Patient activation levels are low in patients undergoing revascularization for lower limb arterial disease but do not correlate with 30-day clinical outcomes

<h2>Abstract</h2><h3>Background</h3> Patient activation refers to the ability of individuals to engage in their healthcare. Studies have shown a positive association between patient activation and improved clinical outcomes in some patient groups. <h3>Objective</h3> This study aims to characterise the level of activation in patients with peripheral arterial disease (PAD) undergoing revascularisation procedures and to determine if patient activation is associated with 30-day clinical outcomes. <h3>Methods</h3> This is a single-centre, prospective, observational study (ethics reference: 23/NS/0078). Patients undergoing planned lower limb revascularisation within a 5-month period were invited to participate and to complete the Patient Activation Measure (PAM) survey prior to their surgery. Responses were scored on a Likert scale and an overall PAM score produced between 1 and 100 (lowest to highest activation). The relationship between baseline characteristics and PAM score was evaluated using linear regression. Spearman's rank-order correlation and logistic regression was conducted to examine the relationship between PAM scores and 30-day clinical outcomes. <h3>Results</h3> Eighty patients were included in this study. The median age was 71 years (IQR 3 years) and 70% were male. The median PAM score was 53 (IQR 16). Current smokers and patients with type 2 diabetes had significantly lower PAM scores than non-smokers (p<0.05) and non-diabetics (p<0.001). Multivariate regression revealed age and type 2 diabetes were significant predictors of PAM score. There was no association between PAM score and any 30-day clinical outcomes. <h3>Conclusions</h3> Patient activation is low in our sample of PAD patients undergoing revascularisation procedures. This suggests more work is needed to educate and engage patients in self-management of this long-term condition. Patient activation was not correlated with 30-day clinical outcomes, but further research is warranted to determine whether it is related to medium or long-term clinical outcomes.