Reliability, feasibility and satisfaction of telemedicine evaluations for cervical dystonia

Abstract

Introduction Telemedicine is used successfully for evaluating patients with neurologic diseases, but has not been tested in Cervical Dystonia (CD). CD is uniquely suited for telemedicine as the scales validated to assess its severity rely only on visual inspection. The study sought to determine reliability, feasibility and satisfaction of telemedicine visits for evaluating CD. Methods Patients 18 years and older with a diagnosis of CD and scheduled for botulinum toxin (BoNT) injections were recruited, with a total of 46 enrolled. Dystonia severity was evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale. Three total evaluations took place: an initial telemedicine evaluation on the day prior to a scheduled BoNT injection; an in-person evaluation in clinic immediately before injections; and a follow-up telemedicine visit 4–6 weeks after injection with subsequent completion, by both participants and the clinician, of satisfaction questionnaires. Agreement between telemedicine and in-person TWSTRS data was calculated using intra-class correlation coefficients (ICC) and kappa statistics where appropriate. Feasibility was determined by the percent of patients completing all three visits, and satisfaction with telemedicine visits was determined based on answers to satisfaction questionnaires. Results There was excellent agreement between visit types for the TWSTRS motor severity summary score (κ = 0.890; 95th CI 0.713; 0.949). Only two individual TWSTRS items failed to meet the threshold for moderate agreement. Feasibility and satisfaction were high. Discussion Telemedicine is reliable and feasible in the evaluation of CD. Some CD patients would prefer telemedicine visits. Participants and the clinician were satisfied with telemedicine visits.

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“…For patients with cervical dystonia, telemedicine was found useful to evaluate the efficacy of botulinum toxin during its peak effect. Overall, the agreement between the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale assessed in clinic vs. telemedicine visits was excellent, with good acceptance among users [ 63 ]. Other candidates for teletreatment are those homebound persons with movement disorders and multimorbid conditions.…”

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“…The session was video recorded and the TWSTRS was scored at a later date using the recorded session. It has been shown that there is excellent agreement between the TWSTRS motor severity domain when it is administered in-person vs. when it is administered during a telemedicine evaluation (17). Lastly, physical function was assessed using the five times sit to stand (FTSTS) (36).…”

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