Table 1.

Studies using the PAM-13 in kidney disease

Investigators, Country of Origin, and Study Design	Population and Sample Size (N)	PAM-13 Activation Level		Characteristics and Outcomes Associated with Patient Activation OR/β (95% CI)a or r (P Value)
Bos-Touwen et al.21 (Netherlands), cross-sectional	CKD (eGFR<60 ml/min per 1.73 m2; n=219)	Level 1 versus Levels 2–4		Characteristics: patients with CKD had the lowest activation levels compared with those with DM2, COPD, CHF
				Outcomes: multivariable linear regression (R2=0.2 if NS variables of social support and comorbidity score were included in model): BMI, 1.05 (1.01 to 1.08); living alone, 1.50 (1.10 to 2.06); some financial distress, 1.60 (1.17 to 2.18); some education, 1.41 (1.03 to 1.92); disease vintage >5 yr, 0.66 (0.45 to 0.96); depression, 1.05 (1.01 to 1.10); illness perception/understanding, 1.03 (1.01 to 1.04)
Hamilton et al.22 (United Kingdom), cross-sectional	HD/PD (n=173); KT (n=417)	Levels 1–4; median: level 3		Outcomes: multivariable linear regression (R2 not reported): dialysis use, −4.52 (−6.94 to −2.10); younger age of RRT, −3.09 (−5.89 to −3.00); medication adherence (P value for trend <0.01)
		Level 1: 26%
		Level 2: 18%		Level 2: 0.5 (−0.0 to 0.9)
		Level 3: 36%		Level 3: 0.7 (0.3 to 1.1)
		Level 4: 20%		Level 4: 0.6 (0.1 to 1.1)
Johnson et al.23 (United States), cross-sectional	Comorbid HTN, DM2, CKD (eGFR<60 ml/min per 1.73 m2; n=62); HD (n=19)	Levels 1–4; Level 1: 10%		Characteristics: patients with stage 5 CKD had lower activation levels compared with those at earlier CKD stages
		Level 2: 28%
		Level 3: 28%
		Level 4: 34%		Outcomes: no significant associations between patient activation and GFR decline
Lo et al.24 (Australia), cross-sectional	Comorbid DM2 and CKD (eGFR<60 ml/min per 1.73 m2; n=199)	Levels 1–4; Level 1: 20%		Characteristics: no significant associations between activation scores and glycemic control or BP control
		Level 2: 23%
		Level 3: 29%
		Level 3: 29%
Magnezi et al.25 (Israel), cross-sectional	Kidney disease (unknown type; n=25)			Characteristics: individuals aged 20–29 had lower activation levels compared with older adults
The Renal Association,26 National Health Service (England), longitudinal cohort	CKD (unknown eGFR; n=320); HD (n=921); PD (n=51); KT (n=617)	Levels 1–4; Level 1: 25%		Characteristics: those aged 25–44 and those who received KT had the highest activation levels. Patients on HD had lowest activation levels. Those who reported better quality of life had higher activation levels. Inverse relationship between neighborhood deprivation and patient activation level. Inverse relationship between symptom burden and patient activation level
		Level 2: 18%
		Level 3: 33%
		Level 4: 17%
				Outcomes: no association between patient activation level and calcium, phosphorus, or hemoglobin overall or by treatment modality. No association between clinician support and patient activation. Resurveying (without an intervention) resulted in improvements in patient activation among those who were previously at levels 1 and 2
Nelson et al.27 (United States), randomized controlled trial	CKD (mean eGFR =101–105 ml/min per 1.73 m2; n=125)	Levels 1–4; Level ≥3: 84% (usual care) versus 68% (home care); mean in both groups: level 3		PAM-13 as primary outcome: 8.7 points higher on activation score at 12 mo with receipt of home-based care (1.90 to 15.5)
Rivera et al.28 (United States), cross-sectional	CKD (unknown eGFR; n=67)	Levels 1 and 2 versus levels 3 and 4		Outcomes: no significant associations between activation scores and hospitalizations or emergency department visits
Van Bulck et al.29 (Belgium), cross-sectional	HD (n=192)	Levels 1–4; mean: level 2		Characteristics: univariable linear regression: age, −0.33; self-reported health, 0.33; nonuniversity higher education, 0.22; university education, 0.21; part-time work, 0.19; full-time work, 0.15; leisure activities, 0.33; having children, −0.22; living alone, 0.33; living with someone, 0.49; >1 care service at home, −0.29; receipt of KT, 0.16; treatment in hospital #2, −0.17. Multivariable linear regression (R2=0.31): age, −0.28; self-reported health, 0.28; leisure activities, 0.21; treatment in hospital #3, −0.02; living with someone, 0.14
Vélez-Bermúdez et al.30 (United States), cross-sectional	CKD (eGFR=7–25 ml/min per 1.73 m2; n=64)	Levels 1–4; Mean: level 3		Characteristics: patients who stated they would choose PD had highest activation scores. Pearson correlations: presence of heart disease, −0.28 (<0.05); decisional conflict, −0.47 (<0.01); CKD-related treatment satisfaction, −0.36 (<0.01)
				Outcomes: patient activation found to mediate relationship between treatment satisfaction and decisional conflict
Zimbudzi et al.31 (Australia), cross-sectional	Comorbid DM2 and CKD (eGFR<60 ml/min per 1.73 m2; n=305)	Levels 1 and 2 versus levels 3 and 4; levels 1-4 for multivariable linear regression; Level 1: 22%		Characteristics: univariable linear regression: self-care score, 0.21 (0.06 to 0.37); symptoms of kidney disease of KDQOL-36, 0.15 (0.05 to 0.25); burden of kidney disease of KDQOL-36, 0.11 (0.05 to 0.16); effects of kidney disease of KDQOL-36, 0.09 (0.02 to 0.17); PCS, 0.17 (0.01 to 0.33); MCS, 0.26 (0.09 to 0.42). Multivariable linear regression (R2 not reported): self-care score, 0.18 (0.02 to 0.35); burden of kidney disease of KDQOL-36, 0.11 (0.05 to 0.17)
		Level 2: 23.6%
		Level 3: 36.4%
		Level 4: 18%

DM2, type 2 diabetes; COPD, chronic obstructive pulmonary disease; CHF, chronic heart failure; NS, nonsignificant; BMI, body mass index; HD, in-center hemodialysis; PD, peritoneal dialysis; KT, kidney transplantation; HTN, hypertension; KDQOL-36, Kidney Disease–Related Quality of Life-36; PCS, physical composite summary; MCS, mental composite summary.

^aIf available. All numerical results are statistically significant.