Patient Activation Measure (2024)

June 5–7
In-person or Virtual
Act now—Seats are limited!

Offered by Academy, Shirley Ryan AbilityLab

Neurological Disorders

Renal Disease

Osteoarthritis

Orthopedic Surgery

Older Adults and Geriatric Care

Non-Specific Patient Population

Multiple Sclerosis

Mixed Populations

Convergent validity:

Non-Specific Patient Population:(Hibbard et al., 2004; n = 1515; age >= 45; mean age = 55; age range = 45 to 97; female = 958 (63%); reported ≥1 chronic disease, n = 1192 (79%); 22-item PAM administered via telephone survey)

• Adequatecorrelation between PAM scores and general health, as measured by the SF-8 (r = 0.38)

Discriminant validity:

Non-Specific Patient Population: (Hibbard et al., 2004; n = 1515)

• Excellentdiscriminant validity between PAM scores and doctor office visits/emergency room visits/and hospital nights (r = -0.07)

“An 80-item pool was constructed by selecting questions from existing instruments and creating new ones were none existed. The items in the pool were categorized under the domains they were intended to measure and were reviewed by a subset of the expert panel for face and content validity. All 80 items were further refined with three rounds of face-to-face cognitive testing with 20 respondents with chronic conditions. Items were evaluated in terms of how well they were understood, the degree to which there was variability in responses, and the adequacy of the response categories (Hibbard et al., 2004, p. 1010-1011).”

Cardiac Rehabilitation Patients and Employees of a Large Health System: (Hibbard et al., 2004; n= 486 (120 cardiac rehabilitation patients via self-administered questionnaire and 366 employees of a large health system in a second community via a web-based version of the survey; 118 (24%) reported no chronic disease)

• Excellent: Cronbach’s alpha = 0.91*

Inpatient Cardiac and Oncology:(Prey et al., 2016; n = 100; mean age (SD) = 64.1 (1.69) years; inpatient population; unplanned admissions n = 50; USA, Dominican Republic, and Puerto Rico samples)

• Excellent: Cronbach’s alpha = 0.81

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Convergent validity:

Inpatient Cardiac and Oncology: (Prey et al., 2016)

• Adequateconvergent validity between Patient Activation Measure (PAM) scores and Patient Reported Outcomes Measurement Information System (PROMIS) Global Health scores (r = 0.40)
• Adequateconvergent validity between PAM scores and PROMIS Physical Health scores (r = .40)
• Adequate convergent validity between PAM scores and PROMIS* Mental Health scores (r = 0.45)

Discriminant validity:

Inpatient Cardiac and Oncology: (Prey et al., 2016)

• Significantdifference in PAM levels of participants who had planned vs. unplanned admissions
  • 56% of participants with unplanned admissions had low activation compared to 24% of participants with planned admissions (p= 0.001)
  • Patients with unplanned admissions were more likely to have low activation compared to patients with planned admissions, even after controlling for baseline covariates (adjusted OR = 5.7, p= 0.008)

Osteoarthritis:(Eyles et al., 2020; n = 217; mean age (SD) = 65.5 (10.8) years, mean visual analog pain scale = 4.0 (2.3))

• Excellent:Cronbach’s alpha = 0.92*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Convergent validity:

Osteoarthritis: (Eyles et al., 2020; n= 217)

• Poorconvergent validity between PAM and Depression, Anxiety, and Stress Scale (DASS): r = -0.26
• Adequate convergent validity between PAM and Assessment of Quality of Life (AQoL-6D) (r = 0.32)

Discriminant validity:

Osteoarthritis: (Eyles et al., 2020; n= 217)

• Excellentdiscriminant validity between:
  • PAM and the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain (r = 0.13)
  • PAM scores and KOOS Activities of Daily Living (KOOS-ADL) (r = 0.15)
  • PAM scores and Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain (r = -0.06)
  • PAM scores and HOOS ADL (r = -0.23)

Chronic Kidney Disease (CKD) - Not Requiring Dialysis:(Lightfoot et al., 2021; n = 942; mean age (SD) = 66.4 (20.8) years; male = 554 (59%); estimated glomerular filtration rate (SD) = 36 (21) ml/min)

• Excellent:Cronbach’s alpha = 0.925*, (95% CI = 0.917 – 0.932)
• Poor:Average inter-item correlation = 0.502

*Score higher than 0.9 may indicate redundancy in the scale questions.

Chronic Kidney Disease (CKD) - Not Requiring Dialysis:(Lightfoot, et al., 2021)

• Adequate:Floor effects of 2-5% for all items
• Adequate:Ceiling effects of <20% for 6 items
• Poor: Ceiling effects of >=20% for 7 items

Neurological Conditions:(Packer et al., 2015; n = 722; female = 65%)

• Excellent:Cronbach’s alpha = 0.87

Multi-morbid, Community-Dwelling:(Skolasky et al., 2011; n = 855; mean age (SD) = 77.3 (6.4) years; mean ADL score (SD) = 0.57 (1.10); mean IADL score (SD) = 1.01 (1.37))

• Excellent:Cronbach’s alpha = 0.87

Convergent validity:

Multi-morbid, Community-Dwelling:(Skolasky et al., 2011)

• Adequateconvergent validity between PAM scores and the communication subscale of the Primary Care Assessment Survey (PCAS) (r = 0.339)
• Adequate:Adequate correlation between PAM and the integration subscale of the PCAS (r = 0.304)

Discriminant validity:

Multi-morbid, Community-Dwelling:(Skolasky et al., 2011)

• Excellentdiscriminant validitybetween PAM scores and the physical health subscales of the SF-36 (r = 0.215)
• Excellentdiscriminant validitybetween PAM scores and the mental health subscales of the SF-36 (r = 0.193)

Elective Lumbar Spine Surgery: (Skolasky et al., 2009; n = 283; mean age (SD) = 59 (15.7) years; female = 158 (56%); subset of 65 participants completed retest within 1 week of initial test)

• Acceptabletest-retest reliability (ICC = 0.84)

Elective Lumbar Spine Surgery: (Skolasky et al., 2009; calculated using split-half scores from the baseline PAM and adjusted using the Spearman-Brown formula)

• Excellent:split-half reliability = 0.92*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Multiple Sclerosis:(Stepleman et al., 2010; n = 199; female = 163 (82%); mean age (SD) = 46.24 (10.83) years; mean years since diagnosis (SD) = 8.3 (6.84) years; type of MS: relapse remitting = 131 (69%), progressive = 8 (4%), secondary progressive = 15 (8%), unsure = 37 (19%); respondents recruited from a regional Multiple Sclerosis Center affiliated with an academic medical center in southeastern U.S.)

• Excellent:Cronbach’s alpha = 0.88

Convergent validity:

Multiple Sclerosis Clinic:(Stepleman et al., 2010)

• Adequateconvergent validity between PAM scores and Multiple Sclerosis Self-Efficacy Scale (r = 0.50)
• Adequate convergent validity between PAM scores and Beck’s Depression Inventory (r = -0.43)
• Poor convergent validity between PAM scores and self-reported frequency of missing disease-modifying therapy injections (r = -0.04)