Preserving Valued Activities in Life for Adults With Rheumatoid Arthritis: Development and Pre-Testing Refinement of...

Rehabilitation is rarely integrated into routine rheumatology care, despite high rates of functional limitation in adults with rheumatoid arthritis (RA). The Preserving Valued Activities in Life (PREVAIL) model of care proposes a function-focused screening survey administered during routine rheumatology visits to guide referrals to rehabilitation and facilitate integration into standard RA care. This study aimed to assess the perceived feasibility and acceptability of the PREVAIL model and inform modifications for pilot testing.

We used a multimethod approach including (1) a cross-sectional survey of 309 adults with RA to assess the feasibility and validity of a proposed screening tool to identify functional limitations for referral and (2) semistructured interviews with 24 adults with RA, 6 rheumatology clinicians, and 6 physical therapists to evaluate the perceived acceptability and feasibility of the PREVAIL model of care.

The proposed screening tool demonstrated moderate correlations with established measures of functional status and disease activity but identified 90% of participants for rehabilitation referral based on proposed disability risk criteria, necessitating refinement. Interview data revealed broad support for the PREVAIL model across key vested parties. Participants emphasized the value of proactively addressing function, identified patient and clinician knowledge gaps regarding rehabilitation, and highlighted the model's potential to enhance patient-clinician communication. Modifications to improve feasibility included remote survey completion, educational materials for key vested parties, and an interim physical therapy consultation call to better prioritize referrals.

The PREVAIL model of care was perceived to be both feasible and acceptable. Study findings directly inform refinements to support real-world implementation in a pilot clinical trial.