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Psychometric properties of the Patient Activation Measure among individuals presenting for elective lumbar spine surgery

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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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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Richard L. Skolasky & Lee H. Riley III

  2. Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Ellen J. Mackenzie

  3. Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Stephen T. Wegener

  4. c/o Elaine Henze, Medical Editor, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A665, Baltimore, MD, 21224-2780, USA

    Richard L. Skolasky

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  1. Richard L. Skolasky
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  4. Stephen T. Wegener
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Correspondence to Richard L. Skolasky.

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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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