Abstract
Background
An individual’s propensity to engage in adaptive health and rehabilitation behaviors may account for variation in postsurgical outcome.
Purpose
To determine the psychometric properties and construct validity of the recently developed Patient Activation Measure (PAM) (previously unused in spine research) in persons undergoing elective lumbar spine surgery.
Methods
We prospectively used the PAM to assess activation in 283 patients undergoing elective lumbar spine surgery. Reliability statistics were computed using repeated assessment (baseline and 1-week follow-up) before surgery. Additional psychological attributes were assessed at baseline and correlated with patient activation. Factor analysis was used to confirm the theoretical structure of patient activation.
Results
Repeat PAM administrations had an intraclass correlation coefficient of 0.85. The PAM showed positive correlation with optimism (r = 0.75), hope (r = 0.73), self-efficacy (r = 0.65), and internal locus of control (r = 0.65) but no correlation with comorbidity (r = 0.01). Confirmatory factor analysis of the PAM items indicated reasonable fit between observed data and a three-factor patient activation model.
Conclusions
The PAM is a reliable, valid measure of patient activation for individuals undergoing elective lumbar spine surgery and may have clinical utility in identifying those at risk for poor engagement in postsurgical rehabilitation.
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Abbreviations
- CFI:
-
Bentler’s Comparative Fit Index
- CI:
-
Confidence interval
- DF:
-
Degrees of freedom
- ECVI:
-
Expected Cross-Validation Index
- GFI:
-
Goodness-of-Fit Index
- LOT-R:
-
Life Orientation Test—Revised
- MHLC:
-
Multidimensional Health Locus of Control
- MMSE:
-
Mini-Mental Status Examination
- NFI:
-
Normed Fit Index
- PA:
-
Patient activation
- PAM:
-
Patient Activation Measure
- RMSR:
-
Root mean square residual
- SD:
-
Standard deviation
- SEPT:
-
Self-efficacy to participate in physical therapy
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Acknowledgments
This project was supported by grant number 1 R03 HS016106 from the Agency for Healthcare Research and Quality.
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Skolasky, R.L., Mackenzie, E.J., Riley, L.H. et al. Psychometric properties of the Patient Activation Measure among individuals presenting for elective lumbar spine surgery. Qual Life Res 18, 1357–1366 (2009). https://doi.org/10.1007/s11136-009-9549-0
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DOI: https://doi.org/10.1007/s11136-009-9549-0