Quality of Life Research

, Volume 18, Issue 10, pp 1357–1366 | Cite as

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

  • Richard L. Skolasky
  • Ellen J. Mackenzie
  • Lee H. RileyIII
  • Stephen T. Wegener



An individual’s propensity to engage in adaptive health and rehabilitation behaviors may account for variation in postsurgical outcome.


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.


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.


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.


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.


Patient Activation Measure Validation Lumbar spine surgery 



Bentler’s Comparative Fit Index


Confidence interval


Degrees of freedom


Expected Cross-Validation Index


Goodness-of-Fit Index


Life Orientation Test—Revised


Multidimensional Health Locus of Control


Mini-Mental Status Examination


Normed Fit Index


Patient activation


Patient Activation Measure


Root mean square residual


Standard deviation


Self-efficacy to participate in physical therapy



This project was supported by grant number 1 R03 HS016106 from the Agency for Healthcare Research and Quality.


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Richard L. Skolasky
    • 1
    • 4
  • Ellen J. Mackenzie
    • 2
  • Lee H. RileyIII
    • 1
  • Stephen T. Wegener
    • 3
  1. 1.Department of Orthopaedic SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Health Policy and ManagementThe Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Physical Medicine and RehabilitationThe Johns Hopkins University School of MedicineBaltimoreUSA
  4. 4.c/o Elaine Henze, Medical Editor, Department of Orthopaedic SurgeryJohns Hopkins Bayview Medical CenterBaltimoreUSA

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