BACKGROUND CONTEXT

Patient activation is a patient's willingness to take independent actions to manage their own health care.

PURPOSE

The goal of this study is to determine whether preoperative patient activation measure (PAM) predicts minimum clinically important difference (MCID) for Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function, depression, and anxiety for patients undergoing elective spine surgery.

STUDY DESIGN/SETTING

Retrospective review.

PATIENT SAMPLE

A single-institution, academic database of patients undergoing elective spine surgery.

OUTCOME MEASURE

MCID at 1-year follow-up for PROMIS pain, physical function, depression and anxiety.

METHODS

We retrospectively reviewed a single-institution, academic database of patients undergoing elective spine surgery. Preoperative patient activation was evaluated using the PAM-13 survey, which was used to stratify patients into four activation stages. 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 PROMIS pain and the physical function.

RESULTS

Of the 430 patients, 220 (51%) 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 follow up, 248 (58%) achieved MCID for PROMIS physical function, 256 (60%) achieved MCID for PROMIS pain, 151 (35.28%) achieved MCID for PROMIS depression, and 197 (46%) achieved MCID for PROMIS anxiety. For PROMIS physical function, when compared to patients at stage 1 activation, patients at stage 2 (aOR:3.49, 95% CI:1.27, 9.59), stage 3 (aOR:3.54, 95% CI:1.40, 8.98) and stage 4 (aOR:7.88, 95% CI:3.29, 18.9) were more likely to achieve MCID. For PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.82, 95% CI:1.18, 6.76) and stage 4 (aOR:5.44, 95% CI:2.41, 12.3) were more likely to achieve MCID. For PROMIS depression, when compared against patients at stage 1, patients at stage 4 were more likely to achieve MCID (Adjusted Odds Ratio (aOR):2.59, 95% CI:1.08–6.19). For PROMIS anxiety, when compared against patients at stage 1, stage 3 (Adjusted Odds Ratio (aOR):3.21, 95% CI:1.20–8.57), and stage 4 (aOR:5.56, 95% CI:2.20–14.01) were more likely to achieve MCID.

CONCLUSION

Patients at higher stages of activation were more likely to achieve MCID for PROMIS pain, physical function, depression, and anxiety at 1-year follow-up. Routine preoperative assessment of patient activation may help identify patients at risk of poor outcomes.

中文翻译：

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术前患者激活可预测择期脊柱手术患者 PROMIS 疼痛和身体功能的最小临床重要差异

背景语境

患者积极性是指患者愿意采取独立行动来管理自己的医疗保健。

目的

本研究的目的是确定术前患者激活测量 (PAM) 是否可以预测患者报告的结果测量信息系统 (PROMIS) 疼痛、身体机能、抑郁和焦虑的最小临床重要差异 (MCID) 接受择期脊柱手术的患者.

研究设计/设置

回顾性审查。

患者样本

接受择期脊柱手术患者的单一机构学术数据库。

结果测量

针对 PROMIS 疼痛、身体机能、抑郁和焦虑的 1 年随访 MCID。

方法

我们回顾性地审查了接受择期脊柱手术患者的单一机构学术数据库。使用 PAM-13 调查评估术前患者激活，该调查用于将患者分为四个激活阶段。主要结果变量是在 1 年随访 PROMIS 疼痛和身体功能时达到 MCID。多变量逻辑回归分析用于确定患者激活对 PROMIS 疼痛和身体功能的影响。

结果

在 430 名患者中，220 名 (51%) 为女性，平均年龄为 58.2±16.8 岁。术前，34 人 (8%) 处于激活阶段 1，45 人 (10%) 处于阶段 2，98 人 (23%) 处于阶段 3，253 人 (59%) 处于阶段 4。在 1 年的随访中，248 ( 58% 的人获得了 PROMIS 身体功能的 MCID，256 人（60%）获得了 PROMIS 疼痛的 MCID，151 人（35.28%）获得了 PROMIS 抑郁症的 MCID，197 人（46%）获得了 PROMIS 焦虑的 MCID。对于 PROMIS 身体功能，与第 1 阶段激活患者、第 2 阶段患者 (aOR:3.49, 95% CI:1.27, 9.59)、第 3 阶段 (aOR:3.54, 95% CI:1.40, 8.98) 和第 4 阶段患者相比(aOR:7.88, 95% CI:3.29, 18.9) 更有可能实现 MCID。对于 PROMIS 疼痛，与 1 期患者相比，3 期患者 (aOR:2.82, 95% CI:1.18, 6.76) 和 4 期患者 (aOR:5.44, 95% CI:2.41, 12.3) 更有可能实现MCID。对于 PROMIS 抑郁症，与第 1 阶段的患者相比，第 4 阶段的患者更有可能实现 MCID（调整后的优势比 (aOR)：2.59，95% CI：1.08–6.19）。对于 PROMIS 焦虑，与第 1 阶段、第 3 阶段（调整后的优势比 (aOR)：3.21，95% CI：1.20-8.57）和第 4 阶段（aOR：5.56，95% CI：2.20-14.01）的患者相比，更有可能实现 MCID。

结论

在 1 年的随访中，处于较高激活阶段的患者更有可能在 PROMIS 疼痛、身体功能、抑郁和焦虑方面达到 MCID。患者激活的常规术前评估可能有助于识别有不良预后风险的患者。