Effectiveness of Occupational Therapy Interventions for Adults With Systemic Lupus Erythematosus: A Systematic Review

BACKGROUND: Systemic lupus erythematosus (SLE) is a highly inflammatory autoimmune disease that affects multiple organ systems such as the kidneys, skin, central nervous system, heart, and lungs. SLE severely affects participation in work, leisure, parenting, and household occupations (Connolly, McNally, Moran, & Ryan, 2014; McElhone, Abbott, Gray, Williams, & Teh, 2010; Poole, Rymek, Mendelson, Sanders, & Skipper, 2012; Stamm et al., 2014). Furthermore, the activity limitations have been found to be related to fatigue, cognitive impairments, and decreased muscle strength (Connolly et al., 2014; McElhone et al., 2010; Poole et al., 2012). There is very limited literature on the role of occupational therapy in management of SLE. Yet, people with SLE want more information on management of fatigue, pain, cognitive impairment, and ability to perform daily activities (McElhone et al., 2010), all of which are within the scope of occupational therapy practice. An understanding of the effectiveness of interventions targeted at improving these outcomes can help occupational therapy practitioners select evidence-based interventions for people with SLE.

PURPOSE: The purpose of this review is to summarize evidence to answer the following question: What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice that address occupational performance, pain, fatigue, depression, and cognitive impairment in persons with SLE?

DESIGN AND METHOD: This systematic review was part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Databases and sites searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and Ergonomics Abstracts. Also included were consolidated evidence-based medicine reviews such as the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, and the Database of Abstracts of Reviews of Effectiveness. In addition, bibliographies from articles included in the databases and relevant journals were hand searched as needed to confirm that all appropriate articles were included. Examples of key words included lupus, exercise, cognitive behavior therapy, energy conservation, education, and rehabilitation. Inclusion criteria required an intervention approach within the scope of occupational therapy practice, peer-reviewed scientific literature (Level I–IV) published in English between January 2000 and July 2014, and adult participants with SLE.

RESULTS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to summarize the articles. The initial search yielded 45 studies; 13 were included in the final review. Articles were reviewed and compiled into evidence and bias tables, and interventions were grouped into the following subthemes: physical activity, self-management, cognitive–behavioral approaches, and cognitive strategy training. In general, physical activity interventions that included aerobic exercises and home programs generally resulted in reduction of fatigue and depressive symptoms and improvements in occupational performance. Cognitive strategy training that included cognitive training by an occupational therapist resulted in improvements in memory and attention, self-efficacy, and depression. Both self-management and cognitive–behavioral approaches resulted in improvements in depressive symptoms, fatigue, and occupational performance.

CONCLUSION: This systematic review found evidence to support the use of physical activity and psychoeducational interventions for improving occupational performance, pain, fatigue, depression, and cognitive function in persons with SLE. These interventions could be incorporated into occupational therapy practice for persons with SLE.

IMPACT STATEMENT: Few interventions were conducted by occupational therapists, but occupational therapists are best suited to design and provide occupation-based interventions, particularly for fatigue and cognitive impairments. Further research is needed to show the effectiveness and benefits of occupational therapy for this population.

References

Connolly, D., McNally, A., Moran, D., & Ryan, M. (2014). Fatigue in systemic lupus erythematosus: Impact on occupational participation and management strategies. British Journal Occupational Therapy, 77, 373–380. https://doi.org/10.4276/030802214X14044755581862

McElhone, K., Abbott, J., Gray, J., Williams, A., & Teh, L. S. (2010). Patient perspective of systemic lupus erythematosus in relation to health-related quality of life concepts. Lupus, 19, 1640–1647. https://doi.org/10.1177/0961203310378668

Poole, J., Rymek M., Mendelson, C., Sanders, M., & Skipper, B. (2012). Parenting: The forgotten role of women with systemic lupus erythematous. Clinical Rheumatology, 31, 995–1000. https://doi.org/10.1007/s10067-011-1929-5

Stamm, T., Hieblinger, R., Boström, C., Mihai, C., Birrell, F., Thorstensson, C., . . . Coenen, M. (2014). Similar problem in the activities of daily living but different experience: A qualitative analysis in six rheumatic conditions and eight European countries. Musculoskeletal Care, 12, 22–33. https://doi.org/10.1002/msc.1047