Multiple Sclerosis Clinical Video Telehealth (MS-CVT) for Neurology Care and Tele-Rehabilitation into the Home

Background:

It is estimated that the Veterans Health Administration (VHA) cares for more than 28,000 Veterans who have been diagnosed with Multiple Sclerosis (MS) ¹. Nearly 45 percent of these patients live in rural or highly rural areas. This geographic distance can be a significant barrier to Veterans with MS who need to access health care, especially for subspecialty care in the U.S. Department of Veterans Affairs (VA). Tele-rehabilitation is a healthcare delivery model that shows improvements in functional status and high patient acceptance². Physical activity positively impacts mobility, 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. 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.

Objectives:

1. To expand specialty care via CVT for neurology and physical rehabilitation services to Veterans with MS with difficulty accessing physical therapy
2. To implement CVT for rehabilitative care to improve or maintain functional independence and health-related quality of life 
3. Decrease travel hours, costs and burden for veteran and caregiver

Methods:

130 veterans (n=10/site) with progressive MS and mild to moderate disability are enrolled in a dual CVT Neurology/CVT Rehabilitation program. 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. Veterans and caregivers are assessed at the beginning of the program using standardized measures of function and health-related quality of life. Enrollees receive a minimum of 6 weeks of individualized physical therapy using CVT. 

Results:

Participants reported savings in travel time and round trip (RT) mileage to access specialty services to their closest VA Medical Centers at the exit in-person visit.  CVT decreased no-show rates and increased motivation to participate in therapy. Providers reported high levels of satisfaction using CVT and rehabilitation software. Standardized functional outcomes will be presented.

Conclusions:

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.