![]() ![]() The extra concentration and effort that is required for someone with a hearing impairment when using the telephone may well impact on test performance. Further difficulties come from the absence of visual cues from the assessor such as smiling and nodding that are important in reassuring people that they are performing well and that they have rapport, and the assessor can also be disadvantaged by the lack of visual cues, for example, signs that the participant cannot hear adequately or are confused or anxious about something. (2020) argue that participants with reduced hearing will be disadvantaged by the “impoverished conditions” of telephone communication and the reduced range of hearing frequencies. It may be impossible to tell if something is “missed” due to perception problems or a lapse of attention on the part of either party. For example, the assessor cannot be sure that the participant is not writing down words to remember, using a calculator or checking the date when they are unable to see the participant. Wittich and Philips (2020) note that remote delivery using the telephone introduces some uncertainty to the testing process. In the first few months of the pandemic, some of the MoCA’s co-developers highlighted the challenges associated with remote delivery, with particular consideration to hearing loss. It is similar to MoCA Full but with slight adjustments to the delivery of some items, and other items requiring visual abilities removed, so is scored out of 22. The MoCA Blind/Telephone test is an adapted version for administration by voice only, for use with participants with visual impairment and for remote assessment by telephone. It is conducted face to face in-person or using videoconferencing in approximately 10 minutes and is scored out of 30 points. The MoCA Full test assesses short-term memory visuospatial abilities executive functions attention, concentration and working memory language and orientation to time and place. The Montreal Cognitive Assessment (MoCA) is an example of a cognitive screening instrument that is widely used in research as an eligibility screening tool, baseline measure and/or outcome assessment. The COVID-19 pandemic has forced many research teams to adjust the way they conduct studies, including moving to remote delivery of some or all of their recruitment and data collection processes. Personalised care planning for older people with frailty ISRCTN16123291. If choosing remote methods, consider the practicality of using videoconferencing and think about the possible impact of telephone assessment on the relationship with the (potential) research participants. Researchers should weigh up the pros and cons for each individual study, especially those involving older adults. However, as we have found, telephone testing is not always straightforward. ![]() The MoCA is a useful tool when cognitive impairment is part of screening and data collection and it is helpful to have the option to use the test remotely. We discuss the potential impact of these issues on trial recruitment and participant engagement, and the feasibility of videoconferencing as an alternative method of conducting the MoCA. It was hard for the researchers to judge the emotional impact that undertaking the assessment was having on the older people on the telephone, without visual warning signs of fatigue or mood. Some participants experienced practical difficulties when combining holding a telephone and completing one of the assessment items. We found that in comparison with conducting the assessment in-person, telephone administration caused uncertainty for the researchers about whether participants were struggling to answer questions due to cognition or hearing impairment. One of the changes was for the researchers to conduct a cognitive assessment for eligibility during an initial telephone call, rather than during the subsequent home visit for consent and baseline data collection. In response to COVID-19, a number of changes were made to the trial’s screening and recruitment procedures, to minimise the amount of time the researchers would spend in the participants’ homes when recruitment began in May 2021. Here, we reflect on our experiences of administering the MoCA Blind/Telephone as part of the initial telephone eligibility check for participation in a randomised controlled trial with community-dwelling older people with frailty. The Montreal Cognitive Assessment (MoCA) is widely used in research and is available in multiple formats for different groups and assessment settings. The COVID-19 pandemic forced many research teams to adjust the way they conduct studies, including moving to remote delivery of some or all of their recruitment and data collection processes.
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