-19 pandemic made us rethink our communication strategies. This study determined satisfaction with remote visits for people with MS (pwMS) by comparing non-inferiority to conventional visits.

Methods: TELE MS was a randomized controlled trial that was open to any person with MS. We randomized a volunteer sample of 45 patients. We compared satisfaction with remote visits (via phone or via videochat) with conventional outpatient visits. The primary endpoint was patient satisfaction determined by the Telemedicine Perception Questionnaire (TMPQ, min: 17 and max: 85 points) with the hypothesis of non-inferiority of televisits to conventional visits. Physician satisfaction measured on the PPSM score (Patient and Physician Satisfaction with Monitoring, min: 5 and max: 25 points) was the secondary endpoint.

Results: The trial met both endpoints. Mean (SD) TMPQ scores in the individual groups were 58 (6.7) points for conventional visits, 65 (7.5) points for phone visits, and 62 (5.5) points for video visits. Physician satisfaction over the whole cohort was similarly high. Median (range) PPSM scores were 23 (16-25) for the whole cohort, 19 (16-25) for conventional visits, 25 (17-25) for phone visits, and 25 (16-25) for video visits.

Conclusions: Televisits in multiple sclerosis yield a high level of satisfaction for both patients and treating physicians. This concept for remote patient monitoring adopted during the current pandemic may be communicable to other chronic diseases as well. ClinicalTrials.gov identifier: NCT04838990.

Keywords: Multiple sclerosis; remote monitoring; satisfaction; teleconsultation; telemedicine.

Conflict of interest statement

Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2022.

Figures

Figure 1.

Study overview of the TELE MS RCT. MSIS-29 – Multiple Sclerosis Impact Scale, MS – Multiple sclerosis, MSologist – Neurologist treating persons with MS, PPSM – Patient and Physician Satisfaction with Monitoring, RCT – Randomized Controlled Trial, TMPQ – Telemedicine Perception Questionnaire.

Figure 2.

CONSORT flow diagram for the TELE MS trial. CONSORT flow diagram showing participant flow through each stage of the TELE MS randomized open controlled trial (enrollment, intervention allocation, follow-up and final analysis).

Figure 3.

Patient satisfaction with the study visit. This box and whiskers plot shows scores on the TMPQ scale (y-axis, higher scores indicate greater satisfaction) for the three study groups and the whole cohort (x-axis). Boxes indicate the interquartile range and whiskers min-max. TMPQ – Telemedicine perception questionnaire.

Figure 4.

Physician satisfaction with the study visit. This box and whiskers plot shows scores on the PPMS scale (y-axis, higher scores indicate greater satisfaction) for the three study groups and the whole cohort (x-axis). Boxes indicate the interquartile range and whiskers min-max. PPSM – Physician and Patient Satisfaction with Monitoring.

Figure 5a-d.

Patient characteristics in groups with satisfaction below and above this study's median TMPQ score. This box and whiskers plots illustrates patient characteristics (y-axis) along scores on the TMPQ scale (x-axis). In case there were no ourliers, boxes indicate the interquartile range and whiskers the min-max. Outliers, if existent, are indicated by black dots and, in that case, whiskers indicate values ranging from 1.5 times the IQR from the first and third quartile. TMPQ – Telemedicine perception questionnaire. Figure 5e-f Satisfaction score (TMPQ) in relation to change in the MSIS score. This box and whiskers plots illustrates patient characteristics (y-axis) along scores on the TMPQ scale (x-axis). Boxes indicate the interquartile range and whiskers min-max. TMPQ – Telemedicine perception questionnaire, MSIS – Multiple Sclerosis Impact Scale.