Feasibility of telephone and computerized cognitive testing as a secondary outcome in an acute stroke clinical trial: A mixed methods sub-study of the AcT Trial.
Sajeevan Sujanthan, Pugaliya Puveendrakumaran, Katie N Dainty, Morgan Barense, Krista L Lanctot, Adrian M Owen, Nishita Singh, Brian H Buck, Houman Khosravani, Shelagh B Coutts, Mohammed Almekhlafi, Ramana Appireddy, Aleksander Tkach, Jennifer Mandzia, Heather Williams, Thalia S Field, Alejandro Manosalva, Muzaffar Siddiqui, Gary Hunter, MacKenzie Horn, Fouzi Bala, Michael D Hill, Michel Shamy, Aravind Ganesh, Tolulope Sajobi, Bijoy K Menon, Richard H Swartz
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引用次数: 0
Abstract
Introduction: Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently.
Patients and methods: Prospective cognitive outcomes were collected at 90-180 days using both telephone MoCA (T-MoCA; range 0-22; <17 impairment) and Creyos, a computerized cognitive battery. Key variables associated with completion were assessed using logistic regressions. Mixed methods brief structured interviews and exit survey were performed to explore barriers to completing computer testing.
Results: Of 791 potentially eligible patients (mean age 70 ± 14 years), there was low feasibility of remote cognitive testing, with only 401 (51%) completing the T-MoCA, and 242 (31%) completing Creyos. Our regression models show that age (ORT-MoCA: 0.95 (95% Confidence Interval (CI): 0.94-0.97); ORCreyos: 0.95 (95% CI: 0.94-0.96)), functional impairment (mRS 2-5; ORT-MoCA: 0.55 (95% CI: 0.37-0.81); ORCreyos: 0.66 (95% CI: 0.44-0.98)), quality of life (EQ-VAS; ORT-MoCA: 1.02 (95% CI: 1.01-1.03); ORCreyos: OR:1.02 (95% CI: 1.01-1.03)) and length of hospital stay (ORT-MoCA: 0.98 (95% CI: 0.96-0.99); ORCreyos: 0.97 (95% CI: 0.94-0.99)) predicted both telephone and computer cognitive test completion; computer literacy predicted computer test completion (ORCreyos: 1.12 (95% CI: 1.04-1.21)). In interviews, a preference for accessibility of computerized testing was reported.
Discussion: Remote cognitive testing has limited feasibility as a secondary outcome in large acute stroke trials. Patients who are older, with worse quality of life, or severe functional impairment post-stroke are less likely to complete remote cognitive outcomes.
Conclusion: Innovative approaches to post-stroke cognitive outcomes in acute stroke trials are needed.Data AccessData available upon request.
期刊介绍：
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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