Patient Activation and Health Outcomes in Spinal Surgery: A Systematic Literature Review of Measures, Effects, and Strategies

OBJECTIVES: Patient activation is defined as a patient's knowledge, skills, confidence, and behaviours in managing their health. Patient activation is crucial in spinal surgeries, where the complexities of procedures, rehabilitation protocols, and long-term recovery necessitate active patient involvement. Thus, this systematic literature review aimed to understand the association between activation and patient health outcomes and assess the strategies employed to increase patient activation in spine surgical patients.

METHODS: Medline (OVID), EMBASE (OVID), PsychINFO (OVID), and Cochrane's Central Register for Controlled Trials (CENTRAL) were searched. Search terms included a combination of keywords and subject headings such as patient activation, empowerment, engagement, spine, surgery, digital health, health literacy, and care pathways.

RESULTS: Forty-nine studies were included in this review. Ten studies (20.4%) utilised the Patient Activation Measure (PAM-13). Twenty-seven studies (55.1%) used strategies to increase patient engagement. These strategies included digital care pathways, health literacy interventions, and motivational interviews and were found to decrease the length of stay and complications and enhance functional and physical outcomes. Eleven studies (22.4%) found a positive association between patient satisfaction and improved patient activation, and eight (16.3%) were associated with the activation strategies implemented. Four studies (8.2%) found a negative association with depression, while two (4.1%) of these studies also found a negative association with anxiety. Enhanced pain relief and functional recovery were also associated with increased levels of patient activation.

CONCLUSIONS: This review found that patient activation was linked with health outcomes such as improved physical health, self-efficacy, locus of control, and satisfaction. Strategies designed to enhance patient activation proved effective, leading to higher satisfaction, reduced complications, shorter hospital stays, and improved functional outcomes. These findings highlight the critical role of patient activation in optimising spinal surgery outcomes, emphasising the significance of integrating activation strategies to enhance patient well-being and surgical experiences.