ReviewsNeed for Standardization of Measurement of Time to Reorientation as a Predictor of Cognitive Adverse Effects of Electroconvulsive TherapyTripathi, Chidrup DO∗; Khan, Bilal MS∗; Youssef, Nagy A. MD, PhD∗,†Author Information From the ∗Department of Psychiatry and Health Behavior †Academic Affairs, Medical College of Georgia at Augusta University, Augusta, GA. Received for publication December 20, 2019; accepted April 24, 2020. Reprints: Nagy A. Youssef, MD, PhD, Department of Psychiatry and Health Behavior and Office of Academic Affairs, Medical College of Georgia at Augusta University, 997 St Sebastian Way, Augusta, GA 30912 (e-mail: [email protected]). N.A.Y. received research support (but not salary support) from Merck & Co, VistaGen Therapeutics, Inc, MECTA Corporation, the US Department of Veterans Affairs, and August Biomedical Research Corporation. The other authors have no conflicts of interest or financial disclosures to report. The views expressed are those of authors and do not represent Medical College of Georgia or the Department of Veterans Affairs. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ectjournal.com). The Journal of ECT: March 2021 - Volume 37 - Issue 1 - p 13-17 doi: 10.1097/YCT.0000000000000703 Buy SDC Metrics Abstract Testing for time to reorientation (TRO) after electroconvulsive therapy (ECT) has been one of the most predictive measures for cognitive adverse effects of ECT. However, measuring TRO varies between clinical trials, and there is no standardized approach on its measurement between studies. The objective of this report is to systematically review the literature on the different ways of measuring TRO. This would be a first step to establish a consensus on a standard method for TRO. We performed a systematic literature review from 1968 to October 2019 for clinical trials with a sample size of more than 50 and published in English that describe measures of TRO. We searched both PubMed and Web of Science databases. The literature search generated 12 clinical trials, which met the inclusion criteria. Studies measured TRO using 3-, 5-, or 10-item questionnaires. Most studies measured full orientation as answering 4/5 questions. Other studies smaller than 50 required 14/14 items to be answered correctly. There was wide variation between studies on how often and when orientation questions were initiated. These factors have obvious implications to the results and interpretation of the ECT literature.There was no clear consensus on measuring TRO in a uniform fashion. Research and clinical care would benefit from a standardized approach to measuring TRO. Measuring TRO using a 4/5 method seems the most common and quickest way, whereas using a 14/14 method seems to be the most rigorous and sensitive to change in trials. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.