Reliability and Usability of Telemedicine Evaluations for Facial Dystonia

This study investigated telemedicine reliability and usability in evaluating facial dystonia grading and treatment complications. Eighty-two telemedicine recordings from 43 adults with blepharospasm (12,28%) and hemifacial spasm (31,72%) were obtained (mean age 64.5+9.3 years, 32 females (64%)). Two recorded in-hospital telemedicine visits were arranged with in-person visits at baseline and 4-6 weeks. After 8 weeks, neuro-ophthalmologists who performed the in-person visits re-evaluated the telemedicine videos records. Intra-rater agreements in assessing spasm gradings were moderate (severity: kappa=0.42, 95%CI 0.21-0.62, frequency: kappa=0.41, 95%CI 0.21-0.61) with substantial agreement in detecting lagophthalmos (kappa=0.61, 95%CI 0.36-0.86). Adding symptoms to signs increased sensitivity and NPV in detecting lagophthalmos (67% to 100% and 94% to 100%) and drooping lips (38% to 75% and 94% to 96%), respectively. Thai version Telehealth Usability Questionnaire showed high mean usability score of 6.5(SD0.8) out of 7. Telemedicine could further be developed as an alternative platform to evaluate facial dystonia.