Background/Purpose: Approximately 60-70% of patients with PsA do not reach minimal disease activity (MDA) on therapy. However, in many cases, this may not be related to active disease as defined by clinical assessments such as joint count. We hypothesized that “off target” symptoms like fatigue, sleep disturbance, and mood could be addressed by lifestyle behaviors in parallel to standard medical therapy to improve outcomes. The objective of this study was to understand the participant experience in the PsOWell trial through a qualitative process evaluation.

Methods: We conducted the PsOWell pilot? trial among patients with PsA not currently in MDA and with active disease as defined by patient-reported outcomes (PSAID >4 or patient global assessment >4). Patients were required to plan to stay stable on therapy for at least the next 3 months. Patients completed the PSAID and Eq5D at baseline and follow-up within 4-6 months; MDA was recorded at both visits (Figure 1). Between the two primary visits, patients completed two telemedicine visits with a nurse practitioner or clinical research nurse. During these visits, patients chose a target health domain from the Informatree.com site. The provider, trained in motivational interviewing, conducted a first visit using the Action Plan for the corresponding health domain to set goals. A second visit was conducted to check in and modify the plan. The provider took notes for the participant to access through their chart. The primary outcome was achievement of MDA at the follow up visit. We conducted a qualitative interview at the final visit among the first 25 study completers (target recruitment for the pilot trial is 80 participants). Themes were derived from interviews using content analysis.

Results: We identified recurrent themes about the participants’ experiences and the program’s impact. The main strengths identified were the ease and convenience of participating via telemedicine and the positive impact of accountability on behavior change. Participants recalled that the nurse practitioners were supportive and provided useful advice to help them execute lifestyle changes. Many participants reported improvements in their chosen health domains. Opportunities for improvement were also identified. Some participants expressed that their lifestyle changes could be solidified by more frequent follow-up calls, nudging messages, more written resources, and a longer program duration. Some noted that the advice from the NPs could be more specific. Some participants wished that physical symptoms of PsA, such as skin issues, could also be addressed during the telemedicine visit. However, this was beyond the scope of the intervention.

Conclusion: The PsOWell program was received well by participants. Many expressed that they achieved positive changes in health behaviors by participating. The program’s main strengths are its convenience and being supported and held accountable by the NPs. However, increasing the frequency of check-ins and extending the program duration could strengthen its impact on sustainable behavior change.

Figure 1. Study Design

Table 1. Informatree Health Domains

Table 2. Example Quotes

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-telemedicine-to-address-off-target-symptoms-in-psoriatic-arthritis-psa-implementation-of-psowell-in-psa/