Patient Activation and Disability in Upper Extremity Illness

• Published in: The Journal of hand surgery (American ed.) Vol. 39; no. 7; pp. 1378 - 1383.e3
• Main Authors: Gruber, Jillian S., BA, Hageman, Michiel, MD, Neuhaus, Valentin, MD, Mudgal, Chaitanya S., MD, Jupiter, Jesse B., MD, Ring, David, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014
• Subjects: Activities of Daily Living; Adult; Aged; Arm Injuries - diagnosis; Arm Injuries - surgery; Attitude to Health; Cross-Sectional Studies; disability; Disability Evaluation; Female; Hand Injuries - diagnosis; Hand Injuries - surgery; Humans; Male; Middle Aged; Motor Activity - physiology; Orthopedic Procedures - methods; Orthopedic Procedures - rehabilitation; Orthopedics; PAM; Patient activation; Patient Participation - statistics & numerical data; Patient Selection; Preoperative Care - methods; Self Efficacy; Surveys and Questionnaires; upper extremity; Upper Extremity - physiopathology; Upper Extremity - surgery; Young Adult; Patient activation; PAM; disability; upper extremity; self-efficacy
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2014.03.042

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.