Patient activation during the first 6 months after the start of spinal cord injury rehabilitation: a cohort study.

Abstract

Background: Spinal cord injury (SCI) is a serious injury that leads to motor and sensory disorders and ultimately affects people's physiological, psychological, and social well-being.

Aim: To test patient activation from discharge from the department of spinal surgery until 6-month follow-up.

Design: Longitudinal inception cohort study.

Setting: This study was conducted at the Spinal Surgery Department of the Third Affiliated Hospital of Soochow University in China.

Population: A total of 367 participants with traumatic SCI received community-based or hospital-based rehabilitation between October 2020 and November 2023 and were recruited using convenience sampling.

Methods: Patient activation was evaluated using the short version of the Patient Activation Measure (PAM). Assessments were conducted at baseline, 3-month, and 6-month follow-up.

Results: At baseline, the mean PAM score was 53.2, with the number of participants in PAM levels 1, 2, 3, and 4 being 92, 142, 114, and 19, respectively. Between baseline and 6-month, 164 participants remained at the same PAM level, 85 participants increased, 86 participants decreased. The multivariate mixed-effects model analysis showed that the PAM score decreased significantly over time (P=0.007). Older age had a positive effect on improvement over time (P=0.023). Higher self-efficacy, resilience, health literacy, and Modified Barthel Index (MBI) remained significantly related with higher PAM scores over time (P<0.001, P<0.001, P<0.001, and P=0.010, respectively). Fewer symptoms of depression remained significantly related with higher PAM scores over time (P<0.001).

Conclusions: PAM scores decreased slightly over time from the start of rehabilitation up to the 6-month follow-up. Furthermore, about two-third of participants remained at low levels of patient activation, which suggests that patient-centered care interventions during rehabilitation to improve patient activation might be of value.

Clinical rehabilitation impact: This study examined the course of patient activation from the start of SCI rehabilitation to the 6-month follow-up period. These findings provide the necessary basis for the development and evaluation of effective interventions to promote patient activation levels and enhance self-management in people with SCI.