395education can bring about improvements in health status [ 51 ], and many health
professionals believe it to be the key to improved adherence, however, what appears
to be consistent across studies of chronic diseases is the notion that patient educa-
tion efforts alone are not suffi cient to improve adherence. Treatment adherence is
defi ned as the extent to which patients follow recommendations and take the medi-
cations prescribed by their physicians [ 52 ]. Another theoretical question also was
raised regarding whether the statistically signifi cant changes produced by the visual
feedback intervention were clinically meaningful. In concordance with the note that
“patients tend to forget,” sharing with the patients their reported scores before and
after self-management or therapeutic interventions was reported to have a positive
impact on the patients’ disease activity status as well as treatment. An earlier study
[ 53 ] revealed that implementing patient education as part of the standard day-to-day
practice and sharing the outcomes with the patients regularly had a positive and
signifi cant impact on the disease activity control. Results of another recent work
[ 54 ] revealed that in early infl ammatory arthritis patients the visual feedback pro-
vided a signifi cant greater reduction in disease activity parameters as well as
improvement of the patients’ adherence to antirheumatic therapy. Also stopping the
disease-modifying drug therapy because of intolerance was signifi cantly less in the
active group. Concern about the future was signifi cantly less in the active group
whereas inability to cope with daily life and disease stress were signifi cantly greater
among the control group. The improvement of disease activity parameters was asso-
ciated with improvement in functional disability as well as quality of life scores.
Adherence to medication was signifi cantly correlated with changes in all measured
disease parameters. The fi ndings of this pilot study revealed that by incorporating
the visual feedback approach into clinical practice a new experience can be created.
Using visual feedback in the patients’ management as well as patient education
enabled the patients to see how they are doing regarding their disease activity and
helps to optimize their adherence to their treatment.
Patient Activation Measure
“Patient activation” is a recently recognized concept that describes the knowledge,
skills, and confi dence a person has in managing their own health and healthcare
[ 55 ]. People who have low activation levels are less likely to play an active role in
remaining healthy. They are less good at seeking help when they need it, at follow-
ing a doctor’s advice, and at managing their health when they are no longer being
treated. The Patient Activation Measure is a patient-reported measure that has been
validated in the United Kingdom and was reported to be a powerful and reliable
measure of patient activation [ 56 ]. Patient activation scores have been strongly dem-
onstrated to predict a number of health behaviors. They are linked to clinical out-
comes, patients’ ratings of their experience, as well as the costs of healthcare.
Highly activated patients are more likely to adopt healthy behavior, to have better
clinical outcomes, to report higher levels of satisfaction with services, and lower
16 PROMs and Patient Education