Patient Activation and Functional Recovery in Persons Undergoing Spine Surgery

The importance of individuals’ participation in their own health and recovery has been the focus of recent research. It is believed that patient activation, defi ned as “an individual’s propensity to engage in adaptive health behavior that may lead to improved outcomes,” can infl uence the diffi culty or ease with which patients recover from surgery. The researchers of this Level I article sought to determine whether there was an association between preoperative patient activation and functional recovery after lumbar spine surgery. Patient activation was assessed using the Patient Activation Measure, which was used to group individuals into difference stages of activation: Stage I (low activation), Stages II and III (intermediate activation), and Stage IV (high activation). In this study, 65 patients undergoing elective lumbar spine surgery were preoperatively stratifi ed according to their levels of patient activation: Stage I (n 15) Stage II (n 12), Stage III (n 22), Stage IV (n 16). Patients were compared based on pain, disability, physical health, and mental health. Postoperatively, the authors found that individuals grouped in Stage I were less likely to attend prescribed physical therapy sessions than individuals grouped in Stage IV. The physical therapists also stated that patients in Stage I were less engaged in their therapy sessions. Overall, pain and disability decreased (P .05) 24 months postoperatively; however, patients in Stage IV were found to have a signifi cantly better decrease in pain (P .049) and disability (P .035) than did patients in Stage I. Moreover, the authors also found that the intensity of current pain at baseline was signifi cantly lower for individuals in Stage III and IV than those in Stage I. There was no association between patients’ level of activation and change in mental health (P .081). Overall, higher patient activation (ie, participants in Stage IV) was associated with better recovery postoperatively. Individuals with high patient activation preoperatively experienced signifi cantly more resolution of their disability 2 years postoperatively than did those with low patient activation. Each month, this column summarizes a Level I article and provides a thought-provoking review on how the treatment in the article has either stood the test of time or serves as an example of how conventional wisdom has changed.