Neurologists’ perceptions of utilising tele-neurology to practice remotely during the COVID-19 pandemic

Courtney, Ellie; Blackburn, Daniel; Reuber, Markus

doi:10.1016/j.pec.2020.12.027

Cited by 42 publications

(81 citation statements)

References 25 publications

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“…In a recent paper evaluating neurologists’ perceptions of switching from face-to-face clinical work to tele-neurology, over 80% of participants complained of a reduction in work satisfaction but mostly due to logistic difficulties in performing tele-health such as lack of reliable internet networks or telephone access in some areas and inability to perform laboratory testing and other investigations [ 29 ]. Therefore, further infrastructural development and countries’ digitalization in all countries are required to achieve the full potential of tele-neurology.…”

Section: Discussionmentioning

confidence: 99%

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

et al. 2021

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Background The COVID-19 pandemic outbreak has dramatically disrupted healthcare systems. Two rapid WHO pulse surveys studied disruptions in mental health services, but did not particularly focus on neurology. Here, a global survey was conducted and addresses the impact of the pandemic on neurology services. Methods A cross-sectional study was carried out in which 34 international neurological associations were asked to distribute the survey to national associations. The responses represented the national situation, in November–December 2020, with regard to the main disrupted neurological services, reasons and the mitigation strategies implemented as well as the disruption on training of residents and on neurological research. A comparison with the situation in February–April 2020, first pandemic wave, was also requested. Findings 54 completed surveys came from 43 countries covering all the 6 WHO regions. Overall, neurological services disruption was reported as mild by 26%, moderate by 30%, complete by 13% of associations. The most affected services were cross-sectoral neurological services (57%) and neurorehabilitation (56%). The second wave of the pandemic, however, was associated with the improvement of service provision for diagnostics services (44%) and for neurorehabilitation (41%). Governmental directives were the major cause of services’ disruption (56%). Mitigation strategies were mostly established through telemedicine (48%). Almost half of respondents reported a significant impact on neurological research (48%) and educational activities (60%). Most associations (67%) were not involved in decision making for neurological patients’ issues by their national government. Interpretation The COVID-19 pandemic affects neurological services and raises the universal need for the development of neurological health care at the policy, systems and services levels. A global national plan on mitigation strategies for disruption of neurological services during pandemic situations should be established and neurological scientific and patients associations should get involved in decision making. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10641-3.

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Section: Discussionmentioning

confidence: 99%

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

et al. 2021

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“…However, remote consultations remain limited in their scope because specific assessments – such as rigidity and balance – cannot be performed remotely, and because subtle features such as bradykinesia or tremor are prone to be underdetected by video-based ratings compared to in-person ratings [ 12 ]. Indeed, a qualitative study showed that neurologists experienced reduced confidence in their decisions because of these limitations, and additional in-person examinations were often necessary to verify the remote observations [ 13 ▪ ]. Therefore, teleconsultations seem only suitable when the medical history or a partial neurological examination is sufficient for the neurologist to adjust the treatment plan.…”

Section: Teleconsultationmentioning

confidence: 99%

The state of telemedicine for persons with Parkinson's disease

Bergh

Bloem

Meinders³

et al. 2021

Current Opinion in Neurology

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Purpose of review The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders. Recent findings Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment. Summary The availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.

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“…When possible, in-person visits were replaced by telephone visit or video visit, with different levels of doctors and patients' satisfaction, mostly depending on the type of visit (audio/video), patient's age, diagnosis, socioeconomic status, quality of the available technological devices, and presence of a caregiver [2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Patient’s point of view on the use of telemedicine in multiple sclerosis: a web-based survey

et al. 2021

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Restrictions in the access to healthcare facilities during COVID-19 pandemic have raised the need for remote monitoring of chronic medical conditions, including multiple sclerosis (MS). In order to enable the continuity of care in these circumstances, many telemedicine applications are currently tested. While physicians’ preferences are commonly investigated, data regarding the patients’ point of view are still lacking. We built a 37 items web-based survey exploring patients’ propensity, awareness, and opinions on telemedicine with the aim to evaluate the sustainability of this approach in MS. Analysing 613 questionnaires out of 1093 that were sent to persons with MS followed at the Multiple Sclerosis Center of Tor Vergata University, Rome, we found that more than half of respondents (54%) were open to having a televisit. Propensity toward telemedicine significantly depended on having a higher income (p = 0.037), living farther from the center (p = 0.038), using computer and tablet (p = 0.010) and using the Internet for other remote activities (p < 0.001), conversely it was not influenced by any specific disease characteristics (i.e. degree of disability). The main advantages and disadvantages of televisit reported by participants were respectively saving time (70%) and impossibility to measure physical parameters (71%). Although the majority of respondents are in favour of televisit, so far this approach is restricted to those displaying better socioeconomic conditions and higher familiarity with technology. Implications of the study are that telemedicine platforms should be better tailored to patients’ demands in order to spread the use of telemedicine, to enhance usability and to increase patients’ adherence.

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Neurologists’ perceptions of utilising tele-neurology to practice remotely during the COVID-19 pandemic

Cited by 42 publications

References 25 publications

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

The state of telemedicine for persons with Parkinson's disease

Patient’s point of view on the use of telemedicine in multiple sclerosis: a web-based survey

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