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Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis.

ABSTRACT: Motor dysfunction, particularly ataxia, is one of the predominant clinical manifestations in patients with multiple sclerosis (MS). Assessment of motor dysfunction suffers from a high variability. We investigated whether the clinical rating of ataxia can be improved through the use of reference videos, covering the spectrum of severity degrees as defined in the Neurostatus-Expanded Disability Status Scale. Twenty-five neurologists participated. The variability of their assessments was significantly lower when reference videos were used (SD?=?0.12; range?=?0.40 vs SD?=?0.26; range?=?0.88 without reference videos; p?=?0.013). Reference videos reduced the variability of clinical assessments and may be useful tools to improve the precision and consistency in the clinical assessment of motor functions in MS.

SUBMITTER: D'Souza M

PROVIDER: S-EPMC6088490 | biostudies-literature | 2018 Jul-Sep

REPOSITORIES: biostudies-literature

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Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis.

D'Souza Marcus M Steinheimer Saskia S Dorn Jonas J Morrison Cecily C Boisvert Jacques J Kravalis Kristina K Burggraaff Jessica J van Munster Caspar Ep CE Diederich Manuela M Sellen Abigail A Kamm Christian P CP Dahlke Frank F Uitdehaag Bernard Mj BM Kappos Ludwig L

Multiple sclerosis journal - experimental, translational and clinical 20180701 3

Motor dysfunction, particularly ataxia, is one of the predominant clinical manifestations in patients with multiple sclerosis (MS). Assessment of motor dysfunction suffers from a high variability. We investigated whether the clinical rating of ataxia can be improved through the use of reference videos, covering the spectrum of severity degrees as defined in the Neurostatus-Expanded Disability Status Scale. Twenty-five neurologists participated. The variability of their assessments was significan ...[more]

PMID: 30116550

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Project description:ObjectiveTo assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.MethodAudio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS).ResultsMean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing "preferred patient approach to receiving information" and "preferred patient level of involvement." Highest scores were for "clinician drawing attention to identified problem", "indicating need for decision making," and "need to review the decision." Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score.ConclusionsIn line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers', although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.

Dataset Information

Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis.

Publications

Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis.

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