Patient Activation During the First 6 Months After the Start of Stroke Rehabilitation

Abstract

Objective: To examine patient activation from the start of stroke rehabilitation and its course up until the 6-month follow-up.

Design: Inception cohort study with a follow-up of 6 months.

Setting: Multidisciplinary rehabilitation facility.

Participants: A total of 478 patients (N=478) with stroke who received inpatient or outpatient rehabilitation, with a median age of 63.0 years (interquartile range, 56.0-70.0 years) with 308 (64.2%) being men. The study was completed by 439 patients (91.8%).

Interventions: Not applicable.

Main outcome measures: Patient activation was measured with the Patient Activation Measure (PAM) (score 0-100, 4 levels, where a higher score and level denotes more patient activation). The PAM was measured at the start of the rehabilitation (baseline) and 3 and 6 months thereafter and was analyzed using the multivariate mixed model analysis.

Results: At baseline, the mean PAM score was 60.2±14.3, with the number of patients in PAM levels 1, 2, 3, and 4 being 76 (17.8%), 85 (19.9%), 177 (41.4%), and 90 (21.0%), respectively. The multivariate mixed-model analysis demonstrated that the PAM score increased over time (baseline 60.2±14.3 vs 3 months 60.7±14.8 vs 6 months 61.9±18.0; P.007). Between baseline and 6 months, 122 patients (41.4%) remained at the same PAM level, 105 patients (35.6%) increased, and 68 patients (23.1%) decreased. At all time points, >35% of patients were in level 1 or 2.

Conclusions: PAM scores increased slightly over time from the start of rehabilitation up to the 6-month follow-up. However, more than one-third of patients remained at low levels (ie, level 1 and 2) of patient activation, which indicates that specific interventions during rehabilitation to increase patient activation might be of value.

Keywords: Patient participation; Rehabilitation; Stroke.