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

Abstract

<h3>BACKGROUND CONTEXT</h3> 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. <h3>PURPOSE</h3> 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. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of single, academic institution database. <h3>PATIENT SAMPLE</h3> A total of 430 patients were identified who had undergone elective spine surgery and had minimum 1-year follow-up. <h3>OUTCOME MEASURES</h3> The primary outcome measure was whether patients achieved MCID for PROMIS pain and physical function at 1-year follow-up. <h3>METHODS</h3> 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. <h3>RESULTS</h3> 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 stage 2 (aOR:3.40, 95% CI: 1.25, 9.30), stage 3 (aOR:3.39, 95% CI: 1.34, 8.56) and stage 4 (aOR:7.63, 95% CI: 3.19, 18.3) were far more likely to achieve MCID. With regards to PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.78, 95% CI: 1.17, 6.63) and stage 4 (aOR:5.49, 95% CI: 2.43, 12.4) were far more likely to achieve MCID. Of note, for PROMIS pain, no difference in achieving MCID were observed between patients at stage 1 and 2. <h3>CONCLUSIONS</h3> We found patient activation to be an independent predictor of MCID for both PROMIS pain and physical function for patients undergoing elective spine surgery. Given our findings, we recommend routine assessment of patient activation. And, for patients found to be at the lowest stage of activation, they should be counseled regarding the increased risk of poor outcomes, and interventions to increase activation should be considered. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.