Article

OBJECTIVE: To determine the effect of health behavior change counseling (HBCC) on
patient activation and the influence of patient activation on rehabilitation
engagement, and to identify common barriers to engagement among individuals
undergoing surgery for degenerative lumbar spinal stenosis. DESIGN: Prospective
clinical trial. SETTING:
Academic medical center.
PARTICIPANTS: Consecutive
lumbar spine surgery patients (N=122) defined in our companion article (Part I)
were assigned to a control group (did not receive HBCC, n=59) or HBCC group
(received HBCC, n=63). INTERVENTION: Brief motivational interviewing-based HBCC
versus control (significance, P<.05). MAIN OUTCOME MEASURES: We assessed patient
activation before and after intervention. Rehabilitation engagement was assessed
using the physical therapist-reported Hopkins Rehabilitation Engagement Rating
Scale and by a ratio of self-reported physical therapy and home exercise
completion. Common barriers to rehabilitation engagement were identified through
thematic analysis. RESULTS: Patient activation predicted engagement (standardized
regression weight, .682; P<.001). Postintervention patient activation was
predicted by baseline patient activation (standardized regression weight, .808;
P<.001) and receipt of HBCC (standardized regression weight, .444; P<.001). The
effect of HBCC on rehabilitation engagement was mediated by patient activation
(standardized regression weight, .079; P=.395). One-third of the HBCC group did
not show improvement compared with the control group. Thematic analysis
identified 3 common barriers to engagement: (1) low self-efficacy because of lack
of knowledge and support (62%); (2) anxiety related to fear of movement (57%);
and (3) concern about pain management (48%). CONCLUSIONS: The influence of HBCC
on rehabilitation engagement was mediated by patient activation. Despite
improvements in patient activation, one-third of patients reported low
rehabilitation engagement. Addressing these barriers should lead to greater
improvements in rehabilitation engagement.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS