Toward a low-cost, in-home, telemedicine-enabled assessment of disability in multiple sclerosis

Riley Bove*, Carolyn Jean Bevan, Elizabeth Crabtree, Chao Zhao, Refujia Gomez, Priya Garcha, John Morrissey, Jason Dierkhising, Ari J. Green, Stephen L. Hauser, Bruce A.C. Cree, Mitchell T. Wallin, Jeffrey M. Gelfand

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background: Remote assessment of neurological disability in people with multiple sclerosis (MS) could improve access to clinical care and efficiency of clinical research. Objective: To develop and validate a telemedicine-based MS disability examination that does not require an in-home examiner. Methods: Adults with MS were recruited after a standardized in-person Expanded Disability Status Scale (EDSS) evaluation, and within 1 week underwent a blinded televideo-enabled EDSS examination with a different clinician. EDSS and tele-EDSS scores were compared. Results: Overall, 41 adults participated (mean (standard deviation (SD)) age: 47.0 years (11.6); median EDSS: 2 (range: 0–7)); 37 required no in-home assistance for the tele-EDSS evaluation (e.g. help positioning camera). Mean difference between EDSS and tele-EDSS was 0.34 (95% confidence interval (CI): 0.07–0.61). For 88% of evaluations, tele-EDSS and EDSS scores were within 1 point (similar to reported in-person inter-rater differences). Unweighted kappa for agreement within 0.5 point was 0.72. Correlation for individual functional systems (FS) ranged from modest (vision: 0.37) to high (bowel/bladder: 0.79). Overall correlation between EDSS and tele-EDSS was 0.89 (p < 0.0001); and 0.98 (p < 0.0001) at EDSS range: 4–7. Conclusion: In this proof of principle study, disability evaluation in mild to moderate MS is feasible using telemedicine without an aide at the patient’s location.

Original languageEnglish (US)
Pages (from-to)1526-1534
Number of pages9
JournalMultiple Sclerosis Journal
Issue number11
StatePublished - Oct 1 2019


  • Telemedicine
  • digital health
  • disability
  • multiple sclerosis
  • remote trials

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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