Preoperative patient activation is predictive of improvements in patient-reported outcomes following minimally invasive
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ORIGINAL ARTICLE
Preoperative patient activation is predictive of improvements in patient‑reported outcomes following minimally invasive lumbar decompression Nathaniel W. Jenkins1 · James M. Parrish1 · Shruthi Mohan1 · Cara E. Geoghegan1 · Caroline N. Jadczak1 · Nadia M. Hrynewycz1 · Kern Singh1 Received: 26 July 2019 / Revised: 21 May 2020 / Accepted: 15 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine whether there is an association between preoperative 10-Item Patient Activation Measure (PAM-10) scores and clinical outcomes following MIS LD. Methods Patients undergoing a primary MIS LD were retrospectively reviewed and stratified according to their preoperative PAM-10 scores: “low PAM,” “moderate PAM,” and “high PAM.” Preoperative PAM score cohorts were tested for improvements in Oswestry Disability Index (ODI), 12-Item Short-Form Physical Component Score (SF-12 PCS), and Visual Analog Scale (VAS) back and leg pain using multivariate linear regression. Results Eighty-nine patients were included: 29 had a low PAM score, 32 had a moderate PAM score, and 28 had a high PAM score. Cohorts experienced similar preoperative VAS back pain, VAS leg pain, ODI, and SF-12 PCS. Patients with low PAM scores experienced a trend of higher pain scores throughout 6 months with VAS back pain being significant at 3 months and VAS leg pain being significant at 6-week and 3-month follow-up. Patients with lower PAM scores experienced a worse improvement in ODI at 6-week, 3-month, and 6-month timepoints. Lastly, patients with lower PAM scores demonstrated less improvement in SF-12 PCS at 3-month and 6-month follow-up. Conclusions Lower preoperative PAM scores were associated with worse improvement in clinical outcomes following MIS LD. Patients with lower PAM scores had diminished improvement in long-term patient-reported outcomes including ODI, SF-12, and VAS back and leg pain. Our investigation suggests that preoperative PAM assessments may be an effective tool to predict postoperative outcomes following MIS LD. Keywords 10-Item Patient Activation Measure · PAM-10 · Clinical outcomes · Minimally invasive lumbar decompression · MIS LD
Introduction Increased patient activation, or motivation to maintain positive health behaviors, is associated with better outcomes following orthopedic and spinal procedures [1, 2]. Patient activation has been established as a strong indicator for adherence to medications and physical therapy in the postoperative period, which may play a role in greater * Kern Singh [email protected] 1
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, USA
improvements in functional recovery [3–6]. As outcomes in spine surgery are heavily influenced by following postoperative measures for optimal clinical recovery, assessing patient activation in the preoperative period may allow for better management of patient goals and expectations regarding the postoperative course. Patient activ
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