Teleneurology in patients with multiple sclerosis: EDSS ratings derived remotely and from hands-on examination

We compared the telemedicine assessment of 20 patients with multiple sclerosis (MS) with the findings of a hands-on examiner. The remote specialist was a neurologist with expertise in MS; the hands-on examination was performed by an experienced mid-level practitioner. We also compared the findings of a second specialist viewing the examination in the room with the patient. The videoconference link operated at a bandwidth of 384 kbit/s. All three examiners independently completed a standardized rating scale for neurological functions. Cronbach's alpha for the three raters' total expanded disability status scale (EDSS) score was 0.99 with individual correlations ranging from 0.96-0.97. Agreement between raters for individual neurological domain scores was more variable. The most consistent assessments were for optic, bowel and bladder, and cerebral functions. The least consistent were for cerebellar and brain stem functions. Agreement between the remote and local examiners was similar to that reported for different neurological examiners directly assessing the same patient using the EDSS rating system.