Multiple Sclerosis in-HOME Clinical VIDEO Telehealth (MS-CVT) for Rehabilitation Follow-up for Veterans at Geographic Disadvantage

Background: Geographic distance can be a significant barrier to individuals who need to access health care. This is true for subspecialty care in the Veterans Health Administration (VHA). Almost half of Veterans with Multiple Sclerosis (MS) live in rural areas, hours from their nearest VA Medical Center, or need to contend with geographic barriers. Veterans with MS and mobility impairments facing these obstacles often require a companion, such as a family member, friend, or a paid caregiver. The cumbersome process of getting to medical appointments is a disincentive to obtaining health services that minimize secondary impairments and promote functional independence.

Physical activity positively impacts mobility, mood, fatigue, sleep, cognition, and other secondary impairments that limit health and function in MS. Clinical Video Telehealth (CVT) is one form of distance technology that eliminates geographic barriers and connects Veterans to subspecialty providers such that they can access the services that may not be available. This particular Rural Promising Practice program brings specialty MS physical therapy into the home of Veterans to promote mobility and physical activity, and functional independence.

Objectives:

1. Extend specialty care from Neurology into Physical Medicine and Rehabilitation for Veterans with MS.

2. Determine the usability of the CVT devices in a variety of settings.

3. Evaluate Veteran functional status, satisfaction and quality of life.

4. Decrease travel hours and costs.

5. Minimize caregiver time, burden, and other costs.

 Methods: Sixty volunteers (N= 10 per site) with progressive MS and mild to moderate disability will be enrolled. Participants undergo 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.  Enrollees receive 6 weeks of twice weekly individualized physical therapy using CVT or in-person, as needed. Veterans and caregivers are assessed at the end of the program using standardized measures as well as health reported quality of life and satisfaction with CVT. Multiple types of communication devices including Android-based tablets, iPads and motion sensor monitors approved by the VA Office of Telehealth are utilized and evaluated for connectivity and usability. There is a minimum requirement of Wi-Fi and/or 4G connectivity capability for all equipment. All communication is Health Insurance Portability and Accountability Act-compliant and takes place through the VA’s secure network.

 Results: In many of these rural areas fee based care is unavailable, or the Veteran would have to travel several hours roundtrip to obtain care. Initial response to program is very positive and Veterans report satisfaction, an increased ability to access physical therapy, and increased motivation to attend other medical appointments. Standardized functional outcomes will be presented.

 Conclusions: none