BALTIMORE—Of the more than 28,000 veterans with multiple sclerosis (MS) who receive care at the VHA, almost 45% of them live in rural or highly rural areas, a recent conference presentation pointed out.

The study presented at the 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, TN, this summer, described how the geographic distance can be a significant barrier to veterans with MS who need to access healthcare, especially for subspecialty care.1

To remedy that, a team led by researchers from the Baltimore VAMC decided to test telerehabilitation, a healthcare delivery model that can improve functional status and has high patient acceptance “Physical activity positively impacts mobility, fatigue, sleep, cognition and other secondary impairments that limit health and function in MS,” study authors explained.

They opted for Clinical Video Telehealth (CVT), one form of distance technology that helps ameliorate the negative effects of geographic distance and connects veterans to subspecialty providers.

Background information in the article noted that the Office of Rural Health initiated a pilot study on the use of distance technology to improve access to care in the North Florida Veterans Health System.

“As a result of this pilot study, a Rural Promising Practice program was developed for specialty-focused care into the home of veterans with MS to promote mobility, physical activity, and functional independence. In September 2017, this became an enterprise-wide initiative,” the researchers described.

The Baltimore VAMCs worked with colleagues from the Veterans Rural Health Resource Center in Gainesville, FL, the VA Puget Sound Health Care System in Seattle, WA and the MS Center of Excellence in Washington to try to meet the objective of expanding specialty care using CVT for neurology and physical rehabilitation services. Targeted were veterans with MS who have difficulty accessing physical therapy.

The goals were to help those MS patients improve or maintain functional independence and health-related quality of life. Toward that end, the study team sought to decrease travel hours, costs, and burden for both veterans and caregivers.

To do that, they focused on 130 veterans—10 per site—with progressive MS and mild-to-moderate disability, enrolling them in a dual CVT neurology/CVT rehabilitation program.

To participate in the program, patients underwent a face-to-face medical assessment by an MS specialist, functional assessment by a licensed physical therapist, education on the plan of care and training to use the device.

At program start, veterans and caregivers were assessed using standardized measures of function and health-related quality of life. Patients then were provided a minimum of six weeks of individualized physical therapy using CVT.

At in-person exist visits, participants reported savings in travel time and round-trip mileage to access specialty services to their closest VAMC, the researchers reported.

Results indicated that CVT decreased no-show rates and increased motivation to participate in therapy. At the same time, the study found that providers reported high levels of satisfaction using CVT and rehabilitation software. Standardized functional outcomes were presented at the conference.

“Physical therapy is feasible and safe to deliver to veterans who have difficulty with access to VA or community services, and access was increased in areas where fee-based care was unavailable or face-to-face veteran care would have required significant travel,” study authors concluded.

1. Kunce, A, Fritz J, Haselkorn JK, Wallin, M. Multiple Sclerosis Clinical Video Telehealth (MS-CVT) for Neurology Care and Telerehabilitation into the Home. Presented at the 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers 30 May 2018 to 2 June 2018 in Nashville, Tennessee.