Background/Purpose: Plants for Joints (PFJ) is a multidisciplinary intervention centered around a whole-food plant-based diet, physical activity, and sleep and stress management.¹ The PFJ intervention successfully decreased disease activity in patients with rheumatoid arthritis (RA) and improved pain, stiffness, and function in patients with metabolic syndrome associated osteoarthritis (OA). This mixed-method process evaluation consequently aimed to understand the context, implementation, and mechanism of impact of the PFJ intervention and provide insights into the working elements and why the intervention was effective.

Methods: Quantitative and qualitative data were collected across the evaluation domains context (i.e. reach), implementation (i.e. recruitment and delivery), and mechanism of impact (i.e. experiences) of both the participants and program executors according to the UK MRC guidelines for process evaluations.² Data was collected from the participants via focus groups and questionnaires, and all program executors (n = 9) were interviewed. Qualitative data was analyzed using Atlas.ti.

Results: Of the 155 participants who completed the lifestyle intervention, 106 (68%) took part in the questionnaire and 34 (22%) attended a focus group. Overall, participants felt the program was complete and coherent and would recommend the program to others (mean score 9.2 (SD 1.4) out of 10). Participants felt heard and empowered to take control of their lifestyle and health outcomes. Components perceived as most useful were gaining insight into dietary and behavioral habits and one’s progression, practical tools and information, group setting and dynamic, individual guidance, and the multidisciplinary team. Other effective elements identified were the importance of live group sessions in comparison to online, and guidance from dietitians specialized in plant-based nutrition. Participants felt the program was feasible and many perceived it as effective at improving health outcomes. Yet, participants and program executors felt the program would be improved with a more personalized approach and individual guidance, focus on live group sessions, repetition of information, and better view of one’s health outcomes.

Conclusion: This process evaluation offers important insights into various aspects of the PFJ lifestyle intervention including its overall high satisfaction, feasibility, perceived effectiveness, and identification of working elements. Lifestyle interventions, such as PFJ, are a feasible and highly valued treatment option for patients with RA and OA in addition to usual care.

References:

1. Walrabenstein, Trials 2021
2. Moore, BMJ 2015

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/finally-i-can-do-something-about-it-myself-a-process-evaluation-of-the-plants-for-joints-lifestyle-intervention/