(provided by the applicant): Spine surgery is one of the most common and costly inpatient procedures in the United States with rates increasing dramatically during the past two decades, especially among those greater than 60 years of age or with degenerative conditions of the spine. Recovery following spine surgery is highly variable and cannot be explained by traditionally studied factors. The Institute of Medicine (IOM) issued a challenge to the American health care system to improve the patient-centeredness of healthcare. This challenge arises from the fact that patient-centered care has a profound impact on the way that healthcare is planned, delivered, and evaluated. Recent evidence supports the hypothesis that patient-centered interventions improve outcomes through empowerment of the individual patient. This empowerment can be achieved through increases in self-efficacy and patient activation. This approach is a central tenet of several major intervention programs. This project is the direct extension of our previously funded work investigating the role of patient activation in predicting post-operative health behavior. Having a valid and reliable tool to identify individuals with low patient activation and, therefore, at risk for poor recovery speaks to the need for an intervention strategy. The current proposal seeks to investigate the impact of a brief Health Behavior Change Counseling (HBCC) on patient activation and post-operative health behavior and functional recovery. We plan to enroll two consecutive cohorts of individuals undergoing elective surgery for degenerative disease of the lumbar spine. The first cohort will undergo standard preoperative care. The second cohort will undergo standard pre-operative care with an additional brief HBBC intervention session (a patient-centered directive method for eliciting motivation to change behavior). Both groups will be following for 24 months post-operatively.

Public Health Relevance

The current project seeks to identify and intervene among individuals with low patient activation and, therefore, at risk for poor recovery following spine surgery. Based on recommendations from the Institute of Medicine, this proposal speaks directly to the request that healthcare be delivered in a more patient-centered manner. This project is the logical next step to previous work funded by AHRQ to investigate the role that patient activation plays in post-operative health behavior.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Wittenberg, Kim
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Johns Hopkins University
Schools of Medicine
United States
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Skolasky, Richard L; Wegener, Stephen T; Maggard, Anica M et al. (2014) The impact of reduction of pain after lumbar spine surgery: the relationship between changes in pain and physical function and disability. Spine (Phila Pa 1976) 39:1426-32
Young, Arthur K; Young, Benjamin K; Riley 3rd, Lee H et al. (2014) Assessment of presurgical psychological screening in patients undergoing spine surgery: use and clinical impact. J Spinal Disord Tech 27:76-9
Skolasky, Richard L; Riley 3rd, Lee H; Maggard, Anica M et al. (2013) Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes. Contemp Clin Trials 36:207-17