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Title: Questionnaire Can Predict Whether Patients Will Adhere to Physical Therapy After Spine Surgery
URL: http://www.pslgroup.com/dg/22E03E.htm
Doctor's Guide
October 2, 2008

BALTIMORE, Md -- October 2, 2008 -- Patients' responses to a simple questionnaire can reliably predict whether they will adhere to physical therapy after spine surgery, according to a new study in the October 1 issue of Spine.

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.

"It has long been known that physical therapy after spine surgery greatly improves outcomes, but to date, there has been no easy-to-administer, standardised method for assessing a patient's willingness to adhere to therapy," said lead author Richard L. Skolasky, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

"Essentially, the test places patients on a continuum of activation ranging from those who don't see an active role on their part as necessary to those who are highly motivated to take an active role in their own health care."

The study 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 with patients with low PAM scores.

Skolasky and colleagues recruited 65 patients from Johns Hopkins to participate in the study. All underwent their first surgical treatment for a degenerative spine disease between August 2005 and May 2006. Of the patients, 89% were non-Hispanic white, 58% were female, and the mean age was 58 years.

Before the surgery, each patient completed a PAM questionnaire. Then, for the next 6 weeks after surgery, patients recorded how often they attended prescribed physical therapy sessions. After the last therapy session, therapists scored the patients' engagement in physical therapy by rating their attitude, need for prompts, understanding the importance of therapy, and activity during sessions.

Results showed that attendance rose in direct correlation to PAM scores. 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. 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," said Skolasky. He also noted that before they can bring the PAM into the examination room, they will need to develop a protocol for improving PAM scores.

SOURCE: Johns Hopkins Medical Institutions

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