Objectives This study aimed to investigate the distribution of cognitive function in people with systemic lupus erythematosus (SLE) by objective and self-report measures and associations between cognition and participation among people with SLE. Methods Fifty-five volunteers with SLE (age: 39.7 ± 12.7yrs, female: 92.7%) completed the Montreal Cognitive Assessment (MoCA) to measure cognitive ability objectively, the Cognitive Symptom Inventory (CSI) and PROMIS Cognitive Function 8a (CF) to assess self-reported everyday cognition, and PROMIS-43 Profile to assess self-reported ability to participate in social roles and activities (participation) and other disease-associated symptoms (e.g., depression, pain, fatigue). Results The average MoCA score was 25.3 ± 3.1, with 47.3% of participants scoring <26, which is indicative of cognitive impairment. Group average CSI (35.8 ± 7.9), CF (T-score = 45.0 ± 8.5), and participation (T-score = 46.9 ± 11.2) scores suggest mildly impaired functional cognition and participation compared to normative data. Participation correlated with self-reported everyday cognition measures (r ≥ 0.56, p < 0.01) but not with MoCA (r = 0.25, p = 0.06). In hierarchical linear regression analysis, CSI, fatigue, and pain were each significant independent predictors of participation (R2 = 0.78, p < 0.01). Conclusions We found that cognitive dysfunction is common among people with SLE. Along with pain and fatigue, reduced everyday cognitive function contributes to reduced participation in social, leisure, work, and family-related activities.

Importance. Nonsanctioned occupations are those deemed socially unacceptable, unhealthy, or illegal, yet they hold meaning for individuals. A gap in occupational therapy evaluation and intervention to address a broader perspective on occupations prompted the adaptation of the Activity Card Sort tool to explore participation in nonsanctioned occupations. Methods. Develop a new version of the Activity Card Sort-Advancing Inclusive Participation to include occupations experienced by the homeless population, including nonsanctioned occupations. This study occurred in two phases: (1) tool development (item selection, content expert review, line development drawing, and assessment of content validity) and (2) tool use to determine face validity. Participants were selected through a convenience sample at a local homeless shelter and academic institution. Participants experiencing homelessness (phase 1: N=13, phase 2: N=10) were required to be seeking services at the homeless shelter, while nonhomeless participants (phase 2: N=30) worked full-time, resided with a significant other, and had personal transportation. Results. An assessment of 76 occupations, corresponding line drawings, and follow-up questions was created. An initial construct validity study demonstrated differences between occupational participation of those who are homeless and nonhomeless in the areas of social engagement, nonsanctioned occupations, work and education, and home management. Both groups reported previous, current, or desired engagement in the occupations identified in the assessment. Conclusions and relevance. The purpose of this study was to create an inclusive assessment for use in the homeless population and complete a construct validity study of the assessment tool. Although the results indicated some differences in the frequency with which occupations were performed, the results demonstrated that all individuals participate in occupations that many not contribute to their health and wellness. This initial work supports the future development of a tool that is inclusive of all occupations to obtain a holistic picture of an individual’s participation.

No abstract

Date Presented 03/28/20 Over half of the participants in this sample had cognitive impairment according to an objective screener. Reduced reported functional cognition was associated with reduced participation independent of the effects of other disease-related factors, such as pain, sleep, and depressive symptoms. These findings provide rationale for further and more comprehensive investigation into cognitive impairment and its functional relevance in SLE. Primary Author and Speaker: Moon Young Kim Contributing Authors: Deepali Sen, Ronald Drummond, Kathryn Biesanz, Matthew Brandenburg, Carolyn M. Baum, Erin Foster

Background: Evidence indicates occupational therapy (OT) services can address the unmet needs of individuals experiencing homelessness (IEH) to promote health, engagement in meaningful activities, and independent living skills. Additionally, student-run free clinics (SRFCs) are an effective method for developing clinical skills while providing needed services for the community. Based on the available evidence, a student-run OT clinic was developed in partnership with a local homeless services agency. The objective of this pilot study was to evaluate the services established in an OT SRFC in a homeless population to determine the initial effectiveness of the clinic for students and clients. It was hypothesized that the SRFC would increase student perceived clinical skills and provide mutual benefit to clients. Methods: Participants of this SRFC included 17 OT students (n=10 doctoral students, n=7 masters students) and 70 IEH since its opening in Fall 2018. OT students developed and implemented evidenced-based group and individual interventions designed to address health, wellness, and quality of life for the homeless population. Student skills competency, confidence, and client satisfaction were regularly evaluated through survey. Mann-Whitney U tests were used to determine statistical differences. Results: Results indicate that clients are satisfied with clinic services, students’ engagement, and some positive changes in independent living skills. Students reported statistically significant improvement in competency of professional behaviors (p<0.001) and interventions (p=0.003). Conclusion: Providing OT services through an SRFC is a promising approach to service delivery within the homeless population due to the mutual benefit for students to increase clinical and interpersonal skills and attitudes in preparation for entry-level practice.