Feasibility of INSELMA: an interdisciplinary nurse-coordinated self-management intervention for people with inflammatory arthritis and substantial disease impact

Objectives: Inflammatory arthritis significantly impacts daily life, requiring interdisciplinary support despite optimal pharmacological treatment. We developed a 6-month interdisciplinary nurse-coordinated self-management intervention (INSELMA) based on the British Medical Research Council's framework for complex interventions. The intervention includes a biopsychosocial assessment, goal setting, and continuous support from the coordinating nurse, with referrals to other healthcare professionals and municipal offers. This study aimed to evaluate the feasibility of the INSELMA intervention. Methods: We conducted a multicentre single-arm pre-test-post-test study. Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) were recruited via the Danish nationwide Rheumatology registry, DANBIO. Patient-reported outcomes were collected at baseline and end of the intervention. Feasibility was assessed by evaluating recruitment, retention, attendance rates, fidelity, goal setting, activities, resources and data collection methods. Results: A total of 386 patients were screened, 18 were included (8 with RA, 6 with PsA and 4 with AxSpA) and 17 completed the 6-month intervention. The interdisciplinary team allocated an average of 8 hours per participant, with nurses contributing 5.4 hours. Seventy-four per cent of the participants were referred to physiotherapists, 24% to occupational therapists and none to social workers. Patient-reported outcome measures at baseline and 6 months indicated reduced anxiety, depression and pain and improved mental well-being, coping with fatigue, overall disease impact and quality of life. Conclusions: The INSELMA intervention is considered feasible and potentially effective in supporting patients with inflammatory arthritis by reducing disease impact and improving quality of life. Further testing in a larger randomised controlled trial is warranted.