title: Point-of-Care Programming for Neuromodulation:  A Feasibility Study Using Remote Presence.
abstract: BACKGROUND
  The expansion of neuromodulation and its indications has resulted in hundreds of thousands of patients with implanted devices worldwide. Because all patients require programming, this growth has created a heavy burden on neuromodulation centers and patients. Remote point-of-care programming may provide patients with real-time access to neuromodulation expertise in their communities.
  
  
  OBJECTIVE
  To test the feasibility of remotely programming a neuromodulation device using a remote-presence robot and to determine the ability of an expert programmer to telementor a nonexpert in programming the device.
  
  
  METHODS
  A remote-presence robot (RP-7) was used for remote programming. Twenty patients were randomly assigned to either conventional programming or a robotic session. The expert remotely mentored 10 nurses with no previous experience to program the devices of patients assigned to the remote-presence sessions. Accuracy of programming, adverse events, and satisfaction scores for all participants were assessed.
  
  
  RESULTS
  There was no difference in the accuracy or clinical outcomes of programming between the standard and remote-presence sessions. No adverse events occurred in any session. The patients, nurses, and the expert programmer expressed high satisfaction scores with the remote-presence sessions.
  
  
  CONCLUSIONS
  This study establishes the proof-of-principle that remote programming of neuromodulation devices using telepresence and expert telementoring of an individual with no previous experience to accurately program a device is feasible. We envision a time in the future when patients with implanted devices will have real-time access to neuromodulation expertise from the comfort of their own home.
authors.affiliation: Neuromodulation and Remote Medicine Program, Capital Health Division of Neurosurgery, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. mendez@dal.ca
authors.forename: Ivar
authors.initials: I
authors.lastname: Mendez
authors.forename: Michael
authors.initials: M
authors.lastname: Song
authors.forename: Paula
authors.initials: P
authors.lastname: Chiasson
authors.forename: Luis
authors.initials: L
authors.lastname: Bustamante
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003196:Computer Graphics; D003627:Data Interpretation, Statistical; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D009493:Neurosurgery / Q000458:organization & administration*; D019635:Neurosurgical Procedures / Q000379:methods*; D009726:Nurses; D017060:Patient Satisfaction; D010361:Patients; D019095:Point-of-Care Systems / Q000458:organization & administration*; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods / Q000458:organization & administration*; D017216:Telemedicine / Q000379:methods