Patient activation during the first 6 months after the start of spinal cord injury rehabilitation: a cohort study

Spinal cord injury (SCI) is a serious injury that leads to motor and sensory disorders and ultimately affects people's physiological, psychological, and social well-being. To test patient activation from discharge from the department of spinal surgery until 6-month follow-up. Longitudinal inception cohort study. This study was conducted at the Spinal Surgery Department of the Third Affiliated Hospital of Soochow University in China. A total of 367 participants with traumatic SCI received community-based or hospital-based rehabilitation between October 2020 and November 2023 and were recruited using convenience sampling. Patient activation was evaluated using the short version of the Patient Activation Measure (PAM). Assessments were conducted at baseline, 3-month, and 6-month follow-up. At baseline, the mean PAM score was 53.2, with the number of participants in PAM levels 1, 2, 3, and 4 being 92, 142, 114, and 19, respectively. Between baseline and 6-month, 164 participants remained at the same PAM level, 85 participants increased, 86 participants decreased. The multivariate mixed-effects model analysis showed that the PAM score decreased significantly over time (P=0.007). Older age had a positive effect on improvement over time (P=0.023). Higher self-efficacy, resilience, health literacy, and Modified Barthel Index (MBI) remained significantly related with higher PAM scores over time (P<0.001, P<0.001, P<0.001, and P=0.010, respectively). Fewer symptoms of depression remained significantly related with higher PAM scores over time (P<0.001). PAM scores decreased slightly over time from the start of rehabilitation up to the 6-month follow-up. Furthermore, about two-third of participants remained at low levels of patient activation, which suggests that patient-centered care interventions during rehabilitation to improve patient activation might be of value. This study examined the course of patient activation from the start of SCI rehabilitation to the 6-month follow-up period. These findings provide the necessary basis for the development and evaluation of effective interventions to promote patient activation levels and enhance self-management in people with SCI.