Table 1.

Summary of Included Articles on Patient Activation Measure and Rheumatoid Arthritis with Quality Assessment

No.	Author	Year	Country	Study Design	Study Settings	Population	Intervention	PAM Level	Limitations with Regards to PAM	Conclusion	Quality AssessMent (Number and % out of 14 Checklist Items)
Interventional studies
1	Zuidema et al38	2019	Netherlands	Randomized Control Trial	2 Dutch hospitals	157 patients with RA	Web-based self-management enhancing program	Control group mean 46.9 (±4.9), intervention 47.2 (±3.7)	PAM was reported as a continuous variable and was not computed to levels	No positive effects of the program were detected	9 (64%)
2	Mollard et al39	2018	US	Mixed methods	University hospital in Nebraska	63 patients with RA	Live With Arthritis app	Intervention 67.4, control 71.9	PAM was reported as a continuous variable and was not computed to levels	The PAM was negatively correlated with non-significant changes of HAQ-II (Pearson correlations: −0.33, p = 0.10)	11 (79%) For qualitative part 3 (21%)
3	Van Den Bosch et al19	2017	Europe, Israel, Mexico, Puerto Rico, and Australia	Observational study (cohort)	Australia, Belgium, Czech Republic, France, Germany, Greece, Israel, Mexico, Netherlands, Portugal, Puerto Rico, Slovakia, Switzerland, and the United Kingdom	1025 patients with RA	Patient support programs (PSP) and instructions on how to use adalimumab	PSP users mean score 60.7 (±15.3), non-users 58.9 (±14.6)	Focusing on adalimumab treatment, PAM was reported as a continuous variable and was not computed to levels	The percentage of patients that demonstrated improvement in PAM-13 levels was significantly higher among PSP users vs PSP non-users (35.7 vs 28.1%, p = 0.01). Compared to PSP users, PSP non-users had a significantly higher percentage of patients that started at PAM-13 level 4 at baseline and remained at level 4 until week 78 of ADA treatment (64.5 vs 53.8%, p = 0.028).	12 (86%)
4	Gronning et al42	2016	Norway	Qualitative study within the published randomized control trial	University hospital	Adult RA patients last included in the randomized control trial	Nurse-led hospital-based patient education program	26 (intervention 15, control 11) PAM of intervention group 73, of control group 70	A small group of which had RA	The experiences from the Patients in the nurse-led patient education program were in concordance with the pathway of self-efficacy and patient activation, which many patient education programs are based on	10 (71%)
5	Joplin et al40	2014	Australia	Cohort	Mid-North Coast Arthritis Clinic (MNCAC), a community-based rheumatology practice in Coffs Harbour	18 patients with RA	Joint ultrasound	60.0 (±15.5) at baseline	Very small sample size, PAM was reported as a continuous variable and was not computed to levels	PAM-13 scores did not change during the The study, with levels of activation at T1, T2, and T3 of 60.0 (±15.5), 55.7 (±12.0) and 57.8 (±14.8) (p = 0.21), respectively.	7 (50%)
6–8	Gronning et al41,49 follow-up study after 5 years50	2012 2013, 2019	Norway	Randomized control trial	University hospital	141 of which a group of patients had RA 101 follow-up 63 of which had RA	Nurse-led hospital-based patient education program	Reports of the first study include intervention PAM 65.7 (±13.3), control PAM 65.6 (±16.4)	Not all patients had RA, the exact number of RA patients was not mentioned, PAM was reported as a continuous variable and was not computed to levels	Reported results at 4 and 12 months, then 5 years follow-up. A significant improvement of PAM scores among women with intervention at 12 months, mean change 4.2 (0.0, 8.3, p = 0.048).	11 (79%)
9	Sandhu et al43	2012	Canada	Qualitative Pilot before and after study	Patients were recruited either from the primary care clinic in Toronto or via email sent from the Arthritis Society in Canada	Mentors: Adult patients with IA for more than 2 years and receiving drug therapy Mentees: adult patients with early IA	In the mentor training program, the mentee was assessed before and after pairing with a mentor	17 (9 mentors, 8 mentees PAM of mentees mean 75.80 (SD 73.11) p= 11.75 effect size 0.22	A very small number of patients as it is mainly qualitative and IA was not clear if it was RA or not	No difference between groups with regards to PAM level	10 (71%)
Non-interventional studies
10	Jones et al32	2021	UK	Qualitative Semi‐structured interviews at two timepoints	Patient were recruited from two rheumatology departments in south west England	17 participants total, 13 of which had RA	None	Participants demonstrated high levels of patient activation Four were at level 2, four at level 3 and six at level 4	Did not mention the exact level and RA patient were not assessed separately	Patients’ perceptions and experiences of patient activation covered are not always captured by the PAM	14 (100%)
11	Huang et al33	2021	Singapore	Cross-sectional	Specialist outpatient clinics of a tertiary hospital in Singapore	200 participants with chronic conditions 56 of which had other chronic conditions including RA	None	The mean activation score was 58.8 (SD = 15.0)	Small number of participants and RA patient were not assessed separately	Some factors as age, income, education and health literacy are factors contributing to change in patient activation	9 (64%)
12	Zakeri et al35	2021	Iran	Cross-sectional	Chronic patients admitted to the Cardiac Care Unit and medical wards in Ali Ibn Abitaleb Hospital of Rafsanjan	293 patients with chronic conditions 33 had other conditions including RA	None	The mean score of PAM-13 was 56:99 ± 15:32	Small number of participants and RA patient were not assessed separately	The physical and psychological subscales of Quality Of Life (QOL) significantly predicted the levels of PAM	9 (64%)
13	Kosar et al30	2019	Turkey	Cross-sectional	University Hospital in Izmer	130 a group of which had RA	None	PAM scores of the patients ranged from 28.8% to 83.3%. Up to 28.7% of patients were in activation level 1, 44.9% were in activation level 2, 20.2% were in activation level 3 and 6.2% were in activation level 4.	130 patients of which patients with RA, did not mention the exact number	Validity study of PAM-13 in Turkish	9 (64%)
14	McBain et al31	2018	UK	Cross-sectional	National Rheumatoid Arthritis Society, UK	841 (95%) had RA	None	PAM was 57.8 (±15.5). The samples were evenly split across the 4 levels of activation, 251 (28.4%) level 1, 182 (20.6%) at level 2, 204 (23.1%) at level 3 and 248 (28.0%) at level 4.	Not all patients had RA	Only a small proportion of patients attended a self-management structure support program.	8 (57%)
15	Lofland et al37	2017	US	Cross-sectional survey and cost cohort	Claims database	Adult patients receiving biologics	None	453 responders to the cross-sectional survey to assess shared decision making. PAM scores SDM vs non-SDM: 66.9 vs 61.6; P<0.001	RA patients were combined with PsA patients	Patient with SDM had a significantly greater PAM score	11 (79%)
16	Graffigna et al34	2017	Italy	Cross-sectional	Online panel provided by Research Now (secondary database)	Patients over 18 years of age and with chronic conditions	None	352 (11.1%) had RA meaning 39 patients Mean PAM of all patients was 65.3 (range 0–100)	Reported PAM was for the entire population and limited number with RA	Mean PAM of all patients was 65.3 (range 0−100)	10 (71%)
17	Blakemore et al13	2016	UK	Cohort	Cohort study database	Patients ≥ 65 years having at least one long-term condition	None	3390 PAM at baseline 60.8 (SD 15.4), at follow-up 60.3 (SD 20.0), no difference	Patients with RA were combined with all other illnesses and not clear as a separate group	No difference at baseline compared to follow-up with regards to PAM level	11 (79%)
18	Jones et al51	2021	UK	Cross-sectional	Six rheumatology clinics in England	Patients> 18 with an inflammatory rheumatic condition including RA, PsA and AS or SLE	None	166 (66%) patients had RA, PAM was 58.3 (SD 11.5)	Patients with RA were combined with all other illnesses and not clear as a separate group	Self-efficacy and health literacy are targets for patient activation interventions	9 (64%)
19	Oliveria et al36	2021	Brazil	Cross-sectional	Rheumatology outpatient facility at a high-complexity teaching hospital in Brazil	179 patients> 18 years with RA, having at least one year of formal education and being able to read and not having neurological or psychiatric disorders that affect cognition, and having enough visual acuity to read.	None	The average PAM-13 was 65.72, with 10.1% very low activation level, 15.6% having a low activation level, 39.1% moderate activation level and 35.2% having a high activation level.	None	Activation and health literacy are very important in RA patients and improving them could increase functional capacity	8 (57%)