There is much discussion among the medical community about the “digitalization” of medicine—the movement from physical in-person consultations to online. The COVID-19 pandemic accelerated this change by making it a necessity in some cases, as travel restrictions were put in place at various times in different parts of the world. 

The pandemic has made telemedicine palatable to the general public, despite medicine having always been a discipline that requires a physical, personal touch. However, as the world switched to remote working and learning during the pandemic, people rightfully began to ask whether medicine can likewise be practiced remotely. 

The answer is yes. Many nonurgent medical complaints can be seen and treated via telemedicine. If a doctor decides that he or she needs a closer look, the doctor can always request for the patient to come in for an in-person consultation. In addition, doctors can also monitor disease progression via telemedicine, using such measures as cognitive retention, the ability of the patient to ambulate, and mental health parameters. 


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Increased Monitoring and Reduced Patient Burden 

Let’s take a closer look at how telemedicine has impacted the assessment and treatment of neuromuscular disorders in particular.

Dr. Krishnan Ganapathy, in his study on telemedicine and neurological practice in the COVID-19 era, wrote, “Many multiple sclerosis (MS) centers are utilizing telemedicine to avoid non-essential hospital visits during the COVID-19 pandemic . . . Remote monitoring of infection risk, in people with MS, especially those on immunosuppressant drugs, during COVID-19 pandemic is essential.”

His conclusion is that telemedicine is here to stay: “With possible reduction in face-to-face consultations, remote evaluation may become mainstream. The world will never be the same again.” 

Read more about MS etiology 

Montes and colleagues similarly wrote about why telemedicine has become so important for patients with neuromuscular disorders.

“Travel to tertiary care centers for expert care or extended clinical trial visits are often challenging because of accessibility, need for assistance, and prolonged time away from home or work,“ they wrote. “Incorporating remote assessments in patient management and study design allows for data to be collected more frequently and in a person’s natural or home environment, while reducing the burden of the number of in-person visits.” 

In other words, there was already a case to be made for telemedicine even before the pandemic. Montes et al wrote, “Clinically, providers have been interested in developing methods to assess individuals with neuromuscular conditions via telehealth for more than a decade.” Long before COVID-19, medical researchers had already begun thinking of ways to remotely monitor neuromuscular health parameters, such as strength, ambulation, respiratory function, and other patient-reported outcomes.

The crux of the issue is this: the proliferation of telemedicine allows for greater access to health care. Patients who may find it difficult to travel (ie, patients with neuromuscular disorders) are now able to receive health care from the comfort of their own homes. It is the natural, and necessary, evolution of medicine in the digital age. 

Lessons From the Pandemic Era

Health care providers were initially slow to adapt to digital health care opportunities, but then came the pandemic and that changed virtually overnight. The acceleration of telemedicine during the pandemic has allowed us to gain vast insights into what works and what does not. Montes and colleagues wrote, “Despite being able to quickly adapt to the demands of the COVID-19 pandemic, telehealth experiences have uncovered limitations in and opportunities for remote assessments.” 

Here are a few things we have learned: 

  • Surveys and patient-reported outcomes are highly feasible and effective. This is in contrast to clinician-administered assessment, which takes up additional work and time. 
  • Digital technology tools, such as wearable technology and smart-phone based apps, can be incorporated into telemedicine. 
  • Both patients and caregivers need to be familiar with how to use those digital technology tools prior to their implementation. 
  • Remote assessments should be flexible and agile in order to adapt to best practices. 
  • Physicians should monitor the sensitivity, validity, and reliability of assessments carried out remotely. 
  • In the future, medical researchers should look into how remote assessment can be merged with in-person assessment to provide a new, comprehensive manner of health care delivery. 

Taking a Long-Term View

Sobierajska-Rek et al conducted a remote rehabilitation program with a group of boys with Duchenne muscular dystrophy (DMD). This program involved online workshops for both patients and caregivers, as well as an online motor assessment tool that caregivers were asked to complete. Caregivers were also asked to share a photograph of the patient’s posture and upload it onto an app. 

The research team wrote, “In the nonambulant group the emphasis was placed on chest physiotherapy, stretching of upper extremities, positioning and wheelchair ergonomics. The program for the ambulant group focused on lower extremities stretching and full body exercises.” The researchers concluded that home-based rehabilitation is a viable means to continue administering health care during the COVID-19 pandemic. 

Read more about DMD treatment

We are still learning about the long-term impact of telemedicine administered during the pandemic, and will be for the years to come. However, existing studies have shown that telemedicine is a possible solution to the many problems of administering health care to patients with neuromuscular disease — problems that have existed even before the COVID-19 pandemic. As Montes et al concluded, “The combined use of in-person and remote assessments may provide a more holistic view of the clinical manifestations and patient experience.” 

References

Ganapathy K. Telemedicine and neurological practice in the COVID-19 eraNeurol India. 2020;68(3):555-559. doi:10.4103/0028-3886.288994

Montes J, Eichinger KJ, Pasternak A, et al. A post pandemic roadmap toward remote assessment for neuromuscular disorders: limitations and opportunitiesOrphanet J Rare Dis. Published online January 4, 2022. doi:10.1186/s13023-021-02165-w

Sobierajska-Rek A, Mański Ł, Jabłońska-Brudło J, Śledzińska K, Ucińska A, Wierzba J. Establishing a telerehabilitation program for patients with Duchenne muscular dystrophy in the COVID-19 pandemicWien Klin Wochenschr. 2021;133(7-8):344-350. doi:10.1007/s00508-020-01786-8