Telemedicine for Patients Diagnosed with Amyotrophic Lateral Sclerosis

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Telemedicine for Patients Diagnosed with Amyotrophic Lateral Sclerosis
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative neuromuscular condition that has already affected many people and cause many studies about the various aspects of the disease. New knowledge regarding medical assessments and interventions is continuously progressing, especially with the current need to explore another aspect of the condition due to sudden healthcare changes. In response to the current healthcare system with numerous precautions and restrictions, patients with conditions such as ALS are now forced to change their routine to adjust to the new normal, limiting them from attending their regular face-to-face medical consultations with multidimensional assessments for systems such as respiratory, neurological, psychological, functional, etc. Both monitoring and management in patients with ALS are vital, resulting in the emergence of teleconsultation or telemedicine to address ALS patients' needs without increasing the risk of contracting and spreading the COVID-19 virus. However, this method raises concerns regarding virtual medical consultations' effectiveness compared to traditional and hands-on consultations. The purpose of this literature review is to examine the available research on the efficacy of telemedicine with comparison to traditional care and consultation in providing multidimensional care for patients diagnosed with amyotrophic lateral sclerosis.
Search Methods
The research databases used to find studies relevant to the research question are Science Direct, EBSCO Host, and PubMed. The keywords used are telemedicine, remote monitoring, nursing, amyotrophic lateral sclerosis, telehealth, ALS, neurodegenerative muscular conditions, ALS treatment, ALS monitoring, virtual consultation, and teleconsultation. The research studies are further narrowed down by the inclusion and exclusion criteria. The inclusion criteria are either male or female, with a diagnosis of amyotrophic lateral sclerosis and are receiving multidisciplinary care. The exclusion criteria used are comorbidities or conditions that mimic ALS. 5 studies' symptoms are included to be part of the current research.
Research evidence summary: Population
Patients and caregivers are involved in the studies as there are patients with ALS whose quality of life and functions are heavily affected by the condition. The focus of the research are patients diagnosed with ALS who are receiving multidisciplinary care for their condition. The confounding factors such as other conditions or present comorbidities that may affect the study results were identified.
Research evidence summary: Intervention
Features of Telemedicine
Telemedicine utilizes video conferencing instead of telephone communication. This requires a stable internet connection to conduct health care assessments and care. The teleconsultation similar to stroke care with neurological evaluation will be demonstrated. The accessibility and cost-effectiveness of telemedicine will highly benefit ALS patients in providing quality multidisciplinary care for increased survival (Hobson et al., 2016). In addition to the complexity of the technology required in telemedicine, the program's service and flow are also some of the aspects that need to be considered (Hobson et al., 2018). The assessments that are included in the remote consultation are neurologic, respiratory, physical, cognitive, psychological, and nutrition to provide holistic and multidimensional care to ALS patients.
Telemedicine in ALS patients
There is still a limited number of studies on telemedicine's efficacy in the monitoring and treating ALS, but the currently available research supports telemedicine for the decrease of disease progression and number of hospital visits. An example of telemedicine is the study by Selkirk et al., where extensive remote consultations had proven to be beneficial to ALS patients even at remote locations (2017).
Research evidence summary: Comparison
Traditional consultation is given the face-to-face assessment done by ALS specialists, a neurologist, and an ALS nurse. A research study exhibiting holistic and multidisciplinary care involves identifying impairments and disabilities, which dictates the patients' interdisciplinary needs. A meeting with the stakeholders is also required to track possible changes (Selkirk et al., 2017).
Research evidence summary: Outcomes
The clinical outcomes are measured using the standard outcome measure for ALS patients, the ALSFRS-r, which measures the patients' functional status. This quick assessment of speech, swallowing, upper and lower body movement, and repetitive assessments can gauge ALS patients' disease progression over some time (Selkirk et al., 2017). Other outcome measures that are monitored are the mortality rates of ALS patients due to complications. The hospitalization rate is also monitored if telemedicine influences the trend that is expected of ALS patients.
Validity description
The research studies' nature poses current challenges in the validity of the outcome measures used during the remote assessment. There are also possible barriers to the use of technology and the procedures' regulation (Hobson et al., 2016). The internal validity of the research studies is challenged by selection bias and attrition. The participants cannot be blinded and randomized due to the nature of the intervention. Attrition rates are also standard in some of the studies due to non-compliance of the participants, and intention-to-treat analysis is used to address dropouts.
The results of the research studies that were gathered have excellent external validity due to the population's specific characteristics focusing on ALS. Although, the studies' sample size can still be increased to improve the generalizability of the results. The outcomes that were measured through virtual consultations are also highly applicable to other populations or settings.
Research evidence summary: scientific merit related to the problem
All the research studies that met the criteria are involved patients wit...