Scientific Articles   |    
Patient Activation and Functional Recovery in Persons Undergoing Spine Surgery
Richard L. Skolasky, ScD1; Ellen J. Mackenzie, PhD1; Stephen T. Wegener, PhD1; Lee H. Riley, III, MD1
1 c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Departments of Orthopaedic Surgery and Physical Medicine and Rehabilitation, the Johns Hopkins University School of Medicine, and the Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 21;93(18):1665-1671. doi: 10.2106/JBJS.J.00855
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Despite advances in surgical techniques, outcomes after spine surgery are highly variable. Recent research has highlighted the importance of individuals participating in, and taking responsibility for, their health and recovery. Patient activation, defined as an individual's propensity to engage in adaptive health behaviors leading to improved health outcomes, has been identified as a potentially important factor in this process. Our goal was to determine the association between preoperative patient activation and functional recovery after lumbar spine surgery.


We prospectively followed sixty-five consecutive patients undergoing lumbar spine surgery from August 2005 through May 2006. Patient activation was assessed preoperatively as one of four stages. We assessed pain intensity, disability, and functional status preoperatively and postoperatively with use of a numeric rating scale for pain, the Oswestry Disability Index, and the Medical Outcomes Study Short Form-12 (version 2). Comparisons were made for disability and functional status as a function of patient activation. Repeated-measures linear regression models were used to test the association between patient activation and functional recovery over time.


Preoperatively, we rated participant activation as low (Stage I, fifteen patients), high (Stage IV, sixteen patients), and intermediate (Stage II, twelve patients; Stage III, twenty-two patients; total, thirty-four patients). Overall, pain and disability decreased after surgery (p < 0.05). Stage-IV participants experienced a greater degree of decrease in pain (p = 0.049) and disability (p = 0.035) than did Stage-I participants. Overall, physical and mental health improved after surgery (p < 0.05), but only physical health differed according to patient activation, with a significantly smaller improvement in Stage-I participants than in Stage-IV participants (p = 0.044).


High patient activation was associated with better recovery after surgery. Increased patient activation may lead to improved functional recovery through increased physical therapy adherence after spine surgery in adults.

Level of Evidence: 

Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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