In-person versus virtual administration of the ACR gold standard cognitive battery in SLE: are they interchangeable?

Objective:
During the COVID-19 pandemic many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification.

Methods
Data from our multi-visit, SLE CI study included demographic, clinical and psychiatric characteristics and the modified ACR-NB. Three analyses were undertaken for cognitive performance: 1) all visits, 2) non-CI group visits only and 3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually.

Results:
We analysed 328 SLE participants who had 801 visits (696 in-person, 105 virtual). Demographic, clinical and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person.

Conclusions:
Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach this should be accounted for during analysis.