BALTIMORE—Although physical rehabilitation is one of the few nonpharmaceutical therapies for maintaining or improving walking ability for patients with multiple sclerosis, many patients aren’t able to benefit because of travel distance to rehabilitation clinics, neurological disability and limited insurance coverage.
To address those issues, VA Maryland Healthcare System researchers employed a web-based system to support a home-based self-directed exercise program. Results of their efforts were published recently in the Journal of Telemedicine and Telecare.1
For the study, 24 patients were randomized to either routine home rehabilitation or to the multiple sclerosis home automated tele-management system for a six-month period. The study group had a mean age of 50.4 years, 56% of patients were male, and 67% had progressive multiple sclerosis with an overall mean Patient Determined Disease Steps score of 4.4, i.e., cane or crutch required for walking,
Defined as key outcomes were the timed 25-foot-walk, six-minute-walk and the Berg Balance Scale.
Results indicated no statistically significant difference in the change of the primary walking outcome measure, timed 25-foot-walk, at six months between the home automated telemanagement intervention and control groups.
Change scores for the six-minute-walk also were not significantly different between the home automated tele-management or control groups at six months.
“Maintaining overall gait abilities in this group of predominantly progressive multiple sclerosis patients is notable,” study authors wrote. “Exercise adherence was positively associated with higher multiple sclerosis disability and self-reported walking ability. Study engagement and participation in routine home-based exercise for the entire study period was challenging. Further research using clinical video telerehabilitation techniques that optimize patient involvement warrants further study.”
- Conroy SS, Zhan M, Culpepper WJ 2nd, Royal W 3rd, Wallin MT. Self-directed exercise in multiple sclerosis: Evaluation of a home automated tele-management system. J Telemed Telecare. 2017 Jan 1:1357633X17702757. doi: 10.1177/1357633X17702757. [Epub ahead of print] PubMed PMID: 28441894.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.