Conferences are critical for clinicians, allied health professionals, patients, and researchers to network, receive updates on patient care, and present research. Travel logistics and physical attendance have always had challenges. During the height of the coronavirus disease 2019 (COVID-19) pandemic, meetings went virtual, making conferences more accessible despite introducing other challenges. Given most conferences now have limited remote attendance options, accessibility barriers are again becoming more prominent.
Those in rheumatology are uniquely positioned to adapt and improve conference accessibility given our focus on a patient population that often has mobility and functional challenges. With this commentary, we highlight accessibility barriers and provide practical guidance to improve inclusivity, based on our respective fields and personal experiences.
Inclusion across roles and identities. Collins et al1 described how hybrid conferences can improve equity and inclusion by enabling participation by attendees with limited travel flexibility, while also reducing the environmental impact of travel. Beyond these considerations, we must also address how academic meetings are often designed around assumptions about how participants learn, move through spaces, and engage socially. Ensuring that clinicians, researchers, and patients can continue to participate meaningfully in professional meetings is essential to maintaining mentorship, institutional knowledge, and leadership within the field.
Beyond mobility issues, other salient factors can affect participation, including lactation needs, fatigue, immunocompromised status, and neurodivergence (Table). For participants who are neurodivergent, conferences may present particular challenges. Large convention centers are loud and crowded. Unstructured networking opportunities and unclear instructions further disadvantage participants who benefit from particular structure and clear guidance.
Case vignettes depicting potential accessibility barriers and appropriate accommodations.
Rather than accommodation by request, universal design should be considered. In professional settings, many people are reluctant to disclose disability due to concerns about stigma, opportunity, professionalism, and career consequences. Many members of the rheumatology community live with chronic illness, pain, fatigue, rheumatic diseases, or mobility limitations, yet these are rarely visible in the professional space. Recognizing this overlap may help reframe accessibility not as a peripheral concern but as a core aspect of support in the community that cares for patients with rheumatic diseases. Universal design approaches, such as clear communication of logistics, accessible spaces, closed captioning, and predictable scheduling, can reduce reliance on disclosure-based accommodation processes.
Improving accessibility in academic conferences supports the sustainability of the workforce as well as the contributions from patient advocates. By creating environments that anticipate a range of physical, cognitive, and health needs, the rheumatology field can recruit and retain clinicians and researchers whose perspectives enrich scientific dialogue and patient care. Accessibility, in this sense, is not simply about accommodation; it is about ensuring that the rheumatology community remains inclusive of the diverse individuals who contribute to its progress.
Navigating the built environment. Conferences often present systemic, venue-level barriers that unintentionally limit participation for attendees with mobility, sensory, or energetic needs. Reliance upon escalators for central movement, with elevators positioned in distant or less visible areas, creates unnecessary demands upon participants. Many conferences involve long walking distances between sessions, extended standing during poster sessions, and tightly scheduled programming with few opportunities for rest. These features create barriers for individuals with mobility limitations.
Mobility considerations extend beyond wheelchair access and elevator availability. Individuals with a variety of health conditions may experience reduced walking speed, joint instability, orthostatic intolerance, or variable mobility across the day. There is often a tradeoff between “flat and wide” venues (which minimize elevator reliance) and compact vertical spaces (which depend upon elevators). Planning should account for total daily walking burden.
Dispersing accessible seating throughout a room rather than isolating it at the front or back supports autonomy, privacy, and ease of movement. Widening space between seating rows in session rooms and between posters in exhibit halls can facilitate interaction. Reserved seating not requiring early arrival, space for mobility aids, and permission to enter or exit sessions without drawing attention also support participation without necessitating disclosure.
Conference venue selection should consider the following:
Distance between session rooms
Elevator reliability and wait times
Clear, consistent, signage accommodating Color Vision Deficiency, maps that highlight accessible routes
Consideration of a chaperone/assistance service that can help attendees (eg, those with low vision) navigate the conference space, poster hall, and spaces used for social gatherings at the beginning of the meeting
Availability of seating throughout hallways and poster areas for rest breaks
Clear, low-clutter walking paths and room layouts that account for mobility devices
Access to nearby restrooms without excessive travel
Proximity of lactation rooms/quiet rest spaces closer to session areas to reduce travel time.
These architectural limitations are readily apparent from a physical therapist’s perspective. Although these design choices are outside of an organizer’s direct control, they significantly shape conference attendees’ experiences. Even with these architectural constraints, organizers retain meaningful opportunities to influence accessibility.
Supporting participation and engagement throughout the meeting. Occupational therapy conceptualizes participation through the Person-Environment-Occupation model,2 which examines how functional performance emerges from the dynamic interaction between individual factors (eg, fatigue, mobility limitations, cognitive variability), environmental factors (eg, venue layout, lighting, scheduling), and the occupation itself (eg, attending lectures, networking, presenting). Accessibility can be improved not only by focusing upon the individual (encouraging resilience or self-management) but also by optimizing environmental conditions and task demands to better align with fluctuating health status.
The following recommendations are organized by common participation barriers encountered at academic conferences:
• Accommodations for fatigue or reduced energy. Fatigue is among the most prevalent and disabling symptoms in rheumatic diseases and related conditions. Unlike transient tiredness, inflammatory fatigue is often disproportionate to activity level, fluctuates unpredictably, and may worsen with overexertion. Academic conferences typically assume sustained endurance across long days with minimal rest intervals, creating a mismatch between environmental demands and attendees’ energetic capacity.
Hybrid conferences, which include live-streamed sessions, asynchronous recordings, and virtual poster access, allow participants to self-regulate energy expenditure, pace engagement, and reduce postexertional flares. Hybrid structures expand participation without requiring individuals to disclose disability status or request special accommodations.
Additional fatigue-sensitive design considerations include built-in extended breaks between sessions, quiet rest areas within the venue (including those that allow participants to lie down), shorter session blocks, and clear scheduling to reduce cognitive load and decision fatigue.
• Accommodations for immunosuppressed participants. In-person conference participation carries nontrivial infection risk. To reduce barriers for immunosuppressed participants, conference planning should include hybrid or fully virtual participation options; outdoor networking opportunities, when feasible; attention to ventilation quality and airflow; clear communicable disease mitigation policies; explicit encouragement of masking during high-risk periods; and refund policies that accommodate last-minute illness.
Importantly, infection mitigation strategies should be framed as collective responsibility rather than individual vulnerability. Universal policies reduce stigma and prevent participants from having to publicly identify as immunosuppressed.
• Accommodations for sensory sensitivities. Individuals with a variety of conditions may experience symptom exacerbation in high-stimulation environments. Conference environments frequently include bright overhead lighting, amplified audio, dense seating arrangements, and competing background noise. Designated low-stimulation areas with reduced lighting, decreased auditory input, and increased spatial separation can mitigate sensory overload. Flexible seating options, including peripheral seating, standing areas, and access to virtual streaming from quieter locations allow individuals to modulate sensory exposure. These modifications benefit not only neurodivergent attendees but also those experiencing flare-related hypersensitivity.
• Accommodations for neurodivergence and social participation needs. Networking is often an implicit core objective of academic conferences. However, traditional formats (crowded receptions, unstructured mingling) may disadvantage individuals with social anxiety, neurodivergence, or communication variability.
To broaden participation, conferences should offer structured networking sessions with guided prompts, provide text-based or application-based communication options, incorporate smaller-group discussion formats, and arrange mixed seating configurations (tables, high-top perimeters, standing zones) rather than rows-only layouts.
These formats reduce reliance upon spontaneous, high-intensity social interaction and create multiple entry points for engagement.
• Accommodations for executive functioning challenges. Cognitive symptoms, including brain fog, slowed processing speed, and distractibility may be exacerbated by fatigue or medication effects. Presenters and session chairs can improve accessibility by (1) clearly signaling transitions between topics; (2) repeating key points verbally and visually; (3) providing slides in advance; (4) incorporating captions and live transcription; (5) using clear visual design with minimal text density; and (6) providing wayfinding supports, including consistent signage and intuitive room numbering, to reduce cognitive load for attendees navigating large venues.
Allowing discreet movement within rooms and normalizing mid-session exits further supports attentional regulation and symptom management.
In conclusion, rather than relying upon individual accommodation requests, accessibility in professional settings should be grounded in universal design. Because many disabilities are invisible, fluctuating, or stigmatized, clinicians and attendees may hesitate to disclose their needs due to concerns about professionalism, opportunity, and career consequences. Modest adjustments can meaningfully expand who is able to participate, contribute, and lead. We commend rheumatology conferences for adaptations made in the evolving post-2020 landscape. Proactively embedding universal design principles into conference planning minimizes stigma, promotes inclusion, and benefits a broad and diverse group of participants. Accessibility must be treated as a core element of equitable and sustainable professional engagement.
ACKNOWLEDGMENT
JWL would like to acknowledge Dr. Jennifer Davids (Boston Medical Center) for being the catalyst that spurred this manuscript.
Footnotes
FUNDING
The authors declare no funding or support for this work.
COMPETING INTERESTS
The authors declare no conflicts of interest relevant to this article.
- Copyright © 2026 by the Journal of Rheumatology
