Neurological examinations for DMD require personal contact between doctors and patients, making virtual examinations during teleconsultations challenging [30]. Available data comparing virtual examinations to traditional physical examinations are limited, and standardized protocols for televisits are lacking in the literature [31-34].

To address these challenges, researchers have developed their televisit systems and protocols. Structured surveys such as the Brook and Vignos scales or Egen Scale Classification used for clinical evaluation and functionality can be useful for collecting standardized data [35-38]. Additionally, other scales commonly used in clinical trials (the 6-Minute Walk Test, Quantitative Muscle Testing, the DMD Functional Ability Self-Assessment Tool, or the Performance of the Upper Limb Scale) can be utilized in telemedicine for assessing muscle function and progression of disease [39-41]. For children or adult patients with advanced-stage DMD, the presence of a telepresenter during the virtual examination can be helpful [17,28].

Although telemedicine became prevalent during the pandemic, hybrid programs combining telemedicine with in-person care emerged after the pandemic. Nowadays, it is recommended that the initial diagnostic visit for patients with DMD takes place in-person at the center, with possible follow-up teleconsultations [42,43].

Respiratory function is crucial for the quality and length of life of patients with DMD; therefore, annual evaluation of respiratory function is recommended for patients with gait preservation and every 6 months for those without or even more frequent if clinical symptoms dictate [44]. This includes collecting information on the type, number, and duration of respiratory infections, presence of cough reflex, daytime hypoventilation symptoms and sleep quality, as well as pulmonary function tests, including spirometry, peak cough flow, respiratory muscle strength (sniff nasal inspiratory pressure, maximal static inspiratory and expiratory pressures), and sleep study (polysomnography) with overnight capnography. Some of these procedures can be supported by telemedicine, for example, during virtual visits, health care professionals can provide information on respiratory care and collect data on chest infections and symptoms of hypoventilation or ineffective sleep (preferably using validated questionnaires, eg, Sleep-Disordered Breathing Questionnaire In Neuromuscular Patients [SiNQ‑5]) [45].

In a case series involving 3 patients with neuromuscular disorders—including one with DMD—video consultations, supported by baseline physiological monitoring, facilitated early identification of respiratory complications and helped avoid hospitalization [46]. Further, telemonitoring of pulmonary function by using portable devices at home (e-spirometry with assessment of forced vital capacity), in addition to traditional spirometry in reference centers, can be employed in patients with DMD [47,48].

Web-based care services could potentially be beneficial for adolescent and young adults in the later stages of the disease who require ventilatory support, aiding in decision-making and providing timely interventions for respiratory issues. A study conducted during the pandemic found that weekly video consultations (averaged 23 minutes) and ventilator telemonitoring successfully addressed most problems related to general clinical status and ventilation in a group of 21 children (including 5 with neuromuscular diseases), who relied on long-term ventilatory support (noninvasive and invasive) and living at home [49]. That study also identified challenges with telemedicine, particularly the absence of sufficient technology at home, such as low internet signal or lack of internet connectivity, which affected 17% of the participants [49]. Studies presenting comprehensive virtual respiratory care dedicated exclusively to patients with DMD are generally lacking. However, data from pediatric patients with other conditions requiring long-term respiratory support at home indicate that although clinical complications are common and respiratory decompensation is the most common cause, telemedicine can facilitate early diagnosis and treatment of life-threatening events [50]. In addition, it has been shown to reduce the frequency of hospitalizations and improve caregivers’ sense of security and confidence in home care among ventilated patients [51].

DMD can lead to significant cardiac complications, including cardiomyopathy, arrhythmias, and heart failure, which are all potentially lethal [52,53]. Early diagnosis and treatment of cardiomyopathy leads to favorable ventricular remodeling [54]. Because adverse myocardial changes can occur at a younger age than previously thought and due to the importance of diagnosis before overt cardiac dysfunction, yearly cardiac screening is recommended [54]. Cardiac diagnostics with electrocardiography, echocardiography, Holter monitoring, and magnetic resonance imaging require in-person visits. However, telemedicine can provide access to specialized care for patients who may not have local access to cardiologists [55]. Telemedicine enables remote monitoring of cardiac function and arrhythmias by using wearable sensors and implantable devices, allowing for timely interventions to prevent or treat cardiac complications [56].

Proper nutrition is vital for patients with DMD. Eating disorders at the early stage of the disease due to steroid therapy and immobilization cause concern for excessive body weight. At later stages of the disease, there is a risk of malnutrition due to the weakening of the muscles of the gastrointestinal tract [4]. Teleconsultations can involve assessing the nutritional status, monitoring diet and fluid intake, and providing nutritional counseling. Web-based surveys such as the Food Frequency Questionnaire-6 item questionnaire [57] are useful in collecting dietary data. Software applications can assist patients in monitoring their dietary goals and measurements [58]. These interventions can address both excessive body weight in the early stages of the disease and the risk of malnutrition in later stages.

Psychological support is needed at every stage of chronic disease. Studies [59] have shown that psychological and peer support via telehealth programs such as video sessions are useful and helpful for people with DMD and their caregivers. Telehealth programs can include health promotion causing improvement in the health-related quality of life. One study demonstrated the benefits of virtually delivered health coaching sessions (the first session was face-to-face, followed by 4 virtual sessions) related to physical activity and diet for males with DMD [60].

According to the World Physiotherapy and the International Network of Physical Therapy Regulatory Authorities, the purpose of digital physical therapy practice is to facilitate the effective delivery of physical therapy services by improving access to care and information and managing health care resources [61]. Telerehabilitation consists of consulting, diagnostics, and therapy conducted with the use of interactive digital technologies in real-time connection (synchronous) or through prerecorded videos (asynchronous). Caregiver involvement is crucial for individuals with DMD to ensure the proper execution of exercises during telerehabilitation [62]. Web-based video instructions are more acceptable than live workshops [63]. Another study showed that 8-week telerehabilitation sessions enhanced muscle strength in ambulatory patients with DMD and that regular web-based meetings with physiotherapists were more effective than prerecorded or streaming video exercises [64]. Telerehabilitation can be supported by telemonitoring in patients with DMD (eg, cardiovascular parameters with electrocardiogram [65], overall physical activity level, step activity with accelerometers [66], effects of respiratory rehabilitation with home spirometers [47]). Virtual reality, including video games, has proven to be a valuable assistive technology for home-based rehabilitation [47].

Some studies [67-69] have shown that telemedicine can be used at every stage of chronic disease, including patients in the terminal phase of the disease, both in adults and children. This is important because patients with DMD can present hospice phase and have a premature death at a young age. Hospice programs utilizing telemedicine have mostly focused on children with oncological diseases, but the benefits extend to patients with neuromuscular diseases even in the form of simple teleconsultations [67-73]. Devices with touch screens, large letters, and easy-to-understand pictograms have proven useful in telemedicine for patients in the terminal phase [74]. Despite this, patients with end-stage DMD (requiring always multidimensional palliative support) remain underrepresented in telehealth research. Formative studies are needed to develop and evaluate integrated telemedicine approaches that address the specific needs of these patients.

Home health and nursing services may complement telemedicine in end-stage DMD by enabling in-home assessments, medication administration, and laboratory sample collection. This type of care can serve as an effective bridge between virtual supervision and hands-on clinical support, ensuring continuity for patients with complex needs. Evidence from other chronic conditions shows that nurse-led telehomecare can reduce hospitalizations and improve the quality of life [75,76]. However, this hybrid approach remains underexplored in neuromuscular disorders. Future studies should evaluate its feasibility by using indicators such as hospital admissions, clinical stability, and caregiver satisfaction.