Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study

Ali M Alam; Glynn W Webb; Ceryce Collie; Sashini Mariathasan; Yun Huang; Orla Hilton; Rajish Shil; Katherine C Dodd; James B Lilleker; Craig J Smith; Ava Easton; Arina Tamborska; Rhys H Thomas; Nicholas W S Davies; Thomas M Jenkins; Michael Zandi; Laura Benjamin; Mark A Ellul; Tom Solomon; Thomas A Pollak; Tim Nicholson; Gerome Breen; Daniel J van Wamelen; Nicholas W Wood; Benedict D Michael; (on Behalf of the COVID-CNS Group)

doi:10.1016/j.clinme.2024.100241

Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study

Clin Med (Lond). 2024 Sep;24(5):100241. doi: 10.1016/j.clinme.2024.100241. Epub 2024 Sep 6.

Authors

Ali M Alam¹, Glynn W Webb¹, Ceryce Collie¹, Sashini Mariathasan², Yun Huang¹, Orla Hilton¹, Rajish Shil¹, Katherine C Dodd³, James B Lilleker³, Craig J Smith⁴, Ava Easton⁵, Arina Tamborska¹, Rhys H Thomas⁶, Nicholas W S Davies⁷, Thomas M Jenkins⁸, Michael Zandi², Laura Benjamin², Mark A Ellul¹, Tom Solomon⁹, Thomas A Pollak¹⁰, Tim Nicholson¹¹, Gerome Breen¹², Daniel J van Wamelen¹³, Nicholas W Wood¹⁴, Benedict D Michael¹⁵; (on Behalf of the COVID-CNS Group)¹

Affiliations

¹ Infection Neuroscience Laboratory, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK.
² National Hospital for Neurology and Neurosurgery, London, UK.
³ Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
⁴ Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK; Divsion of Cardiovascular Sciences, University of Manchester, Manchester, UK.
⁵ Infection Neuroscience Laboratory, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK; Encephalitis International, Malton, UK.
⁶ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
⁷ Department of Neurology, Charing Cross Hospital, London, UK.
⁸ Sheffield Institute for Translational Neuroscience, University of Sheffield, UK; Curtin University, Perth, Western Australia.
⁹ Infection Neuroscience Laboratory, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK; The Pandemic Institute, Liverpool, UK.
¹⁰ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹¹ Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² Institute of Psychiatry, Psychology & Neuroscience; Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK.
¹³ Institute of Psychiatry, Psychology & Neuroscience, Department of Neuroimaging, King's College London, London, UK.
¹⁴ Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK.
¹⁵ Infection Neuroscience Laboratory, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK. Electronic address: benmic@liverpool.ac.uk.

Abstract

Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.

Keywords: COVID-19; Clinical study; Neurological assessment; Neurology; Outcome tool.

Publication types

Multicenter Study

MeSH terms

COVID-19* / diagnosis
Humans
Nervous System Diseases* / diagnosis
Neurologic Examination* / methods
Neurologic Examination* / standards
Reproducibility of Results
SARS-CoV-2
Severity of Illness Index