| ObjectiveTo determine the psychometric properties and construct validity of the Chinese version of PAM in persons who will undergo Posterior lumber interbody fusion surgery for degenerative disc disease.To know the patient activation status and influencing factors in persons who will undergo Posterior lumber interbody fusion surgery for degenerative disc disease.MethodsBy convenient sampling,from January 2017 to June 2017,we conducted a questionnaire survery of 120 patients who will undergo Posterior lumber interbody fusion surgery for degenerative disc disease in the first affiliated hospital of Soochow University.There are three questionnaires: General Condition Questionnaire,the Chinese version of PAM and self-efficacy scale for managing chronic disease.Thirty patients were selected by the convenience sampling method,and the PAM questionnaire was completed again 2 weeks later.SPSS 21.0 statistical software was used for data analysis.Descriptives analysis of general demographic data was carried out by using frequency and percentage.The reliability analysis was carried out from internal consistency reliability and retest reliability.The validity analysis was carried out from content validity,structure validity and criterion correlation validity.By convenient sampling,From September 2017 to February 2018,we conducted a questionnaire survery of 200 patients who will undergo Posterior lumber interbody fusion surgery for degenerative disc disease in the first affiliated hospital of Soochow University.A total of seven questionnaires were included.They are General Condition Questionnaire,the Chinese version of PAM,Oswestry Disability Index,Hospital Anxiety and Depression Scale,Society Support Scale,Medical Coping Mode Questionnaire,and Short Form-36 health survey.SPSS 21.0 statistical software was used for data analysis.Descriptives analysis of general demographic data was carried out by using frequency and percentage.The difference between non-normal data was compared with the mann-whitney U test of two independent samples or Kruskal-Wallis H-test for multiple independent samples.The correlation between age,anxiety,depression,Oswestry Disability Index,Social Support and its dimension,each dimension of SF-36 and Patient activation were analyzed by Spearman rank correlation.The patient activation was taken as the dependent variable,multivariate stepwise linear regression analysis was performed.ResultsThe Project analysis of Chinese version of PAM was carried out from two aspects: critical ration and homogeneity test.The critical ratio t statistic was range from 4.567~10.015,which was greater than the minimum standard 3.0,it means all items has higher discrimination.The correlation coefficient r between each item score and the total score was 0.478~0.697,which was greater than the minimum standard r=0.4,it means the items and the overall scale were of higher homogeneity.Cronbach’s α is 0.835,and the minimum correlation coefficient between the items is 0.057,the maximum is 0.653,and the average value is 0.29.The retest reliability was 0.878.The content validity index of the total scale is 0.923,and the content validity index of each item is 0.833~1.Four common factors were extracted by principal component analysis,with the characteristic value greater than 1 as extraction standard,and the accumulated variance contribution rate was 63.75%.The four common factors were named as awareness,knowledge,ability and faith of Self-rehabilitation management.The Spearman correlation coefficient between PAM and self-efficacy scale for managing chronic disease was 0.689(P<0.01).The median,interquartile range of PAM is 48.90 and 10.30.There are 41.5% patients in the first level of patient activation,and they did not realize the importance of postoperative self-health management,but only passively received treatment and care.There are 32.0% patients in the second level,and they lack relevant knowledge and skills of postoperative self-health management.19.5% patients are in the third level,lacking the ability to judge correct healthy behaviors and confidence in self-persistence.only 7.0% of the patients in the fourth level,with positive degrees of postoperative self health management knowledge and confidence,is willing to stick to the change of health behavior,but in the face of life stress or new health crisis need some help in order to maintain the ability of self-management and confidence.The results showed that the difference between patient activation and gender,age,education,marital status,working status,family per capita monthly income,with or without chronic accompanying disease,anxiety,depression and coping style was statistically significant(P<0.05).Those patients who are male,younger,unmarried,on-the-job,with higher educated,higher family per capita monthly income,no chronic disease,no anxiety and depression,in face of the disease actively have higher preoperative patient’s activation.Anxiety and depression were negatively correlated with patient activation(P<0.05).Those patients who are older,with anxiety or depression seriously have lower preoperative patient’s activation.Social support(including subjective support,objective support,social support utilization),self evaluation of physical and mental health condition(including vitality,mental health and general health)were positively associated with patient activation(P<0.05).Those patients who with higher social support(including subjective support,objective support,social support utilization),self evaluation of good physical and mental health condition(including vitality,mental health and general health)have higher preoperative patient’s activation.Multivariate stepwise linear regression analysis revealed that marital status、coping style、education、objective support、depression and age were the most potential powerful predictors of the activation in patients who will undergo Posterior lumber interbody fusion surgery.ConclusionsThe reliability and validity of the Chinese version of the Patient Activation Measure is good,which can be used as an assessment tool for the preoperative activation level of the patients with lumbar degenerative disease.The preoperative activation level of patients with lumbar fusion should be improved.Gender,age,cultural degree,marital status,work status,family per capita income,anxiety,depression,medical coping styles,social support and self-report health status were the factors influencing pre-operative activation level.Among them,doctors and nurses should give more attention to the lower level activation patients who are female,older,with lower education level,non-employment,with lower family per capita income,with more chronic disease,with anxiety or depressive symptoms,with lower social support,in face of the disease negatively,with poor self-evaluation of physical and mental health.The targeted intervention can further improve the preoperative activation level according to these influencing factors... |
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