Psychometric properties of the Patient Activation Measure among individuals presenting for elective lumbar spine surgery
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.
KeywordsPatient Activation Measure Validation Lumbar spine surgery
Bentler’s Comparative Fit Index
Degrees of freedom
Expected Cross-Validation Index
Life Orientation Test—Revised
Multidimensional Health Locus of Control
Mini-Mental Status Examination
Normed Fit Index
Patient Activation Measure
Root mean square residual
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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