ABSTRACT
Introduction: Cognitive difficulties experienced in MS impact areas such as work, socialising, self-care and many activities of daily living. There is a high prevalence of cognitive difficulties in MS, but despite this there are few programmes targeting cognition that focus on the ability to function well in everyday life. The COB-MS programme, an occupation-focused cognitive intervention, was developed to address this. It focuses on both the functional difficulties and the wide-ranging symptoms that present in MS, including the ability to maintain employment, social activities, home management and self-care. Objective(s): Here we report on the results of feasibility and initial efficacy of the COB-MS as a cognitive intervention for people with MS. Method(s): Although initially designed for in-person delivery, the COB-MS was adapted for online delivery due to the COVID-19 pandemic. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in cognition, quality of life, and mood. Result(s): One hundred and twenty-five people with MS and cognitive difficulties were randomised to either usual care or COB-MS intervention. Ninety-four participants were retained at 6-month follow-up. Fidelity data was collected and analysed for occupational therapist conducting the intervention. A qualitative evaluation of the COB-MS from the perspective of participants also took place. All feasibility results will be presented- preliminary efficacy, participant experiences, intervention fidelity, and overall outcomes from the trial. Conclusion(s):The results provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy.
ABSTRACT
Approximately 43-70% of people living with multiple sclerosis (MS) experience cognitive impairment. This study-within-a-trial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS), a holistic therapy on the management of cognitive symptoms in MS. Reliable remote cognitive testing could provide safer and more convenient care for MS patients, during the COVID-19 pandemic and thereafter. The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people to 68 people with MS experiencing cognitive difficulties. Group 1 (N=34) were tested in-person pre-pandemic. Group 2 were tested remotely. No significant differences between virtual and in-person administrations of the CVLT-II and SDMT were detected. BVMT-R scores were significantly higher for virtual administrations, possibly indicating inter-rater differences. Strong positive correlations were found for in-person and virtual scores within Group 1 on the CVLT-II. The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS. Future research with larger samples could investigate performance on BVMT-R with regards to screen size of device used.
ABSTRACT
Introduction: The COVID-19 pandemic has had a significant impact on research and health care in MS. This study-within-atrial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS) that was originally designed to be delivered in-person but was amended to an online environment. As such, reliable remote cognitive testing could provide safer and more convenient care for MS patients. Aims: The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people with MS. Objectives: Performance on BICAMS measures and the TMT administered remotely are compared with performance on tests administered in-person. BICAMS measures include the California Verbal Learning Test, Second Edition (CVLT-II), the Symbol Digit Modality Test (SDMT) and the Brief Visuospatial Memory Test-Revised (BVMT-R). Method: Independent samples t-tests were conducted on a sample of 68 participants to investigate differences in performance between Group 1 (11 males, 23 females), who were visited by a research assistant in their homes before the pandemic and Group 2 (10 males, 24 females) who received online testing only via teleconference platform Zoom. Within-group differences for Group 1 who also received virtual testing after a six-month interval were also examined. Results: The analysis revealed no significant differences in scores between virtual and in-person administrations of the CVLT-II, TMT and SDMT. Strong positive correlations were found for inperson and virtual tests within Group 1 after a six-month interval on the CVLT-II, SDMT, TMT-A and TMT-B. BVMT-R scores were significantly higher for virtual testing (M = 20.59, SD = 6.65) compared to in-person testing (M = 16.35, SD = 6.05). However, this discrepancy may be attributed to inter-rater differences, rather than enhanced performance for online testing. In-person and virtual assessments within Group 1 were also strongly correlated (r = .72). Conclusions: The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS.