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

M. L. Barraclough, J. P. Diaz-Martinez, A. Knight, K. Bingham, J. Su, M. Kakvan, C. Muñoz Grajales, M. C. Tartaglia, L. Ruttan, J. Wither, M. Y. Choi, D. Bonilla, N. Anderson, S. Appenzeller, B. Parker, P. Katz, D. Beaton, R. Green, I. N. Bruce, Z. Touma

Research output: Contribution to journalArticlepeer-review


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.

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.

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.

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.
Original languageEnglish
Publication statusAccepted/In press - 21 Mar 2023


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