Questionnaire can help doctors predict which patients will commit to physical therapy

Patients’ responses to a simple questionnaire can reliably predict whether they will adhere to physical therapy after spine surgery, researchers reported in a new study.

The findings could help physicians identify patients who might benefit from additional preoperative preparation to ensure they attend therapy sessions and follow through with prescribed exercise, a factor that can greatly affect their long-term recovery, according to a press release.

“It has long been known that physical therapy after spine surgery greatly improves outcomes, but to date, there has been no easy-to-administer, standardized method for assessing a patient’s willingness to adhere to therapy,” Richard L. Skolasky, ScD, of the department of orthopedic surgery at Johns Hopkins University School of Medicine in Baltimore, said in the press release.

In the study published in the online issue of Spine, Skolasky and his colleagues demonstrated that spine surgery patients who scored high on the Patient Activation Measure (PAM) questionnaire were 38% more likely to attend physical therapy and were rated as significantly more engaged in rehabilitation by their physical therapists compared to patients with low PAM scores.

The PAM, developed in 2004, is a participant-completed, 13-item questionnaire that assesses a patient’s ability to play an active role in his or her health care. To date, investigators have studied it for use with chronic diseases such as HIV, type-2 diabetes and hypertension. This is the first time it has been applied to surgery and physical therapy, Skolasky said in the press release.

The questionnaire asks patients to rate their agreement to a variety of statements, ranging from strongly agree to strongly disagree. Examples of statements include:

When all is said and done, I am the person who is responsible for managing my health condition.
Taking an active role in my own health care is the most important factor in determining my health and ability to function.
I am confident I can follow through on medical treatments I need to do at home.

Patients who had the lowest PAM scores attended 55.6% of their therapy sessions. In contrast, those with the highest PAM scores attended physical therapy 94.1% of the time, he said. Similarly, engagement scale scores also went up as PAM scores increased.

“These results were very encouraging, and since the PAM is easy to administer, it may provide a practical component to a patient's preoperative treatment,” Skolasky said in the press release.

For more information:
Skolasky RL, Mackenzie EJ, Wegener ST, Riley LH. Patient activation and adherence to physical therapy in persons undergoing spine surgery. Spine. 33(21):E784-E791.