title: Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty.
abstract: BACKGROUND
  Despite widely reported success associated with hip and knee replacements, some patients remain dissatisfied with their outcomes. Patient activation, an individual's propensity to engage in adaptive health behaviors, has been measured as a potentially important factor contributing to health outcomes, cost, and patient experience of care. However, to our knowledge, it has not been studied in patients undergoing total joint arthroplasties (TJAs).
  
  
  OBJECTIVE
  We wanted to determine whether patients with higher activation scores would experience (1) greater resolution of pain and improved activity, (2) greater improvements in postoperative physical and mental health, and (3) greater patient satisfaction after primary THA or TKA.
  
  
  METHODS
  We approached 174 patients and enrolled 135 who were undergoing primary THA or TKA at one of two hospitals between January 2013 and May 2014. Patient Activation Measure (PAM) scores were obtained preoperatively and patient-reported outcomes were assessed and completed for 125 patients pre- and postoperatively at the 6- or 12-month visit. We assessed pain and activity with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and University of California Los Angeles (UCLA) activity scores. We measured physical and mental health by calculating SF12v2® scores and measured patient satisfaction with the Hip and Knee Satisfaction Scale (HKSS). Linear regression models were used to test the association between baseline PAM and postoperative patient-reported outcomes.
  
  
  RESULTS
  Overall, patients with a higher baseline PAM score experienced better pain relief using the HOOS/KOOS pain scores (R2=0.311, p=0.048) and symptoms using the HOOS/KOOS symptom scores (R2=0.272, p=0.021). In addition, higher PAM scores were associated with better postoperative mental health using the SF12v2® (R2=0.057, p<0.001), but were not associated with higher physical health (R2=0.176, p=0.173). Finally, higher PAM scores were associated with having greater postoperative satisfaction after surgery using the HKSS questionnaire (R2=0.048, p=0.023).
  
  
  CONCLUSIONS
  Higher preoperative patient activation was associated with better pain relief, decreased symptoms, improved mental health, and greater satisfaction after TJA. Future efforts should be aimed at studying if improving patient activation before surgery results in better patient-reported outcomes after elective THA or TKA.
  
  
  METHODS
  Level II, prognostic study.
authors.affiliation: Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Andrawis
authors.forename: Sina
authors.initials: S
authors.lastname: Akhavan
authors.forename: Vanessa
authors.initials: V
authors.lastname: Chan
authors.forename: Mandeep
authors.initials: M
authors.lastname: Lehil
authors.forename: Dana
authors.initials: D
authors.lastname: Pong
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D015141:Los Angeles; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010358:Patient Participation; D017060:Patient Satisfaction; D020127:Recovery of Function; D012307:Risk Factors; D012495:San Francisco; D011795:Surveys and Questionnaires; D016896:Treatment Outcome