Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease?

Round 1

Reviewer 1 Report

This is well written and informative overview of the importance of self-management of health,  options and how these may be assessed. There is extensive reference to  the PAM-13  measure,  as an educational, quality of health care indicator or outcome measure assessment  tool,  that is theoretically linked to  self management skills, confidence  and knowledge.  

The authors themselves, have acknowledged the lack of research evidence around the clinical utility of the PAM-13 measure in the CKD population. I  would therefore advise that they modify  the title of the review.  The title is expressed as a question,  which in my view is misleading as the content of the review does not provide any evidence that patient activation could be considered the cornerstone of effective self management in CKD.

Figure 1: I would disagree that regular exercise is an example of medical management. In fact, physical activity behaviours are not routinely recorded, monitored or addressed with people with CKD. I would categorise exercise behaviours under "behavioural management" 

Section 2.1. second paragraph starting with "for those living......." Re write for clarity please.  

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

In this manuscript, Lightfoot and colleagues elegantly discuss (i) patient activation as a key construct of self-management in CKD, (ii) the importance of increasing patient activation and self-management, (iii) assessment methods of patient activation, (iv) the use of PAM-13 in clinical practice and research settings, and (v) interventions aimed at increasing patient activation assessed by PAM-13. The discussion is further strengthened by input from the perspective of two CKD patients with different patient activation levels.

I am not an expert in patient activation and self-management, but this manuscripts seems to cover the current insights in this topic very well. I want to congratulate the authors for this work, which is overall well written and fits the scope of this special issue "Lifestyle Interventions to Prevent Kidney Diseases".

I have no major concerns or suggestions.

Minor suggestions:

* An overview of known or hypothesized interventions and behavior change techniques promoting patient activation and self-management in CKD in the form of a table or figure may be of added value to the reader. Although various examples have been briefly discussed (i.e., education, shared decision making, motivational interviewing, access to medical data, etc.), I feel that the health care providers in the field may benefit from a clear overview of interventions that they may consider, together with a brief description of the resources those interventions would require (time, money, space, staff, expertise, etc.). Of course, this would also include implementation of PAM-13 facilitating tailored education and healthcare discussions, but it should not be limited to it.

* Together with the suggestion above, the authors may briefly discuss how longitudinal studies assessing the implementation and effectiveness of interventions aiming to increase patient activation should best be set up (i.e., effectiveness-implementation hybrid study designs).

* Minor typos/grammar/layout:

P1 L30: National Health Service (NHS)

P3 L76: ‘The goal of self-management is to identify strategies that can be used to help patients 76 manage their condition(s) whilst leading full, active, and productive lives.’ à Shouldn’t this be: The goal of self-management education is to…

P4 L126-127: no start of new line

P11 L 366: Interest in patient activation is growing, and it is increasingly being adopted…. (forgot ‘is’).

References: Be consistent with the use of uppercases in the titles.

References: P8 L281 and L295 (and maybe elsewhere as well): put refs in chronological order.

Author Response

Please see attachment

Author Response File: Author Response.pdf