key: cord-0986407-l1hdktxv authors: Goetz, Christopher G.; Stebbins, Glenn T. title: Is telemedicine the new normal or is the office visit still the Movement Disorder option of choice? date: 2021-05-21 journal: Mov Disord DOI: 10.1002/mds.28673 sha: 8895b938dc541d284cdc42f1b90108b996d0ae06 doc_id: 986407 cord_uid: l1hdktxv nan The Covid pandemic has forced major adaptations for patients and providing health care professionals. Movement Disorders and other major journals have gathered articles and special sections to focus on the challenges of this epoch (1) . In the context of quarantines and confinements, telemedicine, either by telephone or video platform, has allowed physicians and patients to remain in contact and to avoid travel and potential viral exposure. As the pandemic in the US cycles towards mass vaccination, more secure travel, and greater social options, it is reasonable to pose the question of the enduring role of telemedicine in managing our movement disorder patients. Is its high usage rate "a new normal" or are movement disorder practices returning to the traditional office visit with telemedicine taking on its former adjunct position, only slightly more accessed than before the pandemic? To address this issue in an urban university practice involving ten full time movement disorder specialists, three neuropsychologists, a psychiatrist, and two physician assistants, we examined the distribution of appointment types from Jan 2020, two months before pandemic restrictions were implemented and then monthly through April 2021 (Fig) . We charted the percent of visits that were in-office, telephoneor video-based. Prior to March 2020, (first two columns) billable telephone encounters by doctors did not occur, video visits were a welldeveloped but infrequently accessed option, and almost all visits were in-office (green bars). Pandemic-related concerns abruptly altered the number and the visit mix over the next 12 months (columns 3-14, March 2020-Feb 2021) with a sharp reduction in office appointments, a shift to heavy video-(blue) and telephone-(yellow) based care. Over time however and starting as early as June 2020 (column 6), when citybased restrictions began to lift, we noted a slow and steady return to a predominance of office-based care. Since March 2021, (last two Accepted Article columns) and widespread vaccination efforts have dominated the city culture, 15% or less of all visits have been outside the in-office format. As such, we see this movement disorder university-based urban practice as having largely returned to the traditional model of in-office care, but we are pleased that alternate options exist for the small numbers of patients still needing them. We do not see a "new normal", but instead a re-equilibration of practice patterns after a "roller coaster" of agile and adaptive responses to unexpected challenges. We have pondered the reasons for this rapid return to the traditional format of care. Prior research by our group has established that our anchor rating scale, the MDS-UPDRS, cannot be accurately utilized by video with a surrogate Part 3 (Motor Examination) score, because the inability to assess rigidity and the danger of testing Postural Stability outside of a professional setting preclude a valid estimate calculation (2) . We have also previously published on the practicality of video-based examinations but the price in terms of assessment accuracy when rating patients with three-dimensional neurological disorders by a two-dimensional technique (3) . As such, we recognize that doctors have, consciously or not, participated in the effort to return to the traditional model. Considering the patient's voice in this observation as well, however, we have also surveyed our patients and asked them the primary reason for their preferred return to an office setting. In spite of travel time and cost, parking inconvenience, and urban hazards, representative remarks were: "I have been so isolated, it is good to get out."; "I really felt I needed to be examined.". In a charming reinforcement of the power of the doctorpatient relationship, especially in the face of a year of serious challenge, one of the leading comments was: "I missed my doctor." This article is protected by copyright. All rights reserved. Execution; CGG. GTS 2. Statistical Analysis: A. Design, GTS, CGG B. Execution, GTS, C. Review and Critique Movement Disorders in the World of COVID-19 Handling missing values in the MDS-UPDRS Temporal stability of the Unified Dyskinesia Rating Scale This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.