250. The association between patient activation and patient reported outcomes (PROs) for patients undergoing elective spine surgery

• Published in: The spine journal 2021-09, Vol.21 (9), p.S129-S129
• Main Authors: Sachdev, Rahul, Kebaish, Khaled M., McNeely, Emmanuel, Wang, Kevin, Neuman, Brian J., Skolasky, Richard L.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.363

Patient activation refers to the extent with which patients play an active, engaged role in their own health care. An increasing number of studies in spine and broader orthopedic literature have found patient activation to be both modifiable and an independent predictor of clinical outcomes, including satisfaction. No prior studies, however, have explored the impact of patient activation on whether patients achieve minimal clinical improvement difference (MCID) for PROMIS pain and physical function at 1-year follow-up. To determine whether patient activation, a modifiable risk factor, predicts MCID for PROMIS pain and physical function for patients undergoing elective cervical or thoracolumbar spine surgery. Retrospective review of single, academic institution database. A total of 430 patients were identified who had undergone elective spine surgery and had minimum 1-year follow-up. The primary outcome measure was whether patients achieved MCID for PROMIS pain and physical function at 1-year follow-up. We retrospectively reviewed a single-institution, academic database of patients undergoing elective cervical or thoracolumbar spine surgery. Inclusion criteria was (1) age 18 or older, and (2) minimum 1-year follow-up. We assessed patient activation using the validated Patient Activation Measures-13 (PAM-13) survey. Using the PAM-13 survey, we can numerically quantify patient activation and stratify patients into one of four stages of activation (I, II, III, IV), with a higher stage indicating greater activation. Primary outcome variable was achieving MCID at 1-year follow-up for PROMIS pain and physical function. Multivariable logistic regression analysis was used to determine impact of patient activation on MCID for PROMIS pain and physical function while controlling for demographics (age, sex), income and education. Of the 430 patients meeting inclusion criteria, 210 (49%) were female with a mean age of 58.2 ± 16.8. Preoperatively, 34 (8%) were in activation stage 1, 45 (10%) in stage 2, 98 (23%) in stage 3, and 253 (59%) in stage 4. At 1-year postoperative follow up, 248 (58%) achieved MCID for PROMIS function and 256 (60%) achieved MCID for PROMIS pain. Using multivariable logistic regression, patients at higher stages of activation were more likely to achieve MCID for both PROMIS pain and physical function, compared to patients at stage 1 activation. With regards to PROMIS physical function, when compared to patients at stage 1 activation, patients at