Optimizing a physiotherapist-led vocational intervention for people with rheumatoid arthritis or axial spondyloarthritis. A qualitative evaluation from a patient's perspective.

Abstract

Rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) are chronic inflammatory diseases that often lead to reduced work ability. This study explored participants' perspectives on their experiences with a physiotherapist (PT)-led, vocational intervention to improve work ability. A qualitative process evaluation, integrated into the Physiotherapy WORKs randomized controlled trial, compared a PT-led vocational intervention to usual care in people with RA or axSpA and reduced work ability. Semi-structured interviews with 10 participants were conducted using a standardized interview guide, recorded, transcribed verbatim, and analyzed using thematic analysis. Three themes emerged. First, perceived effects included a) enhanced awareness or symptoms and balance between capacity and load; b) improved self-management and c) better physical functioning. Second, facilitators included a) personalized approach, b) trust in physiotherapists' expertise, c) comprehensive, work focused content and d) optionality of treatment modalities. Third, a mismatch was perceived between intervention and the participants' perceived severity of work-related limitations. Employed people with RA or axSpA valued the intervention's personalized approach and the professional expertise of the PT. However, better alignment between the intervention and severity of work-related limitations is needed. These findings offer valuable insights for improving the content and implementation of vocational interventions.