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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(05): 444-451
DOI: 10.1055/s-0043-1768665
Original Article

Feasibility for evaluating motor aspects of Parkinson's disease through video consultations in a resource-limited setting in Southern Brazil

Viabilidade para avaliar os aspectos motores da doença de Parkinson através de consultas por vídeo em um ambiente de recursos limitados no sul do Brasil
Daniel Teixeira-dos-Santos 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
2   Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
,
Daniel Monte Freire Camelo 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
2   Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
,
Matheus Zschornack Strelow 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
2   Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre RS, Brazil.
,
Maysa Tayane Santos Silva 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
3   Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
,
Paula Führ 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
3   Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
,
Letícia Winer Marins 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
3   Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
,
Artur Francisco Schumacher Schuh 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.
4   Universidade Federal do Rio Grande do Sul, Departamento de Farmacologia, Porto Alegre RS, Brazil.
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Abstract

Background Performing motor evaluations using videoconferencing for patients with Parkinson's disease (PD) is safe and feasible. However, the feasibility of these evaluations is not adequately studied in resource-limited settings.

Objective To evaluate the feasibility of performing motor evaluations for patients with PD in a resource-limited setting.

Methods The examiners rated motor aspects of parkinsonism of 34 patients with PD from the Brazilian public healthcare system through telemedicine with the patient's own means by using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) rating scale. Quality measures of the video meeting were also obtained. The feasibility of rating the motor aspects was the primary outcome whereas the rating of individual motor aspects, video meeting quality and predictors of a complete evaluation served as secondary outcomes.

Results The least assessable parameters were freezing of gait (52.9%), gait (70.6%), leg agility, and rest tremor (both 76.5%). Complete MDS-UPDRS part III was possible in 41.2% of patients and 62 out of 374 motor aspects evaluated (16.6%) were missed. Available physical space for a video evaluation was the worst quality measure. Incomplete evaluations were directly associated with disability (p = 0.048, r = 0.34) and inversely with available physical space (p = 0.003, r = 0.55).

Conclusion A significant portion of the MDS-UPDRS part III is unable to be performed during telemedicine-based evaluations in a real-life scenario of a resource-limited setting.

Resumo

Antecedentes Realizar avaliações motoras usando videoconferência para pacientes com doença de Parkinson (DP) é seguro e viável. Entretanto, a viabilidade dessas avaliações não é adequadamente estudada em cenários com recursos limitados.

Objetivo Identificar a viabilidade de realizar avaliações motoras para pacientes com DP em um ambiente com recursos limitados.

Métodos Os examinadores avaliaram os aspectos motores da DP de 34 pacientes do sistema público de saúde brasileiro através da telemedicina com os próprios meios do paciente usando a escala Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Medidas de qualidade da videochamada também foram obtidas. A viabilidade da classificação dos aspectos motores foi o resultado primário, enquanto a classificação dos aspectos motores individuais, a qualidade das videoconferências e os preditores de uma avaliação completa serviram como resultados secundários.

Resultados Os parâmetros menos avaliáveis foram congelamento da marcha (52,9%), marcha (70,6%), agilidade dos membros inferiores e tremor de repouso (ambos 76,5%). A parte III completa da MDS-UPDRS foi possível em 41,2% dos pacientes, mas não foi possível avaliar 62 do total de 374 aspectos motores (16,6%). O espaço físico disponível para uma avaliação em vídeo foi a pior medida de qualidade. As avaliações incompletas foram diretamente associadas ao nível de dependência (p = 0,048, r = 0,34) e inversamente ao espaço físico disponível (p = 0,003, r = 0,55).

Conclusão Uma porção significativa da parte III da MDS-UPDRS é perdida durante as avaliações baseadas em telemedicina em um cenário da vida real com recursos limitados.

Keywords

Parkinson Disease - Videoconferencing - Telemedicine - Remote Consultation - Developing Countries - Neurologic Examination

Palavras-chave

Doença de Parkinson - Comunicação por Videoconferência - Telemedicina - Consulta Remota - Países em Desenvolvimento - Exame Neurológico

Authors' Contributions

DTS: conceptualization, data curation, formal analysis, methodology, project administration, supervision, visualization, writing-original draft, writing-review, and editing; DMFC, MZS: conceptualization, data curation, investigation, writing-review, and editing; MTSS, PF, LWM: data curation, investigation, writing-review, and editing; AFSS: conceptualization, formal analysis, methodology, project administration, supervision, writing-original draft, writing-review, and editing.




Publication History

Received: 09 August 2022

Accepted: 15 January 2023

Article published online:
31 May 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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