Patient Activation and Adherence to Physical Therapy in Persons Undergoing Spine Surgery

Abstract

Study Design. Prospective longitudinal study. Objective. To determine the association between baseline patient activation and participation in postoperative physical therapy in a cohort of individuals after lumbar spine surgery. Summary of Background Data. The Patient Activation Measure is a recently developed tool to assess patient activation. Patient activation is defined as an individual’s propensity to engage in adaptive health behavior that may, in turn, lead to improved patient outcomes. It has not previously been used in spine research. Methods. We assessed baseline patient activation levels in individuals presenting for surgery of the lumbar spine via the Patient Activation Measure. Differences in patient characteristics across patient-activation quartiles were assessed using analysis of variance. After surgery, we assessed attendance (self-reported weekly) and engagement in physical therapy (at the last visit, using the Hopkins Rehabilitation Engagement Rating Scale) and determined the ratio of sessions attended to sessions prescribed. The influence of baseline patient activation, in the setting of other patient characteristics, to predict attendance and engagement with physical therapy was examined using linear regression methods. Results. Scores on the Patient Activation Measure were positively correlated with participation (r = 0.53) and engagement (r = 0.75) in physical therapy. Individuals with low activation were more likely to report low self-efficacy for physical therapy, low hope, and external locus of control compared with those with high activation. Conclusion. Increased patient activation is associated with improved adherence with physical therapy as reflected in attendance and engagement.