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An Experience of Multiple Sclerosis Telerehabilitation During the COVID-19 Pandemic

Nora, Monica MD; Giannarelli, Michela PT; Zicchinella, Cristina PT; Mammi, Patrizia MD; Ranza, Elena MD; Brianti, Rodolfo MD

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American Journal of Physical Medicine & Rehabilitation: March 2021 - Volume 100 - Issue 3 - p 214
doi: 10.1097/PHM.0000000000001679
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To the Editor:

We read with great interest the article by Tenforde et al.1 entitled “Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction With Virtual Visits During the COVID-19 Pandemic.” We commend the authors for the interesting considerations about the benefits and limitations of telerehabilitation perceived by patients and their caregivers and the feasibility of synchronous physical therapy, occupational therapy, and speech therapy visits. A rapid establishment of virtual rehabilitation services has been a challenge for many rehabilitation services during the COVID-19 pandemic; we would like to share our experience as an outpatient clinic for patients with multiple sclerosis. We are affiliated with Rehabilitation Medicine Unit of the University Hospital of Parma, in the North of Italy. Clinic is managed by a multidisciplinary team providing medical evaluation, physiotherapy, and occupational therapy. In accordance with government indications of good clinical practice, on March 2, 2020, outpatient activities were ceased. In April 2020, in accordance with the recommendations of the Italian Society of Physical Medicine and Rehabilitation2 and Ministry of Health National Guidelines,3 we started outpatient activity via telemedicine and telephone calls to keep track of changes in functional status and to provide rehabilitation. All patients followed in the last 5 yrs were contacted by e-mail proposing televisits. Our region’s Emilia Romagna digital platform was used by individual shared links.4

Of 177 patients contacted, just 36 accepted telemedicine program; this included an evaluation visit followed by 10 weekly physiotherapy 1-hr sessions. Each session consisted of a main physiotherapy part (exercises to improve muscular length and strength, articular range of motion, static and dynamic balance and coordination), followed by 15-min relaxation time (mindfulness based5) to reduce anxiety and stress. At the end, a brief exercise set was left for daily practice. Each session started with therapist asking feedback about patient daily exercises and possible concerns emerged during the previous week.

All enrolled patients completed the program, expressing general appreciation of the service and remarking the importance of feeling supported and not abandoned by their rehabilitation team.

Despite the appreciation, it is evident that only a small part (approximately 20%) of the total outpatient sample accepted telemedicine. Different reasons could explain this fact, and two of them were clearly reported.

For many, there were “technical” difficulties such as computer and/or connection problems or unfamiliarity with digital technologies.

Other patients who were working or who were dependent by other working caregivers to participate had difficulties with the time schedules of treatments, available from 12:00 noon to 3:00 p.m. This was the only possible timeslot for therapists: it coincided with pauses between therapists working shifts in hospital COVID and non-COVID wards. Experience of telerehabilitation has been satisfying for many participants, and some of them have expressed preference for this kind of rehabilitation. For most patients, in our opinion, this instrument represents a resource for “emergency” times but should be accompanied by in person visits whenever possible.

Nevertheless, telemedicine seems promising especially in its educational aspect, providing tools to improve a positive attitude toward physical activity, stress management practices, and general health awareness.

Monica Nora, MD
Michela Giannarelli, PT
Cristina Zicchinella, PT
Patrizia Mammi, MD
Elena Ranza, MD
Rodolfo Brianti, MD
Rehabilitation Geriatric
Medical Department
University Hospital
Parma, Italy


1. Tenforde AS, Borgstrom H, Polich G, et al.: Outpatient physical, occupational, and speech therapy synchronous telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. Am J Phys Med Rehabil 2020;99:977–81
2. Negrini S, Kiekens C, Bernetti A, et al.: Telemedicine from research to practice during the pandemic. “Instant paper from the field” on rehabilitation answers to the COVID-19 emergency. Eur J Phys Rehabil Med 2020;56:327–30
3. Linee di indirizzo nazionali sulla telemedicina. Available at: 2014. Accessed November 19, 2020
4. Applicativi. Available at: Accessed November 19, 2020
5. Hofmann SG, Gómez AF: Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am 2017;40:739–49
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