Patients actively engaged in their health are more likely to adhere to physical therapy after spine surgery
Research Activities, June 2009, No. 346
After patients undergo surgery for degenerative conditions of the lumbar spine, the North American Spine Society recommends that they have physical therapy to strengthen weakened back muscles. Richard L. Skolasky, Sc.D., and colleagues at Johns Hopkins University found that the level of patient activation (defined as an individual's propensity to engage in positive health behavior) is associated with better attendance and engagement in physical therapy.
The study enrolled 65 patients who presented for surgery of their degenerative lumbar spinal stenosis. All underwent a baseline assessment prior to surgery. Patient activation was measured using the Patient Activation Measure (PAM). Every week for 6 weeks, patients were asked about how many physical therapy sessions were prescribed and how many they actually attended. At 6 weeks, physical therapists were asked to rate the patients' engagement in physical therapy using a standard rating scale.
According to the researchers, there were no significant differences in patient activation scores with respect to age, gender, marital status, comorbid conditions, or education. The researchers found that as patient activation increased, the severity of depressive symptoms decreased. Self-efficacy and hopefulness grew with increasing patient activation. Patients who demonstrated high activation attended more of their therapy sessions compared with patients with low activation and there was a strong positive association between patient activation and engagement. Physical therapists rated these individuals as highly engaged in their therapy.
The researchers believe this work points to the importance of looking at psychological factors and patient competencies when trying to understand health behaviors, and indicate that the PAM can be used as a valuable tool in clinical practice. Additional research needs to focus on the value of preoperative interventions aimed at increasing patient activation and subsequent recovery. The study was supported by the Agency for Healthcare Research and Quality (HS16106).
See "Patient activation and adherence to physical therapy in persons undergoing spine surgery," by Dr. Skolasky, Ellen J. Mackenzie, Ph.D., Stephen T. Wegener, Ph.D., and Lee H. Riley III, M.D., in the October 2008 Spine 33(21), pp. E784-E791.