Helping Adults with RA PREVAIL: Developing a model to Preserve Valued Activities In Life

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PROJECT ABSTRACT. Disability continues to be common in adults with RA despite pharmacological advances two decades ago that reduced disease activity. Physical therapy and exercise are effective in reducing disability in adults with RA, however they are underutilized in rheumatologic care, particularly in the United States. Key contributors to this underutilization includes lack of sufficient specificity for physical therapy and exercise recommendations in treatment guidelines leaving rheumatologists unclear when to refer and lack of systematic processes for integrating rehabilitation in routine RA care. To facilitate appropriate referral to physical therapy and exercise for adults with RA, we created a model to PREserve Valued Activities In Life (PREVAIL) based on the premise that early identification of functional decline will help direct physical therapy and exercise referrals to address impairments before irreversible disability ensues. PREVAIL inserts disability screening into routine RA care and uses the results of the screening to direct a physical therapy referral matched to disability level and RA- specific exercise guidance. The objective of this research proposal is to develop and pilot test a scalable model (PREVAIL) for integrating rehabilitation into routine care to preserve function and delay disability in adults with RA. The aims will (1) define the distribution of disability levels and related functional needs in adults with RA, (2) obtain key information from patients and providers on the acceptability and feasibility of the PREVAIL model, and (3) conduct a pilot trial to determine feasibility and acceptability of the refined PREVAIL model in at least 50 adults with RA. Successful completion of this proposal will establish feasibility and acceptability, and set the stage for to integrate PREVAIL into rheumatologic care on a larger scale. My long-term goal is to mitigate disability in adults with rheumatic and musculoskeletal diseases. The objectives of this career development award are to (1) deepen my current knowledge of rheumatic disease, specifically in rheumatoid arthritis (RA) care to better understand how to integrate rehabilitation, (2) train in health services research, particularly intervention development and clinical trials, and (3) prepare to design and execute a larger clinical trial in my next phase. My mentors are experts in health services research, rheumatologic care, and RA disability measurement. Together, we developed this research proposal and career development plan to accelerate my scientific development towards my long-term goal and research independence.