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Patient Activation is Not Associated With Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

Patel, Dil V. BS; Yoo, Joon S. BA; Block, Andrew M. BS; Karmarkar, Sailee S. BS; Lamoutte, Eric H. BS; Singh, Kern MD

doi: 10.1097/BSD.0000000000000847
Primary Research

Study Design: This was a retrospective study.

Objective: To determine whether an association exists between preoperative patient activation, as measured by the 10-Item Patient Activation Measure (PAM-10), and postoperative outcomes following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data: Patient motivation in maintaining positive health behaviors, a concept known as patient activation, has been established as an indicator for improvement in pain, disability, and physical function after surgery. However, no studies examine the effect of preoperative patient activation scores on outcomes following ACDF.

Methods: A prospectively maintained database was retrospectively reviewed and included patients that had a primary, 1–3 level ACDF for degenerative pathology. Patients were categorized into 3 subgroups according to their preoperative PAM-10 scores as follows: “low PAM” (bottom quartile), “moderate PAM” (second and third quartile), and “high PAM” (top quartile). Demographics and perioperative characteristics were recorded. Patient-reported outcomes including Neck Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and Visual Analogue Scale (VAS) neck and arm pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month postoperative follow-up.

Results: A total of 64 patients were included in this analysis. Patients were stratified by their PAM scores as follows: 25 had a low PAM score, 19 had a moderate PAM score, and 20 had a high PAM score. There was no difference in inpatient VAS pain scores or narcotic consumption. In addition, there was no difference in improvement in VAS neck pain, VAS arm pain, Neck Disability Index, and SF-12 PCS among subgroups at all postoperative follow-ups.

Conclusions: Although PAM has been associated with better postoperative recovery in lumbar spine patients and other orthopedic surgeries, our investigation suggests that preoperative PAM assessments are not an effective method to predict postoperative outcomes following an ACDF.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL

IRB Approval: ORA# 14051301.

The authors declare no conflict of interest.

Reprints: Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, Chicago, IL 60612 (e-mail:

Received November 19, 2018

Accepted April 19, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.