Patient activation and disability in upper extremity illness

Abstract

Purpose: To determine if higher patient activation (active involvement in one's health care) correlates with fewer symptoms and less disability in patients with hand and upper extremity illness.

Methods: We enrolled 112 patients presenting to our department for the first time. Before meeting with the surgeon, subjects completed a demographics questionnaire, the short form Patient Activation Measure; Quick Disabilities of the Arm, Shoulder, and Hand; Patient Health Questionnaire-2; Pain Self-Efficacy Questionnaire; and an 11-point ordinal rating of pain intensity. We contacted patients 1 to 2 months after enrollment. Seventy-five subjects completed the second evaluation over the telephone, on a secure data-collection web site, or in an office visit, which included the Patient Activation Measure; Quick Disabilities of the Arm, Shoulder, and Hand; numerical rating scale for pain; and ordinal rating of treatment satisfaction.

Results: Patient activation at enrollment correlated with disability, pain intensity, and satisfaction with treatment but was only retained in the multivariable model for pain intensity. Pain self-efficacy at enrollment was the factor that best accounted for variation in disability, pain, and satisfaction with treatment.

Conclusions: Given the consistent relationship between effective coping strategies (eg, pain self-efficacy) and symptoms and disability and the independent influence of patient activation on pain intensity in this study, future research should address the ability of interventions that improve self-efficacy and patient activation to improve upper extremity health.

Type of study/level of evidence: Prognostic II.

Keywords: PAM; Patient activation; disability; self-efficacy; upper extremity.