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March 2023; 10 (2) Research ArticleOpen Access

Remote Observational Research for Multiple Sclerosis

A Natural Experiment

Riley Bove, Shane Poole, Richard Cuneo, Sasha Gupta, Joseph Sabatino, Meagan Harms, Tifffany Cooper, William Rowles, Nicolette Miller, Refujia Gomez, Robin Lincoln, Kira McPolin, Kyra Powers, Adam Santaniello, Adam Renschen, Carolyn J. Bevan, Jeffrey M. Gelfand, Douglas S. Goodin, Chu-Yueh Guo, Andrew R. Romeo, Stephen L. Hauser, Bruce Anthony Campbell Cree; on behalf of the UCSF MS-EPIC Team
First published December 30, 2022, DOI: https://doi.org/10.1212/NXI.0000000000200070
Riley Bove
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Shane Poole
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Richard Cuneo
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Sasha Gupta
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Joseph Sabatino Jr
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Meagan Harms
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Tifffany Cooper
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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William Rowles
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Nicolette Miller
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Refujia Gomez
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Robin Lincoln
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Kira McPolin
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Kyra Powers
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Adam Santaniello
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Adam Renschen
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Carolyn J. Bevan
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Jeffrey M. Gelfand
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Douglas S. Goodin
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Chu-Yueh Guo
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Andrew R. Romeo
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Stephen L. Hauser
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Bruce Anthony Campbell Cree
From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
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Full PDF
Citation
Remote Observational Research for Multiple Sclerosis
A Natural Experiment
Riley Bove, Shane Poole, Richard Cuneo, Sasha Gupta, Joseph Sabatino, Meagan Harms, Tifffany Cooper, William Rowles, Nicolette Miller, Refujia Gomez, Robin Lincoln, Kira McPolin, Kyra Powers, Adam Santaniello, Adam Renschen, Carolyn J. Bevan, Jeffrey M. Gelfand, Douglas S. Goodin, Chu-Yueh Guo, Andrew R. Romeo, Stephen L. Hauser, Bruce Anthony Campbell Cree
Neurol Neuroimmunol Neuroinflamm Mar 2023, 10 (2) e200070; DOI: 10.1212/NXI.0000000000200070

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Abstract

Background and Objectives Prospective, deeply phenotyped research cohorts monitoring individuals with chronic neurologic conditions, such as multiple sclerosis (MS), depend on continued participant engagement. The COVID-19 pandemic restricted in-clinic research activities, threatening this longitudinal engagement, but also forced adoption of televideo-enabled care. This offered a natural experiment in which to analyze key dimensions of remote research: (1) comparison of remote vs in-clinic visit costs from multiple perspectives and (2) comparison of the remote with in-clinic measures in cross-sectional and longitudinal disability evaluations.

Methods Between March 2020 and December 2021, 207 MS cohort participants underwent hybrid in-clinic and virtual research visits; 96 contributed 100 “matched visits,” that is, in-clinic (Neurostatus-Expanded Disability Status Scale [NS-EDSS]) and remote (televideo-enabled EDSS [tele-EDSS]; electronic patient-reported EDSS [ePR-EDSS]) evaluations. Clinical, demographic, and socioeconomic characteristics of participants were collected.

Results The costs of remote visits were lower than in-clinic visits for research investigators (facilities, personnel, parking, participant compensation) but also for participants (travel, caregiver time) and carbon footprint (p < 0.05 for each). Median cohort EDSS was similar between the 3 modalities (NS-EDSS: 2, tele-EDSS: 1.5, ePR-EDSS: 2, range 0.6.5); the remote evaluations were each noninferior to the NS-EDSS within ±0.5 EDSS point (TOST for noninferiority, p < 0.01 for each). Furthermore, year to year, the % of participants with worsening/stable/improved EDSS scores was similar, whether each annual evaluation used NS-EDSS or whether it switched from NS-EDSS to tele-EDSS.

Discussion Altogether, the current findings suggest that remote evaluations can reduce the costs of research participation for patients, while providing a reasonable evaluation of disability trajectory longitudinally. This could inform the design of remote research that is more inclusive of diverse participants.

Glossary

DMT=
disease-modifying treatment;
EDSS=
Expanded Disability Status Scale;
EPIC=
Expression/genomics, Proteomics, Imaging, and Clinical;
ePR-EDSS=
electronic patient-reported EDSS;
MS=
multiple sclerosis;
NS-EDSS=
Neurostatus EDSS;
tele-EDSS=
televideo-enabled Expanded Disability Status Scale

Footnotes

  • Go to Neurology.org/NN for full disclosures. Funding information is provided at the end of the article.

  • The Processing Charge was funded by the authors.

  • The UCSF MS EPIC Team members are listed in Appendix 2 at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Associate Editor Friedemann Paul, MD.

  • Received May 7, 2022.
  • Accepted in final form April 10, 2022.
  • Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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