The Impact of COVID-19 on the COB-MS trial

Conducting research remotely by Fionnuala Rogers, Research Assistant at NUI Galway with the COB-MS feasibility trial.

More than eight months have passed since we first entered lockdown. In that time, we have seen a plethora of changes in our society: with working from home; waving to loved ones through windows; and 2-metre distances being the new social “norms”. The ways in which we can safely conduct research with people, and particularly with those who may be vulnerable to infection, have also been transformed. The pros and cons of conducting such research remotely have become clear to our COB-MS research team at NUI Galway in recent months.

The Cognitive Occupation-Based programme for Multiple Sclerosis (COB-MS) project has been significantly adapted to reduce risks of contracting COVID-19. The project set out in November 2019 to test the feasibility of a new therapy, COB-MS, which focuses on helping people with multiple sclerosis who also experience cognitive difficulties, such as difficulties with memory, concentration and problem-solving through education and developing new skills. In a pre-pandemic world, interventions of eight sessions were to be run by qualified occupational therapists (OTs) in group and individual settings, with six of these sessions to be held in groups of 5-6 people in local community centres. Individual sessions were also to take place in participants’ homes. As well as this, home visits were to be carried out by a research assistant pre- and post- intervention, and at two follow-up timepoints. A year on, the project has changed considerably due to the unforeseen pandemic.

All intervention sessions and cognitive assessments are now taking place online, via the videoconference platform, “Zoom”. Along with this new virtual method of running the intervention and collecting data comes perks and obstacles for both researchers and participants alike. Although some participants are au fait with using Zoom, others need a helping hand in getting things set up, and in making sure the camera, microphone and sound are switched on. Time and resources can be saved due to the lack of travel - a bonus for both participant and researcher. But other factors such as the strength of internet connection, sound quality and video clarity can have a significant impact on the quality of interaction between participant and researcher.

Cognitive assessments rely on an individual’s ability to clearly hear and understand instructions, as well as the researcher’s ability to clearly interpret the participant’s responses. In testing verbal memory in face-to-face scenarios, the researcher simply reads a list of words to the participant, and the participant recites back as many words as they can remember. But, when carried out over Zoom, the validity of this test is reliant on the stability of internet connection and sound quality. Low bandwidth or sound feedback may interfere with the understanding of instructions or auditory processing of word lists. Screen-freezing can also impact assessments that require performances to be accurately timed. In visuospatial memory assessments, which require drawing shapes from memory, the size of screen may have an impact on a participant’s performance, particularly if there are visual deficits. Other technological factors such as security settings, e-mail alerts or error messages popping up can also cause distraction and influence performance.

One of the most notable challenges is building one-to-one relationships with participants based on trust without ever meeting in-person. The subtleties of body language can sometimes be lost over camera, and there is a risk of meetings sometimes feeling impersonal. Effective communication is key to overcome these potential barriers. We are incredibly grateful for the resilience and perseverance of the participants who, despite the obstacles, have gotten on board with this new way of communicating and will not allow the pandemic to stand in the way of progression and research.